The Impact of War in Yemen on Immunization Coverage of Children Under One Year of Age: Descriptive Study

Abstract

BackgroundAfter 2 years of war that crippled the capacity of the Yemeni National Health System and left only 45% of health facilities functioning, Yemen faced increasing vaccine-preventable disease (VPD) outbreaks and may be at high risk of polio importation.ObjectiveThe aim of this study was to determine the impact of the 2015 war on the immunization coverage of children under 1 year.MethodsData on vaccination coverage for 2012-2015 were obtained from the national Expanded Program on Immunization (EPI). The vaccination coverage was calculated at the national and governorate levels by dividing the number of actually vaccinated children by the estimated population of children under 1 year.ResultsAlthough there was an increase from 2012 to 2014 in the national coverage for penta-3 vaccine (82% in 2012 vs 88% in 2014) and measles vaccine (70% in 2012 vs 75% in 2014), the coverage was still below the national target (≥95%). Furthermore, the year 2015 witnessed a marked drop in the national coverage compared with 2014 for the measles vaccine (66% in 2015 vs 75% in 2014), but a slight drop in penta-3 vaccine coverage (84% in 2015 vs 88% in 2014). Bacillus Calmette–Guérin vaccine also showed a marked drop from 73% in 2014 to 49% in 2015. These reductions were more marked in governorates that witnessed armed confrontations (eg, Taiz, Lahj, and Sa’dah governorates). On the other hand, governorates that did not witness armed confrontations showed an increase in coverage (eg, Raymah and Ibb), owing to an increase in their population because of displacement from less secure and confrontation-prone governorates.ConclusionsThis analysis demonstrated the marked negative impact of the 2015 war on immunization coverage, especially in the governorates that witnessed armed confrontations. This could put Yemen at more risk of VPD outbreaks and polio importation. Besides the ongoing efforts to stop the Yemeni war, strategies for more innovative vaccine delivery or provision and fulfilling the increasing demands are needed, especially in governorates with confrontations. Enhancing EPI performance through supportable investments in infrastructure that was destroyed by the war and providing decentralized funds are a prerequisite.

Knowledge and attitude towards cutaneous leishmaniasis among rural endemic communities in Shara’b district, Taiz, southwestern Yemen

“…These findings show that there was poor knowledge among the local community regarding the usage of modern treatment strategies. This low level of knowledge could be a consequence of the collapse of the public health system in Yemen due to the ongoing armed conflict [ 13 ]. Knowledge about personal preventive measures such as wearing long-sleeved clothing, using mesh over windows, and using bed nets or repellents was also poor.…”

“…The ongoing civil war in Yemen, which began in 2015, has resulted in the deterioration of the healthcare infrastructure, a breakdown in the delivery of control programmes, the collapse of the healthcare system, and a shortage in the healthcare workforce, and has also impeded access by the population to healthcare facilities [ 13 ]. Consequently, the incidence of CL has increased rapidly, and new foci of transmission have also been reported, especially in the northwestern region [ 7 ].…”

Knowledge and Attitude of the Local Community Towards Cutaneous Leishmaniasis in Rural Endemic Areas in Southwestern Yemen

“…These ndings showed that there was a poor level of knowledge among the local community regarding the usage of modern treatment strategies. This could be a consequence of the collapse of the public health system due to the ongoing armed con ict [13]. As regards knowledge about personal preventive measures such as wearing long-sleeved clothing, using mesh over windows, and using bed nets or repellents was poor.…”

“…The situation also became more complicated in 2010 due to the Arab Spring movement and the ensuing political crisis. Since March 2015, the armed con ict in the country has led to the destruction of 55% of the healthcare infrastructure, which has had a hugely adverse impact on the implementation of control measures and on immunisation coverage [13]. Unfortunately, the ongoing civil unrest has resulted in the re-emergence and outbreak of several infectious diseases including dengue [31], diphtheria [32] and cholera [33].…”

“…Since early 2015, the civil war in Yemen has resulted in the deterioration of the healthcare infrastructure, a breakdown in the delivery of control programmes, the collapse of the healthcare system, and a shortage in the health workforce, and has impeded access to healthcare facilities [13]. Consequently, the incidence of CL has increased rapidly and new foci of transmission have also been reported, especially in the northwestern region [7].…”