Assessment of biosafety precautions in Khartoum state diagnostic laboratories, Sudan

Background: This study was conducted to evaluate the biosafety precautions that applied by diagnostic laboratories in Khartoum state, 2009. Methods: A total number of 190 laboratories were surveyed about their compliance with standard biosafety precautions. These laboratories included 51 (27%) laboratories from government, 75 (39%) from private sectors and 64 (34%) laboratories belong to organization providing health care services. Results: The study found that 32 (16.8%) of laboratories appointed biosafety officers. Only, ten (5.2%) participated in training about response to fire emergency, and 28 (14.7%) reported the laboratory accident occurred during work. 45 (23.7%) laboratories had a written standard operation procedures (SOPs), and 35 (18.4%) had written procedures for the lean-up of spills. Moreover, biosafety cabinet was found in 11 (5.8%) laboratories, autoclave in 28 (14.7%) and incinerator in only two (1.1%) laboratories. Sharp disposable containers were found in 84 (44.2%). Fire alarm system was found in 2 (1.1%) laboratories, fire extinguisher in 39 (20.5%) laboratories, and fire emergency exit found in 14 (7.4%) laboratories. Furthermore, 19 (10%) laboratories had a hepatitis B virus vaccination programme, 5 (6.2%) applied BCG vaccine, and 2 (1.1%0) vaccinated the staff against influenza. Conclusion: The study concluded that the standards biosafety precautions adopted by the diagnostic laboratories in Khartoum state was very low. Further, the laboratory personnel awareness towards biosafety principles implementation was very low too

Equality Analysis of Main Health Indicators among Children under 5 Years in Uganda

BACKGROUND: Inequality in the access to health services is a major cause of health problemsamong children under five old. The aim of this analysis is to measure the inequality among children under-5 years in relation to main health indicators inUganda.METHOD: Main child health indicators data in Uganda were obtained from WHO inequity data set for the years 1995, 2000, 2001 and 2011. Indicators such as under-5 years mortality rate, underweight prevalence and full vaccination converge and child with infection access to health facilities were included in th analysis. For simple indicators, inequality difference wascalculated, and relative concentration index for complex order indicators was used. Four different inequality dimensions were used to work as stratifies for these indicators.RESULTS: Inequality regarding child health indicators was observed in different dimensions. It was clear that inequality among people living in rural areas were more than urban areas. Femaleshad high inequality than males. Poor and uneducated people are more likely to have inequality than rich and educated people.CONCLUSION: Great effort should be made to decrease inequality among children less than five years through access to health services for all groups in different areas.

Female Genital Mutilation in Sudan

BACKGROUND: Female genital mutilation or female circumcision (FGM) is a serious health problem in Sudan. This procedure is harmful to women and causes many complications during pregnancy and childbirth.OBJECTIVE: This study aims to determine the female genital mutilation (FGM) and its associated factors in Sudan.SUBJECTS AND METHODS: Data from Sudan Multiple Indicator Cluster Survey (MICS - UNICEF) was used in this research. The survey was carried out in 2014 and included women aged between 14 – 49 years. A logistic regression model was used to find an association between dependent and independent variables.RESULT: Total numbers of 21947 women were included in the survey and out of the 6249 (28.5 %) from urban and 15698 (71.5%) from rural areas. The prevalence of female circumcision was 89%. Women who had circumcised daughters were 32.1 %. The highest prevalence of FGM was reported from South Kordofan state with 7.8%, and lowest was in Red Sea state (7.6%). A significant association was observed between circumcised women and their marital status, daughter circumcision, and the level of education.CONCLUSION: The practice of female genital mutilation is spread all over the country. Poor women with low level of education are at high risk for this phenomenon. More efforts have to be provided to end this dangerous practice

Dengue and hepatitis E virus infection in pregnant women in Eastern Sudan, a challenge for diagnosis in an endemic area

