Analyzing Yemen's health system at the governorate level amid the ongoing conflict: a case of Al Hodeida governorate

Community pharmacists' knowledge and experience regarding malaria management: a cross-sectional study in Hodeida, Yemen

BACKGROUND

Malaria remains a significant public health concern in Yemen, ranking fourth in incidence within the Eastern Mediterranean Region. Community pharmacists play a pivotal role in malaria management and often dispense anti-malarial medications without prescriptions. However, little is known about their knowledge and adherence to the National Policy for Antimalarial Drugs. This study aimed to evaluate pharmacists' knowledge, experience, and perceived barriers regarding malaria management in Hodeidah, Yemen.

METHODS

A cross-sectional study was conducted between May and August 2023 across 320 community pharmacies in 16 districts of Hodeidah governorate. A validated questionnaire was used to assess pharmacists' knowledge, experience, and perceived barriers to effective malaria management. Descriptive statistics and logistic regression analysed the associations between sociodemographic factors and pharmacists' knowledge and experience.

RESULTS

Of the 304 respondents, 10 were excluded due to incomplete data, yielding a valid response rate of 91.9% (294). Most pharmacies were independent (74.8%), and 51.4% were located in Hodeidah city. The majority of the pharmacists were male (92.2%), aged 19-30 years (50.3%), and held a pharmacy diploma (69%). Poor knowledge of malaria management was observed in 76.5% of respondents (mean: 9.96, SD 3.47), with only 34.4% and 43.2% accurately identifying first-line treatments for uncomplicated and complicated malaria, respectively. Additionally, 60.9% were aware of the prevalent malaria species, and 53.1% knew the correct diagnostic methods. However, only 17.0% recognized high-risk groups for complicated malaria, 18.4% identified causes of treatment failure, and 7.8% understood the consequences of malaria during pregnancy. In terms of experience, 76.2% of the participants reported inadequate experience related to anti-malarial medications (mean: 56.71, SD 7.32), with the main barriers being lack of training (78.9%) and insufficient knowledge (73.5%). Multivariable logistic regression revealed that older age (AOR: 6.827, p = 0.020), holding a pharmacy diploma (AOR: 2.555, p = 0.036), and fewer perceived barriers (AOR = 3.830, p < 0.001) were predictors of poor knowledge, whereas practicing in Hodeidah city (AOR = 1.865, p = 0.043) predicted inadequate experience.

CONCLUSION

Community pharmacists in Hodeidah demonstrate significant gaps in knowledge and experience related to malaria management. Urgent educational interventions are needed to enhance pharmacists' competency, ensure effective malaria treatment, and prevent the emergence of drug resistance in Yemen.

Enhancing Occupational Health and Safety Through Strategic Leadership: The Mediating Role of Total Quality Management in Hodeida Hospitals, Yemen

Background

Occupational Health and Safety (OHS) is a critical concern in healthcare settings, particularly in resource-constrained environments where safety challenges often compromise staff well-being and patient care. Effective leadership and quality management are increasingly recognized as essential for addressing these challenges.

Objective

This study investigates the impact of Strategic Leadership (SL) on the Occupational Health and Safety System (OHS) in hospitals, with Total Quality Management (TQM) serving as a mediating factor. Utilizing a cross-sectional survey design.

Methodology

Data were collected from 323 healthcare professionals across six hospitals in Hodeida, Yemen, covering both medical and administrative roles. Partial Least-Squares Structural Equation Modeling (PLS-SEM) was employed to analyze the data, examining both direct and indirect relationships among the study variables.

Results

The findings reveal that SL positively influences OHS directly and indirectly through TQM. Specifically, leadership practices that emphasize strategic direction, ethical conduct, and organizational control contribute to fostering a safer work environment. TQM enhances this effect by strengthening operational efficiencies and standardizing safety protocols. These results underscore the critical role of integrated leadership and quality management in advancing OHS practices in resource-constrained healthcare settings.

Conclusion

The study offers practical implications for hospital administrators seeking to improve safety and performance through a combined focus on leadership and quality management. Future research should explore these dynamics in different sectors and geographical contexts to validate and extend these findings.

