The forgotten war: Yemen and human security

This research examines the significance of having all seven aspects of human security. A series of questions were directed toward a sample of Yemeni participants living inside and outside of Yemen in order to get an insight into the daily struggles they face as a result of conflict. The interviews reveal the impact war has on human security and the absence of all seven components of human security put forward by the United Nations. This research argues that security in every shape and form is extremely important as all seven components are interlinked. As the world's attention is on Ukraine and the impact of the Russia–Ukraine War on civilians, this article pushes the reader to question the deafening silence of the world when it comes to the situation in Yemen. Without acknowledgment, raising awareness, and holding those in charge of the war accountable for their wrongdoings, change will never prevail.

Schistosomiasis and soil-transmitted helminthiases: progress report, 2021

In 2021, the number of children who required PC for STH decreased for pre-SAC from 291.2 million to 260.6 million and for SAC from 732.3 million to 653.7 million (Figure 2). This change was mainly due to revision of the numbers of children who require PC for STH in India, which decreased from 103.5 to 80.7 million for pre-SAC and from 332.1 to 259.1 million for SAC. The decreases were based on impact assessment surveys conducted in the past few years, which changed the endemicity status of some districts. Globally, PC coverage of SAC increased from 47% in 2020 to 62.9% in 2021.The number of SAC reached with deworming increased almost to that before the COVID-19 pandemic (411 million in 2021, 344 million in 2020, 455.9 million in 2019), indicating that countries are recovering.

The effects of digital innovations and sustainable supply chain management on business competitive performance post-COVID-19

Purpose: Sustainable supply chain management (SSCM) practices and green entrepreneurial preference (GEP) have gained increasing attention from academicians;however, their impacts on business' competitive performance (BCP) post-coronavirus disease of 2019 (COVID-19) remain unclear. Although SSCM is vital for supporting BCP, the previous publications indicate the absence of significant relationships among GEP, SSCM and BCP. This study tries to fill this literature gap by investigating if GEP and SSCM can shape BCP. This study also suggests the moderation effect of digital innovations such as artificial intelligence and big data analytics (AIBD) on those relationships from a COVID-19 viewpoint. Design/methodology/approach: Data were collected from 245 Halal food firms in Yemen, and the research framework was assessed using structural equation modeling (SEM). Findings: The empirical findings show that there are significant impacts of GEP on SSCM and subsequently on BCP. The findings also reveal that SSCM practice mediates GEP-BCP link. Besides, digital innovations such as AIBD positively moderate the link of GEP-SSCM. Originality/value: This study is the first attempt that advises Halal food firms to formally adopt GEP, SSCM and digital innovations to boost BCP, especially in uncertain times like post-COVID-19. Unlike earlier studies that observe SSCM usage as a direct predictor of firm performance, this study delivers an innovative insight that digital innovations can assist in GEP and SSCM incorporation in the in-house operations of the firms post-COVID-19. © 2023, Emerald Publishing Limited.

Financial Inclusion or Encampment? Rethinking Digital Finance for Refugees

Humanitarian actors touting financial inclusion posit that access to financial services builds refugees' resilience and self-reliance. They claim that new digital financial tools create more efficient and dignified pathways for humanitarian assistance and enable refugees to better manage their savings and invest in livelihoods, especially during protracted displacement. Our in-depth, repeat interviews with refugees in Kenya and Jordan refute this narrative. Instead, self-reliance was hindered primarily by refugees' lack of foundational rights to move and work. Financial services had limited ability to support livelihoods in the absence of those rights. The digital financial services offered to refugees under the banner of ‘financial inclusion' were not mainstream services designed to empower and connect. Instead, they were segregated, second-class offerings meant to further isolate and limit refugee transactions in line with broader political desires to encamp and exclude them. The article raises questions about the circumstances in which humanitarian funding ought to fund financial service interventions and what those interventions are capable of achieving.

An assessment of the current epidemiological and laboratory capacities for influenza-like illnesses and severe acute respiratory infection surveillance, Yemen 2022.

