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Health screening of workers in Saudi Arabia

Because large numbers of workers come from different countries with diverse economies, cultures and endemic diseases to work in the Kingdom of Saudi Arabia (KSA), the Ministry of Health has required screening for infectious and non-infectious diseases for foreign workers. Before 1995, health certificates for workers' visas could be issued by any clinic or physician in the country of origin. Approved Health Clinics (AHCs) operating under guidelines set by the Gulf States may issue certificates for workers' visas. To assess the new AHC system we carried out a quality assurance survey (QAS) on workers who had entered Saudi Arabia within 3 months prior to the study.
From a list of companies which had requested more than 25 foreign workers in the last six months, 22 companies were selected at random. From these 22 companies, 501 newly arrived workers were selected. We repeated 14 clinical and laboratory tests and defined a screening failure as any result in any test that would have resulted in a rejection of an individual worker during the initial AHC screening. We tested the null hypothesis that the observed failure rate was less than a failure rate of 1.5%.
We identified 4 failures (0.8%, 95% CI=0.26-2.2) of the AHC screening program originating from 4 different AHCs in 3 countries. The 0.8% failure rate was not significantly less than 1.5%. The failures included 3 workers (0.6%, 95% CI= 0.15-1.9) with reactive reagin (VDRL) and one worker (0.2%, 95% CI=0.01-1.3) with chest film with old right upper lobe tuberculosis. All three reactive VDRL tests were confirmed with a treponemal test (TPHA). No screening failure was found in investigation indicating chronic or physiologic diseases and this 0% failure rate was less than the 1.5% standard (P<0.01) with a 95% CI from 0% to 0.95%.

Editorial note:

This new AHC system for worker screening showed excellent quality overall for chronic and physiologic and for most infectious diseases. The screening failure for infectious diseases was specifically due to a laboratory test for syphilis (VDRL) known for poor sensitivity in asymptomatic (latent or early primary) infections. In the future the known sensitivity of specific tests and the prevalence of infection in the country of origin will need to be taken into account in setting an acceptable failure rate for evaluating the AHC program. From this study we can continue the assessment of this program by periodically repeating the QAS.