Public Health articles list

Background: The first wave of the COVID-19 pandemic was associated with significant morbidity and mortality among healthcare workers worldwide. The present study aimed to assess the knowledge, attitudes, and practices of healthcare workers toward COVID-19 at Ataq General Hospital, and three other hospitals and health centers in Shabwah Governorate, Yemen. Materials and Methods: From January 1, 2022, to February 28, 2022, a cross-sectional survey of healthcare workers was conducted in the city of Ataq, Shabwah Governorate at the following hospitals: Ataq General Hospital, Al Shefa’a Hospital, Al Aafiah Hospital, and COVID-19 Isolation Center. Results: A total of 107 healthcare workers completed the survey. Their mean age was 28.17 ± 7.73 years, 79 (73.8%) of them were male and 28 (26.2%) were female. The overall knowledge was good, with a score of 19 out of 21; however, most participants were unaware of some of the extra-respiratory symptoms of the disease, such as diarrhea and confusion, and about 57% of them were unaware that eating or interacting with wild animals may contribute to the infection with the COVID-19 virus. Attitude analysis of the participants revealed that about half of those surveyed do not believe that Yemen can contain COVID-19. In general, the practice of the participants was good. Conclusion: Although the overall knowledge score in this study was good, most respondents could not recognize some of the extrapulmonary manifestations of COVID-19 and were unaware of the possibility of transmission of the disease from wild animals. In addition, about half of those surveyed do not believe that Yemen can contain COVID-19

Karishma

Ascaris lumbricoides infestation is a worldwide common soil-transmitted helminths infection mainly affecting children in the developing and low socioeconomic status countries where the transmission is by contamination of soil by human feces or use of untreated feces as fertilizer [1]. However, it is rare in Qatar, and most cases have been reported among non-Qatari residents who visited their home country while on vacation. In this report, we presented a case of A. lumbricoides infection in a preschool child who arrived in Qatar after a trip to the Gaza strip.

Karishma

The leaves of khat (Catha edulis) are chewed as a social habit for the central stimulant action of their cathinone content. There is growing concern about the health hazards of chronic khat chewing. Many authors have addressed the adverse effects of khat chewing on the cardiovascular and other systems. Based on a limited number of case reports and few prospective controlled studies, associations between khat chewing and the occurrence of myocardial infarction, dilated cardiomyopathy, and vascular diseases such as hypertension and cerebrovascular ischemia have been proposed. This review outlines the current knowledge on the adverse health effects of khat chewing on the cardiovascular system, assesses the strength and the limitations of the studies, and identifies the questions that the future studies should address.

Karishma

Background: Although stroke is a major problem in Hadhramout Governorate, there is a scarcity of reliable information on risk factors of stroke and predictors of in-hospital mortality. The aim of this study was to explore the risk factors and outcomes of stroke patients admitted to Ibn Sina Hospital, Hadhramout, Yemen, and to identify the predictors of in-hospital mortality. Methods and Materials: This retrospective cross-sectional study was conducted in Ibn Sina Hospital in Mukalla district, Hadhramout Governorate, over a 4-month period (from January 1, 2021, to April 30, 2021). Results: During the study period, we recruited 100 cases of stroke, of whom 77 (77%) were male and 23 (23%) were female. Their mean age was 65.42±12.78 years. Hypertension was the most common risk factor, occurring in 81 (81%) patients, while no risk factors were identified in 5 (5%) cases (Cryptogenic). Ischemic stroke was found in 70 (70%) cases, and hemorrhagic stroke was noticed in 30 (30%) patients. The in-hospital mortality was 29 (29%), and the univariate analysis found male sex, hypertension, and hemorrhagic stroke as probable predictors of in-hospital mortality. Only hemorrhagic stroke (adjusted odds ratio [OR]=2.053 and 95% confidence interval [CI]=0.822–1.599; p<0.001) and hypertension (adjusted OR= 1.677; 95% CI=0.555–1.495; p=0.011) were found to be independent predictors of mortality by multivariate logistic regression analysis. Conclusion: Stroke is a major problem in Hadhramaut Governorate with ischemic stroke being more than hemorrhagic. Men were more likely to have a stroke than women and majority of cases were elderly. Hypertension, diabetes mellitus, smoking, and dyslipidemia were the most commonly identified risk factors that were significantly associated with stroke. Hemorrhagic stroke and presence of hypertension were found to be risk factors for in-hospital mortality; therefore, hypertension should be well-controlled to reduce in-hospital mortality.

