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Esteves Mills J, Thomas A, Abdalla N, El-Alam R, Al-Shabi K, Ashinyo ME, Bangoura FO, Charles K, Chipungu J, Cole AO, Engebretson B, Goyol K, Grasham CF, Grossi V, Hickling S, Kalandarov S, Ababu AK, Kholmuhammad K, Klaesener-Metzner N, Kugedera Z, Kwakye A, Lee-Llacer A, Maani PP, Makhafola B, Mohamed A, Monirul Alam M, Monse B, Northover H, Palomares A, Patabendi N, Paynter N, Prasad-Gautam O, Panthi SR, Rudge L, Saha S, Salaru I, Saltiel G, Sax L, Shahid MA, Gafur MS, Shrestha S, Szeberényi K, Tidwell JB, Trinies V, Yiha O, Ziganshin R, Gordon B, Cumming O. How can global guidelines support sustainable hygiene systems? BMJ Glob Health 2023; 8:e013632. [PMID: 37879652 PMCID: PMC10603483 DOI: 10.1136/bmjgh-2023-013632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/12/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Joanna Esteves Mills
- Water, Sanitation, Hygiene and Health Unit, Department of Environment, Climate Change and Health, World Health Organization (WHO), Geneva, Switzerland
| | - Ann Thomas
- United Nations Children's Fund (UNICEF), New York, New York, USA
| | - Nadia Abdalla
- Water, Sanitation, Hygiene and Health Unit, Department of Environment, Climate Change and Health, World Health Organization (WHO), Geneva, Switzerland
| | - Rola El-Alam
- WHO Regional Office for the Eastern Mediterranean, Amman, Jordan
| | | | | | | | | | - Jenala Chipungu
- Centre for Infectious Disease Research, Zambia (CIDRZ), Lusaka, Zambia
| | | | - Betsy Engebretson
- Water, Sanitation, Hygiene and Health Unit, Department of Environment, Climate Change and Health, World Health Organization (WHO), Geneva, Switzerland
| | - Kitka Goyol
- UNICEF Ethiopia Country Office, Addis Ababa, Ethiopia
| | | | - Valentina Grossi
- European Centre for Environment & Health, WHO Regional Office for Europe, Bonn, Germany
| | | | | | | | | | | | | | | | - Andrea Lee-Llacer
- Department of Health, Government of the Philippines, Manila, Philippines
| | - Pauke P Maani
- Department of Public Health, Ministry of Health, Funafuti, Tuvalu
| | - Belinda Makhafola
- Ministry of Health, Government of South Africa, Pretoria, South Africa
| | | | | | - Bella Monse
- German Agency for International Cooperation, Bonn, Germany
| | | | - Aarin Palomares
- Global Handwashing Partnership, Washington, District of Columbia, USA
| | | | | | | | - Sudan Raj Panthi
- Environmental Health, World Health Organization, Kathmandu, Nepal
| | - Lisa Rudge
- Foreign Commonwealth & Development Office, Government of the United Kingdom, London, UK
| | | | - Ion Salaru
- National Agency for Public Health, Government of the Republic of Moldova, Chisinau, Moldova (the Republic of)
| | | | - Laurent Sax
- Health Emergency Interventions, WHO, Geneva, Switzerland
| | - Mir Abdus Shahid
- Department of Public Health Engineering, Government of Bangladesh, Dhaka, Bangladesh
| | | | | | - Katalin Szeberényi
- National Center for Public Health, Government of Hungary, Budapest, Hungary
| | | | - Victoria Trinies
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Osman Yiha
- WHO Ethiopia Country Office, Addis Ababa, Ethiopia
| | | | - Bruce Gordon
- Water, Sanitation, Hygiene and Health Unit, Department of Environment, Climate Change and Health, World Health Organization (WHO), Geneva, Switzerland
| | - Oliver Cumming
- London School of Hygiene and Tropical Medicine, London, UK
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Kotiso M, Qirbi N, Al-Shabi K, Vuolo E, Al-Waleedi A, Naiene J, Senga M, Khalil M, Basaleem H, Alhidary A. Impact of the COVID-19 pandemic on the utilisation of health services at public hospitals in Yemen: a retrospective comparative study. BMJ Open 2022; 12:e047868. [PMID: 34980605 PMCID: PMC8724586 DOI: 10.1136/bmjopen-2020-047868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to a global crisis, creating an unprecedented situation, which has taken the world by storm, overshadowing on all life' aspects and having a significant impact on the health systems of most countries. In this study, the delivery of health services is investigated both before and during the outbreak of the COVID-19 pandemic at public hospitals in Yemen to assess the impact of COVID-19 on the utilisation of health services. METHOD Data collected from 127 hospitals in Yemen were reviewed using the DHIS2 system. The data represented 3 months before the outbreak of COVID-19 between January and March 2020 and during the outbreak of COVID-19 outbreak between April and June 2020. The results were then compared with the same period in 2019. The utilisation pattern of healthcare services during the period of investigation was compiled and analysed by applying a generalised estimating equation (GEE) to examine the effects of the COVID-19 outbreak in Yemen. The data collected from the targeted hospitals included information related to consultations, surgeries, deliveries, C-sections and penta-3rd dose immunisation. RESULTS The trendline of health services used during the pandemic showed a gradual decline beginning from April 2020 for consultations, surgeries and penta-3rd dose utilisation. The GEE model revealed a significant effect (p<0.05) during the outbreak compared with preoutbreak in the consultation services (B=-1,343.9; 95% CI -1,767.2 to -920.6; χ2=38.718), surgeries (B=-54.98; 95% CI -79.13 to -30.83, χ2=19.911) and penta-3rd dose (B=-24.47; 95% CI -30.56 to -18.38 and χ2=62.010). As for deliveries and C-sections, the results were shown to be statistically non-significant. CONCLUSION The impact of COVID-19 on continuity of health services delivery in Yemen has been distinct and profound, where the study revealed that the number of the consultations, surgeries and number of vaccinated children have been declined during the COVID-19 pandemic, likely due to the partially lockdown measures taken and fear of being infected. However, the deliveries and C-section services remained nearly in the same level and did not affect by the COVID-19 pandemic.
