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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] [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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El-Jardali F, Fadlallah R, Daher N. Multi-sectoral collaborations in selected countries of the Eastern Mediterranean region: assessment, enablers and missed opportunities from the COVID-19 pandemic response. Health Res Policy Syst 2024; 22:14. [PMID: 38267995 PMCID: PMC10807098 DOI: 10.1186/s12961-023-01098-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has emphasized the importance of multi-sectoral collaboration to respond effectively to public health emergencies. This study aims to generate evidence on the extent to which multi-sectoral collaborations have been employed in the macro-level responses to the COVID-19 pandemic in nine selected countries of the Eastern Mediterranean region (EMR). METHODS The study employed in-depth analytical research design and was conducted in two phases. In the first phase, data were collected using a comprehensive documentation review. In the second phase, key informant interviews were conducted to validate findings from the first phase and gain additional insights into key barriers and facilitators. We analysed the macro-level pandemic responses across the following seven components of the analytical framework for multi-sectoral collaborations: (1) context and trigger; (2) leadership, institutional mechanisms and processes; (3) actors; (4) administration, funding and evaluation; (5) degree of multi-sectoral engagement; (6) impact; and (7) enabling factors. RESULTS Governments in the EMR have responded differently to the pandemic, with variations in reaction speed and strictness of implementation. While inter-ministerial committees were identified as the primary mechanism through which multi-sectoral action was established and implemented in the selected countries, there was a lack of clarity on how they functioned, particularly regarding the closeness of the cooperation and the working methods. Coordination structures lacked a clear mandate, joint costed action plan, sufficient resources and regular reporting on commitments. Furthermore, there was no evidence of robust communication planning both internally, focused on promoting internal consensual decision-making and managing power dynamics, and externally, concerning communication with the public. Across the selected countries, there was strong representation of different ministries in the pandemic response. Conversely, the contribution of non-state actors, including non-governmental organizations, civil society organizations, the private sector, the media and citizens, was relatively modest. Their involvement was more ad hoc, fragmented and largely self-initiated, particularly within the selected middle- and low income- countries of the EMR. Moreover, none of the countries incorporated explicit accountability framework or included anti-corruption and counter-fraud measures as integral components of their multi-sectoral plans and coordination mechanisms. Key enablers for the adoption of multi-sectoral collaborations have been identified, paving the way for more efficient responses in the future. DISCUSSION Mirroring global efforts, this study demonstrates that the selected countries in the EMR are making efforts to integrate multi-sectoral action into their pandemic responses. Nevertheless, persistent challenges and gaps remain, presenting untapped opportunities that governments can leverage to enhance the efficiency of future public health emergency responses.
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Affiliation(s)
- Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Racha Fadlallah
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon.
| | - Najla Daher
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
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Klein A, Bastard M, Hemat H, Singh S, Muniz B, Manangama G, Alayyan A, Tamanna AH, Barakzaie B, Popal N, Kakar MAZ, Poulet E, Finger F. Factors associated with adverse outcomes among patients hospitalized at a COVID-19 treatment center in Herat, Afghanistan. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001687. [PMID: 37619213 PMCID: PMC10449473 DOI: 10.1371/journal.pgph.0001687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/30/2023] [Indexed: 08/26/2023]
Abstract
Though many studies on COVID have been published to date, data on COVID-19 epidemiology, symptoms, risk factors and severity in low- and middle-income countries (LMICS), such as Afghanistan are sparse. To describe clinical characteristics, severity, and outcomes of patients hospitalized in the MSF COVID-19 treatment center (CTC) in Herat, Afghanistan and to assess risk factors associated with severe outcomes. 1113 patients were included in this observational study between June 2020 and April 2022. Descriptive analysis was performed on clinical characteristics, complications, and outcomes of patients. Univariate description by Cox regression to identify risk factors for an adverse outcome was performed. Adverse outcome was defined as death or transfer to a level 3 intensive care located at another health facility. Finally, factors identified were included in a multivariate Cox survival analysis. A total of 165 patients (14.8%) suffered from a severe disease course, with a median time of 6 days (interquartile range: 2-11 days) from admission to adverse outcome. In our multivariate model, we identified male gender, age over 50, high O2 flow administered during admission, lymphopenia, anemia and O2 saturation < = 93% during the first three days of admission as predictors for a severe disease course (p<0.05). Our analysis concluded in a relatively low rate of adverse outcomes of 14.8%. This is possibly related to the fact that the resources at an MSF-led facility are higher, in terms of human resources as well as supply of drugs and biomedical equipment, including oxygen therapy devices, compared to local hospitals. Predictors for severe disease outcomes were found to be comparable to other settings.
