Medical mission to the Yemen, Southwest Arabia, 1951. II. A cursory survey of the intestinal protozoa and helminth parasites in the people of the Yemen.
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Animals↗
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University of Aden, Democratic Yemen: medical education in the People's Democratic Republic of Yemen.
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Curriculum↗
Complement-fixing antibodies against rotaviruses in healthy children in the Czech Socialist Republic and People's Democratic Republic of Yemen.
Levels of complement-fixing antibodies against rotaviruses were evaluated in the sera of 900 healthy children aged 1-9 years 300 sera were collected in the People's Democratic Republic of Yemen in September-October 1985, 300 sera were obtained in the Czech Socialist Republic in the same period and another 300 also in the Czech Socialist Republic in September-October 1986. The latter two groups were investigated in the framework of immunological surveys. A complement-fixation antigen was prepared from a simian strain of the rotavirus type SA-11 in a tissue cell line MA-104. The sera from Yemen featured lower mean titres in the age groups and thus the lowest overall titre. As the antibody titre increased, the portion of seropositive sera from Yemen declined by far more rapidly than in the Czech children, where it remained virtually the same. The sera from Yemen showed the lowest negative rate and lowest ratio of high titres. The antibody titre of 1:64 and higher was not detected in children from Yemen, while they occurred in the two groups of Czech children. There was no correlation between antibody titres and probands' sex, nor was there linear dependence of titre magnitude on age. The mean positivity rate in each group as assessed by the antibody titres was the lowest in the sera from Yemen. The percentage of positive sera in all age groups was higher in the Czech children with the exception of children from Yemen aged 6 and 9 years. The aim of the present study was to evaluate the antibody status in infant populations and thus expand knowledge of rotavirus epidemiology.
Age Factors↗
Risk factors for human brucellosis in Yemen: a case control study.
Brucellosis is known to occur in Yemen but its epidemiology has not been extensively studied. The present investigation examined risk factors for human brucellosis in Yemen using a hospital-based case-control study. A total of 235 consecutive patients with brucellosis attending the Central Health Laboratory in Sana'a, Yemen, were matched in respect of age, sex, and place of residence, rural or urban, with 234 controls selected from individuals attending the Central Health Laboratory for unrelated health problems. Clinical information on patients and controls was supplemented with occupational and socio-economic data obtained by interview of cases and controls using a standard questionnaire. After controlling for confounding factors significant risk factors for infection related to occupation as a farmer (OR 2.5 (95% CI 1.4-4.5, P < 0.0001)), shepherd (OR 7.8 (95% CI 1.0-61, P 0.05)) or microbiologist (OR 24.5 (95% CI 2.9-204, P 0.003)); and drinking fresh milk (OR 2.0 (95% CI 1.3-4.3, P 0.001)) and laban (OR 22.7 (95% CI 1.7-4.2 P < 0.0001)). Taking other milk products and offal were not risk factors. Socio-economic and educational factors were also independent risk factors. Occupational, food and socio-economic risk factors significantly confounded one another. Yemen shares some but not all of the risk factors of neighbouring countries. The interrelation between the various factors is complex and studying any one in isolation may give a false impression of its public health significance. Control through education of the population to minimize exposure to, and contact with, animals and their milk and milk products and to boil milk before drinking it or using it to make buttermilk, would be difficult as these would represent such fundamental changes to established patterns of behaviour of this society. Ideally there would be a campaign to control the infection by animal vaccination but the costs and logistic difficulty would be great. Presently there is a clear need for doctors in Yemen to be made aware of the frequency of this infection, the means available for clinical and laboratory diagnosis and effective treatment, while strategies to control the disease in Yemen are formulated and field tested.
Adolescent↗
Task analysis in education and evaluation: an application among midwives in the Republic of Yemen.
The political union between the countries of North and South Yemen prompted nurse-midwife educators to re-examine the midwifery curricula of both countries and define the roles midwives play as members of the health team, based on the unique circumstance in which Yemeni midwives operate within the health care system. The faculty of the Health and Manpower Institute (HMI), the main educational institution for the education of midwives, recognised that the delineation of tasks attributed to the practice of midwifery varied widely within Yemen, and between Yemen and other countries, despite the existing international definition of the role. In 1992, the Agency for International Development (AID) funded a workshop for the HMI faculty. Nineteen midwives, nurses and other health care professionals used task analysis techniques to define key knowledge, skills and attitudes that a midwife should be taught in Yemen. Task analysis, a psychometric (test development) technique, is a process that can be used to develop specific role delineations. This article describes in detail the process of task analysis in identifying key skills, knowledge and attitudes to be taught to student midwives in Yemen, clarifying the role of midwives and identifying the usefulness of a derived task listing in educational development and student evaluations.
