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Beshr MS, Beshr IA, Al-Qubati H. The prevalence of depression and anxiety among medical students in Yemen: A cross-sectional study. J Affect Disord 2024; 352:366-370. [PMID: 38401805 DOI: 10.1016/j.jad.2024.02.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/17/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Medical students may experience mental health disorders like anxiety and depression during medical school, which can negatively impact their productivity, education, and overall quality of life. Currently, there are no studies examining the mental health of medical students in Yemen. Our study aimed to estimate prevalence of depression and anxiety among Yemeni medical students. METHODS The study utilized a cross-sectional design. A survey was conducted using validated psychometric tests: the Patient Health Questionnaire-9 (PHQ-9) for depression and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety. A survey of medical students from 10 Yemeni medical schools took place from June 6 to July 20, 2023. It included only actively enrolled students in the 7-year undergraduate program. RESULTS A total of 706 responses were collected. The prevalence of depression was 48.4 % for cases classified as moderate, moderately severe, and severe, while it was 20 % for cases categorized as moderately severe and severe. The rate of suicide ideation was 14.7 %. Anxiety was found to have a prevalence of 34.8 % for cases categorized as moderate and severe. Furthermore, both depression and anxiety were higher among females, and in earlier academic years; all of these associations had a p-value <0.05. Conversely, age, living status, income stability, and displacement risk all showed no significant association with depression or anxiety. CONCLUSION Our study highlighted the prevalence of depression and anxiety among Yemeni medical students. Tailored interventions are imperative to address these challenges. Future research needs to examine the root causes that might contribute to these disorders.
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Affiliation(s)
- Mohammed S Beshr
- Sana'a University, Faculty of Medicine and Health Sciences, Yemen.
| | - Ibrahem A Beshr
- Sana'a University, Faculty of Medicine and Health Sciences, Yemen
| | - Hibah Al-Qubati
- Sana'a University, Faculty of Medicine and Health Sciences, Yemen
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Ibrahim A, El Baldi M, Mohammed S, El Rhazi K, Benazzouz B. Cancer statistics in Yemen: incidence and mortality, in 2020. BMC Public Health 2024; 24:962. [PMID: 38580993 PMCID: PMC10996160 DOI: 10.1186/s12889-024-18207-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/24/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND The current cancer epidemiological profile in Yemen suffers from a lack of locally representative data and resources, posing a challenge in determining the real incidence, prevalence, survival and mortality rates, particularly data extracted from national hospitals. This study aims to provide a comprehensive overview of the cancer burden and trends in Yemen for 2020, including incidence and mortality rates. METHODS The current study provides cancer statistics and their trends in Yemen, including incidence and mortality, in 2020 by using descriptive statistics. The data was obtained using the Global Cancer Observatory (GCO) 2020 online database. RESULTS According to the (GCP) database in 2020, the crude incidence rate (CIR) of all cancers in Yemen was 55.2 per 100.000. The age-standardized rate (ASR) was 97.0 per 100.000, and the cumulative risk (0-74) was 22.0 per 100.000. The age-standardized rate (ASR) was 76.5 per 100.000, and the cumulative risk (0-74) was 19.6 per 100.000. Furthermore, the crude mortality rate (CIR) of all cancers was 40.6 per 100.000. Breast cancer was most prevalent in Yemen across all age groups and genders (31.1%), followed by colorectal cancer (7.7%) and leukemia (5.7%). Breast cancer also ranked as the primary cause of mortality at an estimated percentage of 13.5%, followed by colorectal cancer (8.8%) and stomach cancer (7.1%). CONCLUSION Cancer has become a significant life-threatening illness in Yemen with an increase in the disease burden of breast cancer in women. Furthermore, leukemia in children and colorectal cancer in both sexes have experienced a more significant burden as well. Therefore, it is imperative for initiatives for cancer control and prevention to be prioritised at national and regional levels.
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Affiliation(s)
- Amran Ibrahim
- Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdullah University, Fez, Morocco.
- Department of Biology, Laboratory of Biology and Health, Faculty of Sciences, Ibn Tofail University, Kénitra, Morocco.
- Department of Hematology, Faculty of Medicine and Health Sciences, Aden University, Aden, Yemen.
| | - Marwa El Baldi
- Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdullah University, Fez, Morocco
| | - Sawsan Mohammed
- Department of Hematology, Faculty of Medicine and Health Sciences, Aden University, Aden, Yemen
| | - Karima El Rhazi
- Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdullah University, Fez, Morocco
| | - Bouchra Benazzouz
- Department of Biology, Laboratory of Biology and Health, Faculty of Sciences, Ibn Tofail University, Kénitra, Morocco
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Mughalles AA, Alkholidy GG, AlSaifi MS, Al-Gabaly WM, Al-Haddad KM. Total hip replacement among sickle cell patients in a low-income country-Yemen. Int Orthop 2024; 48:923-930. [PMID: 38036693 DOI: 10.1007/s00264-023-06049-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE Sickle cell patients presented with progressive hip pain and limitation of daily activities, as evidenced by low preoperative hip scores and failed conservative therapy. Management of femoral head avascular necrosis (AVN) using total hip replacement (THR) in sickle cell disease (SCD) is widespread in developed countries, but it is still in its initiation stage in developing countries. The outcome of using cementless THR among SCD patients is still unknown with lack of published studies from regional countries. This study aimed to evaluate the outcome of using cementless primary THR among patients with sickle cell disease with end-stage hip avascular necrosis in Yemen. METHODS Thirty cementless primary total hip arthroplasty (THA) were performed for AVN of the femoral head in 27 sickle cell patients, at Al.-Thawra Modern General Hospital-Sana'a, Yemen, from January 2018 to December 2022. RESULTS The mean age of the patients was 27 ± five years (ranged 18-37 years) with a male to female ratio was 3:1. Steinberg staging for hip AVN was stage IV, one patient (3%); stage VI, thirteen patients (45%); and stage V, sixteen patients (51%). THR was on right side 14 (52%), left side 10 (37%), and bilateral 3 (11%). The implant used was ceramic on polyethylene acetabular liner. All patients showed improvement in Harris hip score from preoperative mean hip score was 25 ± 8 points to postoperative mean hip score was 88 ± 6 points at the last follow-up. Mean of the length of stay in hospital was 12.7 ± eight days (ranged from 4 to 32 days); the mean operating time was 107 ± 23 min. Three cases had superficial wound infection; four patients had five intraoperative fractures; two cases had pulmonary complications; one case had abdominal crisis. All patients had postoperative leg length discrepancy less than 2 cm. None had deep infection, nerve injury, wound hematoma, aseptic loosing, dislocation, DVT, heterotopic ossification, or death. CONCLUSION THR in SCD has a good outcome using cementless THA with a low rate of complication in Yemen, a developing country.
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Affiliation(s)
- Anwar Abdulqader Mughalles
- Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
- Al-Thawra Modern General Hospital, Sana'a, Yemen
| | | | - Mohammed Saleh AlSaifi
- Al-Thawra Modern General Hospital, Sana'a, Yemen
- Faculty of Medicine, 21 September University of Medical and Applied Sciences, Sana'a, Yemen
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Al Ofairi BA, Saeed MK, Al-Qubaty M, Abdulkareem AM, Al-Jahrani MA. Diagnostic value of IgG antibody and stool antigen tests for chronic Helicobacter pylori infections in Ibb Governorate, Yemen. Sci Rep 2024; 14:7536. [PMID: 38553516 PMCID: PMC10980813 DOI: 10.1038/s41598-024-58165-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/26/2024] [Indexed: 04/02/2024] Open
Abstract
The stool antigen test (SAT) and the serum Helicobacter pylori (H. pylori) IgG antibody assays exhibit significant utility in the clinical diagnosis of H. pylori infection and in distinguishing between acute and chronic infections. The main objective of the current study was to identify the diagnostic value of serum H. pylori IgG antibody and SAT in the detection of H. pylori infections among chronic H. pylori-infected patients residing in Ibb Governorate, Yemen. 200 patients with H. pylori infection, confirmed through positive results in the serum immunochromatographic antibody test, were selected for H. pylori infection confirmation using serum H. pylori IgG antibodies and SAT across diverse hospitals, gastroenterology, and Hepatology clinics in Ibb Governorate. After the selection of patients, blood and stool specimens were obtained from all participants and underwent analysis via the Statistical Package for the Social Sciences (SPSS). The prevalence of H. pylori infection demonstrated variability based on the confirmatory tests, with rates of 54% for SAT and 78.5% for serum H. pylori IgG antibody, contrasting with a 100% prevalence observed in the screening serum immunochromatographic antibody test. Clinically, the study categorized H. pylori infections into four stages, whereby a significant proportion of patients (40.5%) exhibited positivity for both serum H. pylori IgG antibody and SAT, indicative of active chronic infections. The majority of positive cases only manifested serum H. pylori IgG antibody presence (chronic infections) at 38%, whereas 13.5% exclusively tested positive for SAT, corresponding to acute infections. Moreover, 88% of patients did not have either serum H. pylori IgG antibody or SAT (absence of infections) during confirmatory tests. Noteworthy is the study's approach employing multiple tests for H. pylori infection detection, focusing predominantly on chronic infections-prevailing types caused by H. pylori. The results revealed a significant association between serum levels of H. pylori IgG antibody and SAT results with the presence of diverse gastrointestinal symptoms among patients, which increased with long H. pylori infection durations.
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Affiliation(s)
- Bashir A Al Ofairi
- Section of Microbiology, Departement of Biological Sciences, Faculty of Science, Sana'a University, Sana'a, Yemen.
- Departement of Medical Laboratory, Faculty of Medical Sciences, Queen Arwa University, Sana'a, Yemen.
| | - Marwan K Saeed
- Section of Microbiology, Departement of Biological Sciences, Faculty of Science, Sana'a University, Sana'a, Yemen.
- Department of Medical Laboratories, University of Science and Technology, Ibb, Yemen.
| | | | - Ahmed M Abdulkareem
- Section of Microbiology, Departement of Biological Sciences, Faculty of Science, Sana'a University, Sana'a, Yemen
| | - Majed A Al-Jahrani
- Section of Microbiology, Departement of Biological Sciences, Faculty of Science, Sana'a University, Sana'a, Yemen
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Al-Qassimi MA, Al Amad M, Al-Dar A, Al Sakaf E, Al Hadad A, Raja'a YA. Circulating vaccine derived polio virus type 2 outbreak and response in Yemen, 2021-2022, a retrospective descriptive analysis. BMC Infect Dis 2024; 24:321. [PMID: 38491425 PMCID: PMC10943856 DOI: 10.1186/s12879-024-09215-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The outbreaks of circulating Vaccine Derived Polio Viruses (cVDPVs) have emerged as a major challenge for the final stage of polio eradication. In Yemen, an explosive outbreak of cVDPV2 was reported from August 2021 to December 2022. This study aims to compare the patterns of cVDPV2 outbreak, response measures taken by health authorities, and impacts in southern and northern governorates. METHOD A retrospective descriptive study of confirmed cases of VDPV2 was performed. The data related to cVDPV2 as well as stool specimens and environmental samples that were shipped to WHO-accredited labs were collected by staff of surveillance. Frequencies and percentages were used to characterize and compare the confirmed cases from the southern and northern governorates. The average delayed time as a difference in days between the date of sample collection and lab confirmation was calculated. RESULTS The cVDPV2 was isolated from 227 AFP cases reported from 19/23 Yemeni governorates and from 83% (39/47) of environmental samples with an average of 7 months delayed from sample collection. However, the non-polio AFP (NPAFP) and adequate stool specimen rates in the north were 6.7 and 87% compared to 6.4 and 87% in the south, 86% (195) and 14%(32) out of the total 227 confirmed cases were detected from northern and southern governorates, respectively. The first and second cases of genetically linked isolates experienced paralysis onset on 30 August and 1st September 2021. They respectively were from Taiz and Marib governorates ruled by southern authorities that started vaccination campaigns as a response in February 2022. Thus, in contrast to 2021, the detected cases in 2022 from the total cases detected in the south were lower accounting for 22% (7 of 32) of compared to 79% (155 of 195) of the total cases the north. CONCLUSION A new emerging cVDPV2 was confirmed in Yemen. The result of this study highlighted the impact of vaccination campaigns in containing the cVDPV2 outbreak. Maintaining a high level of immunization coverage and switching to nOPV2 instead of tOPV and mOPV2 in campaigns are recommended and environmental surveillance should be expanded in such a risky country.
