Background: Influenza virus infection is an important cause of under-five mortality. Maternal vaccination protects children younger than 3 months of age from influenza infection. However, it is unknown to what extent paediatric influenza-related mortality may be prevented by a maternal vaccine since global age-stratified mortality data are lacking. Methods: We invited clinicians and researchers to share clinical and demographic characteristics from children younger than 5 years who died with laboratory-confirmed influenza infection between January 1, 1995 and March 31, 2020. We evaluated the potential impact of maternal vaccination by estimating the number of children younger than 3 months with in-hospital influenza-related death using published global mortality estimates. Findings: We included 314 children from 31 countries. Comorbidities were present in 166 (53%) children and 41 (13%) children were born prematurely. Median age at death was 8¢6 (IQR 4¢5À16¢6), 11¢5 (IQR 4¢3À24¢0), and 15¢5 (IQR 7¢4À27¢0) months for children from low-and lower-middle-income countries (LMICs), uppermiddle-income countries (UMICs), and high-income countries (HICs), respectively. The proportion of children younger than 3 months at time of death was 17% in LMICs, 12% in UMICs, and 7% in HICs. We estimated that 3339 annual influenza-related in-hospital deaths occur in the first 3 months of life globally. Interpretation: In our study, less than 20% of children is younger than 3 months at time of influenza-related death. Although maternal influenza vaccination may impact maternal and infant influenza disease burden, additional immunisation strategies are needed to prevent global influenza-related childhood mortality. The missing data, global coverage, and data quality in this study should be taken into consideration for further interpretation of the results. Funding: Bill & Melinda Gates Foundation.
Background: Rituximab is currently approved for the treatment of relapsed and refractory indolent lymphomas, which was added to the protocol in Yemen although it was highly costly. The study aimed to determine the long-term response of rituximab on Non-Hodgkin Lymphomas (NHL) patients. Methods: A retrospective cohort study was conducted in the National Oncology Center (NOC) in Aden by review of medical registries for NHL patients from 2017-2020. Sociodemographic and clinical data were extracted from patients’ files by a well-trained team. SPSS version 23 was used for the analysis of data, and Kaplan Meier survival curve was used to measure overall survival (OS) and progression-free survival (PFS) between two groups CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) and rituximab-CHOP group in two follow up periods (12-months and 4-years). Cox regression was used to evaluate the association between the risk factors. A P-value of < 0.05 at a confidence interval of 95% is considered statistically significant. Results: Of 100 patients, 50 for each group of CHOP and R-CHOP. The under 60 years represented 70%. Advanced Stage represented 64% and diffuse large B cell lymphoma represented 47% of all subtypes of NHL. Significant association difference in OS in two periods of follow-up (12-month and 4-years) for CHOP vs. R-CHOP was 63% vs. 86%, and 10% vs. 33%, respectively (P=0.01 and P=0.04). In contrast, the difference was non-statically significant in the PFS in two periods 39% vs. 66%, and 12% vs. 27% for CHOP vs. R-CHOP, respectively (P=0.10 and P=0.31). The age group > 60 years, ≥ 6 cycles of chemotherapy received, abnormality of LDH, and married patients were the significantly hazard proportion that was associated with poor prognostic factors (P= 0.009, 0.001,0.010, and 0.011, respectively). Conclusion: The addition of rituximab to CHOP chemotherapy had a statistical difference in overall survival and there is no difference in PFS. Elderly, married patients, more than 6 cycles of chemotherapy received, and abnormality of LDH were the most important prognostic factors. Therefore, providing the oncology center with Rituximab for ongoing use of NHL patients especially those under 60 years, further assessment for hospital-related risk factors that lead to decreased survival are recommended.