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Al‐Waleedi AA, Thabet AA, bin Azoon N, Dandarwe A, Al‐Amoudi AS, Al‐Gailani A, Atef B. An assessment of the current epidemiological and laboratory capacities for influenza-like illnesses and severe acute respiratory infection surveillance, Yemen 2022. Influenza Other Respir Viruses 2023; 17:e13130. [PMID: 37065468 PMCID: PMC10098675 DOI: 10.1111/irv.13130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/02/2023] [Indexed: 04/18/2023] Open
Abstract
Background and Objectives We aim to re-activate influenza sentinel surveillance system in Yemen after disruption related to repurposing for COVID-19 pandemic. WHO Country Office (CO) in collaboration with Yemen's Ministry of Public Health and Population (MOPH&P) jointly conducted an assessment mission to assess the current situation of the influenza sentinel surveillance system and assess its capacity to detect influenza epidemics and monitor trends in circulating influenza and other respiratory viruses of epidemic and pandemic potential. This study presents the results of the assessment for three sentinel sites located in Aden, Taiz, and Hadramout/Mukalla. Methodology A mixed methods approach was used to guide the assessment process and to help achieve the objectives. Data were collected as follows: desk review of the sentinel sites records and data; interviews with stakeholders, including key informants and partners; and direct observation through field visits to the sentinel sites, MOPH&P and the Central Public Health Laboratory (CPHL). Two assessment checklists were used: assessment of sentinel sites for SARI surveillance, and checklist for assessment of availability of SARI sentinel surveillance. Results and Conclusion COVID-19 has affected health systems and services, and this was demonstrated in this assessment. The influenza sentinel surveillance system in Yemen is not effectively functional; however, there is plenty of room for improvement if investment in the system's restructuring, training, building technical and laboratory capacities, and conducting continuous and regular supervision visits.
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Affiliation(s)
| | | | - Nasreen bin Azoon
- Department of Disease Control and SurveillanceInfluenza Program Focal Point, MOPH&P00967AdenYemen
| | - Adham Dandarwe
- Department of Disease Control and SurveillanceMOPH &P00967AdenYemen
| | | | - Amar Al‐Gailani
- Department of Disease Control and SurveillanceMOPH &P00967AdenYemen
| | - Bakil Atef
- Department of Disease Control and SurveillanceMOPH &P00967AdenYemen
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Short communication of the challenges and recommendations about the unreliable control of COVID19 in Yemen. Ann Med Surg (Lond) 2022; 78:103876. [PMID: 35664687 PMCID: PMC9148439 DOI: 10.1016/j.amsu.2022.103876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 05/22/2022] [Indexed: 11/24/2022] Open
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Almoughales AA, Swed S, Sawaf B, Alibrahim H. COVID-19 vaccine hesitancy among indigenous people in Yemen: An incipient crisis. Ann Med Surg (Lond) 2022; 73:103206. [PMID: 34976393 PMCID: PMC8702593 DOI: 10.1016/j.amsu.2021.103206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 12/02/2022] Open
Abstract
There are many reasons that push Yemenis not to take the Corona vaccine, as the deteriorating health and living reality as a result of the war and the destruction that afflicted the country created a state of ignorance and backwardness and prevented the arrival of awareness and education campaigns regarding the importance, effectiveness and safety of taking the vaccine, all of which put the Yemeni people in a state of hesitation, fear and Ignorance about the risks of not taking the vaccine.