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Affiliation(s)
- Mutahar Ahmed Al-Qassimi
- National Polio surveillance coordinator, Yemen Ministry of Public Health and Population, Sana'a, Yemen.
| | - Mohammed Al Amad
- Department of Community Medicine, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Ahmed Al-Dar
- Department of Community Medicine, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Ehab Al Sakaf
- General Director for Diseases Control and Surveillance, Yemen Ministry of Public Health and Population, Sana'a, Yemen
| | - Ahmed Al Hadad
- Faculty of Medicine and Health Sciences, Sana'a university, Sana'a, Yemen
- Yemen National Certification of polio eradication Committee chairperson, Sana'a, Yemen
| | - Yahia Ahmed Raja'a
- Faculty of Medicine and Health Sciences, Sana'a university, Sana'a, Yemen
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Bashir IM, Al-Waleedi AA, Al-Shaibani SM, Rajamanar M, Al-Akbari S, Al-Harazi A, Salim Aliwah L, Ahmed Salem N, Al-Ademi D, Barakat A, Sarkis N, Abubakar A, Senga M, Musani A, Abdel Moneim ARI, Mahmoud N. Strengthening laboratories in response to outbreaks in humanitarian emergencies and conflict settings: Results, challenges and lessons from expanding PCR diagnostic capacities for COVID-19 testing in Yemen. PLoS One 2024; 19:e0298603. [PMID: 38394178 PMCID: PMC10889613 DOI: 10.1371/journal.pone.0298603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND When the COVID-19 pandemic was declared, Yemen, a country facing years of conflict had only one laboratory with PCR testing capacity. In this article, we describe the outcome of the implementation of molecular based diagnostics platform in Yemen and highlight the key milestones the country went through to increase access to testing for its populations residing in a geographically vast and politically divided country. METHODS A retrospective assessment of COVID-19 laboratory response activities was done detailing the needs assessment process, timelines, geographical coverage, and outcomes of the activities. Laboratory data was analyzed to construct the geographical locations of COVID-19 testing laboratories and the numbers of tests performed in each facility to highlight the demands of testing for travelers. Finally, we discuss the impact these activities had in enabling the movement of people across international borders for economic gains and in delivery of critical humanitarian aid. OUTCOME PCR testing capacities in Yemen significantly improved, from one laboratory in Sanaa in April 2020 to 18 facilities across the country by June 2022. In addition, the number of functional Real-Time PCR thermocyclers increased from one to 32, the PCR tests output per day improved from 192 to 6144 tests per day. Results from analysis of laboratory data showed there were four peaks of COVID-19 in Yemen as October 2022. The majority of laboratory tests were performed for travelers than for medical or public health reasons. Demand for laboratory testing in Yemen was generally low and waned over time as the perceived risk of COVID-19 declined, in parallel with rollout of the COVID-19 vaccines. DISCUSSION/CONCLUSION The successful expansion of laboratory testing capacity was instrumental in the control and management of COVID-19 cases and critical in the implementation of public response strategies, including restrictions on gathering. Laboratory testing also facilitated the movement of humanitarian agencies and delivery of aid and enabled hundreds of thousands of Yemeni nationals to travel internationally. By virtue of these outcomes, the impact of laboratory strengthening activities was thus felt in the health sector and beyond.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Amal Barakat
- World Health Organization, East Mediterranean Regional Office, Cairo, Egypt
| | | | - Abdinasir Abubakar
- World Health Organization, East Mediterranean Regional Office, Cairo, Egypt
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Nasr H, Al-Zumair M, Al-Mahbashi T, Dureab F. Factors associated with the cholera outbreak in Al-Mahweet-Yemen: Analytic Study. J Infect Dev Ctries 2024; 18:66-74. [PMID: 38377087 DOI: 10.3855/jidc.17571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 07/04/2023] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION The emergence of cholera in 2016 in Yemen, worsened the morbidity and mortality of diarrheal diseases, particularly among children under five. Multiple outbreaks in Yemen are triggered by years of conflict and the collapse of basic infrastructure including water supply and sanitation systems. This study aims to assess factors associated with the cholera outbreak, in a cholera-prone region, in Al-Mahweet, Yemen. METHODOLOGY We conducted a multivariate analysis of the data collected through a household survey of 384 households in Al-Mahweet, Yemen. RESULTS Families with children under five years, large households, and those living in Al Mahweet district were associated with a higher incidence of cholera. Water treatment by boiling, filtering, and chlorination as a protective practice against cholera showed a borderline significance, while other WASH practices including regular hand washing, open defection, safe water source, and improved sanitation facilities were statistically insignificant. Community awareness of cholera transmission and prevention measures showed no association with cholera incidence. CONCLUSIONS Findings suggest that living conditions, including large households and lack of access to treated water, increase the risk of cholera. Interventions to increase access to treated water and improve the hygienic conditions of large households are of central importance. Affected communities must receive effective educational campaigns that are adjusted to change hygienic practices and improve knowledge of cholera transmission and protection measures.
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Affiliation(s)
- Hani Nasr
- IRIA, Akkon-Hochschule für Humanwissenschaften, Berlin, 12099, Germany
| | - Marwah Al-Zumair
- IRIA, Akkon-Hochschule für Humanwissenschaften, Berlin, 12099, Germany
| | | | - Fekri Dureab
- IRIA, Akkon-Hochschule für Humanwissenschaften, Berlin, 12099, Germany
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Al-Huthaifi BH, Al Moaleem MM, Alwadai GS, Nassar JA, Sahli AAA, Khawaji AH, Juraybi AK, Alsheri YA, Aldhorae K, Yaqoub AA, Aljabali SA, Dobashi AM, Al-Qubati SW. High Prevalence of Musculoskeletal Disorders Among Dental Professionals: A Study on Ergonomics and Workload in Yemen. Med Sci Monit 2023; 29:e942294. [PMID: 38115571 PMCID: PMC10790725 DOI: 10.12659/msm.942294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/23/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Dentists frequently have work-related musculoskeletal disorder (MSD) diseases, which are the profession's second most common cause of disability. Awareness of dental ergonomics is necessary for controlling MSDs associated with dental workload. Dental professionals need additional training in dental ergonomics to reduce serious complications associated with dental workload. This questionnaire-based study aimed to evaluate the understanding of physical ergonomics and musculoskeletal disorders in 310 dental health professionals and students in Yemen. MATERIAL AND METHODS This was a cross-sectional study was conducted among 400 dental professionals working in various clinics and universities in Sana'a City, Yemen. They received a self-administered questionnaire that was developed from earlier studies. Five sections made up the questionnaire. The first section of the survey included questions about sex, age, and clinical professions; the second section focused on ergonomic awareness; the third section asked about work conditions; the fourth section asked about the prevalence of musculoskeletal disorders; and the fifth section asked about interventions used. Data were analyzed using SPSS version 25.0, and a P value of ≤0.05 was considered significant. RESULTS Only 310 questionnaires were completed. The participants'; level of understanding of ergonomics was low. One-way ANOVA showed a significant portion of respondents reported having MSDs, and they frequently reported pain related to workload. The neck, lower back, upper back, and shoulders experienced the highest levels of pain. CONCLUSIONS The prevalence of MSDs was high among dental professionals, especially in the lower back, upper back, and shoulder. This necessitates preventive measures like ergonomic positions, ergonomic equipment, regular exercise, and work breaks.
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Affiliation(s)
- Basem H. Al-Huthaifi
- Department of Preventive and Biomedical Science, College of Dentistry, University of Science and Technology, Sana’a City, Yemen
| | - Mohammed M. Al Moaleem
- Department of Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Ghadeer S. Alwadai
- Department of Restorative Dental Science, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Jihad Abou Nassar
- Fixed Prosthodontics Department, Faculty of Dentistry, Damascus University, Damascus, Syrian Arab Republic
| | | | | | | | - Yazeed Ali Alsheri
- Dental Intern, College of Dentistery, King Faisal University, Dammam, Saudi Arabia
| | - Khalid Aldhorae
- Orthodontic Department, Faculty of Dentistry, Thamar University, Thamar, Yemen
- Faculty of Dentistry, University of Ibn al-Nafis for Medical Sciences, Sana’a, Yemen
| | - Amal A. Yaqoub
- Dental Intern, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Shuaib Ali Aljabali
- Department of Restorative and Prosthodontics, Collage of Dentistry, University of Science and Technology, Sana’a, Yemen
| | | | - Sahl Waleed Al-Qubati
- Department of Preventive and Biomedical Science, College of Dentistry, University of Science and Technology, Aden, Yemen
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Al-Ashwal MA, Atroosh WM, Al-Adhroey AH, Al-Subbary AA, Yee-Ling L, Al-Mekhlafi HM. A disfiguring neglected tropical disease sweeps war-torn Yemen: a community-based study of prevalence and risk factors of cutaneous leishmaniasis among rural communities in the western highlands. Trans R Soc Trop Med Hyg 2023; 117:823-838. [PMID: 37486252 DOI: 10.1093/trstmh/trad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/03/2023] [Accepted: 06/30/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is a major health problem in Yemen and is endemic in many rural areas across the country. METHODS A community-based cross-sectional survey followed by unmatched case-control comparisons was conducted among 612 participants in Utmah district, western Yemen. A total of 223 participants were included in the case-control analysis to identify the significant risk factors. Skin scrapping samples were examined by microscopy and internal transcribed spacer 1 nested polymerase chain reaction. RESULTS Overall, 33% (202/612) of the participants had active skin lesions and/or scars that met the clinical criteria for CL. A total of 90 (14.7%) participants had suspected active CL lesions; however, a prevalence of 8.7% (53/612) was obtained based on molecular and parasitological examination, with Leishmania tropica being the only causative agent identified. Multivariable logistic regression analyses showed that being ≤10 y old, being female, living in houses with cracked walls, living in the presence of other family members with typical ulcerating skin diseases and sleeping outside were factors significantly associated with an increased likelihood of having CL. Moreover, keeping livestock on the ground floor of the house was significantly associated with a decreased likelihood of having CL. CONCLUSION The study reveals an alarmingly high prevalence of CL among the studied population. Therefore there is an urgent need for effective control measures and improved treatment efforts against this devastating disease.
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Affiliation(s)
- Manal A Al-Ashwal
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Wahib M Atroosh
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
- Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | - Abdulelah H Al-Adhroey
- Department of Community Medicine, Faculty of Medicine and Health Sciences, Thamar University, Dhamar, Yemen
| | - Assia A Al-Subbary
- National Centre of Public Health Laboratories, Ministry of Public Health and Population, Dhamar, Yemen
| | - Lau Yee-Ling
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Hesham M Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
- Department of Epidemiology, Faculty of Public Health and Tropical Medicine, Jazan University, Jazan 45142, Saudi Arabia
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a 1247, Yemen
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Al-Maimoony T, Al-Sageer N, Bahaj S, Al-Motarreb A, Agati L. Behavior of Coronavirus pandemic in Yemen: practical experience review. Minerva Cardiol Angiol 2023; 71:653-658. [PMID: 35767238 DOI: 10.23736/s2724-5683.22.06109-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
COVID-19 is caused by a coronavirus called SARS-CoV-2, which spread, all over the world. The virus is spreading very easily and sustainably between people. Information from the ongoing pandemic disease suggests that this virus is spreading more efficiently than influenza. Older adults and people who have severe underlying medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID-19 illness. Coronavirus constantly changes through mutation. When a virus has one or more new mutation, it has called a variant of concern. There is no data from Yemen to show what type of coronavirus variant is spread in Yemen. We believe it is a unique situation where almost all people have been affected by the coronavirus. We tested the cardiac center workers and we found all of them have positive results. No severe symptoms among our staff were reported and many of them suffered from mild to moderate symptoms, which does not need admission to the hospital. Young age among this worker sample may explain the mild severity of COVID-19 infection detected; another explanation is the frequent exposure to viral infection in Yemen and the type of coronavirus variant in Yemen. We conducted this review to describe the current situation and our experience during the pandemic and further studies are needed to identify the exact variant in Yemen and the immunity response for this coronavirus variant in the Yemeni Society.
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Affiliation(s)
- Taha Al-Maimoony
- Cardiac Department, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | - Nora Al-Sageer
- Cardiac Department, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | - Saleh Bahaj
- Department of Microbiology and Immunology, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | - Ahmed Al-Motarreb
- Cardiac Department, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | - Luciano Agati
- Department of Cardiology, Sapienza University, Rome, Italy
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Tarnas MC, Al-Dheeb N, Zaman MH, Parker DM. Association between air raids and reported incidence of cholera in Yemen, 2016-19: an ecological modelling study. Lancet Glob Health 2023; 11:e1955-e1963. [PMID: 37973343 DOI: 10.1016/s2214-109x(23)00272-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Yemen continues to endure cholera outbreaks during ongoing conflict and destructive environmental events. Air raids have been used throughout the conflict to target military and civilian infrastructure. We aimed to assess the association between air raids and cholera incidence while taking into account geographical, environmental, economic, and demographic factors that drive outbreaks. METHODS In this ecological modelling study, we used data from Sept 12, 2016, to Dec 29, 2019, for the number of air raids, vegetation coverage, surface water, precipitation, temperature, economic variables, and cholera case and population data to model the association between conflict and the weekly incidence of cholera (per 100 000 people) in Yemen. Data were transformed into weekly intervals and governorates were categorised according to air raid severity (the number of raids in the previous 3 months). We used a negative binomial generalised additive model that accounted for geographical location and environmental, temporal, economic, and demographic variables to estimate incidence rate ratios for the association between air raid severity and cases of cholera. FINDINGS During the study period, 2 107 912 cases of cholera were reported in Yemen, and a minimum of 11 366 air raids were recorded. After controlling for relevant factors, compared with no air raids, all other levels of air raid severity were significantly associated with cholera incidence. The largest effect was noted in governorates with severe air raid levels (ie, ≥76 during the previous 3 months), which had an incidence rate ratio of 2·06 (95% CI 1·59-2·69; p<0·0001) for cholera compared with governorates with no air raids in the previous 3 months. Economic factors were also significantly associated with increased cholera incidence. INTERPRETATION Air raids were significantly associated with the burden of cholera in Yemen, even after controlling for other relevant factors. Quantification of this relationship further shows that the cholera outbreak is largely a result of human action rather than a natural occurrence, and demonstrates the conflict's devastating effects on health. Our findings highlight the need for ceasefire and peacebuilding efforts, as well as infrastructure and economic restoration, to reduce Yemen's cholera burden. FUNDING None. TRANSLATION For the Arabic translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Maia C Tarnas
- Department of Population Health and Disease Prevention, University of California, Irvine, Irvine, CA, USA.
| | | | - Muhammad H Zaman
- Department of Biomedical Engineering, Boston University, Boston, MA, USA; Center on Forced Displacement, Boston University, Boston, MA, USA
| | - Daniel M Parker
- Department of Population Health and Disease Prevention, University of California, Irvine, Irvine, CA, USA; Department of Epidemiology & Biostatistics, University of California, Irvine, Irvine, CA, USA
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12
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Beshr IA, Beshr MS, Al-Qubati HA. Polio outbreak response, Yemen. Bull World Health Organ 2023; 101:808-812. [PMID: 38024246 PMCID: PMC10680107 DOI: 10.2471/blt.23.290122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 12/01/2023] Open
Abstract
Problem A decrease in vaccine coverage in conflict-affected areas has placed Yemen at higher risk of polio outbreaks caused by vaccine-derived poliovirus strains. Approach In response to polio outbreaks, the Yemeni health ministry and partners initiated multiple vaccination campaigns to deliver vaccines to children. We also implemented several measures to enhance communication, education, health promotion and hygiene, especially in camps for internally displaced people. Local setting In 2009, Yemen achieved polio-free status and maintained it until 2019. However, the ongoing political conflict since 2015, coupled with challenges in delivering the polio vaccine to conflict-affected areas, resulted in two polio outbreaks: 35 cases caused by vaccine-derived poliovirus strain 1 between 2019 and 2021, and 230 cases due to vaccine-derived poliovirus strain 2 between November 2021 and December 2022. Relevant changes In response to the first outbreak, by the end of 2020, we vaccinated 7.2 million children through nationwide vaccination campaigns, except in Sa'ada governorate due to a ban by the authorities. By the end of 2021, 3 800 313 children younger than 5 years had received polio vaccines. For the second outbreak, by the end of 2022, 4 463 389 vaccines had been given to children younger than 10 years, and 1 217 423 to those younger than 5 years. Lessons learnt Vaccination campaigns in conflict-affected areas with low vaccine coverage remain crucial in eradicating polio. Efforts are needed to reach vulnerable groups such as displaced populations. Advocacy, communication and social mobilization actions help ensure broader public inclusion and participation in vaccination efforts to prevent polio outbreaks.
