Leishmaniasis is a parasitic infection endemic in more than ninety countries of the world and the cutaneous leishmaniasis is a most common form of this infection caused by phlebotomine sand fly . The World Health Organization reported in 2016 that about 15 million individuals have leishmaniasis and more than 360 million individuals are breathing in those regions which are prone for this infection and this infection causes ~ 70,000 deaths per year . It is now well documented that CL is caused by more than 22 different species of the genus Leishmania but their prevalence varies from region to region . Species is important for the prescription of appropriate therapy . Species cause harmful effects to the patients as the attribution of the relative importance of specific L.
In general, diagnosis is still based on clinical symptoms, microscopic parasitic detection and tissue culturing of promastigotes. However in cases with promastigotes culture, additional efforts should also be needed such as biochemical and serological analysis for further characterization of parasites . Species are time taken and are not sensitive, not accurate and sometime give wrong information . Species were developed, which are rapid, sensitive and accurate and now become a powerful approach to determine the L.
Species types at all levels of detection such as genus, complex, and species . Recently, Abuzaid et al. have extensively reviewed the prevalence of CL in Saudi Arabia. They noticed that CL remains an unsolved public health issue of the country . Although, CL is endemic in all over the regions of Saudi Arabia but the majority of patients are continuously reported in Riyadh, Hassa, Aseer, Hail, Madinah, Taif and also in Qassim . Despite of all taking care by the Ministry of Health, Saudi Arabia but CL remains to be a major health issue of the country, which may be due to urbanization and huge population immigration .
Species in different provinces of Saudi Arabia is poor, therefore the current study was aimed to identify the L. Species in different provinces of Qassim, Saudi Arabia using highly specific and sensitive PCR-based approach. The World Health Organization announced COVID-19, a novel coronavirus outbreak, as a pandemic in 2020.
In the month of February 2020, the disease began to spread through the Middle East. The first case of COVID-19 in the Kingdom of Saudi Arabia was identified in March 2020, and it is now one of the region's most affected countries. Analyzing the disease's propagation pattern may aid in the development of pandemic-fighting strategies.
This study aims to analyze the trend of COVID-19's spread, its recovery, and mortality in the Kingdom of Saudi Arabia . Two to three major cities from the 13 provinces of the country were chosen, and the rate of infection recovery was recorded from the first month until the number of confirmed cases showed a decline. The data published on the official Ministry of Health website were recorded on an Excel sheet, graphically represented as figures to indicate the pattern of spread. According to the study's findings, COVID-19 positive cases were discovered in the majority of provinces as early as March 2020.
The province of Makkah had the largest number of COVID-19 positive cases (30.7%), followed by Riyadh (23%). The province of Al Jowf had the lowest number of COVID-19 cases (0.3%). Tabuk province had the highest rate of recovery (97.8%), followed by the Northern Border Province (96.7%).
Makkah province had the highest mortality rate (2.6%), followed by Al Jawf province (2.4%). The peak case–fatality ratio was recorded in August and September. The highest number of tests to detect the COVID-19 was performed in the month of July, and the highest percentage of positive cases was detected in June (19.55%). All the provinces from the month of September 2020 showed a progressive decline in the number of confirmed COVID-19 cases.
According to this study, COVID-19 infection was found in the majority of Saudi Arabian provinces in March 2020, with a peak in June–July 2020. Considering the climatic and demographic characteristics of the region, specific modalities need to be adopted in collaboration with international guidelines to defeat the COVID-19 pandemic. Desertification and degradation of limited agricultural and forestry land constitute a major challenge for development. Goal Seven in the plan intends to ensure environmental sustainability by setting several targets. Target 12 aims to integrate the principles of sustainable development into the country's policies and programmes and reverse the loss of environmental resources. Target 13 aims to achieve a significant reduction in the rate of loss of biodiversity.
By 2010, maintenance of current land and water resources was stabilized. Target 14 aims at halving the proportion of people by 2015 without sustainable access to safe drinking water and sanitation. By 2010, 96 percent of the population had access to safe drinking water and 100 percent had access to sanitation services through septic tanks and waste-water treatment systems. All pandemics follow a certain pattern of population distribution. Understanding this could enable policymakers to assess the path of infection, which could aid in the creation of pandemic-control strategies. Saudi Arabia is mostly comprised of deserts with some forests, grasslands, and mountains.
The population of the country is mostly located in the eastern and western coastal areas and rarely in deserts. The country has 13 provinces, and the population is mainly pocketed in cities and small towns . In this study, CL infected skin biopsies were used from those CL patients which were attending various dermatological clinics in different provinces of Qassim, Saudi Arabia. The majority of the patients for this study were from Buraidah (63%) and Unaizah (19%) and the rest (18%) were from other parts of Qassim region including Ar Rass, Bukariya, Uglat Asugour (Fig. 1).
