Maternal and neonatal service usage and determinants in fragile and conflict-affected situations: a systematic review of Asia and the Middle-East.

BACKGROUND: Fragile and conflict-affected situations (FCS) in Asia and the Middle-East contribute significantly to global maternal and neonatal deaths. This systematic review explored maternal and neonatal health (MNH) services usage and determinants in FCS in Asia and the Middle-East to inform policy on health service provision in these challenging settings. METHODS: This systematic review was conducted using a standardised protocol. Pubmed, Embase, Web of Science, and selected development agency websites were searched for studies meeting inclusion criteria. Studies were assessed for methodological quality using an adapted evaluation tool. Qualitative and quantitative data were synthesized and pooled odds ratios generated for meta-analysis of service-usage determinants. RESULTS: Of 18 eligible peer-reviewed studies, eight were from Nepal, four from Afghanistan, and two each from Iraq, Yemen, and the Palestinian Territories. Fragile situations provide limited evidence on emergency obstetric care, postnatal care, and newborn services. Usage of MNH services was low in all FCS, irrespective of economic growth level. Demand-side determinants of service-usage were transportation, female education, autonomy, health awareness, and ability-to-pay. Supply-side determinants included service availability and quality, existence of community health-workers, costs, and informal payments in health facilities. Evidence is particularly sparse on MNH in acute crises, and remains limited in fragile situations generally. CONCLUSIONS: Findings emphasize that poor MNH status in FCS is a leading contributor to the burden of maternal and neonatal ill-health in Asia and the Middle-East. Essential services for skilled birth attendance and emergency obstetric, newborn, and postnatal care require improvement in FCS. FCS require additional resources and policy attention to address the barriers to appropriate MNH care. Authors discuss the 'targeted policy approach for vulnerable groups' as a means of addressing MNH service usage inequities.

Sex and ethnic-origin specific BMI cut points improve prediction of 40-year mortality: the Israel GOH study.

BACKGROUND: Although obesity has been associated with a higher risk for premature death, the sex and ethnic-origin specific body mass index (BMI) levels that are associated with increased mortality are controversial. We investigated the 40-year cumulative all-cause mortality, in relation to the BMI in adult life, among men and women originating from Yemen, Europe/America, Middle East and North Africa, using sex and ethnic-origin specific BMI cut points. METHODS: A random stratified cohort (n = 5710) was sampled from the central population registry and followed since 1969 for vital status. Weight, height and blood pressure were measured, and smoking status was recorded at baseline. BMI was analysed according to conventional categories and according to sex and ethnic-origin specific quintiles. RESULTS: Elevated and significant mortality hazard ratios (HRs) of 1.21 [95% confidence interval (CI) 1.00-1.45] for women and 1.22 (95%CI 1.03-1.44) for men were found for the highest origin-specific BMI quintile. In men, the lowest ethnic-origin specific quintile was also significantly associated with increased mortality (HR of 1.22 95% CI 1.03-1.45), adjusting for age, smoking and blood pressure. Obesity was associated with mortality in non-smokers (HR = 1.29, 95% CI 1.04-1.61 in men and HR = 1.46, 95% CI 1.19-1.79 in women), whereas leanness was associated with mortality only among smoking men (HR = 1.39, 95% CI 1.09-1.77). CONCLUSION: Refinement of BMI categories using country of origin specific quintiles demonstrated significantly increased mortality in the upper quintile in both sexes, while according to the conventional values this association did not prevail in men. We propose the establishment of sex and origin-specific BMI categories when setting goals for disease prevention.

Lactase persistence variants in Arabia and in the African Arabs.

