Costs associated with tuberculosis diagnosis and treatment in Yemen for patients and public health services.

This study determined the costs associated with tuberculosis (TB) diagnosis and treatment for the public health services and patients in Sana'a, Yemen. Data were collected prospectively from 320 pulmonary and extrapulmonary TB patients (160 each) who were followed until completion of treatment. Direct medical and nonmedical costs and indirect costs were calculated. The proportionate cost to the patients for pulmonary TB and extrapulmonary TB was 76.1% arid 89.4% respectively of the total for treatment. The mean cost to patients for pulmonary and extrapulmonary TB treatment was US$ 108.4 and US$ 328.0 respectively. The mean cost per patient to the health services for pulmonary and extrapulmonary TB treatment was US$ 34.0 and US$ 38.8 respectively. For pulmonary and extrapulmonary TB, drug treatment represented 59.3% and 77.9% respectively of the total cost to the health services. The greatest proportionate cost to patients for pulmonary TB treatment was time away from work (67.5% of the total cost), and for extrapulmonary TB was laboratory and X-ray costs (55.5%) followed by transportation (28.6%).

Hepatitis B virus carrier rate, prevalence and susceptibility and impact of immunization program among households in the city of Taiz, Yemen.

OBJECTIVE: To examine the carrier rate, prevalence and susceptibility to hepatitis B virus infection in the city of Taiz, Yemen. METHODS: In a community-based household survey 521 subjects from 98 randomly selected households were enrolled. Carrier rate, prevalence and susceptibility of hepatitis B virus infection in the city of Taiz, Yemen were examined. RESULTS: The median age of the subjects was 19 years (range <1-85 years), 219 (42.0%) of whom were males and 305 (58.0%) were females. The HBsAg carrier rate was 4.2% (22/521), the prevalence was 16.9% (88/521) and the susceptibility rate was 57.5% (287/499). Male vs female carrier rate, prevalence and susceptibility rate were comparable. Children (age ≤ 18 years) vs adults had carrier rates of 2.7% vs 5.7% (odds ratio=2.2) and a prevalence of 5.1% vs 28.4% (OR: 5.6). The carrier rate, prevalence and immunity to HBV among subjects who reported vaccination vs those unvaccinated was; 2.1% vs 5.5%, 11.3 vs 20.8% and 53.1% vs 18.8%. A proportion of 47.2% of subjects who aged ≤ 10 years had isolated anti-HBs. Of 142 of the cohort born after full implementation of vaccination program (age:≤ 9 years) 72 (50.7%) were immune and 70 (49.3%) were susceptible whereas of 357 subjects borne before program implementation (Age:≥ 10 years) 140 (39.2%) were immune and 217 (60.8%) were susceptible (p<0.02 (Pearson) OR: 1.6 CI=0.42-0.93). CONCLUSIONS: An intermediate endimicity was identified in Taiz city. Vaccination reduced carrier rate prevalence and susceptibility among vaccinated subjects. The high rate of subjects with isolated anti- HBs together with the reduced susceptibility rate among the cohort born after inclusion of HBV vaccine to EPI reflects impact of the program. Improving vaccination coverage will further reduce susceptibility rate.

Costs associated with tuberculosis diagnosis and treatment in Yemen for patients and public health services

This study determined the costs associated with tuberculosis [TB] diagnosis and treatment for the public health services and patients in Sana'a, Yemen. Data were collected prospectively from 320 pulmonary and extrapulmonary TB patients [160 each] who were followed until completion of treatment. Direct medical and nonmedical costs and indirect costs were calculated. The proportionate cost to the patients for pulmonary TB and extrapulmonary TB was 76.1% and 89.4% respectively of the total for treatment. The mean cost to patients for pulmonary and extrapulmonary TB treatment was US$ 108.4 and US$ 328.0 respectively. The mean cost per patient to the health services for pulmonary and extrapulmonary TB treatment was US$ 34.0 and US$ 38.8 respectively. For pulmonary and extrapulmonary TB, drug treatment represented 59.3% and 77.9% respectively of the total cost to the health services. The greatest proportionate cost to patients for pulmonary TB treatment was time away from work [67.5% of the total cost], and for extrapulmonary TB was laboratory and X-ray costs [55.5%] followed by transportation [28.6%]

Quality of management for acute respiratory tract infections and diarrhoeal diseases in rural Yemen.

