Correspondence
Yemen’s health-care system has witnessed improvements since 1990; however, these improvements are disappointing when compared with successes achieved by neighbouring Gulf countries. Women and child health is a chief concern requiring advance ment and effective intervention. Recent initiatives have been de veloped to target Millennium Developmental Goals 4 and 5, which buttress reduction in child mortality rates and improvement of maternal health.1 Among these initiatives, the National Midwifery Strategy led by the Ministry of Public Health and Population, the National Reproductive Health Strategy, and the CATALYST Consortium in partnership with USAID aimed at improving training of midwives, staff retention, and methods used in family planning and reproductive-health service delivery.2 However, present data show that these projects exhibit some challenges and have had limited success. Yemen has an infant death rate of 51 deaths per 1000 livebirths and a maternal mortality rate of 365 per 100 000 livebirths.3 At present, 22 women die every year because of poor maternal health facilities in Yemen, and 1 in 39 women die during childbirth. 4 According to the UN Population Fund (UNFPA),1 although there has been a 61% decline in maternal mortality rate since 1990, maternal mortality is expected to rise in the future. This is, partly, due to the recent political and economic crises, which have affected mobility and resources, further hindering access to health care—particularly for women. It seems unlikely that Yemen will achieve the UN Millennium Development Goal with regard to the empowerment of women by 2015. The sociocultural and educational structure of Yemeni society seems to play an important part in hindering progress towards the above-mentioned goals. www.thelancet.com Vol 383 June 21, 2014
For example, the average cut off age for women’s education stands at a disturbing 7 years, and women’s literacy rate is an alarming 59·1%.5 Moreover, from child marriages to unequal rights for divorce, custody, and inheritance within marriages, Yemeni society suffers from marked discrimination against women. The future of Yemen’s women depends heavily on greater public awareness about wellbeing, increased and diverse access to health care, and equal educational and socioeconomic rights. Lawmakers and governmental organisations must recognise the threat posed by child marriages and unequal marital status not only for women and children’s health, but also at sociopsychological levels, and amend legal policies to combat these issues. Furthermore, it is crucial that projects targeting women’s empowerment and health care are placed under regular and rigorous surveillance and adjusted on the basis of analysis of gains and benefits to the community. International col laboration with neighbouring Gulf countries, in particular, is necessary to solve existing and impending concerns regarding women’s health in Yemen. We declare no competing interests.
Tehreem A Khan, Abdulaziz M Eshaq, Abdulrahman A Al-Khateeb, *Abdulhadi A AlAmodi [email protected] College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia 1
2
3
4
5
UNFPA. Situation analysis. http://yemen. unfpa.org/sub.php?module=pages& lang=en&id=4 (accessed April 19, 2014). Yemen Ministry of Public Health and Population. NGOs and international organizations in Yemen. http://www.mophpye.org/english/links.html (accessed April 19, 2014). Save the Children. Yemen. http://www. savethechildren.org/site/c.8rKLIXMGIpI4E/ b.6153153/k.BDE3/Yemen.htm (accessed April 19, 2014). Hadreas O. Yemen: worst place to live as a woman. Borgen Project. Nov 2, 2013. http:// borgenproject.org/yemen-worst-place-livewoman/ (accessed April 19, 2014). UNICEF. Yemen statistics. http://www.unicef. org/infobycountry/yemen_statistics.html (accessed April 19, 2014).
Weight loss intervention for football fans In their Article about weight loss for football fans (April 5, p 1211),1 Kate Hunt and colleagues conclude that the Football Fans in Training (FFIT) intervention programme can help a large proportion of men to lose a clinically important amount of weight. We agree with David Lubans that this is an innovative and promising approach.2 However, we have a few remarks. Hunt and colleagues randomly assigned participants to intervention and comparison groups. The comparison group was put on a waiting list, participants were promised to receive the intervention after 12 months. Both groups received information about weight management. The authors noted that the information provided at baseline might have been sufficient to help men in the comparison group to lose weight independently, because the results showed a mean weight reduction of 0·58 kg (95% CI 0·04–1·12) in the comparison group. However, people in the waiting group could have postponed their lifestyle change. Therefore the small weight reduction in the comparison group might have been larger if they did not know they would receive the intervention later on. Was the overall effect of the intervention thus overestimated? Furthermore, the study1 had a dropout rate of 11·0% in the intervention group and 5·1% in the comparison group. Sensitivity analyses for missing data were done; missing data assumed missing at random. Selective dropout of people with little or no weight loss however might well have influenced the study results. It is unclear if possible selective dropout was considered in the sensitivity analysis.
Science Photo Library
Women’s health and empowerment in Yemen
For more on the CATALYST Consortium see http://www. rhcatalyst.org/sitePageServer?pa gename=WhereWeWo_Asia_ Yemen
We declare no competing interests.