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Affiliation(s)
- Ibrahem Abduallah Beshr
- Faculty of Medicine and Health Sciences, Sana’a University, Wadi Dhaher Road, PO Box 13078, Sana’a, Yemen
| | - Mohammed Sadeq Beshr
- Faculty of Medicine and Health Sciences, Sana’a University, Wadi Dhaher Road, PO Box 13078, Sana’a, Yemen
| | - Hibah Abdulqader Al-Qubati
- Faculty of Medicine and Health Sciences, Sana’a University, Wadi Dhaher Road, PO Box 13078, Sana’a, Yemen
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13
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Lassalle F, Al-Shalali S, Al-Hakimi M, Njamkepo E, Bashir IM, Dorman MJ, Rauzier J, Blackwell GA, Taylor-Brown A, Beale MA, Cazares A, Al-Somainy AA, Al-Mahbashi A, Almoayed K, Aldawla M, Al-Harazi A, Quilici ML, Weill FX, Dhabaan G, Thomson NR. Genomic epidemiology reveals multidrug resistant plasmid spread between Vibrio cholerae lineages in Yemen. Nat Microbiol 2023; 8:1787-1798. [PMID: 37770747 PMCID: PMC10539172 DOI: 10.1038/s41564-023-01472-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/11/2023] [Indexed: 09/30/2023]
Abstract
Since 2016, Yemen has been experiencing the largest cholera outbreak in modern history. Multidrug resistance (MDR) emerged among Vibrio cholerae isolates from cholera patients in 2018. Here, to characterize circulating genotypes, we analysed 260 isolates sampled in Yemen between 2018 and 2019. Eighty-four percent of V. cholerae isolates were serogroup O1 belonging to the seventh pandemic El Tor (7PET) lineage, sub-lineage T13, whereas 16% were non-toxigenic, from divergent non-7PET lineages. Treatment of severe cholera with macrolides between 2016 and 2019 coincided with the emergence and dominance of T13 subclones carrying an incompatibility type C (IncC) plasmid harbouring an MDR pseudo-compound transposon. MDR plasmid detection also in endemic non-7PET V. cholerae lineages suggested genetic exchange with 7PET epidemic strains. Stable co-occurrence of the IncC plasmid with the SXT family of integrative and conjugative element in the 7PET background has major implications for cholera control, highlighting the importance of genomic epidemiological surveillance to limit MDR spread.
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Affiliation(s)
- Florent Lassalle
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK.
| | | | | | - Elisabeth Njamkepo
- Institut Pasteur, Université Paris Cité, Unité des Bactéries pathogènes entériques, Paris, France
| | | | - Matthew J Dorman
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK
- Churchill College, Cambridge, UK
| | - Jean Rauzier
- Institut Pasteur, Université Paris Cité, Unité des Bactéries pathogènes entériques, Paris, France
| | - Grace A Blackwell
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK
- EMBL-EBI, Hinxton, UK
| | - Alyce Taylor-Brown
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK
| | - Mathew A Beale
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK
| | - Adrián Cazares
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK
| | | | | | - Khaled Almoayed
- National Centre of Public Health Laboratories, Sana'a, Yemen
| | - Mohammed Aldawla
- Ministry of Public Health, Infection Control Unit, Sana'a, Yemen
| | | | - Marie-Laure Quilici
- Institut Pasteur, Université Paris Cité, Unité des Bactéries pathogènes entériques, Paris, France
| | - François-Xavier Weill
- Institut Pasteur, Université Paris Cité, Unité des Bactéries pathogènes entériques, Paris, France
| | - Ghulam Dhabaan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
| | - Nicholas R Thomson
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK.
- London School of Hygiene and Tropical Medicine, London, UK.
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14
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Al-Taj MA, Al Serouri A, Al-Muradi AM, Al-Dharhani E, Al-faeq NN, Al-amodi FM, Abdulwahab MM, Nawfal AM, Alshemerry MH, Mujahed MA. Concurrent wasting and stunting among marginalised children in Sana'a city, Yemen: a cross-sectional study. J Nutr Sci 2023; 12:e91. [PMID: 37587974 PMCID: PMC10425760 DOI: 10.1017/jns.2023.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/16/2023] [Accepted: 07/10/2023] [Indexed: 08/18/2023] Open
Abstract
Concurrent wasting and stunting (WaSt) is a serious form of malnutrition among young children, particularly vulnerable groups affected by the conflict. Understanding the prevalence and risk factors of WaSt among vulnerable children is important to develop effective intervention measures to reduce the burden of WaSt. The present study aimed to identify the prevalence of and risk factors for WaSt among marginalised children aged 6-59 months in Sana'a city, Yemen. A community-based cross-sectional design was conducted on a total sample size of 450 marginalised children aged 6-59 months who lived at home with their mothers. Multivariable logistic regression analysis was performed and the prevalence of WaSt was found to be 10⋅7 %. Children aged 24-59 months were protected from WaSt (adjusted odds ratio (AOR) 0⋅40, 95 % confidence interval (CI) 0⋅21, 0⋅75). A higher prevalence of WaSt was associated with male sex (AOR 2⋅31, 95 % CI 1⋅13, 4⋅71), no history of being breastfed (AOR 3⋅57, 95 % CI 1⋅23, 10⋅39), acute diarrhoea (AOR 2⋅12, 95 % CI 1⋅12, 4⋅02) and family income sources of assistance from others (AOR 2⋅74, 95 % CI 1⋅08, 6⋅93) or salary work (AOR 2⋅22, 95 % CI 1⋅10, 4⋅47). Continued breast- and bottle-feeding were not associated with WaSt in children aged 6-23 months. Mothers' age, education and work status, family size and drinking water source were not associated with WaSt. Overall, we found that the prevalence of WaSt among marginalised children remained high. Interventions to improve household income, hygienic conditions and child feeding practices are necessary to promote child growth.
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Affiliation(s)
- Mansour Abdu Al-Taj
- Department of Community Medicine, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Abdulwahed Al Serouri
- Field Epidemiology Training Programme, Ministry of Public Health and Population, Sana'a, Yemen
| | | | | | - Nada Nabil Al-faeq
- Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | | | | | - Ali Mujahed Nawfal
- Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
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15
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Bin Ghouth A, Mahmoud N. Responding to COVID-19 pandemic at the local level: lessons from Yemen. East Mediterr Health J 2023; 29:508-514. [PMID: 37553737 DOI: 10.26719/emhj.23.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/05/2022] [Indexed: 08/10/2023]
Abstract
BACKGROUND The health authorities in Hadhramaut Valley and Desert responded to the COVID-19 pandemic differently from other areas in Yemen. AIMS To document the response of the local authority and Ministry of Health in Hadhramaut to COVID-19. METHODS The local authority in Syoun (Hadhramaut Valley) convened a meeting of all key players from the health and related sectors in February 2020 where a decision was made to establish a committee to evaluate the health situation and assess the needs. Based on the results of these assessments, a plan was designed to respond to the pandemic. We reviewed available documents on the COVID-19 response in Hadhramaut, interviewed the main stakeholders, and conducted site visits to the COVID-19 response centres. RESULTS There was evidence of the crucial role played by the local authority in response to COVID-19. They established 3 well-equipped isolation centres with a total of 142 beds, a stock of 2250 oxygen cylinders, 2 new polymerase chain reaction units, a simplified referral system, and an effective patient follow-up and oxygen home therapy strategy. CONCLUSION Political commitment at the local level is crucial to bridge the gap between policy and implementation, especially during infectious disease outbreaks. It is important to train public health leaders on how to effectively assess local health needs and develop effective and efficient response strategy. Lessons from this study in Hadhramaut provide evidence on how local authorities can coordinate response to emerging health needs and update their strategies.
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Affiliation(s)
- Abdulla Bin Ghouth
- Department of Community Medicine, Hadhramaut University, Al Mukalla, Yemen
| | - Nuha Mahmoud
- Area Coordinator (Aden), World Health Organization Regional Office for the Eastern Mediterranean, Aden, Yemen
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16
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Al-Taj MA, Al-Hadari MH. Prevalence and drivers of female genital mutilation/cutting in three coastal governorates in Yemen. BMC Public Health 2023; 23:1363. [PMID: 37461020 DOI: 10.1186/s12889-023-16299-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 07/12/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Female genital mutilation/cutting (FGM/C), a violation of human rights, remains common in the coastal areas of Yemen. OBJECTIVE This study aimed to identify the prevalence of FGM/C and its risk factors among the youngest daughters in families in the Yemeni coastal areas, as well as the knowledge and attitudes of the local population towards FGM/C. METHODS A cross-sectional survey was conducted among 646 women and 345 men from six districts in three Yemeni coastal governorates between July and September 2020 using a structured questionnaire. Categorical data were described by proportion. The chi-square test was used to identify factors associated with FGM/C. All factors with a p-value of ≤ 0.05 were included in the multivariate analysis. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated in the multivariate logistic regression analysis. RESULTS The prevalence of FGM/C in Yemeni coastal areas was 89.0% (95% CI 84.0%-92.5%) among women and 79.8% (95% CI 73.5%-84.8%) among the youngest daughters in the surveyed families. Nearly two-thirds of women and half of the men recorded a poor knowledge level about the harms of FGM/C. Furthermore, almost two-thirds of both women and men would like to continue the practice of FGM/C. Among women, significant predictors of FGM/C among youngest daughters included advanced maternal age of ≥ 40 years (AOR 7.16, 95% CI 2.73-18.76), mother's desire to continue FGM/C (AOR 8.07, 95% CI 3.64-17.89), and living in a rural area (AOR 3.95, 95% CI 1.51-10.30). Daughters of mothers who did not undergo FGM/C were more protected from FGM/C than those whose mothers had undergone FGM/C (AOR 0.04, 95% CI 0.02-0.09). Among men, the father's desire to continue FGM/C (AOR 15.10, 95% CI 6.06-37.58) was significantly associated with FGM/C among the youngest daughters. CONCLUSION This study confirmed that FGM/C is still prevalent among communities in Yemeni coastal areas. Thus, community-based interventions with a focus on the rural population are vital to improving the awareness of various harms of FGM/C.
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Affiliation(s)
- Mansour Abdu Al-Taj
- Department of Community Medicine, Faculty of Medicine, Sana'a University, Mudbah Street, Sana'a, 773169022, Yemen.
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17
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Al-Mushiki GM, Al-Samhari GA, Alahsab AA, Al-Shaebi F, Tao L, Zhong Q. Understanding risk factors for severe acute malnutrition among children during war conflict in yemen. Indian J Public Health 2023; 67:463-467. [PMID: 37929392 DOI: 10.4103/ijph.ijph_1220_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Severe acute malnutrition (SAM) is a major public health concern in Yemen, particularly in areas affected by ongoing conflict war. SAM is defined as a very low weight for height, by visible severe wasting, or by the presence of nutritional edema. The prevalence of SAM in Yemen has increased dramatically since the onset of the conflict. Prior studies have focused on evaluating prevalence, but this novel study aimed to assess the risk factors associated with SAM prevalence. Five thousand two hundred and seventeen patients of SAM admitted at 12 sentinel hospitals were enrolled, and data were collected and analyzed. Marasmus was the most common form. Numerous risk factors contribute to the high prevalence of SAM in Yemen, including food insecurity. The current conflict has hampered food production, distribution, and access. Awareness of risk factors can prevent SAM in the general population.
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Affiliation(s)
- Gaber M Al-Mushiki
- Post Graduate, Epidemiology and Biostatic Health, School of Public Health, Guangxi Medical University, Nanning; Department of Community Medicine, Faculty of Medicine and Health Sciences, Thamar University, Dhamar, Yemen
| | - Galal A Al-Samhari
- Post Graduate, Epidemiology and Biostatic Health, School of Public Health, Guangxi Medical University, Nanning; Department of Community Medicine, Faculty of Medicine and Health Sciences, Thamar University, Dhamar, Yemen
| | - Ameen A Alahsab
- Head of Children Nutrition Program, Office of Public Health and Population, Dhamar, Yemen
| | - Fadhl Al-Shaebi
- Department of Community Medicine, Faculty of Medicine and Health Sciences, Thamar University; Assistant Professor, Department of Immunology & Key Laboratory of Immune Mechanism and Intervention on Serious Disease in Hebei Province, Hebei Medical University, Shijiazhuang, China
| | - Lijun Tao
- Post Graduate, Epidemiology and Biostatic Health, School of Public Health, Guangxi Medical University, Nanning, China
| | - Qiuan Zhong
- Post Graduate, Epidemiology and Biostatic Health, School of Public Health, Guangxi Medical University, Nanning, China
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Al-Eryani SM, Irish SR, Carter TE, Lenhart A, Aljasari A, Montoya LF, Awash AA, Mohammed E, Ali S, Esmail MA, Hussain A, Amran JG, Kayad S, Nouredayem M, Adam MA, Azkoul L, Assada M, Baheshm YA, Eltahir W, Hutin YJ. Public health impact of the spread of Anopheles stephensi in the WHO Eastern Mediterranean Region countries in Horn of Africa and Yemen: need for integrated vector surveillance and control. Malar J 2023; 22:187. [PMID: 37337209 PMCID: PMC10278259 DOI: 10.1186/s12936-023-04545-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/30/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Anopheles stephensi is an efficient vector of both Plasmodium falciparum and Plasmodium vivax in South Asia and the Middle East. The spread of An. stephensi to countries within the Horn of Africa threatens progress in malaria control in this region as well as the rest of sub-Saharan Africa. METHODS The available malaria data and the timeline for the detection of An. stephensi was reviewed to analyse the role of An. stephensi in malaria transmission in Horn of Africa of the Eastern Mediterranean Region (EMR) in Djibouti, Somalia, Sudan and Yemen. RESULTS Malaria incidence in Horn of Africa of EMR and Yemen, increased from 41.6 in 2015 to 61.5 cases per 1000 in 2020. The four countries from this region, Djibouti, Somalia, Sudan and Yemen had reported the detection of An. stephensi as of 2021. In Djibouti City, following its detection in 2012, the estimated incidence increased from 2.5 cases per 1000 in 2013 to 97.6 cases per 1000 in 2020. However, its contribution to malaria transmission in other major cities and in other countries, is unclear because of other factors, quality of the urban malaria data, human mobility, uncertainty about the actual arrival time of An. stephensi and poor entomological surveillance. CONCLUSIONS While An. stephensi may explain a resurgence of malaria in Djibouti, further investigations are needed to understand its interpretation trends in urban malaria across the greater region. More investment for multisectoral approach and integrated surveillance and control should target all vectors particularly malaria and dengue vectors to guide interventions in urban areas.
