ABSTRACT
Introduction: Sudan has a large and growing private health sector. No survey was done in Sudan to show the extent of the use of private health care services by the population. Also precise data on tuberculosis (TB) diagnosis and treatment in the private sector are not available. Material and methods A facility-based cross-sectional survey was carried out during February2007-June 2007 in Khartoum state; whereby consented private physicians working in the all private clinics (n=110) were interviewed. Results This study showed that a large private sector exist in the country and deliver care to TB patients and reported the non-adherence of this sector to National Tuberculosis Program (NTP) guidelines. 59.1of the interviewed physicians correctly mentioned the TB treatment regimens; only 8(12.3) physicians that reported management of TB patients actually prescribed these regimens to their patients. Similarly; only 10(15.4) physicians requested sputum smear examination for TB diagnosis. Conclusion A considerable proportion of cases is inadequately managed by the private sector and is not notified to NTP. The information delivered by this study can be used to develop a workable Public-private mix (PPM) model with the private sector
Subject(s)
Patient Care Management , Private Sector , Tuberculosis/prevention & control , Tuberculosis/therapyABSTRACT
Background: Methicillin-resistant Staphylococcus aureus (MRSA) which causes nosocomial infections is among the most important multi-resistant pathogens worldwide. Investigations of MRSA outbreaks in nosocomial settings often require strain-typing data to verify effectively that the isolates belong to the outbreak strain; and to discriminate similarity from unsimilarity strains. Quick and reliable typing methods are required to obtain information among MRSA isolates and to allow faster implementation of appropriate control measures. Objective : The aim of this study was to investigate genotyping of methicillin resistant and sensitive Staphylococcus aureus (MRSA and MSSA) in Khartoum Teaching Hospital; Sudan by using antibiotype and polymerase chain reaction-restriction fragment length polymorphism (PCRRFLP) of the coagulase gene. Methods: This is across sectional study. The samples were collected from clinical wound specimens in the wards of surgery; orthopaedic and burns at Khartoum Teaching Hospital; then processed; cultured and subsequently susceptibility test was performed using disc diffusion method. The MRSA strains were investigated by oxacillin 1[g disk diffusion method. PCR used to amplify a sequence of the coagulase (coa) gene; and the PCR products were analyzed by PCR-RFLP using Alu1 restriction enzyme. Result: Forty eight S. aureus strains were isolated and the number of MRSA identified was 9(18.75). All strains of MRSA and MSSA were sensitive to vancomycin; while multi-drug resistance was common among MRSA strains. PCR amplification products of coa gene were approximately at 500 bp (26/48); and 580 bp (22/48). By Alu1 restriction enzyme digestion of the PCR-amplified of coagulase gene; two distinct PCR-RFLP patterns exhibited; coaA and coaB and their fragments were approximately at 190; 310 bp and 190; 390 bp with percentages of 54.2(26/48) and 45.8(22/48) respectively. Conclusion: PCR-RFLP is considered an attractive tool for rapidly demonstrate the frequency of different patterns and discriminate the relatedness of isolates in different hospital wards