Dengue Outbreak during Ongoing Civil War, Taiz, Yemen.
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ABSTRACT:
SUBMITTER: Alghazali KA
PROVIDER: S-EPMC6590741 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The Global Task Force on Cholera Control (GTFCC) created a strategy for early outbreak detection, hotspot identification, and resource mobilization coordination in response to the Yemeni cholera epidemic. This strategy requires a systematic approach for defining and classifying outbreak signatures, or the profile of an epidemic curve and its features. We used publicly available data to quantify outbreak features of the ongoing cholera epidemic in Yemen and clustered governorates using an adaptive time series methodology. We characterized outbreak signatures and identified clusters using a weekly time series of cholera rates in 20 Yemeni governorates and nationally from 4 September 2016 through 29 December 2019 as reported by the World Health Organization (WHO). We quantified critical points and periods using Kolmogorov-Zurbenko adaptive filter methodology. We assigned governorates into six clusters sharing similar outbreak signatures, according to similarities in critical points, critical periods, and the magnitude of peak rates. We identified four national outbreak waves beginning on 12 September 2016, 6 March 2017, 28 May 2018, and 28 January 2019. Among six identified clusters, we classified a core regional hotspot in Sana'a, Sana'a City, and Al-Hudaydah-the expected origin of the national outbreak. The five additional clusters differed in Wave 2 and Wave 3 peak frequency, timing, magnitude, and geographic location. As of 29 December 2019, no governorates had returned to pre-Wave 1 levels. The detected similarity in outbreak signatures suggests potentially shared environmental and human-made drivers of infection; the heterogeneity in outbreak signatures implies the potential traveling waves outwards from the core regional hotspot that could be governed by factors that deserve further investigation.
| S-EPMC8744546 | biostudies-literature
Project description:Since the onset of the ongoing civil war in Syria, the governmental surveillance system for leishmaniasis has lost access to provinces of northern Syria. The MENTOR Initiative, an international not-for-profit organization, was commissioned to implement an integrated leishmaniasis control program, providing an opportunity to reassess the epidemiology of leishmaniasis in northern Syria. Epidemiologic data and biologic samples for molecular species diagnostics were collected from collaborating local health centers. Incidence peaked in March 2015 at 7,743 estimated monthly cases. High levels of transmission were observed in traditional endemic regions but extended to previously hypoendemic regions, such as Al-Raqqa and Al-Hasakah. Incidence decreased to 3,209 in July 2015. Data indicate that the prewar trend of increasing incidence of cutaneous leishmaniasis accelerated during the beginning of armed conflict but declined after implementation of the comprehensive control program by the MENTOR Initiative. Molecular analysis revealed a spectrum of Leishmania species and sporadic cases of visceral leishmaniasis.
| S-EPMC6199995 | biostudies-literature
Project description:After the seminal work of Durkheim (1897), many subsequent studies have revealed a decline in suicide rates during wartime. However, their main focus was inter-state wars and whether the same argument holds for civil conflicts within a country is an important unresolved issue in the modern world. Moreover, the findings of the previous studies are not conclusive due to unobserved confounding factors. This study investigated the relationship between civil war and suicide rate through a more rigorous statistical approach using the Sri Lankan civil war as a case study. For this purpose, we employed a linear regression model with district and year fixed effects to estimate a difference-in-difference in the suicide rate between the peacetime and wartime periods as well as the contested and non-contested districts. The results indicate that the suicide rate in the contested districts in the wartime was significantly lower than the baseline by 11.8-14.4 points (95% CI 6.46-17.22 and 7.21-21.54, respectively), which corresponds to a 43-52% decline. The robustness of the possible confounding factors was analyzed and not noted to have so much effect as to alter the interpretation of the results. This finding supports the Durkheimian theory, which places importance on social integration as a determinant of suicide, even for civil conflicts.
| S-EPMC7592752 | biostudies-literature
Project description:BACKGROUND:The effect of the ongoing war in Yemen on maternal and child health (MCH) has not been comprehensively assessed. Providing a situational analysis at the governorate level is critical to assist in planning a response and allocating resources. METHODS:We used multiple national- and governorate-level data sources to provide estimates of 12 relevant MCH indicators in 2016 around child vaccination, and child and maternal nutritional status, and the change in these estimates for the period 2013-2016 based on shock variables including change in gross domestic product, burden of airstrikes per 1000 population, change in access to untreated water sources and unimproved toilets, and change in wheat flour prices. We also used findings from the Global Burden of Disease 2016 study. RESULTS:Vaccine coverage decreased for all antigens between 2013 and 2016 among children 12-23 months. The largest decrease, 36·4% for first-dose measles vaccine, was in Aden. Among children under the age of five, incidence of diarrhea was at 7·0 (5·5-8·9) episodes per person-year. The prevalence of moderate and severe child anemia ranged from 50·9% (24·9-73·1) in Sana'a City to 97·8% (94·1-99·2) in Shabwah in 2016. Prevalence of underweight among women of reproductive age ranged from 15·3% (8·1-24·6) in Sana'a city to 32·1% (24·1-39·7) in Hajjah, with a national average of 24·6% (18·7-31·5). CONCLUSIONS:The war and siege on Yemen has had a devastating impact on the health of women and children. Urgent efforts to secure food, essential medicines, antibiotics, deworming medicine, and hygiene kits, and cold chains for immunization are needed. Yemen is in dire need of clean water and proper sanitation to reduce the spread of disease, especially diarrhea.
