Risk communication and community engagement as an emerging pillar of health emergency management in Iran: Achievements and the way forward

This article is part of the Research Topic Health Systems Recovery in the Context of COVID-19 and Protracted Conflict. Risk communication and community engagement (RCCE) is an essential component of emergency preparedness and response. In Iran, RCCE is a relatively new area of public health. During the COVID-19 pandemic in Iran, the national task force relied on conventional methods, which is to utilize existing primary health care (PHC) structure to implement RCCE activities around the country. The PHC network and the community health volunteers embedded in it enabled the country to bridge the health system and communities from the very beginning of the COVID-19 pandemic. The RCCE strategy to respond to COVID-19 was adapted over time with the development of a national program, commonly known as the "Shahid Qassem Soleimani” project. This project consisted of six steps including case detection, laboratory testing through the establishment of sampling centers, scale up of clinical care to vulnerable groups, contact tracing, home care for vulnerable population, and COVID-19 vaccination roll out. Nearly 3 years into the pandemic, the importance of designing RCCE for all types of emergencies, allocating a dedicated team to RCCE, coordinating with different stakeholders, improving the capacity of RCCE focal points, practicing more efficient social listening, and using social insight for better planning were identified as some lessons learned. Further, Iran's RCCE experience during the COVID-19 pandemic underscores the importance of continuing to invest in the health system, particularly PHC.

Risk communication and community engagement as an emerging pillar of health emergency management in Iran: Achievements and the way forward.

This article is part of the Research Topic Health Systems Recovery in the Context of COVID-19 and Protracted Conflict. Risk communication and community engagement (RCCE) is an essential component of emergency preparedness and response. In Iran, RCCE is a relatively new area of public health. During the COVID-19 pandemic in Iran, the national task force relied on conventional methods, which is to utilize existing primary health care (PHC) structure to implement RCCE activities around the country. The PHC network and the community health volunteers embedded in it enabled the country to bridge the health system and communities from the very beginning of the COVID-19 pandemic. The RCCE strategy to respond to COVID-19 was adapted over time with the development of a national program, commonly known as the "Shahid Qassem Soleimani" project. This project consisted of six steps including case detection, laboratory testing through the establishment of sampling centers, scale up of clinical care to vulnerable groups, contact tracing, home care for vulnerable population, and COVID-19 vaccination roll out. Nearly 3 years into the pandemic, the importance of designing RCCE for all types of emergencies, allocating a dedicated team to RCCE, coordinating with different stakeholders, improving the capacity of RCCE focal points, practicing more efficient social listening, and using social insight for better planning were identified as some lessons learned. Further, Iran's RCCE experience during the COVID-19 pandemic underscores the importance of continuing to invest in the health system, particularly PHC.

Fielding vaccines-challenges and opportunities in outbreaks, complex emergencies, and mass gatherings.

With the recent COVID-19 pandemic, the importance of vaccine development, distribution, and uptake has come to the forefront of the public eye. Effectively fielding vaccines during an emergency-whether that emergency is a result of an infectious disease or not-requires an understanding of usual vaccine-related processes; the impact of outbreak, complex emergencies, mass gatherings, and other events on patients, communities, and health systems; and ways in which diverse resources can be applied to successfully achieve needed vaccine uptake. In this review, both the emergency setting and briefly vaccine product design are discussed in these contexts in order to provide a concise source of general knowledge from experts in fielding vaccines that can aid in future vaccine ventures and increase general awareness of the process and barriers in various settings.

Impact of the COVID-19 pandemic on the utilisation of health services at public hospitals in Yemen: a retrospective comparative study.

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.

SARS-CoV-2 seroprevalence in Aden, Yemen: a population-based study.

BACKGROUND: In Yemen, initial surveillance of coronavirus disease 2019 (COVID-19) focused primarily on patients with symptoms or severe disease. The full spectrum of the disease remains unclear. To the best of the authors' knowledge, this is the first seroprevalence study performed in Yemen. METHODS: This cross-sectional investigation included 2001 participants from all age groups from four districts in Aden, southern Yemen. A multi-stage sampling method was used. Data were collected using a well-structured questionnaire, and blood samples were taken. Healgen COVID-19 IgG/IgM Rapid Diagnostic Test (RDT) Cassettes were used in all participants. All positive RDTs and 14% of negative RDTs underwent enzyme-linked immunosorbent assay (ELISA) testing (WANTAI SARS-CoV-2 Ab ELISA Kit) for confirmation. RESULTS: In total, 549 of 2001 participants were RDT positive and confirmed by ELISA, giving a prevalence of COVID-19 of 27.4%. The prevalence of immunoglobulin G was 25%. The prevalence of asymptomatic COVID-19 in the entire study group was 7.9%. The highest prevalence was observed in Al-Mansurah district (33.4%). Regarding sociodemographic factors, the prevalence of COVID-19 was significantly higher among females, housewives and subjects with a history of contact with a COVID-19 patient: 32%, 31% and 39%, respectively. CONCLUSION: This study found high prevalence of COVID-19 in the study population. Household transmission was common.