Neglected tropical diseases in Yemen: a systematic review of epidemiology and public health challenges

BACKGROUND

Yemen has experienced a dramatic increase in neglected tropical diseases (NTDs) amidst ongoing conflict and humanitarian crises. This systematic review aims to consolidate and analyse the available literature on NTDs in Yemen, focusing on aetiology, geographic distribution, and associated risk factors.

METHODS

A comprehensive literature search was conducted across five international databases and one national database, resulting in 3,652 identified records. After screening and applying eligibility criteria, 230 articles were included in this review. Data extraction focused on publication year, study design, sample types, diagnostic methods, reported pathogens, and geographic distribution. The aetiology of reported NTDs was categorized into four groups: viruses, bacteria, protozoa, and helminths.

RESULTS

Viral NTDs were the most frequently reported, accounting for 39% of the articles, followed by bacterial (26%), helminthic (21%), and protozoal NTDs (15%). Dengue virus, hepatitis B and C viruses were the most prominent viral pathogens, while bacterial NTDs were primarily caused by Escherichia coli, cholera, and Salmonella. Schistosomiasis and ascariasis were the most reported helminth infections, whereas leishmaniasis and malaria were the leading protozoal NTDs. Geographically, over 69% of the reported studies focused on northern Yemen, with the highest concentrations in Sana'a, Al Hudaydah, and Taiz. The review identified multiple risk factors, including poor sanitation, inadequate water quality, and urbanization, exacerbating NTD prevalence.

CONCLUSIONS

The findings highlight the significant burden and regional disparities of NTDs in Yemen, emphasizing the need for targeted interventions. Prioritizing improvements in sanitation, water quality, and vector control measures, alongside community engagement, is critical. Policymakers must allocate resources effectively to address the root causes of NTDs and strengthen Yemen's healthcare infrastructure.

"It's normal to be afraid": attacks on healthcare in Ouaka, Haute-Kotto, and Vakaga prefectures of the Central African Republic, 2016-2020

INTRODUCTION

Attacks on healthcare have further weakened the already fragile health system in the Central African Republic. We investigated attacks on healthcare in three conflict-affected prefectures-Ouaka, Haute-Kotto, and Vakaga-from 2016 to 2020. The study aim was to gain an in-depth understanding of the immediate and long-term effects of attacks on healthcare workers, facilities, supply chain, quality of care, and other components of the health system. We provide a qualitative description of the incidents, assess their impacts, identify mitigation efforts, and discuss challenges to recovery.

METHODS

We used purposive and snowball sampling to identify participants in the study. Semi-structured key informant interviews were conducted with administrative and health authorities, front-line personnel, and staff of non-governmental organizations. Interviews were done in Sango, French, or English. Recorded interviews were transcribed and notes taken for non-recorded interviews. Transcripts and notes were analyzed using inductive coding, allowing participant responses to guide findings.

RESULTS

Of 126 attacks identified over the study period, 36 key informants discussed 39 attacks. Attacks included killings, physical and sexual assault, abductions, arson, shelling with grenades, pillage, occupations, and verbal threats. The violence led to extended closures and debilitating shortages in healthcare services, disproportionately affecting vulnerable populations, such as children under five, or people who are elderly, chronically ill, or displaced. Healthcare workers faced psychological trauma and moral injury from repeated attacks and the inability to provide adequate care. Personnel and communities made enormous efforts to mitigate impacts, and advocate for assistance. They were limited by failed reporting mechanisms, ongoing insecurity, persistent lack of resources and external support.

CONCLUSION

Effective strategies to safeguard healthcare from violence exist but better support for communities and health workers is essential, including measures to assess needs, enhance security, and facilitate recovery by quickly rebuilding, resupplying, and re-staffing facilities. CAR's government, international organizations, and donors should make concerted efforts to improve reporting mechanisms and end impunity for perpetrators. Their investment in community organizations and long-term health system support, especially for health worker training, salaries, and psychosocial care, are vital steps towards building resilience against and mitigating the impacts of attacks on healthcare.

