Acute sporadic hepatitis in the Republic of Yemen

The causes of acute icteric viral hepatitis were determined in 78 adult Yemeni patients. Acute hepatitis B (IgM anti-HBc positive) was the most common type (26.9%). Acute hepatitis E (IgM anti-HEV positive) occurred in 14% and was not associated with travel outside Yemen. Sixty percent of all 78 patients were positive for IgG anti-HEV as were 40% of a series of 48 healthy male blood donors and pregnant females, indicating that HEV is prevalent in Yemen. Acute hepatitis A (IgM anti-HAV positive) and hepatitis C and D were responsible for 5.1%, 6.4%, and 2.6% cases, respectively. This totals to 106%, as an infection with two viruses occurred in 6.4% cases. In 51.3% of all cases, no virological markers of acute hepatitis were detected, suggesting an as yet undiscovered agent. J Med Virol 51:64–66, 1997. © 1997 Wiley-Liss, Inc.     

Why is Hepatocellular Carcinoma Less Attributable to Viral Hepatitis in Yemen?

The hepatitis B virus (HBV) and the hepatitis C virus (HCV) are still public health problems in Yemen, witholder individuals having much higher prevalence than younger generations. However, research on the prevalenceof viral hepatitis in association with hepatocellular cancer (HCC) has not yet been undertaken in Yemen. The aimof this study was to determine the prevalence of HBV and HCV infection among HCC patients and to estimatethe risk of these infections being associated with the development of HCC. A cross-sectional study was conductedon patients attending oncology outpatient in Sana’a, Yemen, through the period 2008-mid 2010 with confirmeddiagnosis of HCC. A total of 88 cases were studied thoroughly with different investigations such as CT-scan,ultrasound, tumour marker, alpha-feto-protein and histopathological biopsy. A structured questionnaire wasalso applied and physical examination done to assess the general condition of the patients. Statistical package(SPSS version 16) was used for analysis of the data. The mean age of the cases was 61.2 years (±12.6) with halfover 60 years. There were fewer male patients (36%) compared to females and most (97%) only had basic /noformal education. Seventy nine (89%) were diagnosed as HCC cases with histopathological biopsy while therest were diagnosed by ultrasound, CT scan, tumour marker, and alpha-feto-protein. Around one-third of thesubjects were positive for HBsAg and HCV antibodies. Multivariate analysis showed infection with HCV and useof smoking was associated with HCC diagnosis. Although an association was observed between the occurrenceof HCC and viral hepatitis (either HBV or HCV) and cigarette smoking, but the rate of viral infection was lowerthan what has been reported elsewhere.     

Epidemiology of Viral Hepatitis B and C Infections in Ibb City,Yemen

Background

The global epidemic of hepatitis B and hepatitis C is a serious publichealth problem. Chronic hepatitis B and hepatitis C are among the leading causes of preventable death worldwide. World Health Organization (WHO) estimates that up to two billion people in the world have been infected with HBV; about 350 million people live with chronic HBV infection, and about 600,000 people die from HBV- related liver disease or HCC each year. The endemicity of infection is considered high in Yemen. Data for prevalence of HBsAg and HCV antibodies in Ibb city in Yemen is rare and inadequate.

Objectives

The study was undertaken to study the epidemiology and prevalence of viral hepatitis (HBV) and (HCV) in Ibb city, Yemen.

Patients and Methods

554 pre-designed questionnaires and sera samples were collected in July 2010. Sera were tested for HBsAg and HCV antibodies by ELISA quantitative technique. Each individual’s data were collected in a pre-designed questionnaire.

Results

The prevalence of HBV in Ibb city was 1.81 %, whereas, the prevalence of HCV was 1.99 %.

Conclusions

This study revealed low level risk of hepatitis B virus and hepatitis C virus infections. Inadequate information on the prevalence and risk determinants of viral hepatitis among the different population groups in Yemen are responsible about morbidity and mortality of HBV and HCV in Ibb city, Yemen.     

Hepatitis B virus carrier rate, prevalence and susceptibility and impact of immunization program among households in the city of Taiz, Yemen

Objective

To examine the carrier rate, prevalence and susceptibility to hepatitis B virus infection in the city of Taiz, Yemen.