Curriculum↗
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.
Adolescent↗
African links and hepatitis B virus genotypes in the Republic of Yemen.
Hepatitis B virus (HBV) genotypes in three different communities in the Republic of Yemen with and without significant African links were studied. The subjects included indigenous Yemeni blood donors (n = 987), Africans who had settled down in Yemen for several generations (n = 97) and Soqotrans living on an island in the Indian Ocean close to the African coast (n = 99). Phylogenetic analysis of HBV surface region sequences showed the presence of two major genotypes; A and D: sequences from the blood donors were all genotype D (17/17); those from Africans residing in Yemen were predominantly genotype D (7/8) although one sequence was genotype A; whereas a mixture of genotype A and D was found among the Soqotrans (5/8 and 3/8 respectively). Genotype A sequences were associated with higher viral load, but the difference was not statistically significant. Human migration and international travel, may lead to an interaction between HBV genotypes. The Republic of Yemen is at a location where genotypes A and D meet. The results from this study suggest that genotype A is found only in communities with continuing African links and that genotype D remains the dominant genotype in settled populations. More studies are needed to examine possible long-term changes in HBV genotypes in this region.
Africa↗
The management of burns in a developing country: an experience from the republic of Yemen.
BACKGROUND: Burns management and mortality rates have improved in even developing countries including some Arab states. This paper describes an experience with burn victims in the Yemen to draw attention to the victims' plight, the challenge posed to bodies, such as the International Society of Burn Injury (ISBI), and, the basic required corrective measures. PATIENTS AND METHODS: Between 1996 and 1999, sponsored surgical teams paid four visits to four Yemen cities. The patients presented here are a consecutive series of the plastic surgery operations that the teams performed. No literature on burn care in the Yemen could be traced. RESULTS: The cities visited were Mokalla, Sayown, Taiz and Aden. Of 406 plastic procedures, 139 were for post-burn contracture release and are the focus of this paper. The victims were mostly children and the hand (49; 35%) was the most common site. Types of operation performed were release and split skin grafi, excision and full thickness skin grafi, release and local flap, and, multiple Z-plasty. CONCLUSIONS: This experience confirms the believe that, given initiative and efficient organization of available resources, developing countries such as the Yemen can also achieve better burn management. Solutions suggested are determining local health needs; onsite conferences, symposia and training programs; local personnel to visit burn centers overseas; burn research and prevention activities; and epidemiologic studies.
Adolescent↗
Spectrum of skin diseases in Yemen (Hajjah and adjacent region).
BACKGROUND: Epidemiological study of skin diseases from Yemen is not available, although some data has been published from nearby Arab countries. OBJECTIVE: To determine the pattern of skin diseases in Yemen and particularly in Hajjah and nearby regions. METHODS: This is a prospective study and analysis of the consecutive new patients attending the Dermatology Clinic of Saudi Hospital at Hajjah, Yemen, from January 1997 to December 1999. The majority of the patients were from Hajjah and nearby regions but a substantial number of patients came from different distant regions of Yemen. The diagnosis was mainly based on clinical features but supported by laboratory investigations, diagnostic procedures and histopathology when needed. RESULTS: The total number of new patients was 13,840 with 14,259 diseases, with a male to female ratio of 1:0.81. Ninety-nine percent of the patients were Yemeni nationals. The leading group of diseases was dermatitis and eczematous disorders, followed by infections and infestations (including cutaneous leishmaniasis and mycetoma), followed by acne and acneiform disorders. CONCLUSION: The spectrum of skin diseases in this analysis revealed that more than 50% of the diseases belonged to dermatitis and eczematous disorders and infectious diseases groups. Socioeconomic and environmental factors of the region are responsible for this. Implementation of public health programs, a proper health education, and inclusion of a suitable training program of dermatology in the undergraduate medical studies of this country may help to prevent and manage these problems rationally.
Adolescent↗
Spontaneous rupture of a previously scared uterus. A case report and an overview of risk factors in Yemen Republic.
