Rural Yemen Research Articles

STUDYING THE PHENOMENON OF POVERTY IN THE COUNTRYSIDE OF THE DAHHAR DISTRICT IN YEMEN

This research aimed to study poverty in rural Yemen through the percentage, gap, and severity in addition to the standard economic analysis. The study showed that the poverty percent reached 97%, while the gap and severity reached 64, and 45% respectively. A study of the probability distribution of poverty indicators showed that the poverty percent ranged from a minimum of 95.4% to a high of 98.6% at a 95% confidence level. The poverty gap ranged from a low of 59.8% to a high of 68.2% at 95% confidence. The severity of poverty ranged from a minimum of 40.7% to a high of 49.3% at 95% confidence. These results of the study are emphasized on the need for the implementation of several policies. Among these two most important are (1) expanding the activity of NGOs to reduce poverty and hunger, (2) focusing on sustainable development and increasing the economic size of the agricultural sector and its relative importance to poverty reduction. To reduce poverty in the rural areas of the Republic of Yemen, the study recommends (1) the expansion of the activities of civil societies under government supervision to increase their ability to reduce poverty and hunger, (2) the provision of the necessary funding for the expansion of small investment projects that are commensurate with the capabilities and qualifications of poor families and (3) focusing on sustainable development of the agricultural sector is relative importance in reducing poverty.

The Neglected Cestode Infection: Epidemiology of Hymenolepis Nana Infection Among Children in Rural Yemen.

SummaryHymenolepis nana is the most common cestode reported in humans worldwide. It is prevalent among children in the tropics and subtropics, particularly in rural poor communities where sanitation is inadequate or lacking. This cross-sectional study aims to determine the prevalence and significant risk factors of H. nana infection among children in rural Yemen. Faecal samples were collected from 498 children and screened for intestinal parasites by using wet mount, formalin-ether concentration and Kato–Katz techniques. A pretested questionnaire was used to collect demographic, socioeconomic, housing condition, and personal hygiene information. Overall, 77.5 % (386/498) of the children were found to be infected by at least one intestinal parasite species. The overall prevalence of H. nana was 17.5 % (87/498). Multivariate analysis confirmed that an age of < 6 years (adjusted odds ratio [AOR] = 4.28; 95 % (confidence interval [CI] = 2.04, 8.98), presence of other family members infected with H. nana (AOR = 2.48; 95 % CI = 1.45, 4.24), living in the highlands (AOR = 2.87; 95 % CI = 1.56, 5.26), living in a house without improved toilet facilities (AOR = 2.19; 95 % CI = 1.23, 3.88), not washing vegetables before consumption (AOR = 2.11; 95 % CI = 1.06, 4.19), and not washing hands after defecation (AOR = 1.88; 95 % CI = 1.08, 3.27) were the key factors significantly associated with H. nana infection among the studied children. In conclusion, H. nana is prevalent among children in rural Yemen, particularly among preschool-aged children. Thus, an integrated and effective programme to control intestinal parasitic infections should include preschool-aged children. Such a programme should focus on providing health education on hygienic practices, providing adequate sanitation and improved sources of drinking water, and screening and treating other infected family members.

A cross-sectional survey of the knowledge, attitudes and practices regarding schistosomiasis among rural schoolchildren in Taiz governorate, southwestern Yemen.

This cross-sectional survey aimed to assess the knowledge, attitudes and practices (KAP) towards schistosomiasis among rural schoolchildren in Taiz governorate, southwestern Yemen. A total of 406 children were screened for urogenital and intestinal schistosomiasis. A pretested questionnaire was used to collect the children's demographic and socio-economic information and their KAP towards schistosomiasis. Overall, 73 children (18%) were found to be infected by Schistosoma mansoni. None of the children were positive for Schistosoma haematobium. The prevalence of intestinal schistosomiasis was significantly higher among boys than girls (22.1% vs 12%; p=0.010). Approximately two-thirds (63.3% [257/406]) of the children had heard about schistosomiasis, however, only 38.5%, 53.6%, 28.4% and 38.1% had correct knowledge concerning the causes, symptoms, transmission and prevention, respectively. A significantly higher level of knowledge was observed among boys and Schistosoma-infected children compared with girls and non-infected children (p<0.05). However, a better level of knowledge does not seem to translate directly into the performance of hygienic practices. Multivariate logistic regression showed that sex and infection status were the significant predictors of good knowledge. Intestinal schistosomiasis is prevalent among schoolchildren in rural Yemen. The findings reveal that children's knowledge about schistosomiasis is inadequate. Therefore, besides mass drug administration, integrated control programmes should also include health education and the provision of improved drinking water and proper sanitation.