Karishma

Background and Objective: Health care workers (HCWs) are at the highest risk of contracting COVID-19, so their knowledge about the disease and their preventive attitude and practice toward COVID-19 are of concern. The present study aimed to assess the knowledge, attitudes, and practices of HCWs toward COVID-19 in Al-Thawra Hospital, Ibb Governorate, Yemen. Materials and Methods: We conducted a cross-sectional survey among HCWs in Al-Thawra Hospital, Ibb, Yemen, from January 1 to March 31, 2022. Results: Of the 80 participants, 50 (62.5%) were males and 30 (37.5%) were females with a mean age of 29.33±7.86 years. About 51.2% of respondents were aware that sneezing is a recognized symptom of COVID-19, while most were unaware of the extrarespiratory symptoms of the disease, such as diarrhea and confusion. About 28.7% of respondents believed that eating or contacting wild animals would result in infection by the COVID-19 virus, with the majority (71.3%) agreeing that wearing a well-fitting face mask effectively prevents COVID-19 infection. Approximately 48 respondents (60.0%) believed that washing hands could prevent contracting COVID-19, and only 31 (38.7%) agreed that if a patient shows signs and symptoms of COVID-19, they can confidently participate in that patient’s treatment. In response to avoid COVID-19, about 23 respondents (28.7%) had always gone to crowded places, and 35 (43.6%) had always worn face masks at every contact with patients, while only 14 (17.5%) of participants refrained from shaking hands and 37 (46.3%) always washed their hands before and after handling each patient. Conclusion: This study showed that most respondents have poor knowledge regarding the clinical picture of COVID-19 and its mode of transmission as most of them failed to detect an extrapulmonary manifestation of COVID-19 and were unaware of the possibility of transmission of the disease from wildlife. In addition, the attitude and preventive practice of the respondents were unsatisfactory in containing the transmission of the disease.

Karishma

Background and Objectives: The complications of type 2 diabetes mellitus (T2DM) can occur in some organs, such as the heart, blood vessels, eyes, kidneys, and nerves. Stroke, one of such complications, is increasing every year. This study aims to investigate the prevalence of and risk factors for stroke among T2DM patients in Qatar. Methods: This was a secondary post hoc analysis of collected data from our previous study titled “Association of Vitamin D deficiency with dyslipidemia, glycemic control, and microalbuminuria in patients with T2DM in Qatar.” Results: The prevalence of stroke among our patients was 3.8%. A comparison between stroke and no-stroke groups showed a significant association between stroke and other diseases, namely, chronic kidney diseases (CKD) (p=0.007), coronary artery disease (CAD) (p=0.010), peripheral vascular disease (PVD) (p<0.001), retinopathy (p=0.044), prolonged duration of diabetes mellitus (DM) (p=0.041), glycated hemoglobin (HbA1c) (p=0.006), and a high serum creatinine level (p=0.003). In the multivariate analysis, we identified the following variables as independent risk factors for stroke in patients with T2DM: male gender, CKD, CAD, PVD, high HbA1c, a high creatinine level, and prolonged duration of DM. Conclusion: The prevalence of stroke among T2DM patients in Qatar was around 3.8%. The main risk factors were male gender, CKD, CAD, PVD, high HbA1c, prolonged duration of DM, and a high level of creatinine.