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Affiliation(s)
- Samira M Al-Eryani
- Department of Universal Health Coverage/Communicable Diseases Prevention and Control, Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt.
| | - Seth R Irish
- World Health Organization, Headquarters, 1211, Geneva, Switzerland
| | | | - Audrey Lenhart
- Entomology Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adel Aljasari
- World Health Organization, Country Office, Sana'a, Yemen
| | | | - Abdullah A Awash
- World Health Organization, Country Office, Sub-Office, Aden, Yemen
| | | | - Said Ali
- National Malaria Control Programme, Ministry of Health Development, Hargeisa, Somaliland
| | - Mohammed A Esmail
- National Malaria Control Programme, Ministry of Public Health & Population, Sana'a, Yemen
| | | | - Jamal G Amran
- World Health Organization, Country Office, Mogadishu, Somalia
| | - Samatar Kayad
- National Malaria Control Programme, Ministry of Health, Djibouti, Djibouti
| | | | - Mariam A Adam
- World Health Organization, Country Office, Khartoum, Sudan
| | - Lina Azkoul
- Department of Universal Health Coverage/Communicable Diseases Prevention and Control, Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
| | - Methaq Assada
- National Malaria Control Programme, Ministry of Public Health & Population, Sana'a, Yemen
| | - Yasser A Baheshm
- National Malaria Control Programme, Ministry of Public Health & Population, Aden, Yemen
| | - Walid Eltahir
- Directorate of the Integrated Vector Management (IVM), Federal Ministry of Health, Khartoum, Sudan
| | - Yvan J Hutin
- Department of Universal Health Coverage/Communicable Diseases Prevention and Control, Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
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Al-Murisi WMS, Al-Mekhlafi AM, Mahdy MAK, Al-Haidari SA, Annuzaili DA, Thabit AAQ. Schistosoma mansoni and soil-transmitted helminths among schoolchildren in An-Nadirah District, Ibb Governorate, Yemen after a decade of preventive chemotherapy. PLoS One 2022; 17:e0273503. [PMID: 36006980 PMCID: PMC9409567 DOI: 10.1371/journal.pone.0273503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/09/2022] [Indexed: 11/19/2022] Open
Abstract
The Ministry of Public Health in Yemen continues the implementation of school and community–based preventive chemotherapy with praziquantel and albendazole for the control and elimination of schistosomiasis and soil-transmitted helminths (STH). The latest remapping to update the distribution of schistosomiasis and STH was conducted seven years ago. This study aimed to estimate the prevalence, intensity and associated risk factors of Schistosoma mansoni and STH among schoolchildren in An-Nadirah District, Ibb Governorate, Yemen. A cross-sectional study was carried out among schoolchildren aged 6–15 years in four selected schools. Biological, demographic, socioeconomic and environmental data were collected using a pre-tested questionnaire. S. mansoni and STH eggs were detected and counted by the microscopic examination of Kato-Katz fecal smears. Out of 417 schoolchildren, 17.0% were infected with at least one intestinal helminth. Prevalence of S. mansoni and STH were 6.5% and 9.1%, respectively. The most prevalent parasite among STH was Ascaris lumbricoides (8.4%). Unemployed fathers (Adjusted Odds Ratio (AOR) = 3.2; 95% Confidence interval (CI): 1.23, 8.52; P = 0.018), eating exposed food (AOR: 2.9; 95%CI = 1.24, 6.89; P = 0.014), not washing hands before eating and after defecation (AOR: 4.8; 95%CI = 1.77, 12.81; P = 0.002), and schools located close to water stream (AOR: 22.1; 95%CI = 5.12, 95.46; P <0.001) were independent risk factors of ascariasis. Swimming in ponds/stream (AOR: 3.9; 95%CI = 1.63, 9.55; P = 0.002), and schools close to the stream (AOR: 24.7; 95%CI = 3.05, 200.07; P = 0.003) were independent risk factors of intestinal schistosomiasis. The present study does not indicate a reduction in the prevalence of intestinal schistosomiasis in this rural area since the latest remapping conducted in 2014, although ascariasis was reduced by half. The prevalence of the two parasites was highly focal in areas close to the valley, suggesting a significant role of the stream in sustaining and accelerating the parasitic infection. Children practicing swimming and having poor hygienic practices were at high exposure to S. mansoni and A. lumbricoides, respectively. Water, Sanitation and Hygiene intervention, school–based health education, and snail control, in addition to mass drug administration, will help in the interruption of transmission of schistosomiasis and STH.
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Affiliation(s)
| | | | - Mohammed A. K. Mahdy
- Department of Parasitology, Faculty of Medicine, Sana’a University, Sana’a, Yemen
- Tropical Disease Research Center, Faculty of Medicine, University of Science and Technology, Sana’a, Yemen
- * E-mail:
| | - Sami Ahmed Al-Haidari
- Diseases Control & Surveillance, Ministry of Public Health and Population, Sana’a, Yemen
| | - Dhekra A. Annuzaili
- Primary Health Care Department, Ministry of Public Health and Population, Aden, Yemen
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Al-Shehari WA, Yin YA, Wang X, Wang Y, Sun H, Fu Y, Zhang F. Prevalence and surveillance of tuberculosis in Yemen from 2006 to 2018. Epidemiol Infect 2022; 150:e146. [PMID: 35856270 PMCID: PMC9354476 DOI: 10.1017/s0950268822001261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/02/2022] [Accepted: 07/05/2022] [Indexed: 12/14/2022] Open
Abstract
Tuberculosis is a major public health issue in Yemen, a country located at the southwestern tip of the Arabian Peninsula, while the situation of tuberculosis had been further exacerbated since the war started in 2015. The objective of this study is to investigate the incidence of tuberculosis in Yemen before the outbreak of COVID-19, from 2006 to 2018. During the 13-year period, 92 482 patients were enrolled in the TB programme records from the 22 governorates. Almost equal number of cases were diagnosed between males and females (a male to female ratio, 1.03:1). A notable rising incidence was observed in all age groups starting from 2011. The sharpest increase occurred in children under age 15, rising by 8.0-fold from 0.5 in the period 2006-2010 to 4.1 in the period 2011-2018. Paediatric TB accounted for 9.6% of all reported cases. In terms of the patient residence, incidence has more than doubled in Sana'a city, Sana'a Gov., Hajjah and Saadah. Concomitant diseases with tuberculosis included diabetes mellitus (14.0%), brucellosis (6.1%), hepatitis (6.0%), rheumatoid arthritis (4.3%), renal disorders (2.5%) and HIV infection (2.5%). Development of interventions to reduce tuberculosis incidence in children and concomitant communicable diseases is urgently needed.
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Affiliation(s)
- Wadee Abdullah Al-Shehari
- Department of Microbiology, Basic Medical Sciences College, Harbin Medical University, Harbin 150086, China
- Department of Medical Microbiology, Faculty of Sciences, Ibb University, Ibb, Yemen
| | - Yi-An Yin
- Department of Microbiology, Basic Medical Sciences College, Harbin Medical University, Harbin 150086, China
| | - Xinyang Wang
- Department of Microbiology, Basic Medical Sciences College, Harbin Medical University, Harbin 150086, China
| | - Ying Wang
- Department of Microbiology, Basic Medical Sciences College, Harbin Medical University, Harbin 150086, China
| | - Haobo Sun
- Department of Microbiology, Basic Medical Sciences College, Harbin Medical University, Harbin 150086, China
| | - Yingmei Fu
- Department of Microbiology, Basic Medical Sciences College, Harbin Medical University, Harbin 150086, China
| | - Fengmin Zhang
- Department of Microbiology, Basic Medical Sciences College, Harbin Medical University, Harbin 150086, China
- Wu Lien-Teh Institute, Harbin Medical University, Harbin 150086, China
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21
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Alves RNP, de Vasconcelos CAC, Vieira NB, Pereira YTG, Feitosa PWG, Maia MAG, de Carvalho SMF, Neto MLR, de Menezes HL. The silence of the lambs: Child morbidity and mortality from malnutrition in Yemen. J Pediatr Nurs 2022; 65:e13-e14. [PMID: 34998655 DOI: 10.1016/j.pedn.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 11/19/2022]
Abstract
More than 2.3 million children under the age of five in Yemen suffer from acute malnutrition. Approximately 450,000 are expected to suffer from severe acute malnutrition and may die if they do not receive urgent treatment. In this context, without security, stability, and better access for farmers to have the means to resume growing food, children and their families continue to sink deeper and deeper into hunger and malnutrition. As a result, malnourished children are more vulnerable to illnesses, including diarrhea, respiratory infections, and malaria, which are a major concern in Yemen. This situation is a vicious and often deadly cycle.
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Affiliation(s)
| | | | - Nélio Barreto Vieira
- Scientific Writing Laboratory, School of Medicine, Federal University of Cariri, Barbalha, Ceara, Brazil.
| | | | | | | | | | - Modesto Leite Rolim Neto
- Scientific Writing Laboratory, School of Medicine, Federal University of Cariri, Barbalha, Ceara, Brazil
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22
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Simpson RB, Babool S, Tarnas MC, Kaminski PM, Hartwick MA, Naumova EN. Dynamic mapping of cholera outbreak during the Yemeni Civil War, 2016-2019. J Public Health Policy 2022; 43:185-202. [PMID: 35614203 PMCID: PMC9192410 DOI: 10.1057/s41271-022-00345-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 12/03/2022]
Abstract
Widespread destruction from the Yemeni Civil War (2014-present) triggered the world's largest cholera outbreak. We compiled a comprehensive health dataset and created dynamic maps to demonstrate spatiotemporal changes in cholera infections and war conflicts. We aligned and merged daily, weekly, and monthly epidemiological bulletins of confirmed cholera infections and daily conflict events and fatality records to create a dataset of weekly time series for Yemen at the governorate level (subnational regions administered by governors) from 4 January 2016 through 29 December 2019. We demonstrated the use of dynamic mapping for tracing the onset and spread of infection and manmade factors that amplify the outbreak. We report curated data and visualization techniques to further uncover associations between infectious disease outbreaks and risk factors and to better coordinate humanitarian aid and relief efforts during complex emergencies.
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Affiliation(s)
- Ryan B. Simpson
- Nutrition Epidemiology and Data Science Division, Tufts University Friedman School of Nutrition Science and Policy, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Sofia Babool
- Neuroscience Department, The University of Texas at Dallas, Richardson, TX USA
| | - Maia C. Tarnas
- Community Health Department, Tufts University School of Arts and Sciences, Medford, MA USA
| | - Paulina M. Kaminski
- Nutrition Epidemiology and Data Science Division, Tufts University Friedman School of Nutrition Science and Policy, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Meghan A. Hartwick
- Nutrition Epidemiology and Data Science Division, Tufts University Friedman School of Nutrition Science and Policy, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Elena N. Naumova
- Nutrition Epidemiology and Data Science Division, Tufts University Friedman School of Nutrition Science and Policy, 150 Harrison Avenue, Boston, MA 02111 USA
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23
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Colombo S. Are death and suffering in Ukraine different than in Yemen, Afghanistan or Ethiopia? Double standards in humanitarian assistance. Epidemiol Prev 2022; 46:130-133. [PMID: 35775289 DOI: 10.19191/ep22.3.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Sandro Colombo
- Independent consultant, former WHO Medical Officer, Las Rozas, Madrid (Spain);
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24
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Johari NA, Annuzaili DA, El-Talabawy HF, Ba-Break M, Al-Mekhlafi AM, Al-Eryani S, Alkohlani AA, Gabrielli AF, Ben-Ismail R, Alhaidari S, Muaydh A, Alshami R, Al Gunaid M, Hamed A, Kamel N, Palacio K, Fleming F, French MD. National mapping of schistosomiasis, soil-transmitted helminthiasis and anaemia in Yemen: Towards better national control and elimination. PLoS Negl Trop Dis 2022; 16:e0010092. [PMID: 35333859 PMCID: PMC8986123 DOI: 10.1371/journal.pntd.0010092] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 04/06/2022] [Accepted: 02/17/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) are known to be endemic in Yemen. However, the distribution of both diseases had not previously been assessed by a well-structured national mapping study covering all governorates. The main aim of this study was, therefore, to map the prevalence of SCH and STH in Yemen in order to better inform implementation of effective national control and elimination interventions. The assessment of the distribution of anaemia was also included as a well-known consequence of infection with both SCH and STH. Secondarily, the study aimed to provide a broad indication of the impact of large-scale treatment on the distribution of infection. METHODOLOGY AND PRINCIPAL FINDINGS To achive these aims, 80,432 children (10-14 years old) from 2,664 schools in 332 of Yemen's 333 districts were included, in 2014, into this national cross-sectional survey. Countrywide, 63.3% (210/332) and 75.6% (251/332) of districts were found to be endemic for SCH and STH respectively. More districts were affected by intestinal than urogenital SCH (54.2% and 31.6% respectively). SCH infection was mostly mild and moderate, with no districts reporting high infection. One quarter (24.4%) of Yemeni districts had high or moderate levels of Ascaris lumbricoides infection. Infection with Trichuris trichiura was the second most common STH (44.9% of districts infected) after A. lumbricoides (68.1%). Hookworm was the least prevalent STH (9.0%). Anaemia was prevalent in 96.4% of districts; it represented a severe public health problem (prevalence ≥ 40%) in 26.5% of districts, and a mild to moderate problem in two thirds of the districts (33.7% and 36.1% respectively). CONCLUSION This study provided the first comprehensive mapping of SCH, STH, and anaemia across the country. This formed the basis for evaluating and continuing the national control and elimination programme for these neglected tropical diseases in Yemen.