Background Yemen is facing major challenges in ensuring the safety and availability of blood transfusion to meet the increased demand due to the protracted conflict. However, transfusion-transmissible infectious agents (TTIs) such as hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), syphilis, and malaria remain the greatest threats for blood transfusion safety in such fragile, conflict-affected, and vulnerable settings. Objective The aim of this study was to determine the magnitude of TTIs among blood donors attending the National Blood Transfusion and Research Center (NBTRC) and the associated factors. Methods A cross-sectional study was conducted on 340 blood donors at the NBTRC during November and December 2017. Data were collected through face-to-face interviews using a predesigned questionnaire that covered sociodemographic characteristics and possible TTI-associated factors. Blood samples were drawn and tested for HBV surface antigen (HBsAg), HCV antibodies, HIV1, and HIV2 using electrochemiluminescence immunoassays, and syphilis and malaria antibodies were screened with rapid immunochromatographic techniques. Results The overall prevalence of TTIs was 8.8%, with HBV, HCV, HIV, syphilis, and malaria accounting for 2.5%, 1.2%, 0.3%, 1.2%, and 3.2% of all TTIs, respectively. HBV was significantly associated with a history of jaundice and cupping. Furthermore, urethro-vaginal excretion was significantly associated with syphilis, whereas malaria detection was significantly higher among donors from malaria-endemic areas. Nearly three-quarters of donations were from replacement donors who had a significantly higher TTI prevalence than that of the voluntary donors (10.4% vs 3.3%; odds ratio 3.4, 95% CI 1.1-11.6). Conclusions Although the prevalence of TTIs is low, they still pose a serious risk for blood recipients, especially in fragile, conflict-affected, and vulnerable settings where the needs for blood transfusion are increasing and resources are limited. Therefore, using more sensitive screening methods and establishment of a TTIs surveillance system should be considered. Efforts should be made to improve donor recruitment procedures and increase the proportion of regular and voluntary blood donation.
BACKGROUND Yemen is facing major challenges in ensuring the safety and availability of blood transfusion to meet the increased demand for blood transfusion due to the protracted conflict. However, Transfusion-transmissible infectious (TTIs) agents such as hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), syphilis and malaria remains the greatest threats for blood transfusion safety in such fragile, conflict-affected and vulnerable settings. OBJECTIVE To determine the magnitude of TTIs among blood donors attending National Blood Transfusion and Research Center (NBTRC) and its associated factors. METHODS Cross- sectional study was conducted on 340 blood donors at the NBTRC during November and December 2017. Data was collected through face-to-face interview using a predesigned questionnaire that covered socio-demographic characteristics and possible TTIs associated factors. Blood samples were drawn and tested for HBV surface antigen (HBsAg), HCV antibodies, HIV1, 2 by using electrochemi-luminescence immunoassay technique and rapid immunochromato-graphic for screened syphilis and malaria antibodies. RESULTS The overall prevalence of TTIs was 8.8% where 2.5 %, 1.2%, 0.3%, 1.2%, 3.2% have HBV, HCV, HIV, syphilis and malaria respectively. HBV was significantly associated with history of jaundice and cupping. Furthermore, urethero-vaginal excretion was significantly associated with syphilis while malaria was significantly higher among donors from malaria endemic areas. Nearly three-fourth of donations were from replacement donors who had significantly higher TTIs prevalence than the voluntary donors: 10.4% vs. 3.3%, OR 3.4 (CI: 1.1-11.6). CONCLUSIONS Although the prevalence of TTIs is low, it pose a serious risk for blood recipients especially in in fragile, conflict-affected and vulnerable settings where needs for blood transfusion are increasing and resources are limited. Therefore, using more sensitive screening methods and establishment of TTIs surveillance system should be considered. Efforts should be made to improve donor recruitment procedures and increase the proportion of regular and voluntary donation.
BACKGROUND Due to the war and limited access to health facilities, the surveillance of severe acute respiratory infection (SARI) has been expanded to include all hospitals since 2017. OBJECTIVE We aimed to assess the usefulness of SARI surveillance in Sana’a city and to assess its performance in terms of attributes. METHODS The Centers for Disease Control and Prevention’s updated guideline was used for evaluating surveillance systems. Four qualitative attributes, including stability, simplicity, flexibility, and acceptability, and data quality as a quantitative attribute were assessed. An in-depth interview with stakeholders at the central level and self-administered questionnaires with 5 Likert scales and a register review at the peripheral level were used for collecting data. Scores for indicators were used to calculate the total gained scores for each attribute and percentages for ranking them as poor (<60%), average (60% to <80%), good (80% to <90%), and excellent (≥90%). RESULTS SARI surveillance was useful and obtained a total gained score of 94%. The overall performance of the five attributes was average (64%). It was good (82%) at the central level where flexibility was excellent (93%) and stability was average (72%). The performance at the peripheral level was poor (51%); simplicity (61%) and acceptability (74%) were average, and the data quality was poor (20%). CONCLUSIONS Expanding SARI surveillance with a lack of staff training, central communication, and supervision might be the main reason for its weak performance at the peripheral level. Supporting SARI program activities and selecting SARI reporting sites and the surveillance team at each site based on World Health Organization criteria are highly recommended.
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