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Hassan OEH, Al-Aghbari AA, McGowan M, Dar Iang M, Basaleem HO, Al-Sakkaf KA, Hyzam D, Jahn A, Dureab F. Knowledge, attitudes, and practices toward COVID-19 prevention in Yemen: a community-based cross-sectional study. Front Public Health 2023; 11:1178183. [PMID: 37492140 PMCID: PMC10364124 DOI: 10.3389/fpubh.2023.1178183] [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: 03/02/2023] [Accepted: 06/21/2023] [Indexed: 07/27/2023] Open
Abstract
Background Pandemics, especially in fragile war-torn countries like Yemen, challenge their already strained health systems. Community adherence to pandemic prevention measures is necessary to curb the severity and spread of emerging pandemics - which is influenced by factors, such as people's knowledge and attitudes toward the pandemic. No studies in Aden have been published on the communities' knowledge, attitudes, and practices (KAP) toward COVID-19 prevention to date. To understand adherence to pandemic prevention measures in contexts with fragile health systems, this study investigated KAP of Yemeni participants toward the COVID-19 pandemic. Methods We conducted face-to-face semi-structured questionnaires among 400 eligible participants whom were identified for participation in this study through systematic household sampling from eight districts in Aden, Yemen. Eligible participants were Yemeni community members who were ≥ 18 years, living for more than 10 years in Yemen, and were willing to voluntarily participate in the study. The questionnaire included questions surrounding the participants' COVID-19 knowledge (e.g., awareness of spread and prevention), attitudes (e.g., willingness to accept the vaccine or other prevention measures), and prevention practices during the pandemic (e.g., mask wearing, social distancing, vaccine uptake). Total KAP scores were calculated. Univariate and bivariate statistical analyses were conducted using STATA 13 software. Results From January to May 2021 we conducted 400 questionnaires with Yemeni community members. The average age was 41.5 ± 14.5 years (range 18-86 years). The results demonstrated that the participants in this study had an intermediate knowledge (53%) and fair attitude (58%) scores. However, participants reported very poor COVID-19 prevention practices- with only 11% demonstrating these practices. Only 25% (100/400) practiced social distancing, 25% (98/400) wore a mask, and only 6% (27/400) of participants accepted (at least one dose of) the COVID-19 vaccine. Factors associated with increased knowledge were being male, married, and surprisingly those having a primary and middle school education levels (p < 0.05). Also participants who were diagnosed with COVID-19 or had a family member diagnosed with COVID-19 (vs. those not diagnosed OR = 2.08, 95% CI 1.07-3.78, p < 0.05) were more likely to know that the vaccine protects against severe COVID-19 infection and were more likely to apply good practices such as accepting the vaccine (OR = 2.65, 95% CI 1.17-6.00, p < 0.05) compared to those who were not. Conclusion These findings raise awareness for the need of community-oriented education programs for COVID-19 which considers associated factors to improve the level of public knowledge, attitudes, and practices.
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Affiliation(s)
- Ola El Hajj Hassan
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Maureen McGowan
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Maureen Dar Iang
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Huda Omer Basaleem
- Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | | | - Dalia Hyzam
- Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | - Albrecht Jahn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Fekri Dureab
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Institute of Research for International Assistance, Akkon Hochschule, Berlin, Germany
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Letta TT, Belay DB, Ali EA. Determining factors associated with cholera disease in Ethiopia using Bayesian hierarchical modeling. BMC Public Health 2022; 22:1779. [PMID: 36123680 PMCID: PMC9487065 DOI: 10.1186/s12889-022-14153-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background Cholera is a diarrheal disease caused by infection of the intestine with the gram-negative bacteria Vibrio cholera. It is caused by the ingestion of food or water and infected all age groups. This study aimed at identifying risk factors associated with cholera disease in Ethiopia using the Bayesian hierarchical model. Methods The study was conducted in Ethiopia across regions and this study used secondary data obtained from the Ethiopian public health institute. Latent Gaussian models were used in this study; which is a group of models that contains most statistical models used in practice. The posterior marginal distribution of the Latent Gaussian models with different priors is determined by R-Integrated Nested Laplace Approximation. Results There were 2790 cholera patients in Ethiopia across the regions. There were 81.61% of patients are survived from cholera outbreak disease and the rest 18.39% have died. There was 39% variation across the region in Ethiopia. Latent Gaussian models including random and fixed effects with standard priors were the best model to fit the data based on deviance. The odds of surviving from cholera outbreak disease for inpatient status are 0.609 times less than the outpatient status. Conclusions The authors conclude that the fitted latent Gaussian models indicate the predictor variables; admission status, aged between 15 and 44, another sick person in a family, dehydration status, oral rehydration salt, intravenous, and antibiotics were significantly associated with cholera outbreak disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14153-1.
