Geographical distribution of visceral leishmaniasis cases by county in South Sudan, 2009–2012.

<p>Geographical distribution of visceral leishmaniasis cases by county in South Sudan, 2009–2012.</p

Number of new visceral leishmaniasis cases per month in South Sudan, 2009–2012.

<p>Number of new visceral leishmaniasis cases per month in South Sudan, 2009–2012.</p

Timeline of key vaccination events in South Sudan in 2014.

<p>The dots on the timeline represent key vaccination-related events throughout the country. Labels are shown for a selection of events, with the complete timeline shown in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001901#pmed.1001901.s001" target="_blank">S1 Fig</a>. Colors represent different phases of the vaccination campaigns, with red representing planning events, yellow representing logistical activities leading up to the vaccine deployment, and green representing vaccination deployment activities. The epidemic curve is shown as grey vertical bars above.</p

Epidemic curves of suspected cholera cases in key vaccinated (green) and unvaccinated areas (blue).

<p>Panels show the daily incidence rate of suspected cholera cases in the Juba community (A), the Juba PoC camps (B–C), Wau Shilluk camp (D), and Malakal PoC camp (E). Note that panels A–C have a break in the <i>y</i>-axis, as they had a much smaller incidence rate.</p

Illustration of the county-level attack rates in the 2014 cholera epidemic with respect to the vaccination locations (orange dots).

<p>Grey areas represent counties with no suspected cholera cases.</p

Details of OCV deployments in South Sudan in 2014 by site.

<p>LQAS, lot quality assurance sampling</p><p>^<b>‡</b> Target population estimates were made at the time of requesting vaccine.</p><p>*The campaign was conducted during a large population influx, so no reliable denominator figures were available.</p><p>Details of OCV deployments in South Sudan in 2014 by site.</p

Geographical locations of 18 laboratories with PCR, GeneXpert, and genetic sequencing capacity in Yemen by November 2022.

Geographical locations of 18 laboratories with PCR, GeneXpert, and genetic sequencing capacity in Yemen by November 2022.</p

Challenges encountered during the pandemic response in Yemen Challenges.

Challenges encountered during the pandemic response in Yemen Challenges.</p

Timelines highlighting important milestones on the evolution of virus in Yemen and period for the establishment of PCR and other laboratories.

Timelines highlighting important milestones on the evolution of virus in Yemen and period for the establishment of PCR and other laboratories.</p

S1 Dataset -

BackgroundWhen the COVID-19 pandemic was declared, Yemen, a country facing years of conflict had only one laboratory with PCR testing capacity. In this article, we describe the outcome of the implementation of molecular based diagnostics platform in Yemen and highlight the key milestones the country went through to increase access to testing for its populations residing in a geographically vast and politically divided country.MethodsA retrospective assessment of COVID-19 laboratory response activities was done detailing the needs assessment process, timelines, geographical coverage, and outcomes of the activities. Laboratory data was analyzed to construct the geographical locations of COVID-19 testing laboratories and the numbers of tests performed in each facility to highlight the demands of testing for travelers. Finally, we discuss the impact these activities had in enabling the movement of people across international borders for economic gains and in delivery of critical humanitarian aid.OutcomePCR testing capacities in Yemen significantly improved, from one laboratory in Sanaa in April 2020 to 18 facilities across the country by June 2022. In addition, the number of functional Real-Time PCR thermocyclers increased from one to 32, the PCR tests output per day improved from 192 to 6144 tests per day. Results from analysis of laboratory data showed there were four peaks of COVID-19 in Yemen as October 2022. The majority of laboratory tests were performed for travelers than for medical or public health reasons. Demand for laboratory testing in Yemen was generally low and waned over time as the perceived risk of COVID-19 declined, in parallel with rollout of the COVID-19 vaccines.Discussion/ConclusionThe successful expansion of laboratory testing capacity was instrumental in the control and management of COVID-19 cases and critical in the implementation of public response strategies, including restrictions on gathering. Laboratory testing also facilitated the movement of humanitarian agencies and delivery of aid and enabled hundreds of thousands of Yemeni nationals to travel internationally. By virtue of these outcomes, the impact of laboratory strengthening activities was thus felt in the health sector and beyond.</div