Background and Objectives: We aim to re-activate influenza sentinel surveillance system in Yemen after disruption related to repurposing for COVID-19 pandemic. WHO Country Office (CO) in collaboration with Yemen's Ministry of Public Health and Population (MOPH&P) jointly conducted an assessment mission to assess the current situation of the influenza sentinel surveillance system and assess its capacity to detect influenza epidemics and monitor trends in circulating influenza and other respiratory viruses of epidemic and pandemic potential. This study presents the results of the assessment for three sentinel sites located in Aden, Taiz, and Hadramout/Mukalla. Methodology: A mixed methods approach was used to guide the assessment process and to help achieve the objectives. Data were collected as follows: desk review of the sentinel sites records and data; interviews with stakeholders, including key informants and partners; and direct observation through field visits to the sentinel sites, MOPH&P and the Central Public Health Laboratory (CPHL). Two assessment checklists were used: assessment of sentinel sites for SARI surveillance, and checklist for assessment of availability of SARI sentinel surveillance. Results and Conclusion: COVID-19 has affected health systems and services, and this was demonstrated in this assessment. The influenza sentinel surveillance system in Yemen is not effectively functional; however, there is plenty of room for improvement if investment in the system's restructuring, training, building technical and laboratory capacities, and conducting continuous and regular supervision visits.

Assessment of knowledge, attitude, and practice towards COVID-19 among undergraduate students and its psychological impact on their life: A cross-sectional study

Background: The association between widespread outbreaks, such as COVID-19, and psychological distress and symptoms of mental illness is common. This study aimed to assess undergraduate students' knowledge, attitudes, and practices (KAP) toward COVID-19 and its psychological impact on their life. Method(s): A cross-sectional study was done using a self-administered questionnaire. Result(s): The findings revealed that 11.9% of the participants had COVID-19, and 27.7% of their relatives contracted the disease. The overall rate of correct answers for the knowledge statements was 81.6%. Only 16.5% declared that COVID-19 had an extreme effect on their studies. However, 34% reported rarely or never having felt nervous or anxious during the pandemic. Conclusion(s): The findings revealed that undergraduate students have good knowledge and a positive attitude towards COVID-19, while their practice was poor. Also, the pandemic had a negative psychological impact on some students, thus the need for proactive psychological and social support for students.Copyright © 2023 FIP.

Public Perception Toward COVID-19 Disease Nature, Susceptibility to Complication, and Relationship to Influenza: A Cross-Sectional Study from Yemen.

Background: Following the coronavirus disease (COVID-19) declaration as a pandemic, Yemen has started applying preventive measures to prevent its spread. This study aims to identify the perception regarding the nature of the COVID-19 disease, susceptibility to severe forms of the disease, and its relationship to seasonal influenza among the population of Yemen. Methods: This was a cross-sectional study of the public in Yemen. The relationship between participants' sociodemographic factors and their responses was assessed by the chi-square test. Results: A total of 748 participants agreed to participate in the study. Regarding the nature of the diseases, nearly half of the participants (48.8%, n=352) believed that COVID-19 is a naturally occurring human virus that is a serious and fatal disease (61.2%, n=448). The majority (74.9%; n=518) did not agree that bacteria cause COVID-19. More than half of the participants (57.5%, n=423) believed this disease is transmitted to humans through a host animal. Regarding the vulnerable groups to develop severe COVID-19 infection, most of the participants pointed out that the elderly (94.3%, n=705), people with chronic diseases (89.9%, n=669), and pregnant women (53%, n=365) were more susceptible to severe diseases. Regarding symptoms, the majority (61.9%, n=458) of the participants agreed that the symptoms of COVID-19 are similar to those of seasonal influenza. Additionally, the majority (81.9%, n=579) agreed that some individuals develop more severe symptoms than seasonal influenza, particularly those with chronic illness. Gender, age, and education were found to be associated with participants' perceptions regarding the nature of the virus and susceptibility to severe disease. Conclusion: Participants demonstrate a good understanding of the nature and susceptibility to complications associated with COVID-19 disease and its relationship to influenza. However, the respondents with a lower level of education might require additional educational campaigns to improve their awareness of the disease.

Psychosocial Effects of COVID-19 pandemic on Yemeni healthcare workers: A Web-based, Cross-sectional Survey.