Maternal mortality is a significant public health problem. In Yemen it is attributable to socioeconomic, reproductive, health-status and health-services factors, as well as to medical causes. Direct obstetrical causes account for 61% of maternal deaths in Yemen 75% after delivery. Hemorrhage has been found as the second cause of maternal death in Yemen, accounting for 23.68% of all causes, while ruptured uterus accounts for 14.19% of maternal deaths in particular. The high percentage of ruptured uterus as a cause of maternal mortality prompted me to report the case below hoping it would shed light on the influence of factors, which can lead to this serious situations in Yemen.
Adult↗
Increasing single and multi-antibiotic resistance in Shigella species isolated from shigellosis patients in Sana'a, Yemen.
OBJECTIVE: The epidemiology and antibiotic susceptibility of Shigella species changes over time. Updated susceptibility knowledge is necessary for appropriate empirical antibiotic treatment. Thus, this research aimed to study these changes in 2 time periods with an interval of 10 years. METHODS: Two hundreds and three Shigella strains, isolated from stool samples of diarrheic patients at the Central Health Laboratory in Sana'a, Yemen in 2 time periods (1993 and 2003) with a 10-year interval, were examined for serotyping and drug resistance pattern. Resistance patterns of the strains to 12 commonly used antimicrobial agents and minimum inhibitory concentrations of the antibiotics were tested. RESULTS: Shigella flexneri (60%) was found to be the most common isolate of the total Shigella species, followed by Shigella dysenteriae (28.6%) and Shigella boydii (11.3%). In Shigella flexneri strains, Shigella flexneri 3 (30.5%) was the most prevalent serotype, followed by Shigella flexneri 6 (17.2%), and Shigella flexneri 1 (12.3%). All strains were found equally susceptible to cefotaxime, ceftriaxone, ciprofloxacin, and gentamicin, but more than 80% of the strains of 2003 were resistant to tetracycline, co-trimoxazole, and 52% of the same strains were resistant to ampicillin. Resistance to chloramphenicol was found in 61%, cefuroxime in 56.2%, and cephradine, 52% of the strains. Overall, Shigella species showed statistically significant increase in resistance against tetracycline, cephradine, trimethoprim/sulfamethoxazole, nalidixic acid, and aztreonam (p<0.05) over the 10 years period. This indicates decreased efficacy of co-trimoxazole and nalidixic acid for the empirical treatment of shigellosis in Sana'a, Yemen. Almost 55.2% of the strains were resistant to 4 drugs. CONCLUSION: This is one of the first studies reporting epidemiological pattern of Shigella species in Sana'a, Yemen with regard to serotypes and antibiotic resistance patterns. Based on these antibiotic resistance pattern findings, it is suggested that the commonly in use antibiotics including ampicillin, trimethoprim/sulfamethoxazole, tetracycline, and chloramphenicol should not be used for empirical treatment of shigellosis in Yemen.
Anti-Bacterial Agents↗
The impact of problem-based pharmacotherapy training on the competence of rational prescribing of Yemen undergraduate students.
OBJECTIVE: This study aims to reveal whether a short training course of problem-based pharmacotherapy teaching, based on the World Health Organization's (WHO's) Guide to Good Prescribing and the Yemen Essential Drug List and Standard Treatment Guidelines, will improve the competence of rational prescribing among medical and health assistant students in Yemen. DESIGN: In a controlled pre/post-test study, 111 students from universities and health institutes participated on a voluntary basis. They were randomly separated into a study and a control group. Students of the study group were taught to generate standard first-choice drugs for asthma or diarrhoea. The students were then taught how to apply this set of first-choice drugs to specific patient problems, using the WHO six-step problem-solving approach. RESULTS: Students from the study group performed significantly better than those from control in all problems presented and also when compared with the results of the pre-test. The results of the pre-test also show that teaching students all basic knowledge about drugs does not guarantee rational prescribing in Yemen. CONCLUSION: It can be concluded from this study that proper training, i.e. 'immunising' future doctors using problem-based pharmacotherapy teaching, is an efficient way of teaching rational prescribing in Yemen.
Analysis of Variance↗
Bacterial profile and clinical outcome of childhood meningitis in rural Yemen: a 2-year hospital-based study.