Lactase persistence (LP), the state enabling the digestion of milk sugar in adulthood, occurs only in some human populations. The convergent and independent origin of this physiological ability in Europe and Africa is linked with animal domestication that either had started in both places independently or had spread from the Near East by acculturation. However, it has recently been shown that at least in its southern parts, the population of Arabia not only has a different LP-associated mutation profile than the rest of Africa and Europe but also had experienced an independent demographic expansion occurring before the Neolithic around the Pleistocene-Holocene boundary. In Arabia, LP is associated with mutation -13,915*G and not, as in Europe, with -13,910*T or, as in Africa, with -13,907*G and -14,010*C. We show here that, in Arabia, -13,915*G frequency conforms to a partial clinal pattern and that this specific mutation has likely been spread from Arabia to Africa only recently from the sixth century AD onward by nomadic Arabs (Bedouins) looking for new pastures. Arabic populations in Africa that still maintain a nomadic way of life also have more -13,915*G variants and fewer sub-Saharan L-type mitochondrial DNA haplogroups; this observation matches archaeological and historical records suggesting that the migration of Arabic pastoralists was accompanied by gradual sedentarization that allowed for admixture with the local African population.

Factors associated with dental and medical care attendance in UK resident Yemeni khat chewers: a cross sectional study.

BACKGROUND: The chewing of khat leaf with tobacco smoking amongst Yemenis, Somalis and Ethiopians is reported to impact oral and general health. The health status and particularly dental and medical care attendance of UK-khat chewers has not received attention. This study aimed to explore health status and dental and medical attendance and its associated factors in UK permanently resident Yemeni khat chewers. METHODS: A cross- sectional study with a purposively selected sample of 204 khat chewers was conducted. Data were collected through face to face interviews. Data analysis included descriptive, Chi-square tests and binary logistic regressions. RESULTS: The mean age for this study sample was 44.84 (SD = ±19.70) years and 35% were employed. Forty five percent reported symptomatic medical attendance for self reported health conditions in the last two weeks whilst 44% had symptomatic dental attendance. Higher khat chewing dependency levels associated positively with both symptomatic dental and medical attendance (p = 0.004, OR = 1.14, 95%CI = 1.04-1.25; p = 0.003; OR = 1.16, 95%CI = 1.05-1.29, respectively). Higher social participation levels associated negatively with symptomatic dental attendance (p = 0.034, OR = 0.98, 95%CI = 0.96-0.99) whilst increase in age and self-reported health conditions associated positively with symptomatic medical attendance (p = 0.030, OR = 1.03, 95%CI = 1.01-1.06; p = 0.001, OR = 4.51, 95%CI = 2.02-10.08, respectively). CONCLUSIONS: In this study of khat chewers, a significant proportion reported symptomatic dental and medical attendance. Demographic, psychosocial and self reported general health conditions were associated significantly with dental and medical attendance. Strategies to improve the dental and medical care attendance amongst this group should focus on these and other unexplored underlying factors.

Water demand management in Yemen and Jordan: addressing power and interests.

This paper investigates the extent to which entrenched interests of stakeholder groups both maintain water use practice, and may be confronted. The focus is on the agricultural sectors of Yemen and Jordan, where water resource policymakers face resistance in their attempts to reduce water use to environmentally sustainable levels through implementation of water demand management (WDM) activities. Some farmers in both countries that have invested in irrigated production of high-value crops (such as qat and bananas) benefit from a political economy that encourages increased rather than reduced water consumption. The resultant over-exploitation of water resources affects groups in unequal measures. Stakeholder analysis demonstrates that the more 'powerful' groups (chiefly the large landowners and the political elites, as well as the ministries of irrigation over which they exert influence) are generally opposed to reform in water use, while the proponents of WDM (e.g. water resource managers, environmental ministries and NGOs, and the international donor community) are found to have minimal influence over water use policy and decisionmaking. Efforts and ideas attempted by this latter group to challenge the status quo are classified here as either (a) influencing or (b) challenging the power asymmetry, and the merits and limits of both approaches are discussed. The interpretation of evidence suggests current practice is likely to endure, but may be more effectively challenged if a long-term approach is taken with an awareness of opportunities generated by windows of opportunity and the participation of 'overlap groups'.