Yemeni healthcare workers (HCWs) experience high levels of psychosocial stress. The current study provides a psychosocial assessment of Yemeni HCWs during the COVID19 pandemic and the factors that influence this. Between 6 November 2020, and 3 April 2021, 1220 HCWs inside Yemen self-reported levels of stress, anxiety, insomnia, depression and quality of life using a web-based, cross-sectional survey. According to the findings, 73.0%, 57.3%, 49.8%, 53.2%, and 85.2% of all HCWs reported moderate or severe stress, insomnia, anxiety, depression, and a lower quality of life, respectively. Significant positive correlations were found between stress and anxiety, insomnia, and depression scores, as well as anxiety and insomnia and depression, and insomnia and depression (p < 0.001). There was also a significant inverse relationship between wellbeing scores and stress, anxiety, insomnia, and depression scores (p < 0.001). A high percentage of respondents (85.8%) were 40 years old or younger and 72.7% had fewer than 10 years' experience, suggesting that experienced medics leave Yemen for safer and more secure jobs elsewhere. Psychosocial support to assist in building resilience to the prevailing conditions may need to be embedded in medical school training and continuing professional development to help support HCWs within Yemen and prevent even more from leaving the country.

Psychological effect of COVID-19 pandemic on healthcare professionals of Yemen and coping strategies.

COVID-19 pandemic has triggered psychological stress such as anxiety and depression among people around the globe. Due to the nature of the job, healthcare professionals (HCPs) are at high risk of infection and are facing social stigma as well. This research was conducted with the objective to evaluate the psychological influence of the COVID-19 pandemic among HCPs in Yemen and the coping strategies adopted thereof. A web-based, as well as face-to-face cross-sectional study was carried out from July to December 2021 among HCPs of Yemen. The generalized anxiety disorder (GAD-7), patient health questionnaire (PHQ-9), and Brief-COPE scales were applied for the evaluation of anxiety, depression, and coping strategies. A total of 197 HCPs participated in the study where 28.4% and 43.1% had anxiety and depression respectively. The prevalence of both anxiety and depression in the majority were found of the minimal to none and mild categories (71.6% vs. 56.9% respectively). The respondents who had received training on COVID-19 had statistically significant lower GAD-7 scores than those who did not (6.32 vs. 8.02 respectively). A significant statistical difference was observed between physicians versus nurses regarding depression based on the working area (p < 0.05). The physician and pharmacist had a significant positive association with brief COPE scores at the 50th centile compared to other HCPs. The female respondents had statistically significant higher mean Brief COPE scores than male respondents (78.11 vs. 69.50 respectively). Our findings illustrate the requirement for efficient policies through administrative, clinical, and welfare perspectives from the regulatory body in preparedness and preventive measures towards such a pandemic that aids HCPs to provide service in a stress-free condition and assurance of a better healthcare system..

Psychologists' perspective of mental health in Yemen during the civil war and COVID-19: a qualitative inquiry.

In comparison to other Middle Eastern nations that are experiencing conflicts and wars, Yemen has the greatest rate of mental health issues since the war was accompanied by distressing experiences and severe chronic psychological crises. This study aims to examine the current state of psychological problems from the perspectives of psychologists and psychiatrists in light of the ongoing civil war and the COVID-19 pandemic. This study included 20 psychologists and psychiatrists in total. Semi-structured face-to-face interviews with the psychologists and psychiatrists were done between October 2021 and December 2021 and between May 2022 and June 2022. Handwritten notes and field notes were used to record the interview process. The transcripts were inductively analysed using Braun and Clarke's thematic analytic approach to get the main themes and subthemes. The four major themes that emerged from the emerging codes are the impact of war on mental health, the impact of COVID-19 on mental health, the healthcare system, and the lack of awareness about mental health. These themes reveal how the civil war and COVID-19 contributed to Yemenis' mental health issues and resulting psychological disorders. Yemenis' mental health and well-being are under several threats; thus, the government and other relevant authorities must take urgent measures to lessen the impact of mental illness on society.

Medications and Supplements Prescription Patterns during COVID 19 Pandemic in Yemen: A Questionnaire-Based Study.

