Risk factors of post renal transplant anaemia among Sudanese patients, a study in three renal transplant centres

<p>Abstract</p> <p>Background</p> <p>There is a relative lack of recent information about late post kidney transplantation anaemia (PTA), especially in the developing countries; data are scarce about the prevalence and risk factors of PTA. Sudan was a leading country in Africa and Arab world in kidney transplantation. The first kidney transplantation in Sudan was in 1973.</p> <p>Methods</p> <p>This is a cross-sectional hospital analytic study enrolling all kidney transplanted recipients following in the transplant referral clinics at Ahmed Gassim, Selma and Ibn Sina Hospitals, Khartoum/Sudan, in the period from 1/8/2010 to 1/9/2010, clinical and laboratory data were obtained from 114 patients, anaemia was defined as Hb levels of < 13 g/dl for male patients and < 12 g/dl for female patients, exclusion criteria were pregnancy, below 18 years old patients, multiple organ transplantation, and patients with less than one year from the transplantation.</p> <p>Results</p> <p>The study showed that 39.5% of the patients were anaemic. Univariate analysis showed that late PTA is significantly associated with not using Erythropoietin (EPO) in the pre-transplant period (p = < 0.001), history of rejection (p = 0.003), longer time from transplantation (p = 0.015), and eGFR (p < 0.0001). Multivariate analysis showed that eGFR (p = < 0.001) and not use of EPO in the pre transplant period (p < 0.001) are strong predictors of PTA. The use of Angiotensin converting enzyme inhibitors/Angiotensin receptors blockers (ACEI/ARB), immunosuppressive treatments, presence or absence of co-morbidities, donor type and donor age are not significantly associated with late PTA.</p> <p>Conclusion</p> <p>The study concluded that late PTA is common and under recognized. Risk factors for late PTA include renal dysfunction, history of rejection, longer duration of transplantation and not using EPO in the pre-transplant period. Renal dysfunction and not using EPO in the pre-transplant period are major predictors of late PTA.</p

From local to global: a qualitative review of the multi-leveled impact of a multi-country health research capacity development partnership on maternal health in Sudan

Background: There is a substantial body of literature on the principles of good partnerships and the rationale for such partnerships in research capacity strengthening. This paper illustrates the long term effects of a multi-country (8 countries) global partnership for health systems research capacity development (Connecting health Research in Africa and Ireland Consortium - ChRAIC) in relation to its contribution to capacity strengthening, public advocacy and policy influence at different levels and its practical achievements in Sudan in addressing access to maternal health services. Methods: The authors (all members of the global partnership) reflect on the project in one of its’ partner countries, Sudan, over its’ five year duration. This reflection is supported by specific project data collected over the period of the project (2008–2014). The data collected included: (i) 6 monthly and annual donor reports; (ii) a mid-term internal and end of project independent evaluation of the entire project, and; (ii) a Ph.D study conducted by a member of the Sudanese research team. Results: The ChRAIC project in Sudan achieved the deliverables set out at the beginning of the project. These included a national knowledge synthesis report on Sudan’s health system; identification of country level health systems research priorities; research capacity assessment and skills training, and; the training and graduation of a Sudanese team member with a Ph.D. Mechanisms established in Sudan to facilitate these achievements included the adoption of culturally sensitive and locally specific research and capacity strengthening methods at district level; the signing of a Memorandum of Understanding at country level between the Ministry of Health, research and academic institutions in Sudan, and; the establishment of country level initiatives and a research unit. The latter being recognized globally through awards and membership in global health forums. Conclusion: We surmise that the ‘network of action’ approach adopted to partnership formation facilitated the benefits gained, but that adopting such an approach is not sufficient. More local and contextual factors influenced the extent of the benefits and the sustainability of the network

Power, potential, and pitfalls in global health academic partnerships: review and reflections on an approach in Nepal

ABSTRACT Background:: Global health academic partnerships are centered around a core tension: they often mirror or reproduce the very cross-national inequities they seek to alleviate. On the one hand, they risk worsening power dynamics that perpetuate health disparities; on the other, they form an essential response to the need for healthcare resources to reach marginalized populations across the globe. Objectives:: This study characterizes the broader landscape of global health academic partnerships, including challenges to developing ethical, equitable, and sustainable models. It then lays out guiding principles of the specific partnership approach, and considers how lessons learned might be applied in other resource-limited settings. Methods:: The experience of a partnership between the Ministry of Health in Nepal, the non-profit healthcare provider Possible, and the Health Equity Action and Leadership Initiative at the University of California, San Francisco School of Medicine was reviewed. The quality and effectiveness of the partnership was assessed using the Tropical Health and Education Trust Principles of Partnership framework. Results:: Various strategies can be taken by partnerships to better align the perspectives of patients and public sector providers with those of expatriate physicians. Actions can also be taken to bring greater equity to the wealth and power gaps inherent within global health academic partnerships. Conclusions:: This study provides recommendations gleaned from the analysis, with an aim towards both future refinement of the partnership and broader applications of its lessons and principles. It specifically highlights the importance of targeted engagements with academic medical centers and the need for efficient organizational work-flow practices. It considers how to both prioritize national and host institution goals, and meet the career development needs of global health clinicians