Simulating the potential of swarm grids for pre-electrified communities – A case study from Yemen

Swarm grids are an emerging approach to electrification in the Global South that interconnects individual household generation and storage to a small electricity network to make full use of existing generation capacities. Using a simulation tool for demand, weather, and power flows, we analyse the potential of an AC swarm grid for a large pre-electrified village in rural Yemen. Service quality and financial indicators are compared to the cases of individual supply and a centralised micro grid.While the swarm grid would improve supply security from the current 12.4% (Tier 2) to 81.7% (Tier 3) at lower levelised costs, it would be inferior to the micro grid in both service (Tier 4) and costs. This is mainly driven by the large pre-installed fossil-fuel generator and storage capacities in our case study. However, this situation may be representative for other relevant locations. Under these conditions, a swarm grid poses the danger of creating (possibly-undesirable) incentives to invest in diesel generators, and it may fail to support prosumerism effectively. Nevertheless, the swarm's evolutionary nature with the possibility for staggered investments (e.g. in smaller yet complementary groups of consumers) poses a central advantage over micro grids in the short-term alleviation of energy poverty.

Using Household Socioeconomic Indicators to Predict the Utilization of Maternal and Child Health Services Among Reproductive-Aged Women in Rural Yemen.

Using principal component analysis (PCA) and integrating both individual and household factors, we had previously derived and proposed 3 socioeconomic indices (namely, wealth index, educational index, and housing quality index) that can be used to classify rural Yemeni women into different socioeconomic statuses (SES). In the current article, we examined whether the PCA-derived indices can be used to predict the use of maternal and child health care services in rural Yemen. We used data from subnational representative multistage sampling cross-sectional household survey conducted in rural Yemen in 2008-2009 among women (N = 6907) who had given birth. The resulting component scores for each SES index were divided into tertiles. Logistic regression was used to study the associations between the SES indices and 4 indicators of maternal health care use. Higher tertiles of each socioeconomic index increased the likelihood of adequate antenatal care use, delivery assistance, and contraceptive use, but decreased the likelihood of unmet need for contraception. Key maternal health indicators can be determined by socioeconomic indicators. Therefore, in planning maternal and child health interventions, considering disparities of care by socioeconomic factors should be taken into account.

Assessment of undernutrition using Composite Index of Anthropometric Failure among children aged &lt; 5 years in rural Yemen

Impaired nutritional status is a major health problem affecting young children in developing countries that has a significant impact on child morbidity and mortality. This study aimed to assess the prevalence of undernutrition among children aged < 5 years, using conventional indices and the Composite Index of Anthropometric Failure (CIAF), and then comparing their estimated results. A community-based cross-sectional study was conducted and information was collected through house-tohouse visits using precoded structured records. We analysed data from 1292 children aged 6-59 months, from Ahwar and Al-Mahfed rural districts in Abyan Governate, South Yemen, with reference to the 2006 World Health Organization growth standards. CIAF identified undernutrition in 70.1% of children, while conventional anthropometric indices revealed 38.5% stunting, 39.9% wasting, and 55.1% underweight. Compared with conventional indices, CIAF aggregate recognized 31.6%, 30.2% and 15% more undernourished children than stunting, wasting and underweight separately. According to CIAF, 21% had a single anthropometric failure and 49.2% exhibited multiple failures. Stunting Index, Wasting Index and Underweight Index were 0.55, 0.57 and 0.79, respectively. CIAF gives a better estimate of undernutrition than currently used conventional indices; identifies more children with multiple anthropometric failures; and reflects a wider view of the extent and pattern of undernutrition of children living in communities with limited resource settings.