BACKGROUND: Childhood acute bacterial meningitis (ABM) is an important cause of death and long-term neurological disability in Yemen, the only low income-high mortality country in the Arabian Peninsula. The objective of this study was to document the microbial characteristics, the antibacterial sensitivity pattern, and the outcome for children hospitalized with ABM, prior to the introduction of Haemophilus influenzae type b (Hib) vaccine in Yemen. PATIENTS AND METHODS: The study was retrospective, conducted at a rural district hospital, serving the rural population of the northern parts of Yemen. All patients aged 1 month-15 years admitted between May 1999 and June 2001, with clinical evidence of meningitis and cerebrospinal fluid (CSF) cultured, were included in the study. Clinical information from case notes, including CSF result and the outcome on discharge, were obtained. Analysis of extracted data was performed using Epi Info software. RESULTS: During the 2-year study period, 160 study patients met the inclusion criteria, and 7 (4.4%) were negative for bacterial growth. In the 153 positive cultures there were 46 (30.1%) Streptococcus pneumoniae (SP), 23 (15%) H. influenzae (HI), 81 (52.9) Neisseria meningitidis (NM), 2 (1.3%) Staphylococcus aureus (S. aureus), and 1 (0.7%) Escherichia coli. Sixteen study patients died (overall case fatality rate (CFR) 10%), 7 aged under 12 months, 6 aged 12-60 months, and 3 more than 60 months. Ten deaths were due to SP meningitis, 2 HI meningitis, 3 NM meningitis, and 1 had S. aureus. Of the 144 survivors, 28 (19.4%) developed permanent neurological complications, 17 aged less than 12 months, 6 aged 12-60 months, and 5 more than 60 months. SP meningitis accounted for 57.1% (16/28), and 6 (21.4%) had HI meningitis. Among the 89 aged 1-60 months, 13 died (CFR 14.6%), and 23 (30.3%) of the 76 survivors developed permanent complications. Of those tested 20% and 35% of the 20 HI tested isolates and 9.5% and 14.3% of the 42 SP isolates, were resistant to ampicillin and penicillin G, respectively, and the majority of the 81 NM isolates were sensitive to both. The 3 pathogens were largely resistant to gentamicin, and almost all were susceptible to chloramphenicol and cefotaxime. CONCLUSION: In contrast to the studies from the low-mortality countries of the region, our study showed that the predominant pathogens of childhood ABM were SP and NM. SP meningitis was associated with increased mortality and permanent disability.
Adolescent↗
Consanguineous marriage in the capital city Sana'a, Yemen.
Consanguineous marriage is traditionally common throughout the Eastern Mediterranean region, especially in the mainly Muslim countries. To date, there is little information on consanguinity in Yemen. The aim of this study was to ascertain the rate of consanguineous marriage and average coefficient of inbreeding in Sana'a City, Yemen. A population survey was conducted with the intention of covering married couples resident in Sana'a City by means of a multi-stage random sampling technique. A total of 1050 wives and husbands were interviewed on consanguinity in their households. The total incidence of consanguinity was 44-7% (95% CI 41.7-47.7%) with first-cousin marriages constituting 71.6% of the total consanguineous marriages and 32% of all marriages. Paternal parallel first cousins (Type I) accounted for 49% of first-cousin marriages. The average coefficient of inbreeding (F) was 0.02442. The incidence of consanguinity is relatively high in Yemen with predominantly first-cousin marriage. This might be related to the deeply rooted social and cultural beliefs in the country.
Adolescent↗
The epidemiology of iodine deficiency disorders (IDD) in Yemen.