Introduction: the study aims to better understand the COVID-19 prescription treatments and over the counter regimens in Yemen in view of limited published data and limited availability of COVID-19 testing. Methods: A 34 question web-based survey was distributed on social media outlets targeting people in Yemen. Data aggregation, analysis, and visualization were performed using Tableau and Microsoft Excel. Results: 2341 individuals reported symptoms concerning for COVID-19 infection, with 25.4% reporting a chronic medical condition. Female patients were less likely to receive medications for treatment in all age groups examined. Azithromycin was the most prescription medication prescribed (32.8%) and vitamin C being the most supplement used (62%). Around 5.5% were on Hydroxychloroquine prophylaxis prior to their diagnosis and only 12.9% of them continued using after diagnosis. Conclusions: This study provides some important information about the commonly observed treatments and prescription patterns during the COVID-19 pandemic in Yemen during May- July of 2020. The study reflects the influence of global trends in medication prescription even in resource-limited countries.

Knowledge, Attitudes and Practices of the General Population in Yemen Regarding COVID-19: A Cross-Sectional Study.

BACKGROUND: Following the World Health Organization declaration of COVID-19 as a pandemic, Yemen has taken preventive and precautionary measures against COVID-19 to control its spread. This study evaluated the knowledge, attitudes, and practices (KAP) of the Yemeni public regarding COVID-19. METHODS: A cross-sectional study using an online survey was conducted during the period from September 2021 to October 2021. RESULTS: The mean total knowledge score was 9.50 ± 2.12. The majority of the participants (93.4%) were aware that to prevent infection by the COVID-19 virus, going to crowded places and gatherings should be avoided. Approximately two thirds of the participants (69.4%) believed COVID-19 is a health threat to their community. However, in terms of actual behavior, only 23.1% of the participants reported that they did not go to any crowded places during the pandemic, and only 23.8% had worn a mask in recent days. Moreover, only about half (49.9%) reported that they were following the strategies recommended by the authorities to prevent the spread of the virus. CONCLUSION: The findings suggest that the general public has good knowledge and positive attitudes regarding COVID-19, but that their practices are poor.

COVID-19 vaccine hesitancy in conflict zones: A review of current literature.

Background: Vaccine hesitancy (VH) is prevalent in conflict zones due to a lack of essential resources and knowledge, thereby escalating the coronavirus disease of 2019 (COVID-19) cases in these territories. This has resulted in a higher incidence of cases from exposure to a single COVID-19 positive case and further burdens the health care system of conflict zones which are already on the brink of collapsing. Aim: This narrative review aims to determine VH to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine in five conflict zones that include Somalia, Yemen, Palestine, Syria, and Afghanistan. Methodology: A Boolean search was carried out in MEDLINE-PubMed from inception till 6 June 2022. The search was performed by using the following keywords: "(SARS-CoV-2 OR covid OR covid 19) AND (vaccine hesitancy OR covid vaccine acceptance OR intention to vaccinate) AND (Syria OR Yemen OR Palestine OR Afghanistan OR Somalia"). The full text of all relevant articles in English along with their supplementary material was extracted. Results: All the included studies reported at least 30% or more increase in vaccine hesitancy among conflict settings. VH was mostly due to a lack of available resources, lack of appropriate knowledge, and believing misleading rumors about the vaccine. Discussion: Considering the massive amount of reluctance among people residing in conflict zones, the need to take effective measures against VH is undoubtedly apparent. This can be accomplished by carrying out mass vaccinations by the governments and proper health education through raising the public awareness regarding vaccines, thereby eliminating rumors that exacerbate the fear of adverse effects. Conclusion: The approach described in this article to combat VH can be implemented to increase vaccination rates and significantly alleviate R0 across the globe.

Adult mortality before and during the first wave of COVID-19 pandemic in nine communities of Yemen: a key informant study.