Smoking prevalence, attitudes and associated factors among students in health-related Departments of Community College in rural Yemen.

INTRODUCTIONTobacco smoking is a global concern and tobacco use is rising among the youth in Arab countries, such as Yemen, especially among university students. This study aims to examine the prevalence, attitudes and associated factors of smoking among college students in the rural area of Hajja, Yemen.METHODSA cross-sectional descriptive study was conducted at a community college in the Hajja province between August and December 2016. The data were collected from three health related departments (Nursing, Laboratory, and Assistant doctor). A questionnaire based on the Global Health Professional Survey and the Global Youth Tobacco Survey was answered by 380 randomly selected students.RESULTSLogistic regression analyses indicated that sex (OR=0.4, 95% CI: 0.2–0.8, p<0.05), family income (OR=2.0, 95% CI: 1.2–3.3, p<0.05), and residence (OR=0.2, 95% CI: 0.1–0.5, p<0.001), were statistically significant predictors of smoking. Smoking for peer pressure, recreation and proving manhood were all found to be highly significant (p<0.001). The results also revealed that smokers had more negative attitudes towards allowing children to smoke in the future and allowing smoking in the household (p<0.001).CONCLUSIONSCompared to similar studies on the general population, the prevalence of smoking among college students in the rural area was lower. An indication of a growth in tobacco use can be concluded, accordingly, the need for anti-smoking programmes to prevent students from initiating smoking is required.

Undernutrition among children under 5 years of age in Yemen: Role of adequate childcare provided by adults under conditions of food insecurity.

Objective: This study examined the associations between the adequacy of childcare provided by adult caretakers and childhood undernutrition in rural Yemen, independent of household wealth and food consumption.Methods: We analyzed data of 3,549 children under the age of 5 years living in rural areas of Yemen based on the 2013 Yemen Baseline Survey of Mother and Child Health. Nutritional status was evaluated by the presence of underweight, stunting, and wasting according to the World Health Organization child growth standards. The impact of childcare including leaving children alone, putting older children into labor force, and the use of antenatal care while pregnant on child undernutrition was assessed and adjusted for food consumption by children, household composition, demographic and educational background of caretakers, and household wealth.Results: The prevalence of underweight, stunting, and wasting was 46.2%, 62.6%, and 11.1%, respectively. Not leaving children alone, keeping children out of the labor force, and use of antenatal care were associated with a lower risk of underweight (odds ratio [OR] = 0.84, P = 0.016; OR = 0.84, P = 0.036; and OR = 0.85, P = 0.042) and stunting (OR = 0.80, P = 0.004; OR = 0.82, P = 0.024; and OR = 0.78, P = 0.003). After further adjustment for food consumption, the associations between adequate childcare indicators and lower odds of stunting remained significant (OR = 0.73, P = 0.025; OR = 0.72, P = 0.046; and OR = 0.76, P = 0.038).Conclusions: A marked prevalence of stunting among rural children in Yemen was observed. Adequate childcare by adult caretakers in families is associated with a lower incidence of underweight and stunting among children under 5 years of age. Promoting adequate childcare by adult household members is a feasible option for reducing undernutrition among children in rural Yemen.

Measures of Maternal Socioeconomic Status in Yemen and Association with Maternal and Child Health Outcomes.

Reliable measurement of socioeconomic status (SES) in health research requires extensive resources and can be challenging in low-income countries. We aimed to develop a set of maternal SES indices and investigate their associations with maternal and child health outcomes in rural Yemen. We applied factor analysis based on principal component analysis extraction to construct the SES indices by capturing household attributes for 7295 women of reproductive age. Data were collected from a sub-national household survey conducted in six rural districts in four Yemeni provinces in 2008-2009. Logistic regression models were fitted to estimate the associations between the SES indices and maternal mortality, spontaneous abortion, stillbirth, neonatal and infant mortality. Three SES indices (wealth, educational and housing quality) were extracted, which together explained 54 % of the total variation in SES. Factor scores were derived and categorized into tertiles. After adjusting for potential confounding factors, higher tertiles of all the indices were inversely associated with spontaneous abortion. Higher tertiles of wealth and educational indices were inversely associated with stillbirth, neonatal and infant mortality. None of the SES indices was strongly associated with maternal mortality. By subjecting a number of household attributes to factor analysis, we derived three SES indices (wealth, educational, and housing quality) that are useful for maternal and child health research in rural Yemen. The indices were worthwhile in predicting a number of maternal and child health outcomes. In low-income settings, failure to account for the multidimensionality of SES may underestimate the influence of SES on maternal and child health.