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Affiliation(s)
| | - Sarya Swed
- Faculty of Human Medicine,Aleppo University, Aleppo, Syria
- Corresponding author.
| | - Bisher Sawaf
- Department of Internal Medicine,Syrian Private University, Damascus, Syria
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Baaees MSO, Naiene JD, Al-Waleedi AA, Bin-Azoon NS, Khan MF, Mahmoud N, Musani A. Community-based surveillance in internally displaced people's camps and urban settings during a complex emergency in Yemen in 2020. Confl Health 2021; 15:54. [PMID: 34225760 PMCID: PMC8256204 DOI: 10.1186/s13031-021-00394-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/29/2021] [Indexed: 12/28/2022] Open
Abstract
Background The need for early identification of coronavirus disease (COVID-19) cases in communities was high in Yemen during the first wave of the COVID-19 epidemic because most cases presenting to health facilities were severe. Early detection of cases would allow early interventions to interrupt the transmission chains. This study aimed to describe the implementation of community-based surveillance (CBS) in in internally displaced people (IDP) camps and urban settings in Yemen from 15 April 2020 to 30 September 2020. Methods Following the Centers for Disease Control and Prevention guidance for evaluation of surveillance systems, we assessed the usefulness and acceptability of CBS. For acceptability, we calculated the proportion of trained volunteers who reported disease alerts. To assess the usefulness, we compared the alerts reported through the electronic diseases early warning system (eDEWS) with the alerts reported through CBS and described the response activities implemented. Results In Al-Mukalla City, 18% (14/78) of the volunteers reported at least one alert. In IDP camps, 58% (18/31) of volunteers reported at least one alert. In Al-Mukalla City, CBS detected 49 alerts of influenza-like illness, whereas health facilities detected 561 cases of COVID-19. In IDP camps, CBS detected 91 alerts of influenza-like illness, compared to 10 alerts detected through eDEWS. In IDP camps, CBS detected three other syndromes besides influenza-like illness (febrile illness outbreak suspicion, acute diarrhoea, and skin disease). In IDP camps, public health actions were implemented for each disease detected and no further cases were reported. Conclusions In Yemen, CBS was useful for detecting suspected outbreaks in IDP camps. CBS implementation did not yield expected results in general communities in urban areas in the early stage of the COVID-19 pandemic when little was known about the disease. In the urban setting, the system failed to detect suspected COVID-19 cases and other diseases despite the ongoing outbreaks reported through eDEWS. In Yemen, as in other countries, feasibility and acceptability studies should be conducted few months before CBS expansion in urban communities. The project should be expanded in IDP camps, by creating COVID-19 and other disease outbreak reporting sites. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00394-1.
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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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Noushad M, Al-Saqqaf IS. COVID-19: Is herd immunity the only option for fragile Yemen? Int J Infect Dis 2021; 106:79-82. [PMID: 33737135 PMCID: PMC7959686 DOI: 10.1016/j.ijid.2021.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/30/2022] Open
Abstract
The first case of COVID-19 in Yemen was confirmed on 10 April 2020. Having faced with a six-year long conflict that has destroyed half of its healthcare facilities and displaced millions, predictions of infections and mortality in Yemen suggested a looming healthcare catastrophe. Difficulty in implementing coordinated lockdowns and preventive measures due to the daily labor working nature of the majority of the population, provided the perfect breeding ground for the SARS-CoV-2 virus. However, official figures of infections and mortality are very low and there have not been confirmed reports of excess mortality. This could indicate that Yemen is silently marching towards forced herd immunity. Seroprevalence studies will provide useful insight into the COVID-19 transmission trajectory in Yemen, which can serve as a guide in planning vaccine distribution strategies and allocating the limited funds wisely.
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Affiliation(s)
- Mohammed Noushad
- College of Dentistry, Dar Al Uloom University, Riyadh, Saudi Arabia.
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COVID-19 case fatality rates can be highly misleading in resource-poor and fragile nations: the case of Yemen. Clin Microbiol Infect 2021; 27:509-510. [PMID: 33429029 PMCID: PMC7836539 DOI: 10.1016/j.cmi.2021.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/09/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022]
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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] [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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