Correlates of nicotine dependence in U.K. resident Yemeni khat chewers: a cross-sectional study.

INTRODUCTION: Khat chewing is often associated with tobacco use with impacts on health. This cross-sectional study aimed (a) to explore and validate aspects of self-reported tobacco smoking and whether objective measures of tobacco smoking differ in different situations among khat chewers who smoked and (b) to assess the social factors correlated with nicotine dependence among khat chewers who smoked regularly. METHODS: This study recruited a purposive sample of 204 U.K. resident Yemeni khat chewers during random visits to Khat sale outlets. Data were collected via a face-to-face scheduled interview. Data analyses included descriptive tests and a hierarchical linear multiple regression. RESULTS: Of 133 self-reported tobacco smokers, 68% were regular smokers with a mean (SD) carbon monoxide (CO) score (20.53 ± 12.12 ppm) and 32% were episodic smokers with a mean (SD) CO score (16 ± 15.66 ppm). Tobacco smoking as an enhancement of the impacts of khat chewing was reported by 65% and 69% of regular and episodic smokers, respectively. In both groups, higher CO scores were recorded during khat chewing. Hierarchical linear multiple regression modeling showed that increases in levels of severity of dependence on khat chewing were correlated positively with increase in levels of nicotine dependence (ß = .27, p = .006, 95% CI = 0.05, 0.29), whereas social participation was correlated inversely (ß = -.34, p = .001, 95% CI = -0.06, -0.02). CONCLUSIONS: In this study, smoking prevalence was high. Smoking increased during khat chewing. Nicotine dependence levels correlated positively with khat dependence levels, while higher social participation reduced nicotine dependence.

Mitochondrial DNA reveals distinct evolutionary histories for Jewish populations in Yemen and Ethiopia.

Southern Arabia and the Horn of Africa are important geographic centers for the study of human population history because a great deal of migration has characterized these regions since the first emergence of humans out of Africa. Analysis of Jewish groups provides a unique opportunity to investigate more recent population histories in this area. Mitochondrial DNA is used to investigate the maternal evolutionary history and can be combined with historical and linguistic data to test various population histories. In this study, we assay mitochondrial control region DNA sequence and diagnostic coding variants in Yemenite (n = 45) and Ethiopian (n = 41) Jewish populations, as well as in neighboring non-Jewish Yemeni (n = 50) and Ethiopian (previously published Semitic speakers) populations. We investigate their population histories through a comparison of haplogroup distributions and phylogenetic networks. A high frequency of sub-Saharan African L haplogroups was found in both Jewish populations, indicating a significant African maternal contribution unlike other Jewish Diaspora populations. However, no identical haplotypes were shared between the Yemenite and Ethiopian Jewish populations, suggesting very little gene flow between the populations and potentially distinct maternal population histories. These new data are also used to investigate alternate population histories in the context of historical and linguistic data. Specifically, Yemenite Jewish mitochondrial diversity reflects potential descent from ancient Israeli exiles and shared African and Middle Eastern ancestry with little evidence for large-scale conversion of local Yemeni. In contrast, the Ethiopian Jewish population appears to be a subset of the larger Ethiopian population suggesting descent primarily through conversion of local women.

Estimating the number of women with female genital mutilation in Belgium.

OBJECTIVE: To estimate the number of women with female genital mutilation (FGM) living in Belgium, the number of girls at risk, and the target population of medical and social services (MSSs) concerned. METHODS: Data about prevalence of FGM from the most recently published Demographic and Health Surveys and Multiple Indicator Cluster Surveys were applied to females living in Belgium who migrated from countries where excision or infibulation are being practised, and to their daughters. RESULTS: Amongst the 22,840 women and girls living in Belgium who are from a country concerned, 6,260 have 'most probably already undergone a FGM' (women born in the country of origin), and 1,975 are 'at risk' (second generation born in Belgium). The target population of MSSs comprises 1,190 girls less than five years old attending well-baby clinics, 1,690 girls aged 5-19 years attending preventive school health centres, 4,905 women 20-49 years old and 450 women over 50 years of age attending reproductive health services. The population of women concerned is unequally dispersed in Belgium and reflects the distribution of migrant settlement in the different provinces. CONCLUSION: FGM in Belgium requires a more concerted approach in terms of prevention, and medical and social care. Accurate information about the distribution of women concerned should permit better planning of competent services.

