Background: Healthcare workers (HCWs) fighting against the COVID-19 pandemic are under incredible pressure, which puts them at risk of developing mental health problems. This study aimed to determine the prevalence of depression, anxiety, and stress among HCWs responding to COVID-19 and its associated factors. Methods: A multi-country cross-sectional study was conducted during July–August 2020 among HCWs responding to COVID-19 in nine Eastern Mediterranean Region (EMR) countries. Data were collected using an online questionnaire administered using KoBo Toolbox. Mental problems were assessed using the Depression, Anxiety, and Stress Scale (DASS-21). Results: A total of 1448 HCWs from nine EMR countries participated in this study. About 51.2% were male and 52.7% aged ≤ 30 years. Of all HCWs, 57.5% had depression, 42.0% had stress, and 59.1% had anxiety. Considering the severity, 19.2%, 16.1%, 26.6% of patients had severe to extremely severe depression, stress, and anxiety, respectively. Depression, stress, anxiety, and distress scores were significantly associated with participants’ residency, having children, preexisting psychiatric illness, and being isolated for COVID-19. Furthermore, females, those working in a teaching hospital, and specialists had significantly higher depression and stress scores. Married status, current smoking, diabetes mellitus, having a friend who died with COVID-19, and high COVID-19 worry scores were significantly associated with higher distress scores. Conclusions: Mental problems were prevalent among HCWs responding to COVID-19 in EMR. Therefore, special interventions to promote mental well-being among HCWs responding to COVID-19 need to be immediately implemented.

Background: Diphtheria is a contagious vaccine-preventable disease that contributes to the high morbidity and mortality among under 5 children, especially in Yemen. As a consequence of war and collapse of the health system, a fatal epidemic occurred at the end of 2017. This study aims to describe the epidemiology of diphtheria by time, place, and person and vaccination status of affected children. Methods: A study was conducted in Sada'a governorate by using accumulative line list of diphtheria from November 2017 to September 2020 at electronic Integrated Disease Early Warning System (eIDEWS). The case definition of WHO was adopted. Data was analyzed by Microsoft Excel and Epi info- version 7.2 and multivariable logistic analysis used for identifying significant associated factors. Results: 747 cases were met of WHO case definition. The annual peak of cases started during week 31 and weak 49. Males were slightly more than females (51% vs 49%) and about 35% of cases involved children aged 10 to < 15 years. The overall incidence of diphtheria and case fatality rate (CFR) were 69/ 100,000 and 6.4%, respectively. The highest CFR was among age groups under 5 years 11% (P < 0.001) and among females was 8%. Dysphagia and swollen lymph nodes were the predominant symptoms 98%, 92%, respectively. Based on the Vaccination status, the percentage of unvaccinated and unknown were 53% and 41% respectively, with CFR 11% among cases who received one dose. Furthermore, the most case were from Sahar 40% with case fatality rate 8% and the highest CFR was significantly higher among cases in border and ongoing conflict district (P < 0.05). Conclusions: The findings highlight that diphtheria is still an ongoing cause of morbidity and mortality among under 5 children in Sada'a that is rising with the low diphtheria immunization coverage. Therefore, concomitant efforts should now focus on improving and monitoring routine immunization across all age groups and healthcare services, especially in borders and continuing conflict districts.

Background: The establishment of empirical evidence in the Eastern Mediterranean Region necessitates the implementation of wide-scale studies to describe the demographic, clinical features, and severity profile of patients with COVID-19. Objective: This study aims to assess the patterns of COVID-19 severity and mortality in seven countries, and to determine the risk factors of COVID-19 severity and mortality. Methods: This multicountry study was based on a retrospective review of medical records of hospitalized patients confirmed to have COVID-19. This study includes data from Iraq, Pakistan, Sudan, Somalia, Morocco, Egypt, and Yemen. All demographic and clinical data were extracted from hospital records (paper files) by trained data collectors. Results: A total of 4141 patients were included in this study from seven countries. Comorbidities were reported by nearly half of the patients, with hypertension (n=1021, 24.7%) and diabetes (n=939, 22.7%) being the most common. Older age, diabetes mellitus, hypertension, and heart diseases were significantly associated with COVID-19 severity and mortality. Ever smoking and renal diseases were significantly associated with severity but not mortality, while male gender, respiratory diseases, and malignancy were significantly associated with mortality but not severity. Conclusions: The study confirms the role of comorbidities and demographic features on the severity and mortality of COVID-19. Understanding the contributing factors ensures attentive care and informs clinical management of patients with poorer prognoses in the early stages of diseases.

Objectives: To identify diphtheria risk factors related to sociodemographic, immunization, household status and source of infection in Sanaa city. Methods: A retrospective matched case-control study design (1:2 ratio) was conducted. Case defined as any person who met the WHO definition of confirmed diphtheria living in Sana'a city during Jan.-Nov. 2019. Control was any person did not have a history of diphtheria infection, living in the same neighborhood and matched with case by age and sex. Crude and adjusted odds ratio (aOR), and 95% confidence intervals (CI) were calculated to evaluate the association between risk factors diphtheria. Results: A total of 76 confirmed cases and 152 controls were enrolled. Multivariate analysis shows that there were significant associations between diphtheria infection and shared a bedroom with ≥2 persons (aOR= 2.8; 95% CI: 1.2 – 6.6), non-vaccination (aOR= 2.6; 95% CI: 1.2 – 6.0) and contact with diphtheria case (aOR= 10.6; 95% CI: 2.6 – 43.6). Conclusions: This study emphasizes vaccination, not sharing a bedroom with ≥ 2 persons, and isolation of cases to prevent contact with diphtheria cases were the main important measures for protecting the community from diphtheria. Raising community awareness regarding vaccination, transmission and preventive measures are recommended.

Background: Yemen is facing major challenges in ensuring the safety and availability of blood transfusion to meet the increased demand for blood transfusion due to the protracted conflict. However, Transfusion-transmissible infectious (TTIs) agents such as hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), syphilis and malaria remain the greatest threats for blood transfusion safety in such fragile, conflict-affected and vulnerable settings. This study aimed to determine the magnitude of TTIs among blood donors attending National Blood Transfusion and Research Center (NBTRC) and its associated factors. Methods: Cross- sectional study was conducted on 340 blood donors at the NBTRC during November and December 2017. Data was collected through face-to-face interview using a predesigned questionnaire that covered socio-demographic characteristics and possible TTIs associated factors. Blood samples were drawn and tested for HBV surface antigen (HBsAg), HCV antibodies, HIV1, 2 by using electrochemi-luminescence immunoassay technique and rapid immunochromato-graphic for screened syphilis and malaria antibodies. Result: The overall prevalence of TTIs was 8.8% where 2.5 %, 1.2%, 0.3%, 1.2%, 3.2% have HBV, HCV, HIV, syphilis and malaria respectively. HBV was significantly associated with history of jaundice and cupping. Furthermore, urethero-vaginal excretion was significantly associated with syphilis while malaria was significantly higher among donors from malaria endemic areas. Nearly three-fourth of donations were from replacement donors who had significantly higher TTIs prevalence than the voluntary donors: 10.4% vs. 3.3%, OR 3.4 (CI: 1.1-11.6). Conclusions: Although the prevalence of TTIs is low, it poses a serious risk for blood recipients especially in in fragile, conflict-affected and vulnerable settings where needs for blood transfusion are increasing and resources are limited. Therefore, using more sensitive screening methods and establishment of TTIs surveillance system should be considered. Efforts should be made to improve donor recruitment procedures and increase the proportion of regular and voluntary donation.