The Acute Flaccid Paralysis (AFP) Surveillance System in Yemen, 2010-2015: Descriptive Study Based on Secondary Data Analysis.

BACKGROUND: Acute flaccid paralysis (AFP) surveillance is an essential strategy for poliovirus eradication. OBJECTIVE: This study aimed to evaluate the performance of the AFP surveillance system in Yemen from 2010 to 2015, identify components that require strengthening, and compare the indicators by year and governorates. METHODS: This descriptive study was based on secondary analysis of AFP surveillance data reported during 2010-2015 from all Yemeni governorates. The World Health Organization (WHO) minimum performance standards were used to evaluate the performance of the AFP surveillance system. RESULTS: A total of 3019 AFP cases were reported between January 2010 and December 2015. At the national level, AFP surveillance achieved WHO targets throughout the evaluating period for the nonpolio AFP rate of cases per 100,000 members of the population younger than 15 years of age, proportion of AFP cases reported within 7 days, proportion of AFP cases investigated within 48 hours of notification, proportion of AFP cases with two adequate stool specimens, and proportion of stool specimens from which nonpolio enterovirus was isolated. However, the proportion of specimens that arrived at the central level within 3 days of the first sample collection and the proportion of stool specimens with results sent from the reference laboratory within 28 days of receipt did not reach targets in 2011 and 2015, respectively. CONCLUSIONS: The AFP surveillance system in Yemen has met most of the WHO indicator levels. Nevertheless, the evaluation showed areas of weakness regarding the arrival of specimens at the central level within 3 days of the first sample collection and delays in processing of the results and submitting feedback by the laboratory. Therefore, there is a need to strengthen the follow-up of specimens submitted to the laboratory.

An Electronic Disease Early Warning System in Sana'a Governorate, Yemen: Evaluation Study.

BACKGROUND: Electronic Disease Early Warning System (eDEWS) is one of the effective programs in epidemiological surveillance. OBJECTIVE: This study aimed to identify the strengths and weaknesses of eDEWS in Sana'a governorate, determine its usefulness, and assess its performance in terms of the system attributes, including simplicity, flexibility, data quality, acceptability, representativeness, timeliness, and stability. METHODS: Updated guidelines on the evaluation of public health surveillance from the Center for Disease Control and Prevention (CDC) were used to evaluate the eDEWS in Sana'a governorate. Stakeholders from different levels were interviewed about the performance of the eDEWS. RESULTS: The overall score for the usefulness of the eDEWS was good (mean=83%). The overall system performance was good (86%). The highest attribute score was 100% for representativeness and the lowest score was 70% for stability. The system simplicity and acceptability were good. Although the system representativeness and flexibility were excellent, the stability was average. System completeness and timeliness were 100%. CONCLUSIONS: In conclusion, eDEWS in Yemen is useful and met its main objective. The overall level of system performance was good.

Risk Factors for End-Stage Renal Failure Among Patients on Hemodialysis in Aljomhory Hospital, Sa'adah Governorate, Yemen: Hospital-Based Case-Control Study.

BACKGROUND: More than 16% of the world's population is affected by chronic kidney disease, and these people are at the highest risk of developing end-stage renal failure (ESRF). OBJECTIVE: The aim of this study was to determine the risk factors of ESRF in Sa'adah Governorate in Yemen. METHODS: A hospital-based case-control study (86 cases and 263 controls) was conducted in the Aljomhory Hemodialysis Center in Sa'adah city, Yemen. Patients with ESRF who attended the hemodialysis center in Aljomhory Hospital in Sa'adah City from January 1 to February 15, 2016, were included. Control participants were healthy persons without end-stage renal disease (ESRD) who attended Aljomhory Hospital as outpatients' relatives during the study period. RESULTS: A total of 86 cases and 263 controls were included in this study. The mean age was 43.3 (SD 17.7) years for cases and 32.3 (SD 13.0) years for controls. In univariate analysis of factors associated with ESRD, patients aged≥40 years were 3.7 times more likely to have ESRD than younger patients. The odds of ESRD was higher among men than women. Illiteracy was significantly associated with higher odds of ESRD. Hypertension (odds ratio [OR]=8.34), diabetes (OR=3.07), cardiovascular diseases (OR=12.71), presence of urinary stones (OR=21.87), recurrent urinary tract infection (OR=9.64), cigarette smoking (OR=2.44), and shammah use (OR=6.65) were significantly associated with higher odds of ESRD. Hypertension (OR=6.68), urinary stones (OR=16.08), and recurrent urinary tract infection (OR=8.75) remained significantly associated with ERD in multivariate analysis. CONCLUSIONS: Hypertension, presence of urinary stones, and recurrent urinary tract infections were significantly associated with ESRF development. Improving the management of hypertension and designing suitable interventions to control problems of the urinary tract would help reduce ESRD prevalence.