Different effects of apolipoprotein A5 SNPs and haplotypes on triglyceride concentration in three ethnic origins.

Several polymorphisms in the ApoA5 gene emerged as important candidate genes in triglyceride metabolism. The aim of this study was to determine the associations between ApoA5 polymorphisms, plasma triglyceride concentrations and the presence of cardiovascular disease (CVD) in three ethnic origins. Genotypes for 15 single nucleotide polymorphisms (SNPs) were determined in 659 older adults (mean age 71+/-7 years) who immigrated to Israel or whose ancestors originated from East Europe (Ashkenazi), North Africa, Asia (Sephardic) or Yemen (Yemenite). The minor alleles of the four common SNPs (rs662799, rs651821, rs2072560 and rs2266788) are associated with an increase of 27-38% in triglyceride concentration among Ashkenazi and Yemenite Jews compared with the major alleles, but not among those of Sephardic origin. Conversely, among the Sephardic group, the presence of the minor allele in SNP rs3135506 compared with the major allele was associated with an increase of 34% in triglyceride concentration. The four SNPs were in significant linkage disequilibrium (D'=0.96-0.99), resulting in three haplotypes H1, H2 and H3, representing 98-99% of the population. Haplotype H2 was significantly associated with triglyceride concentration among Ashkenazi and Yemenite but not among Sephardic Jews. Conversely, haplotype H3 was associated with triglyceride concentration in Sephardic but not in Ashkenazi and Yemenite Jews. Ashkenazi carriers of H2 haplotype had a CVD odds ratio of 2.19 (95% CI: 1.05-4.58) compared with H1 (the most frequent), after adjustment for all other risk factors. These results suggest that different SNPs in ApoA5 polymorphisms may be associated with triglyceride concentration and CVD in each of these ethnic origins.

Adaptation and psychometric evaluation of the Multidimensional Scale of Perceived Social Support for Arab immigrant women.

We adapted the Multidimensional Scale of Perceived Social Support (MSPSS) for use with Arab immigrant women (MSPSS-AW) and estimated the psychometric properties of the adapted version with a sample of 539 Arab immigrant women living in the United States. Confirmatory factor analysis (CFA) supported the proposed three-factor solution. Internal consistency reliability coefficients for the three subscales ranged from good to very good. Additional evidence for construct validity of the MSPSS-AW subscales was demonstrated through relationships with theoretically related measures. We conclude that the MSPSS-AW is reliable and valid for use with Arab immigrant women.

Predictors of narghile (water-pipe) smoking in a sample of American Arab Yemeni adolescents.

To explore the predictors of water-pipe smoking among American Arab Yemeni adolescents, a descriptive correlational design was used, and regression models representing the proposed relationships in the study were tested from a convenience sample of 297 adolescents who attended a teen health clinic and two high schools. The participants completed five measures. Fourteen hypotheses were tested. Experimentation with tobacco was found to be significant in predicting narghile smoking. Tobacco use prevention and cessation interventions for this population can be focused on targeting the family and peer units, from which their identity is likely derived.

[Human infection due to Bertiella sp (cestode: Anoplocephalidae) in a man originating from Yemen in Algeria]. / Infection humaine due à Bertiella sp (cestode: Ano- plocephalidae) observée en Algérie chez un étudiant originaire du Yémen.