| S-EPMC5918919 | biostudies-literature
Project description:BackgroundAcute bacterial meningitis (ABM) is a serious health issue in Yemen where civil war, which continues unabated, has crippled the healthcare system. We conducted a nationwide retrospective observational study in Yemeni sentinel hospitals to identify the prevalence, aetiology, vaccination coverage and spatio-temporal pattern of ABM in children aged <5 years before and during the civil war, 2014-20.MethodsCerebrospinal fluid samples were collected from hospitalized children and were analysed macroscopically for appearance and microscopically by Gram stain and white blood cell count. Culture and latex agglutination tests were performed. Data on the prevalence of and vaccination coverage for ABM were obtained from the Ministry of Health. Joinpoint regression was used to assess the annual percent change (APC) of ABM prevalence and vaccination coverage. Pearson's correlation was used to evaluate the association between ABM prevalence and vaccination coverage.ResultsIn total, 11 339 hospitalized children had suspected cases of ABM (prevalence, 40.07/100 000 of the whole Yemeni population) and 2.6% (293/11 339) of suspected ABM cases were confirmed (prevalence, 1.04/100 000 of the whole Yemeni population). The dominant pathogens were Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b (Hib). The civil war reduced the Hib and pneumococcal vaccination coverage (APC = -1.92), reaching its lowest (79.5%) in 2018. The prevalence of suspected ABM increased (APC = 3.46), reaching its maximum (6.08/100 000 of the whole Yemeni population) in 2019. The conflict inversely correlated with the ABM prevalence and vaccination coverage (Pearson correlation coefficient (r), -0.69 to -0.53). Ta'izz region, which was severely affected by the civil war, had the highest prevalence of suspected ABM (120.90/100 000 of the whole Yemeni population) and lowest vaccination coverage (60%).ConclusionsThe civil war had a negative impact on vaccination coverage and coincided with increasing prevalence of ABM in Yemen. Streptococcus pneumoniae is the dominant causative pathogen.
| S-EPMC10396411 | biostudies-literature
Project description:Armed conflict within nations has had disastrous humanitarian consequences throughout much of the world. Here we undertake the first comprehensive examination of the potential impact of global climate change on armed conflict in sub-Saharan Africa. We find strong historical linkages between civil war and temperature in Africa, with warmer years leading to significant increases in the likelihood of war. When combined with climate model projections of future temperature trends, this historical response to temperature suggests a roughly 54% increase in armed conflict incidence by 2030, or an additional 393,000 battle deaths if future wars are as deadly as recent wars. Our results suggest an urgent need to reform African governments' and foreign aid donors' policies to deal with rising temperatures.
| S-EPMC2781059 | biostudies-literature
Project description:BackgroundThe civil war in Syria including the deliberate targeting of healthcare services resulted in a complex humanitarian emergency, seriously affecting children's health. The objectives of this study are to document diagnoses and disease categories in Northern Syrian children after four years of conflict, and to document infectious diseases and injuries in this vulnerable population.MethodsIn a prospective cross-sectional observational sample study conducted in May 2015, healthcare workers registered demographics, comorbidities, and diagnoses (categorised according to the International Classification of Diseases version 10) in children visited at home and in internally displaced persons camps in four Syrian governorates.ResultsOf 1080 filled-out records, 1002 were included. Children originated from Aleppo (41%), Idleb (36%), Hamah (15%) and Lattakia (8%). Median age was 6 years (0-15; IQR 3-11), 61% were boys, 40% were younger than 5 years old. Children suffered from respiratory (29%), neurological (19%), digestive (17%), eye (5%) and skin (5%) diseases. Clinical malnutrition was seen in 4%, accidental injury in 3%, intentional injury in 1%, and mental disorders in 2%. Overall, 64% had features of infectious diseases (OR 0.635; CI 0.605-0.665). Most common comorbidities were chronic respiratory diseases (14, malnutrition (5%), acute flaccid paralysis (5%), and epilepsy (4%). Logistic regression analysis indicated that the risk for children to have communicable diseases was higher in Aleppo than in Idleb (OR 1.7; CI 1.2-2.3), Hamah (OR 4.9; CI 3.3-7.5), or Lattakia (OR 5.5; CI 3.3-9.3). Children in Aleppo and Lattakia were more at risk to be injured than in Idleb (OR 5.6; CI 2.1-14.3), or in Hamah (OR 5.9; CI 1.4-25.6), but more often from intentional violence in Lattakia. Mental problems were more prominent in Hamah.ConclusionsFour years far in the conflict, 64% of the studied children in four Northern Syrian governorates suffer from infections, mostly from respiratory, neurological and digestive origin, while 4% was injured or victim of intentional aggression. Substandard living conditions and the lack of paediatric healthcare put Syrian children at risk for serious infections, epidemics and morbidity, and ask for urgent international humanitarian relief efforts.