To evaluate the performance of health workers with respect to diagnosis and treatment of acute respiratory infection (ARI) and acute diarrhoea (AD) in children < 5 years in 11 rural heath facilities in Yemen, we carried out a cross-sectional study on 219 cases of ARI and 93 cases of AD. Mean score for performance was 30.04 (range 21-39). The quality of care provided was fair in 89.4% and poor in 4.5% of cases. A "well done" performance of 6.3% was achieved by medical doctors but only 3.6% of medical assistants and 25% of medical assistants scored "poor" for performance, but only 2.5% of medical doctors. Health workers who had received training courses in ARI and AD performed slightly better than those who had not.

Quality of management for acute respiratory tract infections and diarrhoeal diseases in rural Yemen

To evaluate the performance of health workers with respect to diagnosis and treatment of acute respiratory infection [ARI] and acute diarrhoea [AD] in children < 5 years in 11 rural heath facilities in Yemen, we carried out a cross-sectional study on 219 cases of ARI and 93 cases of AD. Mean score for performance was 30.04 [range 21-39]. The quality of care provided was fair in 89.4% and poor in 4.5% of cases. A "well done" performance of 6.3% was achieved by medical doctors but only 3.6% of medical assistants and 25% of medical assistants scored "poor" for performance, but only 2.5% of medical doctors. Health workers who had received training courses in ARI and AD performed slightly better than those who had not

Profile of paediatric emergency cases in Yemen: the need for evidence-based guidelines.

This study describes the status and characteristics of children presenting to emergency services in hospitals and health centres in Yemen in order to inform the development of guidelines for paediatric emergency services. Information was collected from 7 hospitals and 2 health centres in 5 governorates about 3454 cases, mostly aged < 2 years old. The majority of paediatric emergency cases were due to respiratory system problems (28.6%) and gastrointestinal problems (25.5%); 36.4% of children presented with a duration of complaint exceeding 4 days. One-third of cases (33.2%) were treated with 3rd generation cephalosporins alone or in combination with other antibiotics. The mortality rate was 1.9%. The most important causes of death were cardiac and respiratory failure.

Profile of paediatric emergency cases in Yemen: the need for evidence-based guidelines

This study describes the status and characteristics of children presenting to emergency services in hospitals and health centres in Yemen in order to inform the development of guidelines for paediatric emergency services. Information was collected from 7 hospitals and 2 health centres in 5 governorates about 3454 cases, mostly aged < 2 years old. The majority of paediatric emergency cases were due to respiratory system problems [28.6%] and gastrointestinal problems [25.5%]; 36.4% of children presented with a duration of complaint exceeding 4 days. One-third of cases [33.2%] were treated with 3rd generation cephalosporins alone or in combination with other antibiotics. The mortality rate was 1.9%. The most important causes of death were cardiac and respiratory failure

Malaria signs and infection rate among asymptomatic schoolchildren in Hajr valley, Yemen

This study recorded malaria signs and the rate of parasitaemia among asymptomatic schoolchildren in Hajr valley, Hadhramout governorate, Yemen. Tests were made for malaria parasites and anaemia in 469 randomly selected primary-school children aged 6-11 years, together with clinical examination to determine spleen size, and interviews to study sociodemographic factors. Of the children, 12.8% had positive malaria blood films and 11.3% had spleen enlargement. There were significant associations between malaria infection, anaemia and splenomegaly and fever. Children with malaria parasitaemia were more often absent from school

Rapid assessment of trachoma in 9 governorates and Socotra Island in Yemen.

This study described the pattern of trichiasis, active trachoma and trachoma risk factors in 9 governorates of Yemen plus Socotra Island, using a rapid assessment during October and February 2004. A total of 3169 children aged 1-9 years were examined in a central meeting point or at home. Active trachoma was found in a high percentage of children in Al-Jawf, Mareb and Shabwah governorates and the SAFE strategy (Surgery, Antibiotic treatment, Facial cleanliness, Environmental improvement) should be directed toward these governorates. Trichiasis cases were also found in Hadramout and Taiz, suggesting that eyelid surgery should be provided in these governorates.

Profile of breast lesions among women with positive biopsy findings in Yemen.