All patients were diagnosed as CL based on clinical presentation and microscopy as described previously . In support of our results, previous studies on parasite identification proved that L. Major has also been identified as the main Leishmania species in Riyadh and Al-Hassa regions and now appears to be randomly transmitted in all over Saudi Arabia including Qassim . Species responsible for causing CL infection in Aseer and Al-Bahah provinces which are in southwest part of Saudi Arabia . In view of these and together with the occurrence of Phlebotomus papatasi, a L. Major vector in many provinces of the country , it is now well established that L.
Major is responsible for causing CL infection in most of the provinces of the country, while L. Tropica is also dispersed in other parts of the country other than southwestern area . As CL is well known to be an endemic disease not only in Saudi Arabia but also in other gulf countries and the main causative species were repeated found to be L. Addition of this study in different provinces of Qassim region has now been confirmed that the main causative Lieshmania species of cutaneous leishmaniasis in this region are L. The Kingdom of Saudi Arabia's three-fifths of the population live in major cities, which are well organized with relatively integrated transportation networks and most basic services .
Infrastructure – electricity, water and sewage facilities are less dependent on the public sector, even though there is growth in electricity generation and water desalination capacity , reflecting an expanding private sector in the Kingdom. Demand for services is increasing due to population growth and urban expansion along with the need to expand services, thus, enabling the private sector to offer additional facilities. The observations from this study indicated that COVID-19 infection was more prevalent in urbanized regions. The detection and spread of COVID-19 were also found to be early and fast in the major cities of the country . The pattern of spread of COVID-19 infection indicated that all the provinces of Saudi Arabia except the Northern border and Al Jawf recorded COVID-19 in the month of March .
Further, all the provinces showed a decline in the number of COVID-19 cases from the month of October . The infection rate in different provinces suggested that the thickly populated provinces such as Riyadh, Makkah, and Eastern peaked in the month of June. Moderately populated provinces such as Al Qassim, Hail, Asir, Najran, and Tabuk peaked in July. Al Baha, a less populous but more popular province, peaked in September . The highest proportion of households in the Kingdom are in apartments (41.1%), followed by traditional house (26.2%), villa (17.7%), and floor of a villa (17.7%). Makkah Al-Mokarammah has 54.1 percent; Al-Madina Al-Monawarah has 51.1 percent; the Eastern Region has 46.4 percent; and Tabouk has 46.4 percent of households in apartments .
The Jazan and Hail regions have a low share of such housings (13.4% and 14.1%, respectively) revealing that housing developments differ regionally in the Kingdom. While major regions such as Al-Riyadh, Makkah Al-Mokarramah and the Eastern Region have developed modernized apartments, other regions have not. Thus, single family house incorporating the privacy features and greater number of rooms, providing for segregation of sexes and the guests appears to be the preferred type of dwelling unit in the Kingdom (Rahmaan et al. 1990).
These councils deliberate on the needs of their province, work on the development budget, consider future development plans, and monitor ongoing projects. The governor and deputy governor of each province serve as chairman and vice-chairman of their respective provincial council. As with the Majlis Al-Shura, members of the council participate in committees that focus on various issues of interest to the province. The councils issue reports that are submitted to the Minister of the Interior, and then passed on to the appropriate government ministries and agencies for consideration. The provincial council system is the result of bylaws established by King Fahd in 1992.
These bylaws divided the country into 13 provinces and defined their administrative structure, how they would be administered, and the responsibilities of the governors and other regional officers. In 1993, King Fahd named 210 members to the provincial councils. In 2005, municipal elections were held for half of the members of each of the 178 municipal councils in the Kingdom. The remaining half of the council members and the mayor are appointed. Saudi Arabia's main environmental struggles are with desertification, depletion of underground water resources, and the lack of perennial rivers and other permanent water bodies, which has prompted the development of extensive seawater-desalination facilities. According to some statistics, Saudi Arabia has the third-highest per capita fresh-water consumption in the world, despite being one of the world's driest countries.
Manmade threats come mainly from oil spills, which cause coastal pollution. In addition, carbon dioxide emissions from burning fossil fuels and the production of cement are a main threat. CO2 emissions were estimated at 16.6 metric tonnes per capita in 2008.
In the fourth plan ( ), the country's basic infrastructure was viewed as largely complete, but education and training remained areas of concern. Private enterprise was encouraged, and foreign investment in the form of joint ventures with Saudi public and private companies was welcomed. The private sector became more important, rising to 70% of non-oil GDP by 1987. While still concentrated in trade and commerce, private investment increased in industry, agriculture, banking, and construction companies.