INTRODUCTION: Widespread armed conflict has affected Yemen since 2014. To date, the mortality toll of seven years of crisis, and any excess due to the COVID-19 pandemic, are not well quantified. We attempted to estimate population mortality during the pre-pandemic and pandemic periods in nine purposively selected urban and rural communities of southern and central Yemen (Aden and Ta'iz governorates), totalling > 100,000 people. METHODS: Within each study site, we collected lists of decedents between January 2014-March 2021 by interviewing different categories of key community informants, including community leaders, imams, healthcare workers, senior citizens and others. After linking records across lists based on key variables, we applied two-, three- or four-list capture-recapture analysis to estimate total death tolls. We also computed death rates by combining these estimates with population denominators, themselves subject to estimation. RESULTS: After interviewing 138 disproportionately (74.6%) male informants, we identified 2445 unique decedents. While informants recalled deaths throughout the study period, reported deaths among children were sparse: we thus restricted analysis to persons aged ≥ 15 years old. We noted a peak in reported deaths during May-July 2020, plausibly coinciding with the first COVID-19 wave. Death rate estimates featured uninformatively large confidence intervals, but appeared elevated compared to the non-crisis baseline, particularly in two sites where a large proportion of deaths were attributed to war injuries. There was no clear-cut evidence of excess mortality during the pandemic period. CONCLUSIONS: We found some evidence of a peak in mortality during the early phase of the pandemic, but death rate estimates were otherwise too imprecise to enable strong inference on trends. Estimates suggested substantial mortality elevations from baseline during the crisis period, but are subject to serious potential biases. The study highlighted challenges of data collection in this insecure, politically contested environment.

Telemedicine interventions in six conflict-affected countries in the WHO Eastern Mediterranean region: a systematic review.

BACKGROUND: The COVID-19 pandemic has escalated the use of telemedicine in both high and low resource settings however its use has preceded this, particularly in conflict-affected settings. Several countries in the WHO Eastern Mediterranean (EMR) region are affected by complex, protracted crises. Though telemedicine has been used in such settings, there has been no comprehensive assessment of what interventions are used, their efficacy, barriers, or current research gaps. MAIN BODY: A systematic search of ten academic databases and 3 grey literature sources from January 1st 2000 to December 31st 2020 was completed, identifying telemedicine interventions in select EMR conflict-affected settings and relevant enablers and barriers to their implementation. Included articles reported on telemedicine use in six conflict-affected EMR countries (or territories) graded as WHO Health Emergencies: Afghanistan, Gaza, Iraq, Libya, Syria and Yemen. Data were extracted and narratively synthesised due to heterogeneity in study design and outcomes. Of 3419 articles identified, twenty-one peer-reviewed and three grey literature sources met the inclusion criteria. We analysed these by context, intervention, and evaluation. CONTEXT: eight related to Afghanistan, eight to Syria and seven to Iraq with one each in Yemen and Gaza. Most were implemented by humanitarian or academic organisations with projects mostly initiated in the United States or Europe and mostly by physicians. The in-country links were mostly health professionals rather than patients seeking specialist inputs for specialities not locally available. INTERVENTIONS: these included both SAF (store and forward) and RT (real-time) with a range of specialities represented including radiology, histopathology, dermatology, mental health, and intensive care. EVALUATION: most papers were observational or descriptive with few describing quality measures of interventions. CONCLUSIONS: Telemedicine interventions are feasible in conflict-affected settings in EMR using low-cost, accessible technologies. However, few implemented interventions reported on evaluation strategies or had these built in. The ad hoc nature of some of the interventions, which relied on volunteers without sustained financial or academic investment, could pose challenges to quality and sustainability. There was little exploration of confidentiality, ethical standards, data storage or local healthcare worker and patient acceptability.

Changes in drug demand when a pandemic coincides with other outbreaks in a war zone country: a cross-sectional pilot study.

BACKGROUND: Yemen's health system has severely deteriorated due to the ongoing civil war accompanied by the COVID-19 pandemic which coincided with other outbreaks of endemic infections. Many health institutions closed due to insufficient equipment and supplies. Consequently, pharmacists became the available healthcare provider on the frontlines. This study aimed to evaluate the pattern of demand for prescription and nonprescription drugs during the pandemic based on the pharmacist's perspective in Yemen, a conflict zone country. METHODS: An online survey was developed, validated, and distributed among pharmacists. The questionnaire was composed of two sections: (1) demographic characteristics of the participants and (2) changes in the demand for different drug categories. Chi-square test and Fisher's exact test were used to find statistical associations. RESULTS: Responses (330) were received from pharmacists working in 12 out of 22 governorates in Yemen. During the pandemic, there was an increase in the demand for prescription drugs such as antibiotics, antimalarials, and sedatives (95%, 90%, and 71%, respectively) and an increase in the demand for nonprescription drugs such as vitamins (93%) and paracetamol (> 90%). Some of these drugs could have serious side effects if taken without medical advice, and others could result in severe effects if taken concomitantly. In addition, there was an increase in the demand for prescription drugs without a prescription, which was reported by 50% of the participants. No statistical difference was seen between the frontline districts and major cities in terms of requesting these drugs without a prescription. On the other hand, most participants (75.2%) did not attend any training or workshop during the last 6 months of conducting this survey. CONCLUSION: COVID-19 has increased the demand for many prescription and nonprescription drugs, where the irrational use of these drugs may lead to devastating health effects. In war zone areas hit by a pandemic, policymakers and public health organizations should focus on training and educating pharmacists as important health care and medicine providers for the public.