Methods

In a community-based household survey 521 subjects from 98 randomly selected households were enrolled. Carrier rate, prevalence and susceptibility of hepatitis B virus infection in the city of Taiz, Yemen were examined.

Results

The median age of the subjects was 19 years (range <1–85 years), 219 (42.0%) of whom were males and 305 (58.0%) were females. The HBsAg carrier rate was 4.2% (22/521), the prevalence was 16.9% (88/521) and the susceptibility rate was 57.5% (287/499). Male vs female carrier rate, prevalence and susceptibility rate were comparable. Children (age ≤18 years) vs adults had carrier rates of 2.7% vs 5.7% (odds ratio = 2.2) and a prevalence of 5.1% vs 28.4% (OR: 5.6). The carrier rate, prevalence and immunity to HBV among subjects who reported vaccination vs those unvaccinated was; 2.1% vs 5.5%, 11.3 vs 20.8% and 53.1% vs 18.8%. A proportion of 47.2% of subjects who aged ≤10 years had isolated anti-HBs. Of 142 of the cohort born after full implementation of vaccination program (age:≤9 years) 72 (50.7%) were immune and 70 (49.3%) were susceptible whereas of 357 subjects borne before program implementation (Age:≥10 years) 140 (39.2%) were immune and 217 (60.8%) were susceptible (p < 0.02 (Pearson) OR: 1.6 CI = 0.42–0.93).

Conclusions

An intermediate endimicity was identified in Taiz city. Vaccination reduced carrier rate prevalence and susceptibility among vaccinated subjects. The high rate of subjects with isolated anti- HBs together with the reduced susceptibility rate among the cohort born after inclusion of HBV vaccine to EPI reflects impact of the program. Improving vaccination coverage will further reduce susceptibility rate.     

Healthcare financing in Yemen

Yemen is a low‐middle‐income country where more than half of the population live in rural areas and lack access to the most basic health care. At US$40 per capita, Yemen's annual total health expenditure (THE) is among the lowest worldwide. This study analyses the preconditions and options for implementing basic social health protection in Yemen. It reveals a four‐tiered healthcare system characterised by high geographic and financial access barriers mainly for the poor. Out‐of‐pocket payments constitute 55% of THE, and cost‐sharing exemption schemes are not well organised. Resource‐allocation practices are inequitable because about 30% of THE gets spent on treatment abroad for a small number of patients, mainly from better‐off families. Against the background of a lack of social health protection, a series of small‐scale and often informal solidarity schemes have developed, and a number of public and private companies have set up health benefit schemes for their employees. Employment‐based schemes usually provide reasonable health care at an average annual cost of YR44 000 (US$200) per employee. In contrast, civil servants contribute to a mandatory health‐insurance scheme without receiving any additional health benefits in return. A number of options for initiating a pathway towards a universal health‐insurance system are discussed. Copyright © 2012 John Wiley & Sons, Ltd.     

High relative frequency of oral squamous cell carcinoma in Yemen: qat and tobacco chewing as its aetiological background

To study the association of qat chewing with the occurrence of oral cancer, the frequency of oral cancer among whole body cancers and the patients' histories of tobacco consumption and qat chewing were examined in Yemen where qat chewing has been most popular. All primary malignant tumors listed in the surgical pathology files at Al-Thawra Hospital, University of Sana'a, in the year 2004 were analyzed, and the patients' histories of tobacco consumption and qat chewing were examined. A total of 649 cases of primary malignant tumors (348, 53.6% males and 301, 46.4% females) were extracted. Oral cancer was the most frequent body cancer in both males (17.2%) and females (19.6%). Squamous cell carcinoma (SCC) was the most frequent oral cancer (84%), and the tongue (42%), gingiva (23%) and buccal mucosa (20%) were the most common sites. Among the 119 patients with oral cancer, information on chewing habits and smoking was obtained in 92 patients (77.3%). There were 70 tobacco chewers (76.1%), 55 qat chewers (59.8%), and 22 smokers (23.9%). Simultaneous chewing of tobacco and qat was found in 48 cases (52.2%). The present survey has disclosed for the first time that oral SCC is the most frequent cancer in this study area in Yemen, and that the high relative frequency of oral SCC may be related to the habits of chewing tobacco and qat.