This study described the profile of breast pathology based on records from a reference histopathology laboratory in Yemen of 773 women with positive biopsy or mastectomy findings. Cancers were classified according to the International classification of diseases for oncology. Benign lesions were found in 79.9% of cases. Fibroadenoma was the most prevalent lesion (30.0%) with a mean age at presentation of 22.2 years, followed by fibrocystic disease (27.4%) and breast inflammation (13.1%). Invasive carcinoma was found in 155 cases (20.1%), at a mean age of 44.7 years.

Intestinal parasitosis and nutritional status in schoolchildren of Sahar district, Yemen.

The prevalence and intensity of schistosomiasis and soil-transmitted parasites was estimated among third-year schoolchildren of Sahar district, Sa'dah governorate, Yemen, after 4 schistosomiasis control campaigns. Anthropometric measurements were used to assess nutritional status in relation to infection rates. The prevalence of schistosomiasis infection was low at 5.6%: 3.3% for Schistosoma haematobium (geometric mean 0.16 eggs/10 mL urine) and 2.3% for S. mansoni (0.18 eggs/g faeces). Ascaris lumbricoides was found in 0.4% of the children while other soil-transmitted helminths were not found. Stunting was found in 50.9%, wasting in 4.5% and underweight in 48.7% of the children examined; however, no positive association was found between infection and nutritional status indicators.

Intestinal parasitosis and nutritional status in schoolchildren of Sahar district, Yemen

The prevalence and intensity of schistosomiasis and soil-transmitted parasites was estimated among third-year schoolchildren of Sahar district, Sa'dah governorate, Yemen, after 4 schistosomiasis control campaigns. Anthropometric measurements were used to assess nutritional status in relation to infection rates. The prevalence of schistosomiasis infection was low at 5.6%: 3.3% for Schistosoma haematobium [geometric mean 0.16 eggs/10 mL urine] and 2.3% for S. mansoni [0.18 eggs/g faeces]. Ascaris lumbricoides was found in 0.4% of the children while other soil-transmitted helminths were not found. Stunting was found in 50.9%, wasting in 4.5% and underweight in 48.7% of the children examined; however, no positive association was found between infection and nutritional status indicators

Profile of breast lesions among women with positive biopsy findings in Yemen

This study described the profile of breast pathology based on records from a reference histopathology laboratory in Yemen of 773 women with positive biopsy or mastectomy findings. Cancers were classified according to the International classification of diseases for oncology. Benign lesions were found in 79.9% of cases. Fibroadenoma was the most prevalent lesion [30.0%] with a mean age at presentation of 22.2 years, followed by fibrocystic disease [27.4%] and breast inflammation [13.1%]. Invasive carcinoma was found in 155 cases [20.1%], at a mean age of 44.7 years

Rapid assessment of trachoma in 9 governorates and Socotra Island in Yemen

This study described the pattern of trichiasis, active trachoma and trachoma risk factors in 9 governorates of Yemen plus Socotra Island, using a rapid assessment during October and February 2004. A total of 3169 children aged 1- 9 years were examined in a central meeting point or at home. Active trachoma was found in a high percentage of children in Al-Jawf, Mareb and Shabwah governorates and the SAFE strategy [Surgery, Antibiotic treatment, Facial cleanliness, Environmental improvement] should be directed toward these governorates. Trichiasis cases were also found in Hadramout and Taiz, suggesting that eyelid surgery should be provided in these governorates

The WHO dose pole for the administration of praziquantel is also accurate in non-African populations.

In 2001, WHO developed a pole for the administration of praziquantel without the use of weighing scales, with encouraging results in African populations. In the present study, the pole was tested on height/weight data from 9354 individuals from 11 non-African countries. In more than 98% of the individuals (95% CI 97.8-98.4) the pole estimated an acceptable dosage (30-60 mg/kg), a performance statistically similar to that observed in African populations. Reproducing the present pole in the form of a strip of paper and including it in each container of praziquantel would greatly facilitate the administration of the drug in large-scale interventions.

Prevalence of blood-borne viral hepatitis in different communities in Yemen.