Spectrum of winter dermatoses in rural Yemen.

Surveys that have been carried out to determine the prevalence of skin diseases in rural Yemen are scarce or not available. To investigate the spectrum of winter dermatoses in a rural Yemeni community. A retrospective study was conducted at the dermatology outpatient clinic of the Al-Helal Specialized Hospital (Radaa' district of Al Bayda' Governorate) using data analysis of 700 selected records of patients managed during fourmonths of the 2013-14 winter season. Seven hundred patients with 730 diseases were reported in this study; the major bulk of patients (46.57%) were in the >18-40-year age group, and females outnumbered males. By far, dermatitis, eczematous, and allergic disorders (38.49%) topped the list of the most frequent skin disorders groups, followed by skin infections and infestations (20%) and the pigmentary disorders (13.70%) group. Contact dermatitis (10.68%) was the most prevalent skin disorder, followed by hyperpigmentations (8.77%), acne (8.08%), viral infections (5.75%), atopic dermatitis (5.62%), and parasitic infestations (5.34%). This survey has documented the spectrum of winter dermatoses in a rural Yemeni community but also reflects the pattern of common dermatoses in the whole country. Dermatitis, eczematous, and allergic disorders, skin infections, and pigmentary disorders are the commonest groups. Contact dermatitis is the most prevalent disorder, and leishmaniasis is the most prevalent skin infectious disease. Climate, occupational, social, and environmental factors are the main contributors. Such statistics can form an important basis for community-based health policies.

Detection of Schistosoma mansoni and Schistosoma haematobium by Real-Time PCR with High Resolution Melting Analysis.

The present study describes a real-time PCR approach with high resolution melting-curve (HRM) assay developed for the detection and differentiation of Schistosoma mansoni and S. haematobium in fecal and urine samples collected from rural Yemen. The samples were screened by microscopy and PCR for the Schistosoma species infection. A pair of degenerate primers were designed targeting partial regions in the cytochrome oxidase subunit I (cox1) gene of S. mansoni and S. haematobium using real-time PCR-HRM assay. The overall prevalence of schistosomiasis was 31.8%; 23.8% of the participants were infected with S. haematobium and 9.3% were infected with S. mansoni. With regards to the intensity of infections, 22.1% and 77.9% of S. haematobium infections were of heavy and light intensities, respectively. Likewise, 8.1%, 40.5% and 51.4% of S. mansoni infections were of heavy, moderate and light intensities, respectively. The melting points were distinctive for S. mansoni and S. haematobium, categorized by peaks of 76.49 ± 0.25 °C and 75.43 ± 0.26 °C, respectively. HRM analysis showed high detection capability through the amplification of Schistosoma DNA with as low as 0.0001 ng/µL. Significant negative correlations were reported between the real-time PCR-HRM cycle threshold (Ct) values and microscopic egg counts for both S. mansoni in stool and S. haematobium in urine (p < 0.01). In conclusion, this closed-tube HRM protocol provides a potentially powerful screening molecular tool for the detection of S. mansoni and S. haematobium. It is a simple, rapid, accurate, and cost-effective method. Hence, this method is a good alternative approach to probe-based PCR assays.