Karishma

Background and Objectives: Despite the controversies that prevail regarding the efficacy of episiotomy, it is still practiced widely around the world in various degrees of prevalence. This study aimed to identify and analyze the prevalence, clinical profile, and complications of episiotomy performed on women who delivered at the Asha’ab Obstetric Emergency Center. Patients and Methods: This was a cross-sectional study that involved women who had undergone vaginal delivery at the Asha’ab Obstetric Emergency Center, in Aden city, Yemen, between October 1, 2021, and March 31, 2022. Permission to conduct the study was obtained from the center’s administrative office. Results: During the study period, 858 women delivered vaginally at our center. Out of these, 443 women had had an episiotomy, representing an episiotomy prevalence of approximately 51.6%. These 443 women were enrolled in this study. The episiotomy was more common among primigravida women (n=362, 81.7%), followed by multiparous women (n=42, 9.5%). The most commonly associated medical disorder was anemia (n=167, 37.7%), followed by hypertension (n=33, 7.4%). Perineal pain (n=51, 11.5%) was the most frequently reported post-episiotomy complication, followed by perineal discomfort (n=32, 7.2%), wound infection (n=27, 6.1%), perineal bleeding (n=18, 4.1), difficulty in walking (n=9, 2.0%), wound dehiscence (n=3, 0.7%), and difficulty in defecation (n=1, 0.2%). Conclusion: The prevalence of episiotomy among women who gave birth at the Asha’ab Obstetric Emergency Center, in Aden city, Yemen, was higher than the World Health Organization recommendation, which is around 10% or less with acceptable obstetric evidence indicating the need. Further prospective large-scale studies are recommended to confirm the findings of this study.

Karishma

Background and Objectives: Research by medical students in Yemen is limited both in terms of quantity and quality. In this light, the early recruitment of medical students into research activities can encourage them to become academically adept and professionally renowned physicians. Therefore, the aim of this study was to evaluate the knowledge, attitudes, and obstacles regarding medical research among medical undergraduates in the Faculty of Medicine and Health Sciences, Ibb University, Yemen. Materials and Methods: For the purpose of this study, a cross-sectional survey was conducted among medical students at the Faculty of Medicine and Health Sciences, Ibb University, Yemen. This survey involved medical students at their 3rd, 4th, 5th, and 6th academic years, who participated in this study from August 01, 2022, to September 30, 2022. The permission to conduct the survey was obtained from the Dean of the Faculty of Medicine and Health Sciences, Ibb University. The data gathered from the survey were analyzed using descriptive statistics. Results: About 174 (92.6%) respondents completed the survey questionnaire. The mean age of these respondents was 23.34 years. Notably, most of them demonstrated low levels of concomitant knowledge despite having positive attitudes toward medical research. Only a few students agreed with the following statements in the questionnaire: there is allotted time to pursue research (14.9% agreed); there is adequate training in research methodology (12.1% agreed); there are sufficient reward/motivations for participation in research (9.2% agreed); there is adequate training on writing a manuscript (9.2% agreed); there is adequate training on the performance of simple statistical analysis (10.4% agreed); research mentors are readily available (16.6% agreed); and it is easy to obtain a permit to conduct research from an institution (20.7% agreed). In addition, less than half of the respondents agreed with the statement that adequate medical research facilities exist in Yemen (39.1%). Conclusion: Most of the respondents in this study showed low levels of knowledge regarding research, despite having positive attitudes toward it. The primary barriers hindering research practices were the following: lack of allotted time to pursue research, lack of adequate training on writing a manuscript, and lack of training on the performance of simple statistical analysis. Moreover, the survey respondents noted a lack of research mentors and difficulties in getting approval for conducting research from their institution.

Karishma

Overpopulation is a global problem which affects almost everyone in the globe by reducing the available natural resources in the existence. An epidemiological survey was conducted with the aim to assess the people’s response towards overpopulation and its harms to them. The study was conducted based upon descriptive survey design using interview method. The study comprises 80 people residing in selected rural area. The data was collected based on purposive sampling using checklist. The study reveals that most of the people are residing by doing unskilled work due to unemployment with poor living standard.