Intestinal parasitoses and schistosome infections among students with special reference to praziquantel efficacy in patients with schistosomosis in Hajjah governorate, Yemen

The majority of the population in Yemen lives in rural areas and suffers from parasitic infections. Therefore, the present study aimed to determine the prevalence of intestinal parasitoses and schistosome infections among the students enrolled in the primary schools in Hajjah governorate ­ north of Yemen, along with an assessment of praziquantel (PZQ) in the treatment of microscopy-confirmed cases of Schistosoma mansoni and Schistosoma haematobium. For this purpose, 780 samples (320 stool and 460 urine) were examined microscopically. The present study revealed an overall infection rate of 75.3% (241/320) with intestinal parasites and Schistosoma mansoni. The detected parasite species included Entamoeba histolytica (27.8%), Hymenolepis nana (12.2%), Giardia lamblia (9.7%), Entamoeba coli (9.4%), S. mansoni (9.1%), Ascaris lumbricoides (6.9%), Trichuris trichiura (3.1%), Enterobius vermicularis (2.8%) and Ancylostoma duodenale (2.2%). Schistosoma haematobium was prevalent among 1.7% (8/460) of the investigated students. On the other hand, PZQ yielded a cure rate of 75.7% of Schistosoma-infected students when administered at 40 mg/kg body weight. However, a 100% cure rate was achieved when administered at 60 mg/kg body weight. Therefore, the findings of the present study highlight the importance of monitoring PZQ efficacy through large-scale studies in different settings endemic for schistosomosis in the country.

Evaluation of HIV Reporting Form in Sana'a City, Yemen, 2016.

Yemen has witnessed a significant rise in AIDS-related deaths because of very poor access to antiretroviral treatment and because of the current war situation. This study aimed to assess the attributes of human immunodeficiency virus (HIV) reporting form, including usefulness, simplicity, flexibility, and acceptability, which is used for reporting HIV cases in Sana'a, Yemen. A descriptive cross-sectional study was conducted among 311 physicians from public and private health facilities in Sana'a city. Physicians were interviewed using a structured questionnaire to assess the form's attributes. The mean score was calculated for each attribute and converted to percentages which were interpreted as very poor, poor, average, good, and excellent. The usefulness overall score was 76%, indicating average usefulness. Of the total participants, 283 (91%) and 304 (97.7%) stated that the form is clear and easy to fill, respectively. More than two-thirds (68.5%) of physicians stated that the form ensures the privacy of the customer's identity. The simplicity attribute score was 74.5%, indicating average simplicity. The overall flexibility was 69.2%, indicating average flexibility. A total of 175 (56%) physicians indicated that they are completely satisfied with the reporting form. The acceptability score was 75.2%, indicating that the HIV/AIDS reporting form of HIV is average in acceptability. The HIV/AIDS reporting form in Yemen was scored average in usefulness, simplicity, flexibility, and acceptability. Training health workers on using the reporting form would improve the performance of HIV/AIDS reporting. Moreover, the reporting form could be adapted to be integrated with other surveillance such as tuberculosis surveillance.

The power of counseling: Changing maternal, infant, and young child nutrition and family planning practices in Dhamar, Yemen.

We conducted a study to determine current maternal, infant, and young child nutrition (MIYCN) and family planning (FP) practices and how practices can be improved with counseling. The study consisted of qualitative methods. Mothers and couples were able to attempt and adopt new practices after only one counseling visit, except consuming meat daily due to cost, and adopting contraception, which was challenging due to health system constraints. Most appreciated receiving information, reported positive experiences, and said they would continue practices. It is possible to improve these practices through counseling, although some systems factors should be addressed.

Pattern of road traffic injuries in Yemen: a hospital-based study.

INTRODUCTION: Road traffic injuries (RTIs) are the eighth leading cause of death globally and the leading cause of death for young people. This study aimed to present time-limited trial surveillance in two referral hospitals to describe the pattern of RTIs in Sana'a, Yemen and determine road traffic crashes (RTCs) associated factors. METHODS: All RTIs presented to Emergency Departments (ED) of the two Sanaa city hospitals between August and October, 2015 were studied and described. Data were collected everyday by trained data collectors. A pretested questionnaire modified from WHO injury surveillance form was used for data collection. RESULTS: A total of 156 casualties from 128 RTCs had attended the two study hospitals during the study period. About 73% of victims were less than 30 years old. Only 13% of casualties were transported by ambulance. None of the victims wore the seat belt in case of 4-wheeled vehicles' users nor the helmet in case of 2-wheeled vehicles' users. Poor driving skills were involved in 133 (85%) casualties. Factors related to the vehicles contributed to 12% of RTCs. Of the 156 casualties, 17% had severe injuries and needed ICU admission. After 48 hours of the accident, 38% of patients ended with disability due to fractured limbs, 29% were not improving and their conditions were deteriorating, 18% had recovered and 5% died. CONCLUSION: Several personal, behavioral, environmental and vehicles related factors had contributed to RTIs in Yemen. The burden of RTIs in Yemen in terms of disability and mortality is high.