How Many Provinces Are There In Saudi Arabia These private investments were supported by generous government financing and incentive programs. The objective was for the private sector to have 70% to 80% ownership in most joint venture enterprises. A retrospective analysis of the spread of COVID-19 in different provinces of the Kingdom of Saudi Arabia was performed. The country consists of vast deserts, and the population is remotely distributed into separate regions, called provinces. There are 13 provinces, Riyadh, Makkah, Eastern, Al Madinah, Al Qassim, Hail, Northern border, Asir, Al Baha, Jazan, Al Jawf, Najran, and Tabuk, which include several cities, towns, and villages. In this study, two to three major cities in each province were selected to evaluate the pattern of spread, recovery, and mortality rate .
Marib city is the only major conurbation in northern Yemen completely out of Houthi control. In contrast to Aden – which the internationally recognised government of Yemen has declared Yemen's temporary capital, but which is also a base for increasingly powerful southern secessionists – Marib does not suffer any regionalism-related tensions. Trade – most notably in cooking gas produced in Marib – continues to cross conflict lines into Houthi-controlled territory, even as battles at the nearby fronts rage on.
Buses from Sanaa and other areas under the control of the Houthis and their allies pass by regularly and largely without incident. This is despite the fact that the Houthis and the local administration in Marib remain bitter adversaries. Fighting continues on the Sirwah and Nihm fronts, while the Houthis occasionally launch rockets into the province. The United States and Saudi Arabia share a common concern about regional security, oil exports and imports, and sustainable development. Close consultations between the U.S. and Saudi Arabia have developed on international, economic, and development issues such as the Middle East peace process and shared interests in the Gulf. The continued availability of reliable sources of oil, particularly from Saudi Arabia, remains important to the prosperity of the United States as well as to Europe and Japan.
Saudi Arabia is often the leading source of imported oil for the United States, providing about 20% of total U.S. crude imports and 10% of U.S. consumption. The U.S. is Saudi Arabia's largest trading partner, and Saudi Arabia is the largest U.S. export market in the Middle East. These measures have also been advocated by the WHO as preventive strategies to contain the spread of infections in the population. Previous research has shown that if the virus load is limited, people may become ill, but the immune response effectively fights off the infection . Together, the awareness of health providers created through various media in the public has significantly contributed to seeking medical interventions whenever there are symptoms. During the COVID-19 pandemic, the whole world worked as a single unit, where medical knowledge was freely exchanged between nations, including the Arabian peninsula countries.
Additionally, WHO regularly updates all the new approaches to the treatment and management of COVID-19 on its official website . All skin biopsies were collected from cutaneous leishmaniasis patients, which were attending various dermatological clinics in different provinces of Qassim, Saudi Arabia. Sites of the study are shown in the map of Qassim province of Saudi Arabia (Fig.1). The majority of the patients were from Buraidah (63%) and Unayzah (19%) and the rest (18%) were Ar Rass, Bukariya, Uglat Asugour, etc.
Species in Qassim region, we used quantitative and qualitative PCR for identification of different L. Specificity and validity of each quantitative and qualitative PCR assays were tested by the standard WHO. As shown in Table2, there was a concordance in the characterization of L. Moreover, the results obtained from PCR assays were further validated by using several negative control samples listed in Table 2. Furthermore, no amplification was detected with any of the PCR assays tested for the negative control DNA samples, whereas the presence of extracted DNA was confirmed by β-actin . Infantum/donavani complex were comparable with their respective positive controls.
Importantly, all tested patients samples were found to be negative for L. Tropica samples were characterized by agarose gel electrophoresis and the details are given in Fig.3. Specifically, out of total 206 CL biopsies, 102 was found to be positive for L. Infantum/donovani complex, and 59 CL biopsies were found to be positive for L.
We have also calculated the percent prevalence of these Leishmania species among the studied patients. Tropica are the most abundant types found in 49.5 and 28.6%, respectively, whereas L. Infantum/donovani, was found in 3.9% of the studied subjects (Fig.4). The complete data of the studied patients with the prevalence of L. Water supply in Saudi Arabia receives both appreciation and criticisms even though mineral concentration has been proved at par with the Saudi Arabian and international standards (Hashem and Al-Johany 1994).
A sustainable water resources management plan considering water quality, flood management, perennial flow, water balance and utilization of recycled water was proposed to meet the requirements in the Riyadh region through Wadi Hanifa (Alhamid et al. 2007). Drinking water, sanitation, hygiene and water-resource management strategies support the nation's goal of reducing burden of disease, and this is where Saudi Arabia receives an appreciable position (Pruss-Ustun et al. 2008). Census operations in Saudi Arabia started in 1962–63 but have not been succeeded to establish a periodicity even though subsequent censuses were held in 1974, 1992, 2004 and 2010.
Census reports differ from one another in terms of definitions, classifications and the tables. However, 2004 and 2010 censuses are comparable, where household tables have been consistently reported. Each category has the number of housing units, number of households and number persons in it.