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Affiliation(s)
- Nur Alia Johari
- Schistosomiasis Control Initiative Foundation, London, United Kingdom
| | | | - Hani Farouk El-Talabawy
- Regional Office for the Eastern Mediterranean, Department of Information, Evidence and Research, Department of Communicable Diseases, World Health Organization, Cairo, Egypt
| | - Maryam Ba-Break
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Abdulsalam M. Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Samira Al-Eryani
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | | | - Albis Francesco Gabrielli
- Regional Office for the Eastern Mediterranean, Department of Communicable Diseases, World Health Organization, Cairo, Egypt
| | - Riadh Ben-Ismail
- Regional Office for the Eastern Mediterranean, Department of Communicable Diseases, World Health Organization, Cairo, Egypt
| | - Sami Alhaidari
- The National Schistosomiasis Control Programme (NSCP), Department of Primary Health Care, Ministry of Public Health and Population, Sana’a, Yemen
| | - Adel Muaydh
- The National Schistosomiasis Control Programme (NSCP), Department of Primary Health Care, Ministry of Public Health and Population, Sana’a, Yemen
| | - Rasheed Alshami
- The National Schistosomiasis Control Programme (NSCP), Department of Primary Health Care, Ministry of Public Health and Population, Sana’a, Yemen
| | - Magid Al Gunaid
- The National Schistosomiasis Control Programme (NSCP), Department of Primary Health Care, Ministry of Public Health and Population, Sana’a, Yemen
| | - Alaa Hamed
- The World Bank, Washington D.C, United States of America
| | - Nehad Kamel
- The World Bank, Washington D.C, United States of America
| | - Karen Palacio
- The End Fund, New York, New York, United States of America
| | - Fiona Fleming
- Schistosomiasis Control Initiative Foundation, London, United Kingdom
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Al-Awadi AAH, Abdul-Ghani R, Al-Mekhlafi AM. Toxoplasma gondii Infection Among Institutionalized Children with Down syndrome in Sana'a city, Yemen: Implications of Low IgG Seroprevalence. Acta Parasitol 2022; 67:530-534. [PMID: 34623612 PMCID: PMC8499612 DOI: 10.1007/s11686-021-00473-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/15/2021] [Indexed: 11/28/2022]
Abstract
Purpose To assess the IgG seroprevalence of Toxoplasma gondii as an indicator of past exposure and immunity against infection among children with Down syndrome (DS) in Sana’a city, Yemen. This preliminary study is justified by the primary immunodeficiency of children with DS and the opportunistic nature of the parasite, considering the vague situation of anti-Toxoplasma IgG seroprevalence among children with DS because of neglecting its study on local and global scales. Methods This descriptive, facility-based, cross-sectional study was conducted among 107 children with DS hosted in six randomly selected rehabilitation centers for children with special needs in Sana’a city. Demographics of children and their mothers’ knowledge of toxoplasmosis were collected using a pre-designed, structured questionnaire. Anti-Toxoplasma IgG antibodies were measured in the sera of children using electrochemiluminescence assay. Results Of 107 children with DS, 3 (2.8%) were seropositive for anti-Toxoplasma IgG. Approximately two-thirds (71/106) of the mothers of children with DS were aware of toxoplasmosis. Of whom, 83.1% (59/71) were aware of its congenital complications. Conclusion The majority of children with DS in Sana’a city are seronegative for anti-Toxoplasma IgG, where the seropositivity rate is lower than 3.0%. Therefore, children with DS are non-immune and susceptible to the acquisition of primary infections during their life. Further analytical studies are recommended to determine whether the defective immune response of children with DS is associated with false seronegativity, to assess the role of their mothers’ knowledge in reducing their exposure to infection if they were confirmed truly seronegative and to identify the predictors of infection among them.
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Affiliation(s)
- Asmaa A H Al-Awadi
- Department of Medical Laboratories, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen
| | - Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
- Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen.
| | - Abdulsalam M Al-Mekhlafi
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
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Alves RNP, de Vasconcelos CAC, Vieira NB, Pereira YTG, Feitosa PWG, Maia MAG, de Carvalho SMF, Neto MLR, de Menezes HL, da Silva JIM, Lima NNR. Urgent call to action: Child rights and the state of child morbidity and mortality in Yemen. Child Abuse Negl 2022; 125:105491. [PMID: 35065471 DOI: 10.1016/j.chiabu.2022.105491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
More than 2.3 million children under the age of five in Yemen suffer from acute malnutrition. Approximately 450,000 are expected to suffer from severe acute malnutrition and may die if they do not receive urgent treatment. In this context, without security, stability, and better access for farmers to have the means to resume growing food, children and their families continue to sink deeper and deeper into hunger and malnutrition.
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Affiliation(s)
| | | | - Nélio Barreto Vieira
- Scientific Writing Laboratory, School of Medicine, Federal University of Cariri, Barbalha, Ceara, Brazil
| | | | | | | | | | - Modesto Leite Rolim Neto
- Scientific Writing Laboratory, School of Medicine, Federal University of Cariri, Barbalha, Ceara, Brazil.
| | | | - José Italo Monte da Silva
- Intensive Care at the Federal University of Vale do São Francisco-UNIVASF, Petrolina, Pernambuco, Brazil
| | - Nádia Nara Rolim Lima
- Graduate Program in Neuropsychiatry, Universidade Federal de Pernambuco - UFPE, Recife, Pernambuco, Brazil
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27
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Noushad M, Al-Awar MS, Al-Saqqaf IS, Nassani MZ, Alrubaiee GG, Rastam S. Lack of access to COVID-19 vaccines could be a greater threat than vaccine hesitancy in low-income and conflict nations: the case of Yemen. Clin Infect Dis 2022; 75:1827-1833. [PMID: 35134160 PMCID: PMC8903315 DOI: 10.1093/cid/ciac088] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background Vaccine hesitancy and vaccine inequity are two major hurdles towards achieving population immunity to COVID-19. Although several studies have been published on vaccine hesitancy among numerous populations, there is inadequate information on any potential correlation between vaccine acceptance and lack of access to vaccines. Our cross-sectional study in a low-income country aimed to fill this gap. Methods We conducted a nation-wide cross-sectional survey among the general population in Yemen, a low-income conflict country. Participants from all the provinces in Yemen were included in the study. We evaluated factors influencing agreement to accept a COVID-19 vaccine and any potential correlation between vaccine hesitancy and lack of access to vaccines. Results Overall, 50.1% of the 5329 respondents agreed to accept a COVID-19 vaccine. Only 39.9% of the participants agreed to having access to a COVID-19 vaccine, with females indicating lower access than males. Potential determinants of vaccine acceptance included being male, updating self on the development of vaccines against COVID-19, opinion about severity of COVID-19, anxiety about contracting COVID-19, concerns about the safety of COVID-19 vaccines and lack of access to vaccines. Conclusions our results indicate that the immediate threat in Yemen towards achieving population immunity is the severe shortage and lack of access to vaccines, rather than vaccine hesitancy.
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Affiliation(s)
- Mohammed Noushad
- Corresponding Author: Mohammed Noushad, College of Dentistry, Dar Al Uloom University, Riyadh 13313, Saudi Arabia,
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28
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Kotiso M, Qirbi N, Al-Shabi K, Vuolo E, Al-Waleedi A, Naiene J, Senga M, Khalil M, Basaleem H, Alhidary A. Impact of the COVID-19 pandemic on the utilisation of health services at public hospitals in Yemen: a retrospective comparative study. BMJ Open 2022; 12:e047868. [PMID: 34980605 PMCID: PMC8724586 DOI: 10.1136/bmjopen-2020-047868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to a global crisis, creating an unprecedented situation, which has taken the world by storm, overshadowing on all life' aspects and having a significant impact on the health systems of most countries. In this study, the delivery of health services is investigated both before and during the outbreak of the COVID-19 pandemic at public hospitals in Yemen to assess the impact of COVID-19 on the utilisation of health services. METHOD Data collected from 127 hospitals in Yemen were reviewed using the DHIS2 system. The data represented 3 months before the outbreak of COVID-19 between January and March 2020 and during the outbreak of COVID-19 outbreak between April and June 2020. The results were then compared with the same period in 2019. The utilisation pattern of healthcare services during the period of investigation was compiled and analysed by applying a generalised estimating equation (GEE) to examine the effects of the COVID-19 outbreak in Yemen. The data collected from the targeted hospitals included information related to consultations, surgeries, deliveries, C-sections and penta-3rd dose immunisation. RESULTS The trendline of health services used during the pandemic showed a gradual decline beginning from April 2020 for consultations, surgeries and penta-3rd dose utilisation. The GEE model revealed a significant effect (p<0.05) during the outbreak compared with preoutbreak in the consultation services (B=-1,343.9; 95% CI -1,767.2 to -920.6; χ2=38.718), surgeries (B=-54.98; 95% CI -79.13 to -30.83, χ2=19.911) and penta-3rd dose (B=-24.47; 95% CI -30.56 to -18.38 and χ2=62.010). As for deliveries and C-sections, the results were shown to be statistically non-significant. CONCLUSION The impact of COVID-19 on continuity of health services delivery in Yemen has been distinct and profound, where the study revealed that the number of the consultations, surgeries and number of vaccinated children have been declined during the COVID-19 pandemic, likely due to the partially lockdown measures taken and fear of being infected. However, the deliveries and C-section services remained nearly in the same level and did not affect by the COVID-19 pandemic.
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Affiliation(s)
| | | | | | | | - Ali Al-Waleedi
- Yemen Ministry of Public Health and Population, Aden, Yemen
| | | | | | - Mohammed Khalil
- Yemen Ministry of Public Health and Population, Sana'a, Yemen
| | - Huda Basaleem
- Department of Community Medicine, University of Aden Faculty of Medicine and Health Science, Aden, Yemen
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Sikder M, Altare C, Doocy S, Trowbridge D, Kaur G, Kaushal N, Lyles E, Lantagne D, Azman AS, Spiegel P. Case-area targeted preventive interventions to interrupt cholera transmission: Current implementation practices and lessons learned. PLoS Negl Trop Dis 2021; 15:e0010042. [PMID: 34919551 PMCID: PMC8719662 DOI: 10.1371/journal.pntd.0010042] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/31/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cholera is a major cause of mortality and morbidity in low-resource and humanitarian settings. It is transmitted by fecal-oral route, and the infection risk is higher to those living in and near cholera cases. Rapid identification of cholera cases and implementation of measures to prevent subsequent transmission around cases may be an efficient strategy to reduce the size and scale of cholera outbreaks. METHODOLOGY/PRINCIPLE FINDINGS We investigated implementation of cholera case-area targeted interventions (CATIs) using systematic reviews and case studies. We identified 11 peer-reviewed and eight grey literature articles documenting CATIs and completed 30 key informant interviews in case studies in Democratic Republic of Congo, Haiti, Yemen, and Zimbabwe. We documented 15 outbreaks in 12 countries where CATIs were used. The team composition and the interventions varied, with water, sanitation, and hygiene interventions implemented more commonly than those of health. Alert systems triggering interventions were diverse ranging from suspected cholera cases to culture confirmed cases. Selection of high-risk households around the case household was inconsistent and ranged from only one case to approximately 100 surrounding households with different methods of selecting them. Coordination among actors and integration between sectors were consistently reported as challenging. Delays in sharing case information impeded rapid implementation of this approach, while evaluation of the effectiveness of interventions varied. CONCLUSIONS/SIGNIFICANCE CATIs appear effective in reducing cholera outbreaks, but there is limited and context specific evidence of their effectiveness in reducing the incidence of cholera cases and lack of guidance for their consistent implementation. We propose to 1) use uniform cholera case definitions considering a local capacity to trigger alert; 2) evaluate the effectiveness of individual or sets of interventions to interrupt cholera, and establish a set of evidence-based interventions; 3) establish criteria to select high-risk households; and 4) improve coordination and data sharing amongst actors and facilitate integration among sectors to strengthen CATI approaches in cholera outbreaks.
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Affiliation(s)
- Mustafa Sikder
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, United States of America
| | - Chiara Altare
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, United States of America
| | - Shannon Doocy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, United States of America
| | - Daniella Trowbridge
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, United States of America
| | - Gurpreet Kaur
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, United States of America
| | - Natasha Kaushal
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, United States of America
| | - Emily Lyles
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, United States of America
| | - Daniele Lantagne
- Consultant, Public Health Engineer, Boston, Massachusetts, United States of America
| | - Andrew S. Azman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, United States of America
| | - Paul Spiegel
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, United States of America
- * E-mail:
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Dureab F, Al-Qadasi Y, Nasr H, Al-Zumair M, Al-Mahbashi T. Knowledge on and preventive practices of cholera in Al-Mahweet - Yemen, 2018: a cross-sectional study. J Water Health 2021; 19:1002-1013. [PMID: 34874906 DOI: 10.2166/wh.2021.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Yemen has experienced one of the world's worst cholera outbreaks in the recent history of cholera records. This study aims to identify knowledge and practices among people of Al-Mahweet governorate toward cholera infection, which can play a critical role in reducing cholera morbidity and shaping the public health response. A cross-sectional study was conducted in an area of high cholera prevalence in 2018 using structured questionnaires. Most community respondents were able to correctly identify the symptoms and risk factors of cholera. While 65% of the respondents in this study knew that proper disposal of human waste is an essential measure of cholera prevention, only 11% of the respondents knew that proper washing of fruits and vegetables lowers the risk of cholera infection. About 62.5% of households did not treat water for safe drinking. Water was scarce in about 30% of households and near-home defecation was observed in about 23%. In conclusion, this study reveals several gaps in different aspects of hygienic and preventive practices including water treatment, waste disposal, and defecation practices. Cholera response should contain comprehensive health promotion interventions to improve the public's knowledge and enhance healthy practices. Stakeholders should support communities with sustainable water and sanitation systems.