Prevalence and Risk Factors of Iron Deficiency Anemia among Children in Yemen

Iron deficiency anemia (IDA) is the most common nutritional anemia and considered a major public health problem worldwide. This cross-sectional study was carried out to investigate the prevalence and risk factors of IDA among 187 children aged below 15 years from rural areas in Yemen. Clinical data was collected by measuring hemoglobin level (Hb), serum iron (SI), serum ferritin (SF), and total iron binding capacity (TIBC). Moreover, fecal samples were collected and examined for the presence of intestinal parasites. Demographic and socioeconomic data was collected by a pretested questionnaire. The overall prevalence of anemia and IDA was 48.7% and 34.2%, respectively with IDA represents 70.2% of all anemia cases. Univariate analysis showed significant associations between IDA and age, gender, parent educational level, monthly household income, intestinal parasitic infections. However, gender (female), low household monthly income and low level of mothers’ education were retained by multivariate analysis as the risk factors of IDA. In conclusion, IDA is a serious health problem among children in rural Yemen and there is a need for national intervention strategies and programs to improve the socioeconomic status and health education which will help significantly in controlling anemia and IDA among these children.

Formal and Informal Justice and Punishment

For this article, the authors used ethnographic and interview data collected in 2008 to examine restorative justice rituals performed in Yemen. Interviewees explain that, in rural Yemen, police officers defer to local sheikhs to maintain peace in this region. At the same time, these sheikhs sometimes work with government officials to ensure the early release of prisoners who undergo restorative justice mediation rituals. The authors argue that this produced a hybrid model of rural and state justice in which state agents, such as the police, defer to indigenous, customary law to restore order and justice. This allows those living in rural Yemen to choose the conditions under which justice is meted out. The work advances Braithwaite’s theory of restorative justice by focusing on an understudied aspect of restorative justice, which is the tension and cooperation between formal and informal systems.

Groundwater quality of Yemen volcanic terrain and their geological and geochemical controls

One hundred thirty boreholes of volcanic aquifers in rural Yemen Highland Groundwaters (YHGs) were chemically investigated to assess the suitability of water for drinking. Focus is to identify inorganic constituents of significant risk to health that occur in groundwaters of this area. Results showed that a number of boreholes contain, apart from fluoride, levels of nitrate, some heavy metals, total dissolved solids, and sulfates that could pose a health risk for consumers. The lateral variations of major ions with depth varied within the same aquifer based on the dynamic equilibrium of groundwater and hydrogeological conditions. The main inorganic groundwater contaminant in volcanic YHG is fluoride which is attributed to groundwater lithology and water type. Fluoride appears high in Ca-poor groundwater and where cation exchanges of Ca for Na are dominant. High F concentration in YHG is an extension of East African fluoride-rich groundwater. Majority of tube wells show that Fe concentration exceeds WHO guideline many folds. Much of the iron and manganese in groundwaters are naturally occurring, since the source rocks are enriched in ferromagnesian minerals. NO3− and Cl− concentrations that have been detected in some wells may indicate sewage and/or agricultural runoff. Elevated concentration of chemical constituents in groundwater is a sign of groundwater degradation.

Quality of management for acute respiratory tract infections and diarrhoeal diseases in rural Yemen

To evaluate the performance of health workers with respect to diagnosis and treatment of acute respiratory infection (ARI) and acute diarrhoea (AD) in children < 5 years in 11 rural heath facilities in Yemen, we carried out a cross-sectional study on 219 cases of ARI and 93 cases of AD. Mean score for performance was 30.04 (range 21-39). The quality of care provided was fair in 89.4% and poor in 4.5% of cases. A "well done" performance of 6.3% was achieved by medical doctors but only 3.6% of medical assistants and 25% of medical assistants scored "poor" for performance, but only 2.5% of medical doctors. Health workers who had received training courses in ARI and AD performed slightly better than those who had not.