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Affiliation(s)
| | | | | | | | - Ali Al-Waleedi
- Yemen Ministry of Public Health and Population, Aden, Yemen
| | | | | | - Mohammed Khalil
- Yemen Ministry of Public Health and Population, Sana'a, Yemen
| | - Huda Basaleem
- Department of Community Medicine, University of Aden Faculty of Medicine and Health Science, Aden, Yemen
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Garber K, Fox C, Abdalla M, Tatem A, Qirbi N, Lloyd-Braff L, Al-Shabi K, Ongwae K, Dyson M, Hassen K. Estimating access to health care in Yemen, a complex humanitarian emergency setting: a descriptive applied geospatial analysis. Lancet Glob Health 2020; 8:e1435-e1443. [PMID: 33069304 PMCID: PMC7561303 DOI: 10.1016/s2214-109x(20)30359-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 11/18/2022]
Abstract
Background In conflict settings, data to guide humanitarian and development responses are often scarce. Although geospatial analyses have been used to estimate health-care access in many countries, such techniques have not been widely applied to inform real-time operations in protracted health emergencies. Doing so could provide a more robust approach for identifying and prioritising populations in need, targeting assistance, and assessing impact. We aimed to use geospatial analyses to overcome such data gaps in Yemen, the site of one of the world's worst ongoing humanitarian crises. Methods We derived geospatial coordinates, functionality, and service availability data for Yemen health facilities from the Health Resources and Services Availability Monitoring System assessment done by WHO and the Yemen Ministry of Public Health and Population. We modelled population spatial distribution using high-resolution satellite imagery, UN population estimates, and census data. A road network grid was built from OpenStreetMap and satellite data and modified using UN Yemen Logistics Cluster data and other datasets to account for lines of conflict and road accessibility. Using this information, we created a geospatial network model to deduce the travel time of Yemeni people to their nearest health-care facilities. Findings In 2018, we estimated that nearly 8·8 million (30·6%) of the total estimated Yemeni population of 28·7 million people lived more than 30-min travel time from the nearest fully or partially functional public primary health-care facility, and more than 12·1 million (42·4%) Yemeni people lived more than 1 h from the nearest fully or partially functional public hospital, assuming access to motorised transport. We found that access varied widely by district and type of health service, with almost 40% of the population living more than 2 h from comprehensive emergency obstetric and surgical care. We identified and ranked districts according to the number of people living beyond acceptable travel times to facilities and services. We found substantial variability in access and that many front-line districts were among those with the poorest access. Interpretation These findings provide the most comprehensive estimates of geographical access to health care in Yemen since the outbreak of the current conflict, and they provide proof of concept for how geospatial techniques can be used to address data gaps and rigorously inform health programming. Such information is of crucial importance for humanitarian and development organisations seeking to improve effectiveness and accountability. Funding Global Financing Facility for Women, Children, and Adolescents Trust Fund; Development and Data Science grant; and the Yemen Emergency Health and Nutrition Project, a partnership between the World Bank, UNICEF, and WHO.
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Affiliation(s)
- Kent Garber
- Health, Nutrition, and Population Sector, Middle East and North Africa, World Bank, Washington, DC, USA.
| | - Charles Fox
- Department of Sustainable Development, World Bank, Washington, DC, USA
| | - Moustafa Abdalla
- Health, Nutrition, and Population Sector, Middle East and North Africa, World Bank, Washington, DC, USA
| | - Andrew Tatem
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | | | | | | | - Kennedy Ongwae
- Health and Nutrition Department for UNICEF Yemen, Amman, Jordan
| | - Meredith Dyson
- Health and Nutrition Department for UNICEF Yemen, Amman, Jordan
| | - Kebir Hassen
- Health and Nutrition Department for UNICEF Sudan, Khartoum, Sudan
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