| S-EPMC5590741 | biostudies-literature
Project description:Dengue virus (DENV) is the leading cause of arboviral diseases in humans worldwide. In this study, we investigated the seroprevalence of DENV infection in two districts of Kaohsiung City, a metropolis in southern Taiwan, where major dengue outbreaks have occurred in the past three decades. We enrolled 1,088 participants from the Sanmin and Nanzih districts after the dengue outbreak of 2015, the largest in Taiwan since World War II, and found an overall DENV seroprevalence of 12.4% (95% confidence interval: 10.5-13.4%) based on the InBios DENV IgG ELISA kit. The ratios of clinically inapparent to symptomatic infections were 2.86 and 4.76 in Sanmin and Nanzih districts, respectively. Consistent with higher case numbers during recent outbreaks, the DENV seroprevalence was higher in Sanmin district (16.4%) than in Nanzih district (6.9%), suggesting district differences in seroprevalence and highlighting the importance of screening the DENV immune status of each individual before using the currently available DENV vaccine, Dengvaxia. In the two districts, the seroprevalence rates increased from 2.1% (in the 30-39-year age group) to 17.1% (60-69) and 50% (70-79). The pattern of a sharp and significant increase in seroprevalence in the 70-79-year age group correlated with a dramatic increase in the proportion of clinically severe DENV infections among total dengue cases in that age group. This differed from observations in the Americas and Southeast Asia and suggested that a large proportion of monotypically immune individuals together with other risk factors may contribute to clinically severe dengue among the elderly in Taiwan.
| S-EPMC6218099 | biostudies-literature
Project description:Violence after civil war is a challenge to sustainable peace. Many armed conflicts today are recurrences of previous wars and much of the literature on violence after war explains why armed groups return to the battlefield. But even if peace prevails, many other types of violence take place in postwar environments. This postwar violence is likewise subject to a growing multidisciplinary literature. Using citation network analysis, we show that research on war recurrence and postwar violence has developed in relative isolation from each other-although these phenomena are interrelated. This compartmentalization leads us to overlook important similarities and differences in the drivers of different forms of violence after war. We demonstrate this by reviewing the literature in both of these closely related fields. While war recurrence and postwar violence share a set of common risk factors, some factors can have opposite effects on the two outcomes. Because these insights only emerge when systematically comparing the two strands of literature, we propose a novel framework for the study of violence after wars that aims at overcoming the compartmentalization of research within these two fields. The framework serves both as a conceptual lens and an analytical tool to categorize and compare different forms of violence after war. We then outline how the framework aids scholars in pursuing an integrated research agenda, with concrete suggestions for research questions that should be studied to expand our understanding of violence after wars.
| S-EPMC8427816 | biostudies-literature
Project description:We study whether paternal trauma is transmitted to the children of survivors of Confederate prisoner of war (POW) camps during the US Civil War (1861-1865) to affect their longevity at older ages, the mechanisms behind this transmission, and the reversibility of this transmission. We examine children born after the war who survived to age 45, comparing children whose fathers were non-POW veterans and ex-POWs imprisoned in very different camp conditions. We also compare children born before and after the war within the same family by paternal ex-POW status. The sons of ex-POWs imprisoned when camp conditions were at their worst were 1.11 times more likely to die than the sons of non-POWs and 1.09 times more likely to die than the sons of ex-POWs when camp conditions were better. Paternal ex-POW status had no impact on daughters. Among sons born in the fourth quarter, when maternal in utero nutrition was adequate, there was no impact of paternal ex-POW status. In contrast, among sons born in the second quarter, when maternal nutrition was inadequate, the sons of ex-POWs who experienced severe hardship were 1.2 times more likely to die than the sons of non-POWs and ex-POWs who fared better in captivity. Socioeconomic effects, family structure, father-specific survival traits, and maternal effects, including quality of paternal marriages, cannot explain our findings. While we cannot rule out fully psychological or cultural effects, our findings are most consistent with an epigenetic explanation.
| S-EPMC6217388 | biostudies-literature