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Challa JM, Getachew T, Debella A, Merid M, Atnafe G, Eyeberu A, Birhanu A, Regassa LD. Inadequate Hand Washing, Lack of Clean Drinking Water and Latrines as Major Determinants of Cholera Outbreak in Somali Region, Ethiopia in 2019. Front Public Health 2022; 10:845057. [PMID: 35602140 PMCID: PMC9120658 DOI: 10.3389/fpubh.2022.845057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Cholera remains a serious public health problem characterized by a large disease burden, frequent outbreaks, persistent endemicity, and high mortality, particularly in tropical and subtropical low-income countries including Ethiopia. The recent cholera outbreak in the Somali region began on 4 September to 1 November 2019. Cholera may spread rapidly through a population so that an early detection and reporting of the cases is mandatory. This study aimed to identify determinants of cholera infection among >5 years of age population in Somali region, Ethiopia. Methods A community-based unmatched case-control study was conducted among 228 (76 cases and 152 controls, 1:2 ratio) systematically selected population. Data were collected using a structured questionnaire administered by an interviewer and a record review. Descriptive statistics and multivariable logistic regression analysis was used to identify the determinants of the risk factors of cholera infection with a 95% confidence interval and statistical significance was declared a tap-value < 0.05. Results A total of 228 participants (33.3% cases and 66.7% controls) were enrolled in this study. The majority of the cases were in the range of 20–49 years of age (69.7%). The odds of acquiring cholera infection increased significantly by drinking unsafe pipe water (AOR 4.3, 95% CI 1.65–11.2), not having a household level toilet/latrine (AOR 3.25, 95% CI 1.57–6.76), hand washing only sometimes after the toilet (AOR 3.04, 95% CI 1.58–5.86) and not using water purification methods (AOR 2.3, 95% CI 1.13–4.54). Conclusion Major risk factors for cholera infection were related to drinking water and latrine hygiene. Improvement in awareness creation about cholera prevention and control methods, including water treatment, hygiene and sanitation were crucial in combating this cholera outbreak. Primary public health actions are ensuring clean drinking water, delivery of water purification tablets, soap and hand sanitizers and provision of health care and outbreak response. Long term goals in cholera affected areas include comprehensive water and sanitation strategies. Overall, the strategic role of a multi-sectoral approach in the design and implementation of public health interventions aimed at preventing and controlling cholera are essential to avert cholera outbreaks. Preparedness should be highlighted in cholera prone areas like Somali region especially after drought periods.
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Affiliation(s)
- Jemal Mussa Challa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- *Correspondence: Tamirat Getachew ; orcid.org/0000-0002-0057-9062
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Melkamu Merid
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Genanaw Atnafe
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abdi Birhanu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemma Demissie Regassa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Dureab F, Al-Qadasi Y, Nasr H, Al-Zumair M, Al-Mahbashi T. Knowledge on and preventive practices of cholera in Al-Mahweet - Yemen, 2018: a cross-sectional study. JOURNAL OF WATER AND HEALTH 2021; 19:1002-1013. [PMID: 34874906 DOI: 10.2166/wh.2021.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Yemen has experienced one of the world's worst cholera outbreaks in the recent history of cholera records. This study aims to identify knowledge and practices among people of Al-Mahweet governorate toward cholera infection, which can play a critical role in reducing cholera morbidity and shaping the public health response. A cross-sectional study was conducted in an area of high cholera prevalence in 2018 using structured questionnaires. Most community respondents were able to correctly identify the symptoms and risk factors of cholera. While 65% of the respondents in this study knew that proper disposal of human waste is an essential measure of cholera prevention, only 11% of the respondents knew that proper washing of fruits and vegetables lowers the risk of cholera infection. About 62.5% of households did not treat water for safe drinking. Water was scarce in about 30% of households and near-home defecation was observed in about 23%. In conclusion, this study reveals several gaps in different aspects of hygienic and preventive practices including water treatment, waste disposal, and defecation practices. Cholera response should contain comprehensive health promotion interventions to improve the public's knowledge and enhance healthy practices. Stakeholders should support communities with sustainable water and sanitation systems.