Bertiella is a frequent parasite in animals, particularly in nonhuman primates. The infestation occurs in man by accidental ingestion of the intermediate host, an acarus containing the cysticercoid larva of Bertiella studeri or Bertiella mucronata. The diagnosis is based on the morphology of the gravid proglottis and eggs with pyriform embryo which is characteristic of the Anoplocephalinae. Human infection is asymptomatic or can induce minor non specific digestive disturbances and the niclosamide is effective in one single dose. The authors report the first case of human bertiellosis in Algeria in a student originating from Yemen.

A common founder mutation of CERKL underlies autosomal recessive retinal degeneration with early macular involvement among Yemenite Jews.

PURPOSE: To investigate the genetic basis and clinical manifestations of a characteristic form of retinal degeneration in the Yemenite Jewish population. METHODS: Haplotype analysis for all known genes and loci underlying autosomal recessive nonsyndromic retinal degeneration was performed in a Yemenite Jewish family segregating autosomal recessive severe retinal degeneration. The causative mutation was detected by direct sequencing of the underlying gene, and its prevalence in additional affected and unaffected Yemenite Jews was determined. Patients who were homozygous for this mutation underwent ophthalmic evaluation, including funduscopy, electroretinography, electro-oculography, perimetry, and color vision testing. RESULTS: In the studied Yemenite Jewish family, we found evidence for linkage to the CERKL gene. Direct sequencing revealed a novel homozygous splice-site mutation, c.238+1G>A. An in vitro splicing assay demonstrated that this mutation leads to incorrect splicing. c.238+1G>A was found to cause retinal degeneration in six additional Yemenite Jewish families. The carrier frequency of this mutation in the Yemenite Jewish population is 4.4%. All c.238+1G>A homozygotes manifest widespread progressive impairment of rod and cone function with early macular involvement. CONCLUSIONS: c.238+1G>A is the second reported mutation of CERKL and is a prevalent founder mutation that underlies approximately 33% of autosomal recessive retinal degeneration cases in the Yemenite Jewish population. It is associated with a characteristic retinal degeneration phenotype with early macular involvement, concomitant progression of rod and cone impairment, and characteristic fundus findings. The identification of this mutation and phenotype will facilitate molecular diagnosis, carrier screening, and genetic counseling in the Yemenite Jewish population.

Origin and distribution of the BRCA2-8765delAG mutation in breast cancer.

BACKGROUND: The BRCA2-8765delAG mutation was firstly described in breast cancer families from French-Canadian and Jewish-Yemenite populations; it was then reported as a founder mutation in Sardinian families. We evaluated both the prevalence of the BRCA2-8765delAG variant in Sardinia and the putative existence of a common ancestral origin through a haplotype analysis of breast cancer family members carrying such a mutation. METHODS: Eight polymorphic microsatellite markers (D13S1250, centromeric, to D13S267, telomeric) spanning the BRCA2 gene locus were used for the haplotype analysis. Screening for the 8765delAG mutation was performed by PCR-based amplification of BRCA2-exon 20, followed by automated sequencing. RESULTS: Among families with high recurrence of breast cancer (> or = 3 cases in first-degree relatives), those from North Sardinia shared the same haplotype whereas the families from French Canadian and Jewish-Yemenite populations presented distinct genetic assets at the BRCA2 locus. Screening for the BRCA2-8765delAG variant among unselected and consecutively-collected breast cancer patients originating from the entire Sardinia revealed that such a mutation is present in the northern part of the island only [9/648 (1.4%) among cases from North Sardinia versus 0/493 among cases from South Sardinia]. CONCLUSION: The BRCA2-8765delAG has an independent origin in geographically and ethnically distinct populations, acting as a founder mutation in North but not in South Sardinia. Since BRCA2-8765delAG occurs within a triplet repeat sequence of AGAGAG, our study further confirmed the existence of a mutational hot-spot at this genomic position (additional genetic factors within each single population might be involved in generating such a mutation).

"Wailing lore" in a Yemenite-Israeli community: bereavement, expertise, and therapy.