Alkuwaisi M, Zoromba MA. Prevalence of Depression and Its Associated Factors Among Hemodialysis Patients in Hodeida City, Yemen

Background

Depression has a negative impact on the health outcomes of hemodialysis (HD) patients, including decreased quality of life and increased morbidity and mortality rates. Therefore, this study aimed to determine the prevalence of depression and its associated factors among HD patients in Hodeida city, Yemen.

Methods

A cross-sectional study involving 200 HD patients at the Dialysis Center in Hodeida was conducted from February to May 2022. Data on depression were collected using the 9-item Patient Health Questionnaire (PHQ-9). Association of sociodemographic characteristics of patients with depression were assessed using chi-square, subsequently by multivariable logistic regression. Statistical significance was set at P-values <0.05.

Results

The response rate was 98% (200/204). Depression was prevalent among 63% of HD patients at the Dialysis Center in Hodeida city. Sex was significantly associated with depression, where female patients were more frequently depressed than males (82.4% vs 56.4%, P < 0.001). In addition, employment status and medical insurance were significantly associated with depression, where unemployed patients were more frequently depressed than employed patients (67.6% vs 52.5%, P = 0.041) and patients with medical insurance were less frequently depressed than their counterparts (47.1% vs 66.3%, P = 0.035).

Conclusion

Depression is highly prevalent among HD patients in Hodeida city. Female sex, unemployment and lack of medical insurance are predictors of depression among HD patients. These findings emphasize the urgent need for targeted interventions.

Implications for practice

Depression is common among HD patients, so that, psychiatric physicians and nurses are increasingly needed in HD centers to implement mental health assessment of patients for depression signs and symptoms to help in early diagnosis and management of depression in order to improve patients' quality of life and preventing negative outcomes.

Multi-sectoral collaborations in selected countries of the Eastern Mediterranean region: assessment, enablers and missed opportunities from the COVID-19 pandemic response

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has emphasized the importance of multi-sectoral collaboration to respond effectively to public health emergencies. This study aims to generate evidence on the extent to which multi-sectoral collaborations have been employed in the macro-level responses to the COVID-19 pandemic in nine selected countries of the Eastern Mediterranean region (EMR).

METHODS

The study employed in-depth analytical research design and was conducted in two phases. In the first phase, data were collected using a comprehensive documentation review. In the second phase, key informant interviews were conducted to validate findings from the first phase and gain additional insights into key barriers and facilitators. We analysed the macro-level pandemic responses across the following seven components of the analytical framework for multi-sectoral collaborations: (1) context and trigger; (2) leadership, institutional mechanisms and processes; (3) actors; (4) administration, funding and evaluation; (5) degree of multi-sectoral engagement; (6) impact; and (7) enabling factors.

RESULTS

Governments in the EMR have responded differently to the pandemic, with variations in reaction speed and strictness of implementation. While inter-ministerial committees were identified as the primary mechanism through which multi-sectoral action was established and implemented in the selected countries, there was a lack of clarity on how they functioned, particularly regarding the closeness of the cooperation and the working methods. Coordination structures lacked a clear mandate, joint costed action plan, sufficient resources and regular reporting on commitments. Furthermore, there was no evidence of robust communication planning both internally, focused on promoting internal consensual decision-making and managing power dynamics, and externally, concerning communication with the public. Across the selected countries, there was strong representation of different ministries in the pandemic response. Conversely, the contribution of non-state actors, including non-governmental organizations, civil society organizations, the private sector, the media and citizens, was relatively modest. Their involvement was more ad hoc, fragmented and largely self-initiated, particularly within the selected middle- and low income- countries of the EMR. Moreover, none of the countries incorporated explicit accountability framework or included anti-corruption and counter-fraud measures as integral components of their multi-sectoral plans and coordination mechanisms. Key enablers for the adoption of multi-sectoral collaborations have been identified, paving the way for more efficient responses in the future.

DISCUSSION

Mirroring global efforts, this study demonstrates that the selected countries in the EMR are making efforts to integrate multi-sectoral action into their pandemic responses. Nevertheless, persistent challenges and gaps remain, presenting untapped opportunities that governments can leverage to enhance the efficiency of future public health emergency responses.