Dengue fever and hepatitis E virus infection are both a public health problem in developing countries due to poor sanitation. Infection with viral hepatitis and dengue fever can present with similar clinical such and fever, headache and abortion. This study was conducted in Port-Sudan city in the eastern part of the country. ELISA and Real Time PCR tests were used to detect the infection. A total number of 39 pregnant women with a mean age 26 ±7.8 were included in the study. All of them had fever, 32 (92.3%) admitted with headache, 11 (28.2%) of them had vomiting, and abortion was reported in two cases (5.1%). The study showed that 4 ( 10.3% ) of pregnant women were positive for the Hepatitis E virus, 5 ( 12.8%) positive for Dengue virus IgG, and only one sample (2.6%) was positive for IgM capture ELISA and real time PCR . Death due to hepatitis E infection was reported in one case with 7th month of pregnancy. Most of hepatitis cases were reported in the central sector of the Portsudan city. The diagnosis of hepatitis E virus and dengue virus in an endemic area is a great challenge for health care staff working in these areas. Both Dengue virus and Hepatitis E virus infection should be considered in pregnant women especially in similar settings

Prevalence of Multidrug Resistance Mycobacterium Bovis in Human: A Systematic Review and Meta-Analysis

Introduction: Human infection with multidrug resistant mycobacterium bovis (MDR-M.bovis) is very rare.  Recently, infection with this type of bacteria has been described. The WHO strategy to end TB by 2035, recall for more efforts in the diagnosis and treatment of mycobacterium bovis particularly in resource limited countries. The aim of this systematic review was to determine the prevalence of multidrug resistant tuberculosis M.bovis infects human. Methods: International database including Medline, EMBASE, and Web of Sciences, Scopus, and ScienceDirect were searched for related literature. Google Scholar searching engines as well as references list were explored. Studies met the inclusion criteria were included in the systematic review. Random effects model was used to estimate the pooled prevalence. Results: A total number of (4275) studies were retrieved and nine studies were included in the meta analysis. The overall estimated prevalence of the multidrug resistant Mycobacterium bovis was 0.04 (95% CI: 0.02, 0.06). Based one study quality, time and area of study, subgroup analysis were conducted to check for heterogeneity. The prevalence of MDR-M bovis in low quality studies was 0.04 (95% CI: 0.00, 0.06), and in high quality studies was 0.05 (95% CI: 0.02, 0.08). Conclusions: The finding of this study indicated that the prevalence of multidrug resistant M.bovis in human is low. However, more attention is needed in the diagnosis and treatment of M.bovis infection in Human. Keywords: Tuberculosis, Multidrug-Resistant     Mycobacterium bovis     review  meta-analysis   Human DOI: 10.7176/JHMN/69-01 Publication date: December 31st 201

High Seroprevalence of Dengue Virus Infection in Sudan: Systematic Review and Meta-Analysis

The goal of this study was to systematically review the published data on dengue virus (DENV) seroprevalence in Sudan and to estimate disease burden through meta-analysis. We searched, reviewed, and extracted online available reports on DENV in Sudan. Among 168 identified records, 19 were selected. Dengue infections were documented in 11/18 states. The overall seroprevalence of DENV in Sudan was estimated to be 27%, while the prevalence of dengue IgM was 22% and IgG was 38%. The prevalence of dengue estimated from community and hospital-based cross-sectional studies were 26% and 30% respectively. Additionally, one cohort study and a single PCR-based study reported a prevalence of 1% and 4%, respectively. Regional analysis revealed that the variation in seroprevalence in East, North, West, and Central Sudan was 23%, 24%, 36% and 43%, respectively. Interestingly, we found that DENV is circulating countrywide with a significant spatiotemporal variation in the disease seroprevalence. Furthermore, publications on dengue prevalence are temporally and geographically fragmented, perhaps due to limited resources. However, this gap in data and knowledge highlights the urgent need for a country-wide surveillance system and continued study of dengue burden in Sudan to accurately estimate the disease prevalence and determine the associated risk factors

A Single Lineage of Hepatitis E Virus Causes Both Outbreaks and Sporadic Hepatitis in Sudan