NEERAJ KUMAR BANSAL

Background and Objective: The COVID-19 pandemic affected medical care systems including stroke care, globally. In this study, we investigated the impact of the COVID-19 outbreak on stroke care in Hadramout, in terms of rate of admission, access to care, risk factors, clinical presentation, and outcome. Materials and Methods: A hospital-based cross-sectional study comparing all stroke patients admitted to Ibn-seena University Hospital (ISTH), Mukalla, Hadramout, during two periods, May 1–October 31, 2020, during the pandemic of COVID-19 (COVID-19 group), and from May 1 to October 31, 2019 (pre-COVID-19 group). Data collected from patients’ medical record files into a master sheet, and were processed by the Statistical Package for Social Sciences software. Results: There were 117 stroke patients admitted in COVID-19 pandemic in 2020, and 213 patients admitted in the same period in 2019. Stroke admission declined by 45.1% (Odds Ratio [OR]=0.30, 95% confidence interval [CI] [95% CI]: 0.22–0.42, p<0.0001) with no age and sex differences. Hypertension (HTN) and diabetes mellitus were more frequent in COVID-19 group than the pre-COVID-19 group (OR=1.74, 95% CI: 1.08–2.80, p=0.02) and (OR=1.81, 95% CI: 1.14–2, 88, p=0.01), respectively. No significant difference in other risk factors was found. Patients in COVID-19 group arrived the hospital more late than the patients in pre-COVID-19 group (OR=2.63, 95% CI: 1.64–4.21, p<0.0001). Dysphasia and altered consciousness including coma were more common in COVID-19 group compared with pre-COVID-19 group (OR=4.5, 95% CI: 2.18–9.08, p<0.0001) and (OR=3.2, 95% CI: 2.00–5.12, p<0.0001), respectively. Hospital stay was greatly reduced among COVID-19 group as compared with pre-COVID-19 group (02.9±0.31 days vs. 8.6±0.92 days, p<0.0001) Mortality rate was higher among COVID-19 group than the pre-COVID-19 group (41.9% vs. 27.2%, p=007). Conclusion: The number of stroke patients admitted during the COVID-19 pandemic decreased, they arrived late and spent shorter hospital stays while having higher rates of HTN, diabetes, and impaired consciousness with a high mortality rate.

Karishma

Background and Objectives: Pulmonary tuberculosis (PTB) remains a public health issue in Nigeria. The rapid diagnosis of PTB is essential for the early initiation of treatment and management of patients. The utility of the BACTEC MGIT 960 TB system was evaluated and compared with the Lowenstein Jensen (LJ) culture method for the recovery of Mycobacteria from sputum samples. Methods: A total of 2400 sputum samples submitted to the South East TB Zonal Reference Laboratory, Amachara Umuahia, Nigeria were tested. Samples were decontaminated using the standard N-Acetyl-L-Cysteine Sodium Hydroxide method and concentrated before processing. The processed samples were inoculated into both MGIT 960 tubes and LJ medium and incubated accordingly. Results: From all sputum samples, Mycobacteria were recovered from 201 (8.4%) sputum samples by the MGIT 960 system and 175 (7.3%) by LJ culture (p=0.014). The sensitivity for MGIT and LJ culture for mycobacteria were 95.0% and 80.1%, respectively. Among the 201 MGIT-positive cultures, 127 (63.2%) were identified as Mycobacterium tuberculosis complex and 74 (36.8%) as Mycobacteria other than tuberculosis (MOTT). The recovery rate of MTBC from LJ-positive samples was 84.0% and MOTT 16.0%. MGIT 960 identified more MOTT than LJ culture (p=0.045). The contamination rate associated with MGIT and LJ culture was 4.1% and 2.5%, respectively (p=0.037). The time to detection of mycobacteria in MGIT 960 and LJ was 14.8 days and 33.2 days, respectively. Conclusion: MGIT 960 has good diagnostic accuracy. It provided a more rapid and higher recovery of all mycobacteria than the LJ culture.