Clinical and Epidemiological Presentation of COVID-19 among Children in Conflict Setting.

BACKGROUND: This study aims to describe the observable symptoms of children with COVID-19 infection and analyze access to real-time polymerase chain reaction (RT-PCR) testing among children seeking care in Yemen. METHOD: In the period of March 2020-February 2022, data were obtained from 495 children suspected to have been infected with COVID-19 (from a larger register of 5634 patients) from the Diseases Surveillance and Infection Control Department at the Ministry of Public Health and Population in Aden, Yemen. RESULTS: Overall, 21.4% of the children with confirmed COVID-19 infection were asymptomatic. Fever (71.4%) and cough (67.1%) were the most frequently reported symptoms among children, and children were less likely to have fever (p < 0.001), sore throat (p < 0.001) and cough (p < 0.001) compared to adults. A lower frequency of COVID-19-associated symptoms was reported among children with positive RT-PCR tests compared to children with negative tests. A lower rate of testing was conducted among children (25%) compared to adults (61%). Fewer tests were carried out among children years (11%) compared to other age groups (p < 0.001), for children from other nationalities (4%) compared to Yemeni children (p < 0.001) and for girls (21%) compared to boys (30%) (p 0.031). CONCLUSION: Understanding and addressing the cause of these disparities and improving guidelines for COVID-19 screening among children will improve access to care and control of the COVID-19 pandemic.

Cholera, 2020

This article provides a summary of the 2020 report of the global cholera surveillance and how the COVID-19 pandemic affected cholera detection and case counting. Overall, in 2020, 80 countries reported data on cholera to WHO. Of these, 27 countries reported a total of 323,320 cholera cases and 857 deaths, for a case-fatality rate(CFR) of 0.27%, while 53 countries reported 0 cases for the year (Table 2). After the exclusion of Yemen, which accounted for 85%of cases reported globally to WHO for2020, 47,608 cases and 742 deaths (CFR, 1.5%) were reported from other countries.

An empirical examination of AIS success at the organizational level in the era of COVID-19 pandemic

Purpose - This study aims to empirically examine accounting information system (AIS) success at the organizational level during COVID-19 era. Design/methodology/approach - Based on the information system success model, this paper developed its model and proposed a total of nine hypotheses. This paper gathered the required data via a questionnaire from Yemeni small and medium enterprises (SMEs) owners and managers. To test the proposed research model paths, SmartPLS software, which is known as partial least squares structural equation modeling, was used. Findings - The results showed that the quality dimensions (information quality and system quality) positively affected the use of MS and satisfaction;user satisfaction positively affected the use of AIS. Management support positively affected the AIS users' usage and satisfaction. Finally, the use dimensions (user satisfaction and usage) positively impacted the net benefits in terms of gaining a competitive advantage, productivity enhancement and saving time and cost. In all, this research has succeeded in providing support for DeLone and McLean's IS success model at the organizational level during the COVID-19 era. Practical implications - AIS is becoming increasingly important for SMEs in low-income countries like Yemen, particularly in the present pandemic conditions (COVID-19 era). By using AIS, users can access the enterprise's data and conduct transactions without being limited by distance. Indeed, AIS proved its ability in enhancing the net benefits at the organizational level in the COVID-19 era in terms of gaining a competitive advantage, productivity enhancement and saving time and cost. However, AIS can only be considered useful to the enterprise if it is effective/successful. Originality/value - This study is one of the first to have assessed the impact of AIS success at the organizational level in the era of COVID-19 pandemic, the context of Yemeni SMEs.