SARS-CoV-2 Seroprevalence in Aden, Yemen a Population-Based Study (preprint)

Background: In Yemen; initial surveillance of COVID-19 focused primarily on patients with symptoms or severe disease, and, as such, the full spectrum of the disease, are not clear that make the epidemiology of COVID-19 is uncertain. To the best of our knowledge, this is the first seroprevalence study done in Yemen to measure the seroprevalence of anti-SARS-CoV-2 antibodies in the general population by sex and age group in Aden, Yemen.Methods: It is a one-time cross-sectional investigation among 2000 participants from all age groups from four districts in Aden at southern Yemen. A multi-stage sampling method used. Data collected by using a well-structured questionnaire and blood sample were collected. Healgen COVID-19 IgG/IgM Rapid Test Cassette was used in all participants. All positive RDT and 14% of the negative RDTs underwent ELISA test (WANTAI SARS-CoV-2 Ab Elisa Kit). Results: A 549 out of 2001 participants were RDT positive and proved by ELISA giving the prevalence of COVID-19 infection to 27·4% and specifically the prevalence of IgG was 25%. The prevalence of asymptomatic COVID-19 infection in all the study group was 7·9%. The highest prevalence was observed in Al-Mansurah district (33·4%). Regarding socio-demographic factors females, housewives and history of contact with COVID-19 patients have significant higher prevalence rates (32%, 31% and 39% respectively).Interpretation: high prevalence of SARS-CoV-2 antibodies was reported. Household contacts are the main factors for transmission. Enhancing population immunity is recommended by introducing COVID-19 vaccine.Funding: The study was funded from WHO/ EMRO. Aden OfficeDeclaration of Interest: None to declare. Ethical Approval: This study was approved by the University of Yemen.

The first 2 months of the SARS-CoV-2 epidemic in Yemen: Analysis of the surveillance data.

INTRODUCTION: Yemen was one of the last countries in the world to declare the first case of the pandemic, on 10 April 2020. Fear and concerns of catastrophic outcomes of the epidemic in Yemen were immediately raised, as the country is facing a complex humanitarian crisis. The purpose of this report is to describe the epidemiological situation in Yemen during the first 2 months of the SARS-CoV-2 epidemic. METHODS: We analyzed the epidemiological data from 18 February to 05 June 2020, including the 2 months before the confirmation of the first case. We included in our analysis the data from 10 out of 23 governorates of Yemen, located in southern and eastern part of the country. RESULTS: A total of 469 laboratory confirmed, 552 probable and 55 suspected cases with onset of symptoms between 18 February and 5 June 2020 were reported through the surveillance system. The median age among confirmed cases was 46 years (range: 1-90 years), and 75% of the confirmed cases were male. A total of 111 deaths were reported among those with confirmed infection. The mean age among those who died was 53 years (range: 14-88 years), with 63% of deaths (n = 70) occurring in individuals under the age 60 years. A total of 268 individuals with confirmed SARS-CoV-2 infection were hospitalized (57%), among whom there were 95 in-hospital deaths. CONCLUSIONS: The surveillance strategy implemented in the first 2 months of the SARS CoV 2 in the southern and eastern governorates of Yemen, captured mainly severe cases. The mild and moderate cases were not self-reported to the health facilities and surveillance system due to limited resources, stigma, and other barriers. The mortality appeared to be higher in individuals aged under 60 years, and most fatalities occurred in individuals who were in critical condition when they reached the health facilities. It is unclear whether the presence of other acute comorbidities contributed to the high death rate among SARS-CoV-2 cases. The findings only include the southern and eastern part of the country, which is home to 31% of the total population of Yemen, as the data from the northern part of the country was inaccessible for analysis. This makes our results not generalizable to the rest of the country.