Ans A van der Linden, Bart J van Mastrigt, *Carolien H Teirlinck, Bart W Koes [email protected] Department of General Practice, Erasmus MC– University Medical Centre Rotterdam, 3000 CA, Rotterdam, Netherlands
Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/
2121
Yemen’s health-care system has witnessed improvements since 1990; however, these improvements are disappointing when compared with successes achieved by neighbouring Gulf countries. Women and child health is a chief concern requiring advance ment and effective intervention. Recent initiatives have been de veloped to target Millennium Developmental Goals 4 and 5, which buttress reduction in child mortality rates and improvement of maternal health.1 Among these initiatives, the National Midwifery Strategy led by the Ministry of Public Health and Population, the National Reproductive Health Strategy, and the CATALYST Consortium in partnership with USAID aimed at improving training of midwives, staff retention, and methods used in family planning and reproductive-health service delivery.2 However, present data show that these projects exhibit some challenges and have had limited success. Yemen has an infant death rate of 51 deaths per 1000 livebirths and a maternal mortality rate of 365 per 100 000 livebirths.3 At present, 22 women die every year because of poor maternal health facilities in Yemen, and 1 in 39 women die during childbirth. 4 According to the UN Population Fund (UNFPA),1 although there has been a 61% decline in maternal mortality rate since 1990, maternal mortality is expected to rise in the future. This is, partly, due to the recent political and economic crises, which have affected mobility and resources, further hindering access to health care—particularly for women. It seems unlikely that Yemen will achieve the UN Millennium Development Goal with regard to the empowerment of women by 2015. The sociocultural and educational structure of Yemeni society seems to play an important part in hindering progress towards the above-mentioned goals. www.thelancet.com Vol 383 June 21, 2014
For example, the average cut off age for women’s education stands at a disturbing 7 years, and women’s literacy rate is an alarming 59·1%.5 Moreover, from child marriages to unequal rights for divorce, custody, and inheritance within marriages, Yemeni society suffers from marked discrimination against women. The future of Yemen’s women depends heavily on greater public awareness about wellbeing, increased and diverse access to health care, and equal educational and socioeconomic rights. Lawmakers and governmental organisations must recognise the threat posed by child marriages and unequal marital status not only for women and children’s health, but also at sociopsychological levels, and amend legal policies to combat these issues. Furthermore, it is crucial that projects targeting women’s empowerment and health care are placed under regular and rigorous surveillance and adjusted on the basis of analysis of gains and benefits to the community. International col laboration with neighbouring Gulf countries, in particular, is necessary to solve existing and impending concerns regarding women’s health in Yemen. We declare no competing interests.
Tehreem A Khan, Abdulaziz M Eshaq, Abdulrahman A Al-Khateeb, *Abdulhadi A AlAmodi [email protected] College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia 1
2
3
4
5
UNFPA. Situation analysis. http://yemen. unfpa.org/sub.php?module=pages& lang=en&id=4 (accessed April 19, 2014). Yemen Ministry of Public Health and Population. NGOs and international organizations in Yemen. http://www.mophpye.org/english/links.html (accessed April 19, 2014). Save the Children. Yemen. http://www. savethechildren.org/site/c.8rKLIXMGIpI4E/ b.6153153/k.BDE3/Yemen.htm (accessed April 19, 2014). Hadreas O. Yemen: worst place to live as a woman. Borgen Project. Nov 2, 2013. http:// borgenproject.org/yemen-worst-place-livewoman/ (accessed April 19, 2014). UNICEF. Yemen statistics. http://www.unicef. org/infobycountry/yemen_statistics.html (accessed April 19, 2014).
Weight loss intervention for football fans In their Article about weight loss for football fans (April 5, p 1211),1 Kate Hunt and colleagues conclude that the Football Fans in Training (FFIT) intervention programme can help a large proportion of men to lose a clinically important amount of weight. We agree with David Lubans that this is an innovative and promising approach.2 However, we have a few remarks. Hunt and colleagues randomly assigned participants to intervention and comparison groups. The comparison group was put on a waiting list, participants were promised to receive the intervention after 12 months. Both groups received information about weight management. The authors noted that the information provided at baseline might have been sufficient to help men in the comparison group to lose weight independently, because the results showed a mean weight reduction of 0·58 kg (95% CI 0·04–1·12) in the comparison group. However, people in the waiting group could have postponed their lifestyle change. Therefore the small weight reduction in the comparison group might have been larger if they did not know they would receive the intervention later on. Was the overall effect of the intervention thus overestimated? Furthermore, the study1 had a dropout rate of 11·0% in the intervention group and 5·1% in the comparison group. Sensitivity analyses for missing data were done; missing data assumed missing at random. Selective dropout of people with little or no weight loss however might well have influenced the study results. It is unclear if possible selective dropout was considered in the sensitivity analysis.
Science Photo Library
Women’s health and empowerment in Yemen
For more on the CATALYST Consortium see http://www. rhcatalyst.org/sitePageServer?pa gename=WhereWeWo_Asia_ Yemen
We declare no competing interests.
Ans A van der Linden, Bart J van Mastrigt, *Carolien H Teirlinck, Bart W Koes [email protected] Department of General Practice, Erasmus MC– University Medical Centre Rotterdam, 3000 CA, Rotterdam, Netherlands
Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/
2121