Karishma

Background: There is a lack of adequate data about the prevalence and types of tuberculosis (TB) disease in Hadramout Al-Sahel, Yemen. Hence, this study aimed to investigate the prevalence, types, and outcomes of TB disease in Hadramout Al-Sahel, Yemen. Materials and Methods: This cross-sectional study was conducted at the National TB Program (NTP) center in the city of Al Mukalla, Hadramout, Yemen. The study enrolled TB patients from different districts of Hadramout Al-Sahel who had registered at the NTP center between January 1 and December 31, 2021. Results: A total of 127 new active TB cases were recruited, including 102 (80.3%) with pulmonary TB (PTB) and 25 (19.7%) with extra PTB (EPTB). The overall prevalence of TB disease in 2021 was 12.7 new TB cases per 100,000 population, while the median age of the study population was 38 years. The majority of cases (23.6%) belonged to the age group of 35–44 years. There were 85 (66.9%) males, and most patients (74; 58.3%) were identified in Al Mukalla City. EPTB was detected in 25 (19.7%) patients, with pleural effusion being the most frequent manifestation, found in 12 (48.0%) patients. All patients received 4-agent anti-TB therapies; 99 (77.9%) patients received anti-TB therapy for 6 months; 9 (7.1%) patients received anti-TB therapy for 9–12 months; 8 (6.3%) patients died during treatment; and 11 (8.7%) patients were lost during follow-up. The majority of patients (108; 85%) were cured on completion of treatment. Conclusion: The prevalence of TB in Hadramout Al -Sahel was 12.7 cases per 100,000 population. Males were affected more than females; the pleura was the most commonly affected extrapulmonary site; and 85% of cases were cured. The results indicated the need to support the Al Mukalla NTP center, by providing more resources for improved TB reporting and for conduct of surveillance to detect new TB cases among high risk groups. Health authorities are also urged to provide state hospitals with the equipment needed for TB diagnosis.

Karishma

Background: In addition to the recent civil war in Yemen, the COVID-19 pandemic resulted in a collapse of the health system, a decline in vaccination coverage, and the spread of numerous outbreaks. In 2022, a measles outbreak impacted Al Dali governorate. This study aimed to describe the demographics of measles patients, measles risk factors, and disease outcomes in Al Dali Governorate, Yemen. Methods: All measles-infected children who sought medical attention at Al Tadhamon Hospital in Al Dali, Yemen, between February and December 2022 were included in this prospective and observational study. Results: During the study period, 154 parents gave their consent to enroll their children in this study; 88 (57.1%) were males, and 66 (42.9%) were females. The mean age of the children was 3.56±2.90 (0.3–12 years). More than half of the mothers (n=88, [57.1%]) were illiterate or had a basic educational level, while most of the fathers (n=126, [81.8%]) were well-educated. Nutritional status was normal in most children (n=146, [94.8%]), and all children were unvaccinated. Most children (n=152, [98.7]) came from areas having measles and most of them (n=130, [84.4]) were in contact with measles cases. Health facilities were close (<3 km) to many children (n=151 [98.1]), and house ventilation was good in 66.2% (n=102) of cases while crowdedness was found in 135 (87.7) cases. Family members were 7 or more in 90 (58.4) cases. Two children under the age of 5 years died because of the disease. Conclusion: Our study showed that the main risk factor for the recent measles outbreak in Al Dali governorate was lack of vaccination, as all involved children were unvaccinated. Routine immunization needs to be reinforced through health centers in different districts and community education about the dangers of the disease and the benefits of the vaccines should be enhanced to prevent outbreaks from recurring.

Karishma