The Malaysia DREEM: perceptions of medical students about the learning environment in a medical school in Malaysia.

BACKGROUND: Students' perceptions of their learning environment, by defining its strengths and weaknesses, are important for continuous improvement of the educational environments and curriculum. Therefore, the aim of this study was to explore students' perceptions of their learning environment, among medical students in Malaysia. Various aspects of the education environment were compared between year levels and sex. METHODS: This cross-sectional study was conducted at the Management and Science University, Shah Alam, Malaysia in 2012. A total number of 438 medical students participated in this study, and the response rate was 87.6%. Data were analyzed using SPSS. Comparisons of the mean scores of Dundee Ready Education Environment Measure (DREEM) subscales were calculated. The t-test was used to determine statistically significant differences. RESULTS: The majority of the study participants were female, Malay, and from year 3 (68.7%, 65.3%, and 55.7%; respectively). Analysis of each of the 50 items of the DREEM inventory showed that 47 items scored ranged between 2.00 and 3.00, and three items scored below 2.00. These were identified as problem areas in this medical school that are required to be critically addressed. The overall score showed that the medical students' perceptions were positive. The students' perception toward educational environment was positive for all five DREEM subscales. CONCLUSION: The study found that, in general, the perceptions of the participants about the learning environment were positive. Nevertheless, the study also found there is a need for curriculum improvement in this school and identified priority areas for such improvement.

Practice and barriers toward breast self-examination among young Malaysian women.

INTRODUCTION: The etiology of breast cancer is still unknown and adequate primary prevention strategies or interventions are still not possible. Therefore, early detection remains the first priority and regular practice of breast self-examination (BSE) influences treatment, quality of life, survival, and prognosis of breast cancer patients. OBJECTIVES: The objective of this study was to determine the practices and barriers towards breast self-examination among young Malaysian women. METHODOLOGY: Cross-sectional study was conducted among 251 female students at the Management and Science University, Shah Alam, Selangor, Malaysia. Questionnaires were distributed at gathering places such as the university cafeteria, the university plaza, the Islamic center, and at the library. In addition, questionnaires were distributed in the lecture halls. The proposal of this study was approved by the Ethics and Research Committee of Management and Science University. Data was analysis using SPSS version 13, t-test was used to analyze the associated factors toward the practice of BSE. RESULTS: A total number of 251 students participated in this study. The majority of them were older than 20 years old,of Malay racial origin, single and from urban areas (66.5%; 63.7%; 96%; 70.9% respectively). Regarding their lifestyle practices, the majority of participants do exercise, are non-smokers and do not drink alcohol (71.3%; 98.4%; 94.4% respectively). More than half of the study participants mentioned that they have practiced BSE (55.4%). Regarding the sources of information about BSE, the majority mentioned that radio and TV were their main sources of information (38.2%). Age, exercise and family history of cancer significantly influenced the practice of BSE (p = 0.045; p=0.002; p=0.017 respectively). Regarding the barriers to BSE, the majority who never practiced BSE mentioned that lack of knowledge, not having any symptoms, and being afraid of being diagnosed with breast cancer were the main barriers to practicing BSE (20.3%; 14.3%; 4.4% respectively). CONCLUSION: More than half of the participants practiced BSE. Age, exercise and family history of cancer significantly influenced the practice of the BSE. Lack of knowledge, not having any symptoms and being afraid of being diagnosed with breast cancer were the main barriers to practicing BSE. There is an urgent need to develop a continuous awareness campaign among university students on the importance of performing BSE.

Socioeconomic and environmental factors important for acquiring non-severe malaria in children in Yemen: a case-control study.