Few studies have reported sporadic hepatitis E virus (HEV) infections during non‐outbreak periods in Africa. In this study, the prevalence of HEV infection in Sudan was investigated in 432 patients with acute hepatitis from 12 localities in North Kordofan, and from 152 patients involved in smaller outbreaks of hepatitis in the neighbouring Darfur. HEV infection was diagnosed in 147 (25%) patients: 98 from Kordofan and 49 from Darfur. The mortality was 10%; six of the patients who died from the infection were pregnant women. HEV RNA was detected by quantitative real‐time polymerase chain reaction (RT‐qPCR) in 38 (26%) patients: 22 from Kordofan and 16 from Darfur. Partial open reading frame (ORF) 1 and ORF2 were sequenced from HEV from nine and three patients, respectively. Phylogenetic analysis showed that the Sudanese strains belonged to genotype 1 (HEV1), and confirmed the segregation of African HEV1 strains into one branch divergent from Asian HEV1. It also revealed that the Sudanese strains from this study and from an outbreak in 2004 formed a separate clade with a common ancestor, distinct from strains from the neighbouring Chad and Egypt. This HEV strain has thus spread in a large area of Sudan, where it has caused both sporadic hepatitis E and outbreaks from at least 2004 and onwards. These data demonstrate that hepatitis E is a constant, on‐going public health problem in Sudan and that there is a need for hepatitis E surveillance, outbreak preparedness, and general improvements of the sanitation in these remote areas of the country

Prevalence of malaria and dengue co-infections among febrile patients during dengue transmission season in Kassala, eastern Sudan.

BackgroundMalaria and dengue are common mosquito-borne diseases around the world that cause high mortality and morbidity. The number of cases of both diseases is currently rising in Sudan and is associated with climate and environmental changes. Limited information is available on malaria and dengue co-infections and the severity of the two diseases among febrile patients in eastern Sudan. Thus, this study aimed to estimate the prevalence of malaria and dengue co-infections among febrile patients in Kassala, eastern Sudan.Methodology/principal findingsA cross-sectional hospital-based study was conducted among febrile patients from September to December 2019. A total of 395 patients were enrolled after consenting to participate in the study. Demographic and clinical data were collected by structured questionnaires. Blood samples were provided to diagnose malaria infections using microscopy and polymerase chain reaction (PCR) and for serology diagnosis of dengue using enzyme-linked immune sorbent assay (ELISA) IgM. Multiple logistic regression analysis was used to assess the association between demographic information, clinical symptoms and malaria and dengue co-infections. Out of 395 febrile patients examined 158 (40%) were malaria positive and 67 (17%) were dengue positive. The prevalence of malaria and dengue co-infections was 6.6% (26/395). Results of multiple logistic regression indicated that elder patients (41-60 years) had less rate of co-infections (OR = 0.3, 95% CI 0.11 to 0.81, p-value = 0.018), while patients of co-infections were eight times more likely to have fatigue, and two times more likely to suffer from joint and muscle pain and this difference was statistically significant with (OR = 8.3, 95% CI: 1.89 to 37.22, p-value = 0.005) and (OR = 2.4, 95% CI 1.10 to 5.39, p-value = 0.027), respectively.Conclusions/significanceThis study confirmed the existence of malaria and dengue co-infections among febrile patients in Kassala, eastern Sudan for the first time. The severity of clinical symptoms of patients with malaria and dengue co-infections was observed, and the co-infections were found prevalent among young people

The Targeted Maximum Likelihood estimation to estimate the causal effects of the previous tuberculosis treatment in Multidrug-resistant tuberculosis in Sudan.

IntroductionThis study used Targeted Maximum Likelihood Estimation (TMLE) as a double robust method to estimate the causal effect of previous tuberculosis treatment history on the occurrence of multidrug-resistant tuberculosis (MDR-TB). TMLE is a method to estimate the marginal statistical parameters in case-control study design. The aim of this study was to estimate the causal effect of the previous tuberculosis treatment on the occurrence of MDR-TB using TMLE in Sudan.MethodA case-control study design combined with TMLE was used to estimate parameters. Cases were MDR-TB patients and controls were and patients who cured from tuberculosis. The history of previous TB treatment was considered the main exposure, and MDR-TB as an outcome. A designed questionnaire was used to collect a set of covariates including age, time to reach a health facility, number of times stopping treatment, gender, education level, and contact with MDR-TB cases. TMLE method was used to estimate the causal association of parameters. Statistical analysis was carried out with ltmle package in R-software. Result presented in graph and tables.ResultsA total number of 430 cases and 860 controls were included in this study. The estimated risk difference of the previous tuberculosis treatment was (0.189, 95% CI; 0.161, 0.218) with SE 0.014, and p-value (ConclusionOur findings indicated that previous tuberculosis treatment history was determine as a risk factor for MDR-TB in Sudan. Also, TMLE method can be used to estimate the risk difference and the risk ratio in a case-control study design