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Affiliation(s)
- Fekri Dureab
- Heidelberg Institute of Global Health, Uniklinikum Heidelberg 69115, Germany; IRIA, Akkon-Hochschule für Humanwissenschaften, Berlin, 12099, Germany
| | - Yasameen Al-Qadasi
- Yemeni Public Health Consultant, 2011 VN, Haarlem, The Netherlands E-mail:
| | - Hani Nasr
- Charite Universitätsmedizin-Berlin, Berlin, Germany
| | - Marwah Al-Zumair
- Heidelberg Institute of Global Health, Uniklinikum Heidelberg 69115, Germany; IRIA, Akkon-Hochschule für Humanwissenschaften, Berlin, 12099, Germany
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Bitar AN, Zawiah M, Al-Ashwal FY, Kubas M, Saeed RM, Abduljabbar R, Jaber AAS, Sulaiman SAS, Khan AH. Misinformation, perceptions towards COVID-19 and willingness to be vaccinated: A population-based survey in Yemen. PLoS One 2021; 16:e0248325. [PMID: 34714827 PMCID: PMC8555792 DOI: 10.1371/journal.pone.0248325] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Since the beginning of the COVID-19 outbreak, many pharmaceutical companies have been racing to develop a safe and effective COVID-19 vaccine. Simultaneously, rumors and misinformation about COVID-19 are still widely spreading. Therefore, this study aimed to investigate the prevalence of COVID-19 misinformation among the Yemeni population and its association with vaccine acceptance and perceptions. METHODS A cross-sectional online survey was conducted in four major cities in Yemen. The constructed questionnaire consisted of four main sections (sociodemographic data, misinformation, perceptions (perceived susceptibility, severity, and worry), and vaccination acceptance evaluation). Subject recruitment and data collection were conducted online utilizing social websites and using the snowball sampling technique. Descriptive and inferential analyses were performed using SPSS version 27. RESULTS The total number of respondents was 484. Over 60% of them were males and had a university education. More than half had less than 100$ monthly income and were khat chewers, while only 18% were smokers. Misinformation prevalence ranged from 8.9% to 38.9%, depending on the statement being asked. Men, university education, higher income, employment, and living in urban areas were associated with a lower misinformation level (p <0.05). Statistically significant association (p <0.05) between university education, living in urban areas, and being employed with perceived susceptibility were observed. The acceptance rate was 61.2% for free vaccines, but it decreased to 43% if they had to purchase it. Females, respondents with lower monthly income, and those who believed that pharmaceutical companies made the virus for financial gains were more likely to reject the vaccination (p <0.05). CONCLUSION The study revealed that the acceptance rate to take a vaccine was suboptimal and significantly affected by gender, misinformation, cost, and income. Furthermore, being female, non-university educated, low-income, and living in rural areas were associated with higher susceptibility to misinformation about COVID-19. These findings show a clear link between misinformation susceptibility and willingness to vaccinate. Focused awareness campaigns to decrease misinformation and emphasize the vaccination's safety and efficacy might be fundamental before initiating any mass vaccination in Yemen.
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Affiliation(s)
- Ahmad Naoras Bitar
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Mohammed Zawiah
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Department of Pharmacy Practice, College of Clinical Pharmacy, University of Al Hodeida, Al Hodeida, Yemen
- * E-mail: (FYA); (MZ)
| | - Fahmi Y. Al-Ashwal
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Clinical Pharmacy Department, University of Science and Technology Hospital, Sana’a, Yemen
- * E-mail: (FYA); (MZ)
| | - Mohammed Kubas
- Clinical Pharmacy Department, University of Science and Technology Hospital, Sana’a, Yemen
- Pharmacy Practice Department, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Ramzi Mukred Saeed
- Department of Clinical Pharmacy and Pharmacy Practice, University of Science and Technology, Sana’a, Yemen
- Department of Pharmaceutical sciences, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Rami Abduljabbar
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Ammar Ali Saleh Jaber
- Department of Clinical Pharmacy & Pharmacotherapeutics, Dubai Pharmacy College for Girls, Dubai, United Arab Emirates
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Al-Haidari SA, Mahdy MAK, Al-Mekhlafi AM, Al Murisi WMS, Thabit AAQ, Al-Amad MA, Al-Shamahi H, Bahashwan OS, Al Serouri A. Intestinal schistosomiasis among schoolchildren in Sana'a Governorate, Yemen: Prevalence, associated factors and its effect on nutritional status and anemia. PLoS Negl Trop Dis 2021; 15:e0009757. [PMID: 34547034 PMCID: PMC8454980 DOI: 10.1371/journal.pntd.0009757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 08/24/2021] [Indexed: 11/18/2022] Open
Abstract
Intestinal schistosomiasis is a neglected tropical disease, causing morbidity and mortality in tropical and subtropical countries. Despite the frequent implementation of mass drug administration with praziquantel, the reinfection with Schistosoma mansoni is still common in Yemen. In addition, there is a scarcity of information on the impact of S. mansoni on nutritional status and anemia among schoolchildren. The present study aimed to determine prevalence and risk factors of intestinal schistosomiasis and investigate its impact on nutritional status and anemia among schoolchildren in Sana’a Governorate, Yemen. It was conducted in 2018 on 445 schoolchildren aged 5–15 years. Biodata, socio-economic, demographic, behavioral and environmental data were collected using a standard questionnaire. S. mansoni was identified and quantified by microscopic examination of Kato-Katz fecal smear. Hemoglobin concentration and anthropometric measurements were estimated using standard methods. The prevalence of S. mansoni was higher in Al-Haimah Al-Dakheliah (33.9%) than Bani Mater (1.4%). Household without tap water (Adjusted Odds Ratio (AOR) = 2.9, 95% Confidence interval (CI): 1.12, 7.55, P = 0.028) was the independent risk factor of the infection. The prevalence of wasting and stunting was 25.0% (95%CI: 21.2%, 29.2%) and 45.8% (95%CI: 41.2%, 50.5%), respectively. The prevalence of underweight among schoolchildren aged 5–10 years was 27.3% (95%CI: 21.9%, 33.4%). The prevalence of anemia was 31.7% (95%CI: 27.5%, 36.2%) with 0.5%, 21.1% and 10.1% being severe, moderate and mild anemia, respectively. S. mansoni (AOR = 4.1, 95%CI: 2.16, 7.84, P < 0.001) and early adolescence (AOR = 6.8, 95%CI: 4.26, 10.82, P < 0.001) were independent predictors of stunting among schoolchildren. The early adolescent schoolchildren (AOR = 3.1, 95%CI: 1.86, 4.97, P < 0.001) and children from families with low (AOR = 2.1, 95%CI: 1.01, 4.15, P = 0.046) or moderate wealth (AOR = 2.3, 95%CI: 1.11, 4.77, P = 0.026) were significantly more wasted. Early adolescence (AOR = 1.8, 95%CI:1.14, 2.78, P = 0.011), female (AOR = 1.6, 95%CI: 1.03, 2.43, P = 0.038) and Al-Haimah Al-Dakheliah District (AOR = 3.4, 95%CI: 1.20, 9.55, P = 0.021) were independent risk factors for anemia. The study findings indicate highly focal prevalence of schistosomiasis in Sana’a Governorate with a public health significance that varies from low to high risk. Approximately half of schoolchildren were stunted, which was associated with S. mansoni infection and early adolescence. One quarter of schoolchildren were wasted with early adolescent schoolchildren and children from poor families being at high risk of wasting. Anemia was a moderate public health threat affecting the female and the early adolescent schoolchildren. The study suggests the implementation of control measures to combat schistosomiasis and integrated diseases control programmes to improve the health status of schoolchildren in Sana’a Governorate. The present study aimed to determine prevalence and risk factors of intestinal schistosomiasis and investigate its impact on nutritional status and anemia among schoolchildren in Sana’a Governorate, Yemen. It was conducted in 2018 on 445 schoolchildren aged 5–15 years. Information was collected using a standard questionnaire. S. mansoni was identified by microscopic examination of Kato-Katz fecal smear. Hemoglobin concentration and anthropometric measurements were estimated using standard methods. The prevalence of S. mansoni was highly focal (1.4–33.9%). Schoolchildren living in households without tap water had significantly high infection rate of S. mansoni. The prevalence of wasting, stunting, underweight and anemia among schoolchildren was 25.0%, 45.8%, 27.3% and 31.7%, respectively. Although S. mansoni was significantly associated with stunting, no significant association was found between S. mansoni and wasting, underweight or anemia. The stunting was higher among early adolescent than young schoolchildren. The early adolescent schoolchildren and children from families with low or moderate wealth were significantly more wasted than schoolchildren from families with high wealth. Schoolchildren in the early adolescence, being female or living in Al-Haimah Al-Dakheliah District were at high risk of anemia. The study suggests implementation of control measures to combat schistosomiasis and integrated diseases control programmes to improve the health status of schoolchildren in Sana’a Governorate.
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Affiliation(s)
- Sami Ahmed Al-Haidari
- Department of Parasitology, Faculty of Medicine, Sana’a University, Sana’a, Yemen
- Diseases Control & Surveillance, Ministry of Public Health and Population, Sana’a, Yemen
| | - Mohammed A. K. Mahdy
- Department of Parasitology, Faculty of Medicine, Sana’a University, Sana’a, Yemen
- * E-mail:
| | | | | | | | | | - Hassan Al-Shamahi
- Department of Medical Microbiology, Faculty of Medicine, Sana’a University, Sana’a, Yemen
| | - Othman Saeed Bahashwan
- Field Epidemiology Training Programme, Ministry of Public Health and Population, Sana’a, Yemen
| | - Abdulwahed Al Serouri
- Field Epidemiology Training Programme, Ministry of Public Health and Population, Sana’a, Yemen
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Abstract
BACKGROUND Yemen has been left in shambles and almost destroyed by its devastating civil war, and is now having to deal with the spread of coronavirus. The Yemeni people have been are left to fend for themselves and faced many problems such as hunger, the ongoing war, infections, diseases and lack of equipment even before the COVID-19 pandemic. All together it is a humanitarian crisis. Only around 50% of the hospitals and healthcare facilities are in full working condition, and even those that are functioning are operating at nowhere near full potential. Healthcare staff and facilities lack necessary essential equipment and money. CONCLUSION As, sadly, is common in conflict-affected regions, the violence has brought with it a secondary disaster of infectious disease outbreaks. Yemen is not only battling COVID-19 amid a catastrophic war, but also has to deal with other diseases such as cholera, diphtheria and measles. A number of key measures are needed to support the current efforts against this deadly epidemic and its potential subsequent waves as well as to prevent further epidemics in Yemen.
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Affiliation(s)
- Mohammed Alsabri
- Pediatrics, 1 Brookdale University Hospital and Medical center 1Brookdale Plaza, Brooklyn, NY 11212 USA
- Emergency Department, Al Thawra Modern General Hospital (TMGH), Sana’a City, Yemen
- Emergency Medicine, McLaren Oakland Hospital, 50 N. Perry St, Pontiac, MI 48342 USA
| | - Ayman Alhadheri
- Emergency Medicine, McLaren Oakland Hospital, 50 N. Perry St, Pontiac, MI 48342 USA
| | - Luai M. Alsakkaf
- Emergency Department, Al Thawra Modern General Hospital (TMGH), Sana’a City, Yemen
| | - Jennifer Cole
- Department of Geography, The Royal Holloway University of London. Egham Hill, Egham, Surrey, TW20 0EX UK
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Affiliation(s)
- Abdullah Nasser
- Scientific Research and Development Department, MEDIPAN, Berlin, Germany; Scientific Research and Development Department, GA Generic Assays, Berlin, Germany
| | - Fathiah Zakham
- Faculty of Medicine and Health Sciences, Hodeidah University, Hodeidah, Yemen; Department of Virology, Faculty of Medicine, Department of Veterinary Biosciences, Faculty of Veterinary Medicine, and Faculty of Pharmacy, University of Helsinki, Helsinki 00014, Finland.
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Abstract
Background: Since the Arab uprising in 2011, Libya, Syria and Yemen have gone through major internal armed conflicts. This resulted in large numbers of deaths, injuries, and population displacements, with collapse of the healthcare systems. Furthermore, the situation was complicated by the emergence of COVID-19 as a global pandemic, which made the populations of these countries struggle under unusual conditions to deal with both the pandemic and the ongoing wars. This study aimed to determine the impact of the armed conflicts on the epidemiology of the novel coronavirus (SARS-CoV-2) within these war-torn countries and highlight the strategies needed to combat the spread of the pandemic and its consequences. Methods: Official and public data concerning the dynamics of the armed conflicts and the spread of SARS-COV-2 in Libya, Syria and Yemen were collected from all available sources, starting from the emergence of COVID-19 in each country until the end of December 2020. Datasets were analyzed by a set of statistical techniques and the weekly resolved data were used to probe the link between the intensity levels of the conflict and the prevalence of COVID-19. Results: The data indicated that there was an increase in the intensity of the violence at an early stage from March to August 2020, when it approximately doubled in the three countries, particularly in Libya. During that period, few cases of COVID-19 were reported, ranging from 5 to 53 cases/day. From September to December 2020, a significant decline in the intensity of the armed conflicts was accompanied by steep upsurges in the rate of COVID-19 cases, which reached up to 500 cases/day. The accumulative cases vary from one country to another during the armed conflict. The highest cumulative number of cases were reported in Libya, Syria and Yemen. Conclusions: Our analysis demonstrates that the armed conflict provided an opportunity for SARS-CoV-2 to spread. The early weeks of the pandemic coincided with the most intense period of the armed conflicts, and few cases were officially reported. This indicates undercounting and hidden spread during the early stage of the pandemic. The pandemic then spread dramatically as the armed conflict declined, reaching its greatest spread by December 2020. Full-blown transmission of the COVID-19 pandemic in these countries is expected. Therefore, urgent national and international strategies should be implemented to combat the pandemic and its consequences.
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Affiliation(s)
- Mohamed A. Daw
- Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Tripoli, Tripoli, Libya
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Noman H, Dureab F, Ahmed I, Al Serouri A, Hussein T, Jahn A. Mind the gap: an analysis of core capacities of the international health regulations (2005) to respond to outbreaks in Yemen. BMC Health Serv Res 2021; 21:477. [PMID: 34016124 PMCID: PMC8134964 DOI: 10.1186/s12913-021-06395-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Yemen that has been devastated by war is facing various challenges to respond to the recent potential outbreaks and other public health emergencies due to lack of proper strategies and regulations, which are essential to public health security. The aim of this study is to assess the implementation of the International Health Regulations (IHR 2005) core capacities under the current ongoing conflict in Yemen. METHODS The study simulated the World Health Organization (WHO) Joint External Evaluation (JEE) tool to assess the IHR core capacities in Yemen. Qualitative research methods were used, including desk reviews, in-depth interviews with key informants and analysis of the pooled data. RESULT Based on the assessment of the three main functions of the IHR framework (prevention, detection, and response), Yemen showed a demonstrated or developed capacity to detect outbreaks, but nevertheless limited or no capacity to prevent and respond to outbreaks. CONCLUSION This study shows that there has been poor implementation of IHR in Yemen. Therefore, urgent interventions are needed to strengthen the implementation of the IHR core capacities in Yemen. The study recommends 1) raising awareness among national and international health staff on the importance of IHR; 2) improving alignment of INGO programs with government health programs and aligning both towards better implementation of the IHR; 3) improving programmatic coordination, planning and implementation among health stakeholders; 4) increasing funding of the global health security agenda at country level; 5) using innovative approaches to analyze and address gaps in the disrupted health system, and; 6) addressing the root cause of the collapse of the health services and overall health system in Yemen by ending the protracted conflict situation.
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Affiliation(s)
- Hanan Noman
- Heidelberg Institute of Global Health, Uniklinikum, Heidelberg, Germany
| | - Fekri Dureab
- Heidelberg Institute of Global Health, Uniklinikum, Heidelberg, Germany.
- Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany.