It is generally believed that hepatitis B (HBV) and C (HCV) viruses are highly prevalent in the Republic of Yemen. This study investigated the prevalence of HBV and HCV markers in 494 blood donors from Aden, 493 blood donors from Sana'a, 97 residents from an African ethnic minority in Sana'a and 99 residents of Soqotra Island. There were significant differences in the prevalence of HBV carriage (HBsAg: 6.7, 15, 19.6 and 26.3% respectively; P < 0.001); past HBV infection (anti-HBc: 17.4, 18.5, 30.9 and 59.6% respectively; P < 0.001); susceptibility to HBV (absence of HBV markers: 73.3, 61.9, 38.1 and 9.1% respectively; P < 0.001), infectivity of HBV carriers (HBV DNA: 51.5, 33.8, 52.6 and 65.4% respectively; P = 0.028) and HCV antibodies (RIBA confirmed or indeterminate: 0.6, 0.2, 5.2 and 5.1% respectively; P < 0.001). A significant difference in HBV carrier rate and a borderline significant difference in the prevalence of natural infection was observed between males and females in the African community (P = 0.02 and 0.06 respectively). In contrast, in Soqotra Island, there was no significant sex difference in HBV carrier rate but susceptibility was significantly more prevalent in males (P = 0.03). This study illustrates that significant difference in prevalence and epidemiology exists among different communities within the same country, reflecting political, geographical and social differences. Control strategies should take these differences into account.

Malaria and intestinal parasitosis among children presenting to the paediatric centre in Sana'a, Yemen.

We studied the profile of malaria and intestinal parasitosis among children presenting to the Paediatric Health Centre in Sana'a from January 1998 to December 2000. In stool samples from 9014 children, Ascaris lumbricoides, Entamoeba histolytica, Giardia lamblia and Trichuris trichiura were the most common. Infection with parasites of direct life-cycle were similar in boys and girls. Schistosome infection was significantly higher in boys than girls, but girls were more infected with ascariasis. The only species of malaria parasite found in blood samples from 753 children with suspected malaria was Plasmodium falciparum, with the highest rates in April-June. The majority of positive cases were Yemeni children, but 10.8% were Sudanese or Ethiopian.

Prevalence of rubella antibodies among schoolgirls in Sana'a, Republic of Yemen.

To determine the prevalence of rubella antibodies and age of exposure to rubella among Yemeni schoolgirls, we studied the sera samples of 323 female students (age range 11-21 years; mean age 16.26 +/- 1.89 years) drawn from three schools in Sana'a. All samples were screened for rubella IgG antibodies using enzyme linked immunosorbent assay and, if negative, for IgM in order to exclude the possibility of recent exposure. Of 323 sera, 296 (91.64%) were positive for rubella IgG. All IgG negative sera were also IgM negative. Comparable antibody prevalence was observed in all age groups. The prevalence of rubella IgG among Yemeni schoolgirls is high, with most becoming immune between the ages of 11 and 21 years. Although the age of exposure seems to be < or = 13 years, further investigation is needed to confirm this.

Malaria and intestinal parasitosis among children presenting to the Paediatric Centre in Sana'a, Yemen

We studied the profile of malaria and intestinal parasitosis among children presenting to the Paediatric Health Centre in Sana'a from January 1998 to December 2000. In stool samples from 9014 children, Ascaris lumbricoides, Entamoeba histolytica, Giardia lamblia and Trichuris trichiura were the most common. Infection with parasites of direct life-cycle were similar in boys and girls. Schistosome infection was significantly higher in boys than girls, but girls were more infected with ascariasis. The only species of malaria parasite found in blood samples from 753 children with suspected malaria was Plasmodium falciparum, with the highest rates in April-June. The majority of positive cases were Yemeni children, but 10.8% were Sudanese or Ethiopian

Prevalence of rubella antibodies among schoolgirls in Sana'a, Republic of Yemen

To determine the prevalence of rubella antibodies and age of exposure to rubella among Yemeni schoolgirls, we studied the sera samples of 323 female students [age range 11-21 years; mean age 16.26 +/- 1.89 years] drawn from three schools in Sana'a. All samples were screened for rubella IgG antibodies using enzyme linked immunosorbent assay and, if negative, for IgM in order to exclude the possibility of recent exposure. Of 323 sera, 296 [91.64%] were positive for rubella IgG. All IgG negative sera were also IgM negative. Comparable antibody prevalence was observed in all age groups. The prevalence of rubella IgG among Yemeni schoolgirls is high, with most becoming immune between the ages of 11 and 21 years. Although the age of exposure seems to be </= 13 years, further investigation is needed to confirm this