Obtaining the perspective of the TB patient attending diagnostic services in Yemen: A qualitative study employing In Depth Interviews and Focus Group Discussions

In this entry, we present the qualitative phase of a multi-method, multi-country study exploring barriers and enablers to accessing TB diagnosis. We describe the implementation of the study in Yemen, of particular interest as little qualitative research has been undertaken in this country and, even less so, studies in the area of health that solicit the views of patients. The lack of a precedent and the distinct cultural context meant that implementing a generic protocol presented a range of practical, budgetary, logistical, sociocultural and ethical considerations. Of particular prominence were normative practices surrounding the freedom of women to work, travel and speak autonomously; religious sensitivities influencing the wording of interview questions; and the organisation of individual and group interviews and a cultural tendency to operate in groups. Reflecting on how these considerations were addressed illuminates the planning and problem solving entailed in managing a research project overseas

Evaluation of Immune Response to Hepatitis B Vaccine among Malnourished Children in Yemen

Objectives: To determine the coverage rate of hepatitis B virus (HBV) vaccine and to evaluate the immune response to HBV vaccine by measuring hepatitis B surface antibody (anti-HBs) among malnourished under-five-year old children.Methods: A cross-sectional study was conducted in two tertiary hospitals in Yemen; Al-Sabeen Maternity and Child Hospital in Sana’a and the Yemeni-Swedish Hospital in Taiz city in the period from March 2014 to Dec. 2014. The target population was malnourished children aged from 6 to 59 months old with a history of three HBV vaccine doses in infancy. According to the World Health Organization’s definition of malnutrition, 121 malnourished children were enrolled in the study. Data of malnourished children were collected using a pre-designed, pre-tested questionnaire. Two milliliters of venous blood were taken, and anti-HBs was then tested by enzyme linked immunosorbent assay. An anti-HBs level of at least 10 IU/L was considered a successful response to the vaccine.Results: The coverage rate of HBV vaccine among malnourished children was 89.3%, being higher among girls (52.1%) than boys (37.2%). Response to HBV vaccine (≥10 IU/L) was observed in 72.2% (78/108) of children while 27.8% (30/108) of children failed to respond to the vaccine, with a statistically significant difference (p <0.001).Conclusions: A good HBV vaccine coverage rate was found among malnourished Yemeni children, with a moderate rate of protection. Therefore, re-vaccination or administration of booster doses to a substantial proportion of vaccinated children should be considered

Front-Loading Sputum Microscopy Services: An Opportunity to Optimise Smear-Based Case Detection of Tuberculosis in High Prevalence Countries

Setting. Ethiopia, Nepal, Nigeria, and Yemen. Objective. To reduce the time to complete sputum microscopy. Design. Cross-sectional surveys enrolling 923 patients with chronic cough in the 4 countries and using similar protocols. Spot-morning-spot sputum specimens were collected. An additional sputum specimen (Xspot) was collected one hour after the first, and the yields of the first two or the three specimens collected as spot-morning-spot or spot-Xspot-morning were compared. Results. 216 patients had ≥ one positive smear. 210 (97%) were identified by the spot-morning-spot, and 210 (97%) were identified by the spot-Xspot-morning specimens, with 203 and 200 identified by the first 2 specimens of each approach, respectively. Neither difference was significant. Conclusions. The time to complete smear microscopy could be reduced

Sharing experiences and dilemmas of conducting focus group discussions on HIV and tuberculosis in resource-poor settings

Focus group discussions (FGD) are gaining in popularity in research on HIV and tuberculosis (TB) internationally as researchers seek to understand the experiences, needs and perspectives of people living with TB and/or HIV as well as their carers within the community and health sector. Conducting FGDs in resource-poor settings with vulnerable participants who are living with diseases that are frequently stigmatised poses multiple challenges. Our approach in this discussion paper is to follow the research cycle to present the practical experience of research teams using FGDs in TB and HIV in resource-poor contexts in Africa and Asia in order to contribute to effective practice. The approach highlights dilemmas and shares effective practice for negotiating initial discussions with different communities, constructing sampling frames and samples, choosing a facilitator, encouraging discussion, ethics, translation, pitfalls and dissemination. We demonstrate the techniques and adaptations needed to ensure that FGDs provide rich, high-quality and policy-relevant data on the voices and perspectives of people living with HIV and TB, community groups and health workers within the challenges of resource-poor settings. In applying theory to develop good practice in FGDs across the research cycle, a critical and reflexive approach is needed

Barriers to Completing TB Diagnosis in Yemen: Services Should Respond to Patients' Needs

Objectives and Background Obtaining a diagnosis of tuberculosis (TB) is a prerequisite for accessing specific treatment, yet one third of estimated new cases are missed worldwide by National Programmes. This study investigated economic, geographical, socio-cultural and health system factors hindering adults' attendance and completion of the TB diagnostic process in Yemen, to inform interventions designed to improve patient access to services. Methodology The study employed a mixed methods design comprising a cross-sectional survey and In-Depth-Interviews (IDIs) and Focus Group Discussions (FGDs) among patients abandoning the diagnosis or registering for treatment. Adults with cough of ≥2 weeks attending a large governmental referral centre in Sana'a, Yemen, between 2009 and 2010, were eligible to participate. Results 497 and 446 (89.7%) participants were surveyed the first and second day of attending the services and 48 IDIs and 12 FGDs were also conducted. The majority of patients were disadvantaged and had poor literacy (61% illiterate), had travelled from rural areas (47%) and attended with companions (84%). Key barriers for attendance identified were clinic and transport costs (augmented by companions), distance from home, a preference for private services, strong social stigma and a lack of understanding of the diagnostic process. There were discrepancies between patient- and doctor-reported diagnosis and 46% of patients were unaware that TB treatment is free. Females faced more difficulties to attend than men. The laboratory practice of providing first-day negative smear results and making referrals to the private sector also discouraged patients from returning. Strategies to bring TB diagnostic services closer to communities and address the multiple barriers patients face to attend, will be important to increase access to TB diagnosis and care

Rotavirus and norovirus infections in children in Sana'a, Yemen

Summary objectives To describe the epidemiology of rotavirus and norovirus infection among children with acute gastroenteritis in Sana'a, Yemen. conclusions Rotavirus and norovirus infections are common causes of gastroenteritis in Yemen. Rotavirus vaccines could play a significant role in the control of acute childhood diarrhoea in this setting. keywords norovirus, rotavirus, Yeme