- IRIA, Akkon-Hochschule für Humanwissenschaften, Berlin, Germany.
| | - Iman Ahmed
- Independent Global Health Expert, Montreal, Canada
| | - Abdulwahed Al Serouri
- Yemen Field Epidemiology Training Program, Ministry of Public Health and Population, Sana'a, Yemen
| | | | - Albrecht Jahn
- Heidelberg Institute of Global Health, Uniklinikum, Heidelberg, Germany
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Burki T. Infectious diseases in Yemen. Lancet Infect Dis 2021; 21:610-611. [PMID: 33894845 PMCID: PMC8063071 DOI: 10.1016/s1473-3099(21)00218-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Alkhormi AH, Alshahrani NZ, Mahmood SE. Khat chewing leads to increase in glycaemic parameters in patients with type 2 diabetes mellitus in Jazan region, Saudi Arabia and Yemen. Diabetes Metab Syndr 2021; 15:565-568. [PMID: 33689938 DOI: 10.1016/j.dsx.2021.02.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Khat is known to have a stimulating effect on the sympathetic nervous system by producing a temporary sensation of activeness and happiness, along with mood disturbance and anxiety. Despite growing evidence of the association between khat chewing and glycaemic control in patients with diabetes, the position of khat chewing in DM is not fully recognised. AIM To evaluate the association of khat chewing with the risk of elevated blood glucose levels among patients with type 2 diabetes mellitus. METHOD A web-based literature search was performed using the electronic databases PubMed, EMBASE and Google Scholar. Databases were searched for studies published about khat chewing and diabetes mellitus in the Jazan region, Saudi Arabia and Yemen. RESULT Twenty-five published articles studying the relation between khat chewing and diabetes mellitus were identified, but only 10 studies reported an association between khat chewing and blood glucose levels and were included. CONCLUSION Khat chewing increases fasting blood glucose, post-prandial blood glucose and HbA1c levels in patients with diabetes in the Jazan region, Saudi Arabia and Yemen.
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Affiliation(s)
- Abdulrahman H Alkhormi
- Departement of Preventive Medicine, King Fahd Central Hospital, Ministry of Health, Jazan 84211, Saudi Arabia
| | - Najim Z Alshahrani
- Department of Family and Community Medicine, Faculty of Medicine, University of Jeddah, Jeddah 21589, Saudi Arabia.
| | - Syed Esam Mahmood
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
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Al-zangabila K, Poudel Adhikari S, Wang Q, Sunil TS, Rozelle S, Zhou H. Alarmingly high malnutrition in childhood and its associated factors: A study among children under 5 in Yemen. Medicine (Baltimore) 2021; 100:e24419. [PMID: 33592890 PMCID: PMC7870187 DOI: 10.1097/md.0000000000024419] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Childhood malnutrition is a serious public health problem in Yemen. However, there is a limited information regarding association of malnutrition with different socio-economic factors. This study examines the correlates of socioeconomic and maternal behavioral factors on malnutrition in Yemeni children under 5 years of age.Our study focuses on the nutritional status of children under 5 years of age, and uses the data provided by the cross-sectional study namely Yemen National Demographic and Health Survey. Three anthropometric indicators: stunting, wasting, and underweight were selected for the evaluation of malnutrition. Independent variables include personal and maternal characteristics, socioeconomic and behavioral factors, and illness conditions. The study used the Chi-Squared test to test the significant association between independent variables and logistic regression to estimate the odds of being malnourished.A total of 13,624 Yemeni children under 5 years of age were included in the study. The results show the high malnutrition level - the prevalence of stunting was 47%, wasting was 16%, and underweight was 39%. There is a statistically significant association between socioeconomic status, behavioral factors, and child malnutrition. The odds of malnutrition decreased with the increase in the level of mother's education, economic status, and frequency of prenatal visits. The odds of malnutrition were least for children whose mothers had highest level of education (OR = 0.64; 95%CI = 0.55-0.76), who belonged to highest wealth index (OR = 0.41; 95%CI = 0.36-0.47). Moreover, the likelihood of malnutrition was less among the children whose mother had highest number of prenatal visits during the pregnancy (OR = 0.67; 95%CI = 0.59-0.76).The high prevalence of stunting, wasting, and undernutrition were found in Yemeni children. Different factors such as regional variations, socio-economic disparities, and maternal education and health care utilization behavior are found to be associated with high malnutrition. These findings provide important policy implications to improving childhood malnutrition in Yemen.
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Affiliation(s)
- Khaled Al-zangabila
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Sasmita Poudel Adhikari
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Qingzhi Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Thankam S. Sunil
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Department of Public Health, University of Tennessee, Knoxville
| | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, California
| | - Huan Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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Qaserah AM, Al Amad MA, Al Serouri AA, Khader YS. Risk Factors of Cholera Transmission in Al Hudeidah, Yemen: Case-control study (Preprint). JMIR Public Health Surveill 2021; 7:e27627. [PMID: 36260393 PMCID: PMC8406125 DOI: 10.2196/27627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Mohammed Abdullah Al Amad
- Yemen Field Epidemiology Training Program, Yemen Ministry of Public Health and Population, Sana'a, Yemen
| | | | - Yousef Saleh Khader
- Department of Community Medicine, Public Health, and Family Medicine, Faculty of Medicine, Jordan University of Science & Technology, Amman, Jordan
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Tucker CJ, Melocik KA, Anyamba A, Linthicum KJ, Fagbo SF, Small JL. Reanalysis of the 2000 Rift Valley fever outbreak in Southwestern Arabia. PLoS One 2020; 15:e0233279. [PMID: 33315866 PMCID: PMC7735616 DOI: 10.1371/journal.pone.0233279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 05/01/2020] [Indexed: 11/18/2022] Open
Abstract
The first documented Rift Valley hemorrhagic fever outbreak in the Arabian Peninsula occurred in northwestern Yemen and southwestern Saudi Arabia from August 2000 to September 2001. This Rift Valley fever outbreak is unique because the virus was introduced into Arabia during or after the 1997–1998 East African outbreak and before August 2000, either by wind-blown infected mosquitos or by infected animals, both from East Africa. A wet period from August 2000 into 2001 resulted in a large number of amplification vector mosquitoes, these mosquitos fed on infected animals, and the outbreak occurred. More than 1,500 people were diagnosed with the disease, at least 215 died, and widespread losses of domestic animals were reported. Using a combination of satellite data products, including 2 x 2 m digital elevation images derived from commercial satellite data, we show rainfall and potential areas of inundation or water impoundment were favorable for the 2000 outbreak. However, favorable conditions for subsequent outbreaks were present in 2007 and 2013, and very favorable conditions were also present in 2016–2018. The lack of subsequent Rift Valley fever outbreaks in this area suggests that Rift Valley fever has not been established in mosquito species in Southwest Arabia, or that strict animal import inspection and quarantine procedures, medical and veterinary surveillance, and mosquito control efforts put in place in Saudi Arabia following the 2000 outbreak have been successful. Any area with Rift Valley fever amplification vector mosquitos present is a potential outbreak area unless strict animal import inspection and quarantine proceedures are in place.
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Affiliation(s)
- Compton J. Tucker
- Earth Sciences Division, NASA/Goddard Space Flight Center, Greenbelt, Maryland, United States of America
- * E-mail:
| | - Katherine A. Melocik
- Earth Sciences Division, NASA/Goddard Space Flight Center, Greenbelt, Maryland, United States of America
| | - Assaf Anyamba
- Earth Sciences Division, NASA/Goddard Space Flight Center, Greenbelt, Maryland, United States of America
| | - Kenneth J. Linthicum
- Center for Medical, Agricultural, and Veterinary Entomology, U.S. Department of Agriculture, Gainesville, Florida, United States of America
| | - Shamsudeen F. Fagbo
- One Health Unit, Executive Directorate for Response and Surveillance, National Centre for Disease Prevention and Control, Riyadh, Saudi Arabia
- Department of Public Health, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Jennifer L. Small
- Earth Sciences Division, NASA/Goddard Space Flight Center, Greenbelt, Maryland, United States of America
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Al-Ashwal FY, Kubas M, Zawiah M, Bitar AN, Mukred Saeed R, Sulaiman SAS, Khan AH, Ghadzi SMS. Healthcare workers' knowledge, preparedness, counselling practices, and perceived barriers to confront COVID-19: A cross-sectional study from a war-torn country, Yemen. PLoS One 2020; 15:e0243962. [PMID: 33306750 PMCID: PMC7732096 DOI: 10.1371/journal.pone.0243962] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/02/2020] [Indexed: 12/23/2022] Open
Abstract
Background The coronavirus disease of 2019 (COVID-19) represents a difficult challenge and could have devastating consequences for the healthcare system and healthcare workers in war-torn countries with poor healthcare facilities such as Yemen. Our study aimed to evaluate the knowledge, preparedness, counselling practices of healthcare workers regarding COVID-19, and the perceived barriers to adequately prevent and control COVID-19 in Yemen. Methods Healthcare workers (HCWs) from major healthcare facilities participated in this cross-sectional study. A self-administered questionnaire comprising of five main domains (demographics, knowledge, self-preparedness, counselling practice, perceived barriers) was distributed among HCWs after obtaining informed consent. A convenient sampling technique was used. Descriptive and inferential analyses were applied using SPSS software. Results A total of 1000 participants were initially targeted to participate in the study with 514 (51.4%) responding, of which 55.3% were female. Physicians and nurses constituted the largest proportion of participants, with 39.5% and 33.3%, respectively. The median scores for knowledge, self-preparedness, and counselling practice were 8 (out of 9), 9 (out of 15), and 25 (out of 30), respectively. The physician group showed a statistically significant association with better knowledge compared to the nurse group only, P<0.001. Males had higher preparedness scores than females, p<0.001. Also, the intensive care unit (ICU) and emergency departments presented a statistically significant difference by which the participants from these departments were more prepared compared to the others (e.g. outpatients, paediatrics and surgery) with P < 0.0001. The lack of awareness among the general population about COVID-19 preventive measures was perceived as the most common barrier for the adequate prevention and control of COVID-19 in Yemen (89.1%). Conclusion The major highlight of this study is that HCWs have, overall, good knowledge, suboptimal preparedness, and adequate counselling practices prior to the outbreak of COVID-19 in Yemen, despite the high number of perceived barriers. However, urgent action and interventions are needed to improve the preparedness of HCWs to manage COVID-19. The perceived barriers also need to be fully addressed by the local healthcare authorities and international organisations working in Yemen for adequate prevention and control measures to be in place in managing COVID-19.
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Affiliation(s)
- Fahmi Y. Al-Ashwal
- Clinical Pharmacy Department, University of Science and Technology Hospital (USTH), Sana'a, Yemen
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Mohammed Kubas
- Clinical Pharmacy Department, University of Science and Technology Hospital (USTH), Sana'a, Yemen
- Pharmacy Practice Department, Kulliyyah of Pharmacy, International Islamic University Malaysia (IIUM), Kuantan, Pahang, Malaysia
| | - Mohammed Zawiah
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Department of Pharmacy Practice, College of Clinical Pharmacy, University of Al Hodeida, Al Hodeida, Yemen
- * E-mail:
| | - Ahmad Naoras Bitar
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Ramzi Mukred Saeed
- Department of Clinical Pharmacy and Pharmacy Practice, University of Science and Technology (UST), Sana'a, Yemen
- Department of Pharmaceutical sciences, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Penang, Malaysia
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Al-Kubati AS, Al-Samie AR, Al-Kubati S, Ramzy RMR. The story of Lymphatic Filariasis elimination as a public health problem from Yemen. Acta Trop 2020; 212:105676. [PMID: 32828916 DOI: 10.1016/j.actatropica.2020.105676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 11/19/2022]
Abstract
In 2000, Yemen joined the WHO global efforts to eliminate lymphatic filariasis (LF) as a public health problem by initiating a National LF Elimination Programme (NLFEP), that was fully integrated with the National Leprosy Elimination Programme (NLEP), the Ministry of Public Health and Population. This article reviews the NLFEP extensive efforts and interventions to eliminate LF in Yemen. LF mapping was started in 2000, followed by five annual rounds of mass drug administration (MDA) with ivermectin and albendazole in 8 implementation units (IUs) during 2002-2006. The epidemiological coverage for all MDA rounds was ≥80%. Based on WHO guidelines of 2005, MDA was stopped in 7 IUs, additional MDA rounds were continued in one IU until 2011. Microfilaremia monitoring and evaluation, and MDA stopping surveys were conducted based on WHO guidelines of 2005 and 2011. Information about the presence of patients suffering from lymphoedema/elephantiasis and hydrocele was collected, and basic care provided to all chronic cases by NLEP coordinators, trained on LF morbidity management and disability prevention (MMDP). As of 2017, a total of 610 lymphoedema patients were trained on self-management, and 31 hydrocele patients were referred to local General Hospitals for surgery. The NLFEP made excellent progress due to integration with NLEP, strong collaboration with national and international bodies, intensive training and supervision, and the use of robust advocacy for mobilization of endemic communities. Transmission assessment surveys (TAS), conducted in 2013 and 2016, indicated 0% antigenemia levels in schoolchildren in the 8 IUs. Thus, after almost two decades of sustained effort, Yemen met the WHO criteria for successful elimination of LF as a public health problem. In 2019, WHO validated Yemen as the second country in the WHO' Eastern Mediterranean Region to successfully eliminate LF as a public health problem.
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Affiliation(s)
- Abdul Samid Al-Kubati
- National Filariasis Elimination Programme, National Leprosy Elimination Programme- Taiz, Yemen
| | | | - Saeed Al-Kubati
- Skin and Venereal Disease Hospital, City of light, Taiz, Yemen
| | - Reda M R Ramzy
- National Nutrition Institute, General Organization for Teaching Hospitals and Institutes Cairo, Egypt..