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Affiliation(s)
- Fekri Dureab
- Heidelberg Institute of Global Health, Uniklinikum Heidelberg 69115, Germany; IRIA, Akkon-Hochschule für Humanwissenschaften, Berlin, 12099, Germany
| | - Yasameen Al-Qadasi
- Yemeni Public Health Consultant, 2011 VN, Haarlem, The Netherlands E-mail:
| | - Hani Nasr
- Charite Universitätsmedizin-Berlin, Berlin, Germany
| | - Marwah Al-Zumair
- Heidelberg Institute of Global Health, Uniklinikum Heidelberg 69115, Germany; IRIA, Akkon-Hochschule für Humanwissenschaften, Berlin, 12099, Germany
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Bin-Hameed EA, Joban HA. Cholera Outbreak in Hadhramout, Yemen: The Epidemiological Weeks 2019. INTERNATIONAL JOURNAL OF EPIDEMIOLOGIC RESEARCH 2021. [DOI: 10.34172/ijer.2021.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background and aims: Cholera is a disease of acute watery diarrhea caused by Vibrio cholerae usually transmitted through contaminated water. In this study, we collected and analyzed the related epidemiological data to determine cholera outbreak in Hadhramout, Yemen during the disease epidemic in 2019. Methods: A cross-sectional study was conducted according to screening rapid diagnostic and confirmatory laboratory culture testing methods for diagnosing clinically cholera cases. Results: Suspected cholera cases were tested by rapid diagnostic test (RDT) and 399 (50.5%) out of 794 cases were determined positive, and 76(9.6%) of them were confirmed by laboratory culture test (LCT) with statistically significant difference. Serotype V. cholerae O1 was also detected in patients’ diarrhea. Females were the most affected by the disease manifested in 201 (25.3%) and 43 (5.4%) when tested by RDT and LCT, respectively, with no statistically significant difference. The highest proportion of cholera cases (224) were reported in the age group less than 15 years (56.1%) with statistically significant difference when tested by RDT, and 45(13.3%) when tested by LCT with insignificant statistics difference. Hajr directorate was revealed to be the most affected with 242 (30.47%) followed by Mukalla city directorate with 108 (13.60%) when the cases were tested by RDT; while Hajr and Mukalla city directorates reported 55 (7.0%) and 15 (2.0%), respectively, when it was confirmed by LCT with a statistically significant difference. Conclusion: Severe cholera outbreak occurred during the epidemiological weeks in 2019 in Hadhramout coast. V. cholerae O1 serotype was the causative agent of cholera. Females and age group less than 15 years were the most affected by the disease. Hajr and Mukalla city directorates reported serious outbreak cholera cases.
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Affiliation(s)
| | - Huda Ameen Joban
- The National Center of Public Health Laboratories, Hadhramout Coast Branch, Yemen
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Qaserah AM, Al Amad MA, Al Serouri AA, Khader YS. Risk Factors of Cholera Transmission in Al Hudeidah, Yemen: Case-control study (Preprint). JMIR Public Health Surveill 2021; 7:e27627. [PMID: 36260393 PMCID: PMC8406125 DOI: 10.2196/27627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Mohammed Abdullah Al Amad
- Yemen Field Epidemiology Training Program, Yemen Ministry of Public Health and Population, Sana'a, Yemen
| | | | - Yousef Saleh Khader
- Department of Community Medicine, Public Health, and Family Medicine, Faculty of Medicine, Jordan University of Science & Technology, Amman, Jordan
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Reinventing the Wheel of Echinococcus granulosus sensu lato Transmission to Humans. Trends Parasitol 2020; 36:427-434. [PMID: 32298630 DOI: 10.1016/j.pt.2020.02.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/03/2020] [Accepted: 02/24/2020] [Indexed: 12/31/2022]
Abstract
Control of cystic echinococcosis (CE) relies on interrupting Echinococcus granulosus sensu lato transmission through interventions in dogs and livestock. However, primary prevention measures aimed at avoiding ingestion of Echinococcus eggs may help reduce the burden of human CE. CE is generally considered, to variable extents, to be foodborne, but there is little evidence on the actual contamination of matrices and sociocultural factors involved in parasite transmission. An overall appraisal of published literature suggests that environmental contamination, possibly through hand-to-mouth transmission, may be of primary importance. While in most endemic areas sufficient epidemiological information is available to start CE control programs, identifying the main sources of infection to humans would allow optimization of site-specific interventions while avoiding irrelevant health education messages.
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