This study explores Yemenite-Jewish wailing as an example of how a traditional community copes with bereavement in contemporary Israel. Observations of wailing events and interviews with Yemenite-Israeli wailers and mourners are analyzed in order to understand the respondents' perceptions of wailing as a psychotherapeutic expertise and experience. These findings are further used to substantiate a theoretical reconsideration of models of bereavement, exploring the interplay between the modern, self-centered, and detached psychological model (the "clinical lore") and the traditional, other-oriented, and continuous anthropological model (the "wailing lore"). The article concludes by discussing criticisms of the Western psychotherapeutic paradigm as it relates to bereavement and asking where a mourning ritual such as wailing fits into our understanding of the subjective experiences of grief.

Healthcare attitudes and behaviors of immigrant and US-born women in Hamtramck, Michigan: a MetroNet study.

OBJECTIVE: Recognizing recent immigrant migration into Hamtramck, Michigan, our objective was to conduct a survey focused on female patients seeking health care in an ethically diverse primary care clinic. DESIGN: Cross-sectional exploratory questionnaire survey study. SETTING: A family medicine center (FMC) in Hamtramck, Michigan. PARTICIPANTS: A convenience sample of women patients, age > or =18 years of age who understood English and/or written or spoken Bangla. MAIN OUTCOME MEASURES: Health-seeking behaviors and satisfaction with the US healthcare system. RESULTS: 156 women patients participated. Sixty-seven (43%) were immigrants, primarily representing three ethnicities: Bangladeshi (61%), Yemeni (19%) and Bosnian (13%). The mean length of residence in the United States was eight years. Compared with US-born, the immigrants were more likely to report a household income of less than $15,000; however they had similar rates of health insurance. US-born women reported less satisfaction with our healthcare system. Immigrants were more likely to visit their physician when feeling ill, and to bring a friend or relative to help alleviate communication problems. Immigrant women were also more likely to express a desire for a physician who was female and/ or from a similar cultural background. CONCLUSIONS: The study findings suggest the need for physicians to be culturally sensitive to the particular needs of the immigrant female population they serve and to treat each patient within the context of her environment.

Yemeni families and child lead screening in Detroit.

This project was an exploratory effort to screen and treat immigrant Yemeni children who were at high risk for lead poisoning. The Detroit metropolitan area is home to the largest number of Arabic immigrants in the United States. In addition, Detroit has the largest rate of childhood lead poisoning in the state of Michigan. No published studies were found that explored the prevalence of lead poisoning among Yemeni children in Michigan. Immigrant children from countries where knowledge of lead poisoning is limited may be particularly vulnerable because of difficulties in language and accessing health care. Children's Hospital of Michigan CATCH School Mobile Health Center conducted this health-screening project. This article reports on the gender and health issues encountered during the community outreach lead testing effort within a Yemeni neighborhood in Detroit.

Ethnic Variation in the Association of Hypertension With Type 2 Diabetes.

Lifestyle changes occurring with urbanization increase the prevalence of both type 2 diabetes mellitus (T2DM) and hypertension (HTN). Yemenites who have immigrated to Israel have demonstrated a dramatic increase in T2DM but the prevalence of HTN in diabetic Yemenites is unclear. In a cross-sectional study, the authors evaluated the prevalence of HTN and lifestyle patterns in Israelis with T2DM of Yemenite (Y-DM) and non-Yemenite (NY-DM) origin. Y-DM (n=63) and NY-DM (n=120) had similar age (63±7 vs 64±7 years, P=.5), diabetes duration, diet adherence, and exercise patterns. Y-DM had a lower prevalence of HTN (63%) than NY-DM (83%) (P<.01). Furthermore, Yemenite origin was independently associated with lower prevalence of HTN (odds ratio, 0.3; 95% confidence interval, 0.12-0.71). Blood pressure was well controlled with fewer antihypertensive medications in Y-DM than NY-DM (P<.01). Even though lifestyle patterns were similar in the two groups, Y-DM had a lower prevalence of HTN compared with NY-DM and required fewer antihypertensive medications.