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Liang KYH, Orata FD, Islam MT, Nasreen T, Alam M, Tarr CL, Boucher YF. A Vibrio cholerae Core Genome Multilocus Sequence Typing Scheme To Facilitate the Epidemiological Study of Cholera. J Bacteriol 2020; 202:e00086-20. [PMID: 32540931 PMCID: PMC7685551 DOI: 10.1128/jb.00086-20] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/07/2020] [Indexed: 12/11/2022] Open
Abstract
Core genome multilocus sequence typing (cgMLST) has gained popularity in recent years in epidemiological research and subspecies-level classification. cgMLST retains the intuitive nature of traditional MLST but offers much greater resolution by utilizing significantly larger portions of the genome. Here, we introduce a cgMLST scheme for Vibrio cholerae, a bacterium abundant in marine and freshwater environments and the etiologic agent of cholera. A set of 2,443 core genes ubiquitous in V. cholerae were used to analyze a comprehensive data set of 1,262 clinical and environmental strains collected from 52 countries, including 65 newly sequenced genomes in this study. We established a sublineage threshold based on 133 allelic differences that creates clusters nearly identical to traditional MLST types, providing backwards compatibility to new cgMLST classifications. We also defined an outbreak threshold based on seven allelic differences that is capable of identifying strains from the same outbreak and closely related isolates that could give clues on outbreak origin. Using cgMLST, we confirmed the South Asian origin of modern epidemics and identified clustering affinity among sublineages of environmental isolates from the same geographic origin. Advantages of this method are highlighted by direct comparison with existing classification methods, such as MLST and single-nucleotide polymorphism-based methods. cgMLST outperforms all existing methods in terms of resolution, standardization, and ease of use. We anticipate this scheme will serve as a basis for a universally applicable and standardized classification system for V. cholerae research and epidemiological surveillance in the future. This cgMLST scheme is publicly available on PubMLST (https://pubmlst.org/vcholerae/).IMPORTANCE Toxigenic Vibrio cholerae isolates of the O1 and O139 serogroups are the causative agents of cholera, an acute diarrheal disease that plagued the world for centuries, if not millennia. Here, we introduce a core genome multilocus sequence typing scheme for V. cholerae Using this scheme, we have standardized the definition for subspecies-level classification, facilitating global collaboration in the surveillance of V. cholerae In addition, this typing scheme allows for quick identification of outbreak-related isolates that can guide subsequent analyses, serving as an important first step in epidemiological research. This scheme is also easily scalable to analyze thousands of isolates at various levels of resolution, making it an invaluable tool for large-scale ecological and evolutionary analyses.
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Affiliation(s)
- Kevin Y H Liang
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Fabini D Orata
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
| | | | - Tania Nasreen
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Munirul Alam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Cheryl L Tarr
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yann F Boucher
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Singapore Center for Environmental Life Sciences Engineering, National University of Singapore, Singapore, Singapore
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Al-Waleedi AA, Naiene JD, Thabet AAK, Dandarawe A, Salem H, Mohammed N, Al Noban M, Bin-Azoon NS, Shawqi A, Rajamanar M, Al-Jariri R, Al Hyubaishi M, Khanbari L, Thabit N, Obaid B, Baaees M, Assaf D, Senga M, Bashir IM, Mahmoud N, Cosico R, Smith P, Musani A. The first 2 months of the SARS-CoV-2 epidemic in Yemen: Analysis of the surveillance data. PLoS One 2020; 15:e0241260. [PMID: 33119720 PMCID: PMC7595428 DOI: 10.1371/journal.pone.0241260] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/12/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Yemen was one of the last countries in the world to declare the first case of the pandemic, on 10 April 2020. Fear and concerns of catastrophic outcomes of the epidemic in Yemen were immediately raised, as the country is facing a complex humanitarian crisis. The purpose of this report is to describe the epidemiological situation in Yemen during the first 2 months of the SARS-CoV-2 epidemic. METHODS We analyzed the epidemiological data from 18 February to 05 June 2020, including the 2 months before the confirmation of the first case. We included in our analysis the data from 10 out of 23 governorates of Yemen, located in southern and eastern part of the country. RESULTS A total of 469 laboratory confirmed, 552 probable and 55 suspected cases with onset of symptoms between 18 February and 5 June 2020 were reported through the surveillance system. The median age among confirmed cases was 46 years (range: 1-90 years), and 75% of the confirmed cases were male. A total of 111 deaths were reported among those with confirmed infection. The mean age among those who died was 53 years (range: 14-88 years), with 63% of deaths (n = 70) occurring in individuals under the age 60 years. A total of 268 individuals with confirmed SARS-CoV-2 infection were hospitalized (57%), among whom there were 95 in-hospital deaths. CONCLUSIONS The surveillance strategy implemented in the first 2 months of the SARS CoV 2 in the southern and eastern governorates of Yemen, captured mainly severe cases. The mild and moderate cases were not self-reported to the health facilities and surveillance system due to limited resources, stigma, and other barriers. The mortality appeared to be higher in individuals aged under 60 years, and most fatalities occurred in individuals who were in critical condition when they reached the health facilities. It is unclear whether the presence of other acute comorbidities contributed to the high death rate among SARS-CoV-2 cases. The findings only include the southern and eastern part of the country, which is home to 31% of the total population of Yemen, as the data from the northern part of the country was inaccessible for analysis. This makes our results not generalizable to the rest of the country.
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Affiliation(s)
| | | | | | | | - Hanan Salem
- Ministry of Public Health and Population, Aden, Yemen
| | | | | | | | - Ammar Shawqi
- Ministry of Public Health and Population, Aden, Yemen
| | | | | | | | | | | | | | | | | | | | | | | | - Roy Cosico
- World Health Organization, Sana’a, Yemen
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Alrubaiee GG, Al-Qalah TAH, Al-Aawar MSA. Knowledge, attitudes, anxiety, and preventive behaviours towards COVID-19 among health care providers in Yemen: an online cross-sectional survey. BMC Public Health 2020; 20:1541. [PMID: 33050896 PMCID: PMC7552593 DOI: 10.1186/s12889-020-09644-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/05/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The growing incidence of coronavirus (COVID-19) continues to cause fear, anxiety, and panic amongst the community, especially for healthcare providers (HCPs), as the most vulnerable group at risk of contracting this new SARS-CoV-2 infection. To protect and enhance the ability of HCPs to perform their role in responding to COVID-19, healthcare authorities must help to alleviate the level of stress and anxiety amongst HCPs and the community. This will improve the knowledge, attitude and practice towards COVID-19, especially for HCPs. In addition, authorities need to comply in treating this virus by implementing control measures and other precautions. This study explores the knowledge, attitude, anxiety, and preventive behaviours among Yemeni HCPs towards COVID-19. METHODS A descriptive, web-based-cross-sectional study was conducted among 1231 Yemeni HCPs. The COVID-19 related questionnaire was designed using Google forms where the responses were coded and analysed using the Statistical Package for the Social Sciences software package (IBM SPSS), version 22.0. Descriptive statistics and Pearson's correlation coefficient test were also employed in this study. A p-value of < 0.05 with a 95% confidence interval was considered as statistically significant. The data collection phase commenced on 22nd April 2020, at 6 pm and finished on 26th April 2020 at 11 am. RESULTS The results indicated that from the 1231 HCPs participating in this study, 61.6% were male, and 67% were aged between 20 and 30 years with a mean age of 29.29 ± 6.75. Most (86%) held a bachelor's degree or above having at least 10 years of work experience or less (88.1%). However, while 57.1% of the respondents obtained their information via social networks and news media, a further 60.0% had never attended lectures/discussions about COVID-19. The results further revealed that the majority of respondents had adequate knowledge, optimistic attitude, moderate level of anxiety, and high-performance in preventive behaviours, 69.8, 85.10%, 51.0 and 87.70%, respectively, towards COVID-19. CONCLUSION Although the Yemeni HCPs exhibited an adequate level of knowledge, optimistic attitude, moderate level of anxiety, and high-performance in preventive behaviours toward COVID-19, the results highlighted gaps, particularly in their knowledge and attitude towards COVID-19.
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Affiliation(s)
- Gamil Ghaleb Alrubaiee
- Department of Community Health, Faculty of Medical Sciences, Al-Razi University, Sana’a, Yemen
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Palayew A, Razavi H, Hutchinson SJ, Cooke GS, Lazarus JV. Do the most heavily burdened countries have the right policies to eliminate viral hepatitis B and C? Lancet Gastroenterol Hepatol 2020; 5:948-953. [PMID: 32730784 DOI: 10.1016/s2468-1253(20)30011-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/10/2020] [Accepted: 01/15/2020] [Indexed: 12/12/2022]
Abstract
In 2019, a Lancet Gastroenterology & Hepatology Commission on accelerating the elimination of viral hepatitis reported on the status of 11 viral hepatitis policy indicators in 66 countries and territories with the heaviest burden by global region. Policies were reported as being either in place, in development, or not in place. This study uses the Commission findings to estimate hepatitis B virus (HBV) and hepatitis C virus (HCV) policy scores and rankings for these 66 countries and territories. We applied a multiple correspondence analysis technique to reduce data on policy indicators into a weighted summary for the HBV and HCV policies. We calculated HBV and HCV policy scores for each country. Countries and territories that received higher scores had more policies in place and in development than did countries with lower scores. The highest scoring country for HBV was Australia, whereas Somalia had the lowest score. For the HCV policy score, Australia and New Zealand had perfect scores, whereas Somalia, Sudan, and Yemen had the lowest scores, all having no policy indicators in place.
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Affiliation(s)
- Adam Palayew
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Homie Razavi
- Center for Disease Analysis Foundation, Lafayette, CO, USA
| | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Graham S Cooke
- Department of Infectious Diseases, Imperial College London, London, UK
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, Barcelona, Spain.
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Mousa A, Al-Taiar A, Anstey NM, Badaut C, Barber BE, Bassat Q, Challenger JD, Cunnington AJ, Datta D, Drakeley C, Ghani AC, Gordeuk VR, Grigg MJ, Hugo P, John CC, Mayor A, Migot-Nabias F, Opoka RO, Pasvol G, Rees C, Reyburn H, Riley EM, Shah BN, Sitoe A, Sutherland CJ, Thuma PE, Unger SA, Viwami F, Walther M, Whitty CJM, William T, Okell LC. The impact of delayed treatment of uncomplicated P. falciparum malaria on progression to severe malaria: A systematic review and a pooled multicentre individual-patient meta-analysis. PLoS Med 2020; 17:e1003359. [PMID: 33075101 PMCID: PMC7571702 DOI: 10.1371/journal.pmed.1003359] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Delay in receiving treatment for uncomplicated malaria (UM) is often reported to increase the risk of developing severe malaria (SM), but access to treatment remains low in most high-burden areas. Understanding the contribution of treatment delay on progression to severe disease is critical to determine how quickly patients need to receive treatment and to quantify the impact of widely implemented treatment interventions, such as 'test-and-treat' policies administered by community health workers (CHWs). We conducted a pooled individual-participant meta-analysis to estimate the association between treatment delay and presenting with SM. METHODS AND FINDINGS A search using Ovid MEDLINE and Embase was initially conducted to identify studies on severe Plasmodium falciparum malaria that included information on treatment delay, such as fever duration (inception to 22nd September 2017). Studies identified included 5 case-control and 8 other observational clinical studies of SM and UM cases. Risk of bias was assessed using the Newcastle-Ottawa scale, and all studies were ranked as 'Good', scoring ≥7/10. Individual-patient data (IPD) were pooled from 13 studies of 3,989 (94.1% aged <15 years) SM patients and 5,780 (79.6% aged <15 years) UM cases in Benin, Malaysia, Mozambique, Tanzania, The Gambia, Uganda, Yemen, and Zambia. Definitions of SM were standardised across studies to compare treatment delay in patients with UM and different SM phenotypes using age-adjusted mixed-effects regression. The odds of any SM phenotype were significantly higher in children with longer delays between initial symptoms and arrival at the health facility (odds ratio [OR] = 1.33, 95% CI: 1.07-1.64 for a delay of >24 hours versus ≤24 hours; p = 0.009). Reported illness duration was a strong predictor of presenting with severe malarial anaemia (SMA) in children, with an OR of 2.79 (95% CI:1.92-4.06; p < 0.001) for a delay of 2-3 days and 5.46 (95% CI: 3.49-8.53; p < 0.001) for a delay of >7 days, compared with receiving treatment within 24 hours from symptom onset. We estimate that 42.8% of childhood SMA cases and 48.5% of adult SMA cases in the study areas would have been averted if all individuals were able to access treatment within the first day of symptom onset, if the association is fully causal. In studies specifically recording onset of nonsevere symptoms, long treatment delay was moderately associated with other SM phenotypes (OR [95% CI] >3 to ≤4 days versus ≤24 hours: cerebral malaria [CM] = 2.42 [1.24-4.72], p = 0.01; respiratory distress syndrome [RDS] = 4.09 [1.70-9.82], p = 0.002). In addition to unmeasured confounding, which is commonly present in observational studies, a key limitation is that many severe cases and deaths occur outside healthcare facilities in endemic countries, where the effect of delayed or no treatment is difficult to quantify. CONCLUSIONS Our results quantify the relationship between rapid access to treatment and reduced risk of severe disease, which was particularly strong for SMA. There was some evidence to suggest that progression to other severe phenotypes may also be prevented by prompt treatment, though the association was not as strong, which may be explained by potential selection bias, sample size issues, or a difference in underlying pathology. These findings may help assess the impact of interventions that improve access to treatment.
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Affiliation(s)
- Andria Mousa
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
- * E-mail:
| | - Abdullah Al-Taiar
- School of Community & Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, Virginia, United States of America
| | - Nicholas M. Anstey
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Cyril Badaut
- Unité de Biothérapie Infectieuse et Immunité, Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
- Unité des Virus Emergents (UVE: Aix-Marseille Univ—IRD 190—Inserm 1207—IHU Méditerranée Infection), Marseille, France
| | - Bridget E. Barber
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Joseph D. Challenger
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Aubrey J. Cunnington
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, United Kingdom
| | - Dibyadyuti Datta
- Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Chris Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Azra C. Ghani
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Victor R. Gordeuk
- Sickle Cell Center, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Matthew J. Grigg
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Pierre Hugo
- Medicines for Malaria Venture, Geneva, Switzerland
| | - Chandy C. John
- Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Alfredo Mayor
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Robert O. Opoka
- Department of Paediatrics and Child Health, Makerere University School of Medicine, Kampala, Uganda
| | - Geoffrey Pasvol
- Imperial College London, Department of Life Sciences, London, United Kingdom
| | - Claire Rees
- Centre for Global Public Health, Institute of Population Health Sciences, Barts & The London School of Medicine & Dentistry, London, United Kingdom
| | - Hugh Reyburn
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Eleanor M. Riley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Binal N. Shah
- Sickle Cell Center, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Colin J. Sutherland
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Stefan A. Unger
- Department of Child Life and Health, University of Edinburgh, United Kingdom
- Department of Respiratory Medicine, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Firmine Viwami
- Institut de Recherche Clinique du Bénin (IRCB), Cotonou, Benin
| | - Michael Walther
- Medical Research Council Unit, Fajara, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Christopher J. M. Whitty
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- Gleneagles Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Lucy C. Okell
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
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