Bacterial profile and clinical outcome of childhood meningitis in rural Yemen: A 2-year hospital-based study

Childhood acute bacterial meningitis (ABM) is an important cause of death and long-term neurological disability in Yemen, the only low income-high mortality country in the Arabian Peninsula. The objective of this study was to document the microbial characteristics, the antibacterial sensitivity pattern, and the outcome for children hospitalized with ABM, prior to the introduction of Haemophilus influenzae type b (Hib) vaccine in Yemen. The study was retrospective, conducted at a rural district hospital, serving the rural population of the northern parts of Yemen. All patients aged 1 month-15 years admitted between May 1999 and June 2001, with clinical evidence of meningitis and cerebrospinal fluid (CSF) cultured, were included in the study. Clinical information from case notes, including CSF result and the outcome on discharge, were obtained. Analysis of extracted data was performed using Epi Info software. During the 2-year study period, 160 study patients met the inclusion criteria, and 7 (4.4%) were negative for bacterial growth. In the 153 positive cultures there were 46 (30.1%) Streptococcus pneumoniae (SP), 23 (15%) H. influenzae (HI), 81 (52.9) Neisseria meningitidis (NM), 2 (1.3%) Staphylococcus aureus (S. aureus), and 1 (0.7%) Escherichia coli. Sixteen study patients died (overall case fatality rate (CFR) 10%), 7 aged under 12 months, 6 aged 12-60 months, and 3 more than 60 months. Ten deaths were due to SP meningitis, 2 HI meningitis, 3 NM meningitis, and 1 had S. aureus. Of the 144 survivors, 28 (19.4%) developed permanent neurological complications, 17 aged less than 12 months, 6 aged 12-60 months, and 5 more than 60 months. SP meningitis accounted for 57.1% (16/28), and 6 (21.4%) had HI meningitis. Among the 89 aged 1-60 months, 13 died (CFR 14.6%), and 23 (30.3%) of the 76 survivors developed permanent complications. Of those tested 20% and 35% of the 20 HI tested isolates and 9.5% and 14.3% of the 42 SP isolates, were resistant to ampicillin and penicillin G, respectively, and the majority of the 81 NM isolates were sensitive to both. The 3 pathogens were largely resistant to gentamicin, and almost all were susceptible to chloramphenicol and cefotaxime. In contrast to the studies from the low-mortality countries of the region, our study showed that the predominant pathogens of childhood ABM were SP and NM. SP meningitis was associated with increased mortality and permanent disability.

Public Words and Body Politics: Reflections on the Strategies of Women Poets in Rural Yemen

This paper provides historical perspective on the mediation of women's public verbal activism in the Republic of Yemen by considering the public expressive strategies of two rural women poets. Much of the research on the expressive lives of Middle Eastern women has focused on verbal genres typically designated private or domestic, such as agricultural and wedding songs, lullabies and songs about personal experiences, and stories, tales, or narratives not traditionally considered "poetry." In contrast, this essay attends to public poetry and related discourses produced by and about two speci�c rural women. By examining how these women have managed, appropriated, and interrogated dominant patriarchal discourses of tribalism, Islamism, and nationalism, and by considering how media technologies contribute in different ways to embodying women's voices, this essay articulates a methodological framework that can better account for the expressive capacities of contemporary women activists in the rural Middle East.

Reception, Identity, and the Global Village

Reception, Identity, and the Global Village

Ibrāʾ in Highland Yemen: Two Jewish Divorce Settlements

AbstractThis essay contains a translation and discussion of two Jewish divorce settlements concluded in rural Yemen during the first half of this century. Drawing upon information provided by informants who were eyewitnesses to one of the settlements, I delineate — against a background of Jewish and Islamic law — patterns of behavior followed by Jews and Muslims in the field of marriage relations, drawing attention to some of the intricacies of Judeo-Muslim cultural and legal interaction in Imamic Yemen.

High levels of childhood rickets in rural North Yemen

Despite a warm sunny climate, rickets is extremely common in children living in an isolated mountainous area of North Yemen. In a small township the overall prevalence amongst children under five years attending for vaccination was 27%. The condition was most common at the end of the first year and had disappeared by the fifth year. Marasmus was commonly associated with rickets. Children from the rural villages outside the township had significantly lower rates of rickets. Several factors may contribute to the very high rates of rickets in rural Yemen. However, lack of exposure to sunlight as a consequence of particular cultural practices is likely to be the most important. The major social and behavioural factors which restrict the young child access to sunlight are outlined, and possible remedies discussed.