Little is known about the relative importance of environmental and socioeconomic factors for acquiring malaria in Yemen. A case-control study was conducted to determine the importance of these factors for acquiring malaria among children in Yemen. Cases of non-severe malaria were recruited from health centres; community controls were from the neighbourhood of the cases. Data were collected by personal interview and direct inspection during home visits. In total, 320 cases and 308 controls were recruited. In the multivariate analysis, environmental factors (living near streams and freshwater marshes), earth roofs of houses and history of travel were all significantly and positively associated with the occurrence of malaria, whilst regular spraying with insecticides at home was a protective factor. There was no association with socioeconomic factors, including crowding, education and occupation of parents, and ownership of house assets. An index created based on a number of indicators of wealth showed a significant association with malaria in the univariate analysis but was not significant in the multivariate analysis. Control activities can be targeted on identifiable environmental factors such as stream and freshwater marshes, although this needs further investigation. Extra protective measures may be needed by all those who travel in Yemen.

Who develops severe malaria? Impact of access to healthcare, socio-economic and environmental factors on children in Yemen: a case-control study.

OBJECTIVE: To investigate the impact of socio-economic and environmental factors on developing severe malaria in comparison with mild malaria in Yemen. METHOD: Case-control study comparing 343 children aged 6 months to 10 years diagnosed with WHO-defined severe malaria (cases) at the main children's hospital in Taiz and 445 children with mild malaria (controls) diagnosed in the health centres, which serve the areas where the cases came from. RESULTS: In univariate analysis, age <1 year, distance from health centre, delay to treatment and driving time to health centre were associated with progression from mild to severe malaria. In multivariate analysis, distance to nearest health centre >2 km was significantly associated with progression to severe disease. Environmental and vector control factors associated with protection from acquiring malaria (such as sleeping under bednets) were not associated with protection from moving from mild to severe disease. CONCLUSIONS: Innovative ways to improve access to antimalarial treatment for those living more then 2 km away from health centres such as home management of malaria, especially for infants and young children, should be explored in malaria-endemic areas of Yemen.

Severe malaria in children in Yemen: two site observational study.

OBJECTIVES: To assess the burden of malaria on health services, describe the clinical presentation of severe malaria in children, and identify factors associated with mortality by means of a prospective observational study. SETTING: Two public hospitals in Taiz (mountain hinterland) and Hodeidah (coastal plain), Yemen. PARTICIPANTS: Children aged 6 months to 10 years. RESULTS: Of 12,301 paediatric admissions, 2071 (17%) were for suspected severe malaria. The proportion of such admissions varied according to the season (from 1% to 40%). Falciparum malaria was confirmed in 1332 children; 808 had severe disease as defined by the World Health Organization. Main presentations were respiratory distress (322/808, 40%), severe anaemia (291/800, 37%), and cerebral malaria (60/808, 8%). Twenty two of 26 children who died had a neurological presentation. No deaths occurred in children with severe anaemia but no other signs of severity. In multivariate analysis, a Blantyre coma score < or = 2, history of fits, female sex, and hyperlactataemia predicted mortality; severe anaemia, respiratory distress, and hyperparasitaemia were not significant predictors of mortality. CONCLUSIONS: Severe malaria puts a high burden on health services in Yemen. Although presentation is similar to African series, some important differences exist. Case fatality is higher in girls.

Malaria status in Al-Hodeidah Governorate, Yemen: malariometric parasitic survey & chloroquine resistance P. falciparum local strain.

Malaria continues to be a major public health problem in Al-Hodeidah G. A cross-sectional malariometic parasitic survey including 4000 Yemenis of various age /sex groups were enrolled in this study from 43 villages/or Harah in five selected districts representing Al-Hodeidah G. Duplicate thin and thick blood smears were stained with Giemsa's stain and examined. Out of 4000 examined slides, 646 (16.2%) were found to be malaria positive, 508 (78.6%) of them were detected through ACD, while 138 (21.4%) cases were detected by PCD. The overall parasite rate was 16.2%, a situation of prevalently mesoendemic condition. P. falciparum was the predominant species recorded (96.7%), followed by P. vivax (1.7%), the least prevalent was P. malariae (0.3%). Yemen has been considered free of ovale malaria. The recorded an indigenous case of P. ovale for the first time in Yemen should be taken into consideration for the existence of this particular Plasmodium species when surveying for malaria in the future. The present study was the first document in Yemen to compare simultaneously the in vivo and in vitro response to chloroquine among 209 of P. falciparum field isolate patients that were satisfied all criteria of WHO for the implementation of the in vivo and in vitro tests and were obtained by PCD and ACD methods. Chloroquine resistance of local strain of P. falciparum was recorded in all studied districts (Zabid, Bajil, Azohrah, Azaidiah and Al-Hodeidah city). RIII (high level of resistance) was recorded for the first time in Yemen and should be taken into consideration in the treatment of infected malaria patients. This calls for urgent revision of the current malaria treatment policy in Yemen where chloroquine is the first-line treatment of uncomplicated P. falciparum malaria.