OBJECTIVE: This first nationwide survey was undertaken to estimate the prevalence rates and severity of iodine deficiency disorders (IDD) and the proportion of households consuming iodized salt. DESIGN: The country was stratified into two ecological zones and 30 clusters (primary schools) from each zone, including the required numbers of pupils, were selected randomly. A subsample of pupils provided urine and salt samples for the determination of urinary iodine excretion (UIE) and presence of iodate, respectively. SETTING: Yemen. SUBJECTS: There were a total of 2984 pupils aged 6-12 years of whom 2003 were boys and 981 girls. The majority (1800) pupils were from the lowland/coastal areas (zone II) and the rest (1184) from the mountainous regions (zone I). RESULTS: The total goitre rates (TGR) in the whole country, zones II and I were 16.8%, 31.1% and 7.4%, respectively. The TGR in zone I for males was 32.8% and 27.3% for females, while in zone II the corresponding rates were 8.1% and 5.9%, respectively, and the differences were not statistically significant. Only three cases of visible goitres were encountered. The median UIE levels in zones I, II and the whole country were 13.6, 18.9 and 17.3 microg dl-1, respectively. Based on UIE cut-off points recommended by WHO, IDD was severe in 4.7% of pupils in zone I and 2.6% in zone II. Mild and moderate IDD were found in 18.5% and 8.7% of the pupils respectively. Nearly 70% of the surveyed pupils had UIE values of >/= 10 microg dl-1 (no deficiency). Girls had relatively better iodine nutrition as suggested by higher levels of median UIE. In addition, across all age groups median UIE values were above 10 microg dl-1. Over half of the households consumed iodized salt. CONCLUSIONS: Since the introduction of universal salt iodization in 1996 both the prevalence and severity of IDD in Yemen were reduced markedly and Yemen can now be classified as a country with a mild IDD problem. However, the low level of households consuming iodized salt may hamper the goal of IDD elimination.
Age Distribution↗
Correlates of visit regularity among family planning clients in urban Yemen.
Contraceptive discontinuation has been an important issue in low contraceptive prevalence countries like Yemen. Religious and cultural factors might play a large role in barriers against contraceptive acceptance. This study revealed the characteristics of women who accepted contraception and the factors related to the regularity of visits to a clinic in Yemen. Women perceived that accepting contraception was against neither Islam nor their husband's attitudes. They rather paid attention to mother and child health. Regularity of visits was not related to socioeconomic or demographic factors, but was related to satisfaction with family planning services. This implies that different approaches are needed to promote 'continuation' and 'regular visits'. A population policy which promotes birth spacing for maternal health in accordance with cultural contexts should be an effective and acceptable strategy in Yemen. Regular visits could be prompted by increasing the quality of services, including communication between clients and providers about side-effects and alternative choices of methods.
Adolescent↗
Dermatologists combat leprosy in Yemen.
BACKGROUND: Leprosy has been prevalent in Yemen for many years. The ostracization and stigmatization of leprosy patients are well documented in the yemeni literature. No control activities were carried out until 1980. AIM: To document the development of leprosy control activities in the Republic of Yemen during the period from 1982 to 1996. MATERIALS AND METHODS: The dermatologists in Yemen used various methods, including the media, to fight the stigma of leprosy and thus to mobilize the community for the reintegration of leprosy patients. They sought support from international non-governmental organizations (NGOs) to start mobile teams all over the country. RESULTS: The support of the German Leprosy Relief Association (GLRA) and the World Health Organization (WHO) enabled the National Leprosy Control Program (NLCP) to reach people in remote areas. The prevalence of leprosy has declined from 1.9 per 10,000 population in 1989 to 0.5 per 10,000 population in 1996. CONCLUSIONS: The stigma associated with leprosy also extends to other skin diseases. To combat this stigma, various methods, such as health education, training of medical personnel, and mass treatment for skin diseases, have been used.
Communicable Disease Control↗
Mycetoma in Yemen: clinicoepidemiologic and histopathologic study.
BACKGROUND: Mycetoma is widespread in Yemen, but has not been fully documented. METHODS: A prospective study of 70 patients (53 male, 17 female; from different regions of Yemen) was performed. The clinical profile of the cases was recorded in a special protocol. The diagnosis was based on clinical features, examination of grains, roentgenographic studies, and histopathology (44 cases). RESULTS: Fifty cases were diagnosed as eumycetoma and 20 as actinomycetoma. The identification of the causative species was performed in 44 cases by histopathologic studies. Among the cases of eumycetoma, Madurella mycetomatis was recognized in 27 patients, Leptosphaeria senegalensis in two, and pale-grain fungi in two. Among the cases of actinomycetoma, Streptomyces somaliensis was seen in eight patients, Streptomyces madurae in one, and Nocardia species in four. The treatment of eumycetoma patients with ketoconazole and excision in selected cases controlled the disease activity in the majority. Most of the cases of actinomycetoma were better controlled with drug therapy alone, with a combination of penicillin and cotrimoxazole, or cotrimoxazole alone. CONCLUSIONS: Mycetoma is widespread in Yemen, with a higher incidence of eumycetoma and a maximum number of cases from the Hudaida region. A multicenter study is needed to evaluate the exact extent of disease.
Adolescent↗