Self-Medication with Antibiotics and Its Predictors among the Population in Khartoum Locality, Khartoum State, Sudan in 2018

Background: Self-medication is a personal self-initiated behaviour of diagnosis of a disease and self-treatment of its symptoms and signs.Objective: Toidentify the prevalence of self-medication with antibiotics and the diseases commonly treated with antibiotics, the most commonly used antibiotics, the sources of obtaining it and the predictors of self-medication with antibiotics.Study Design: This was a cross-sectional, descriptive study.Place and Duration of Study: This study was conducted in Khartoum Locality, Khartoum State, Sudan during April 2018.Methods: 246 adults (130 males, 116 females) over 18 years were included in the study. A closed-ended, pretested and pre-validated questionnaire was used to interview the participants.Data was analysedusing SPSS Version 23.0. Descriptive statistics were presented in tables and figures. Logistic regression was conducted to identify the predictors of self-medication with antibiotics. Ethical approval and voluntarily signed consent were obtained prior to embarking on the study.Results:148(60.2%) participants practiced self-medication with antibiotics, 111(75%) of whom obtained the antibiotics over the counter in community pharmacies. The most commonly used antibiotic was amoxicillin/clavulanic acid (38.5%). The major reason behind taking antibiotics without prescription was long distances to healthcare facilities (43.2%). The commonest symptom which encouragedself-medication with antibiotics was abdominal pain (27%). Females were 3.55 times more likely to use self-medication with antibiotics than males. Participants who lacked health insurance cards were 2.65 times more likely to practice self-medication with antibiotics.Conclusion:The prevalence of self-medication with antibiotics is alarmingly high in Khartoum Locality. Over the counter purchase of antibiotics was the main route of self-medication. Gender and lack of health insurance were significant predictors of self-medication. Mass education through different media and policy reform are recommended.

Knowledge of Chikungunya Disease among Academic Population in Private Universities, Khartoum State, Sudan - 2019

Introduction:Chikungunya is a viral disease thatcould lead to chronic symptoms. It has no approved treatment or vaccine to date.Objective:To assessthe level of knowledge about Chikungunyaviral disease following an outbreak in Kassala Sudan among the academic population in private universities in Khartoum State.Methods:A cross-sectional study was carried out in threeprivate universities in Khartoum State during April-August 2019. A sample of 376individuals (346 medical students and 30 teaching staff)was determined. A self-administered questionnaire was distributedto the target population.It included eleven variables about the informationregarding Chikungunya disease.Data was imported into SPSS program version 20 and descriptive statistics were presented. Knowledge variables were categorized into scores as adequate, moderate and poor.Chi square test was used to test the knowledge levels among the study population at the confidence level of 95%. Results:Out of 376 study population, 66(17.6%)hadnever heard about the Chikungunyadisease. Therefore, the knowledge variables were analyzed among 310 individuals who heard about the disease. Outof 310 individuals,235 (75.8%)knewthat the disease is viral and245 (79.0%)knew that fever is the common symptom. Individualswho did not know the mode of transmission were 200 (64.5%).Individuals who did not know the diagnostic methods of the disease and management methodsaccounted for228 (73.5%) and 174 (56.1%)respectively.One hundred seventy-five individuals (56.5%) did not know the prevention by vector control and174 (56.1%)did not know if a vaccine is available or not.Out of 310 individuals, 60(19.4%) hadadequate knowledge about Chikungunyadisease.Moderate to poor knowledge were significantly high among the study population, p value =0.0002.Conclusion:Most of the study population heardabout Chikungunyadiseasebutthe majority hadmoderate to poor knowledge about the disease. Private universities should open channelswith Ministries of Health to facilitate field training of studentsduring outbreaks

Socio-demographic Characteristics, Risk Factors and Awareness of Adults Hypertensive Population in Khartoum Locality, 2014

Aims: To identify the prevalence of hypertensions, socio demographic characteristics, risk factor and awareness of the study population about hypertension in Khartoum Locality.Study Design: A descriptive community-based cross-sectional study.Place of Study: Khartoum locality, Sudan.Methodology:A total of 587 adult participants were interviewed using structured close ended questionnaire. Blood pressure was measured considering hypertension as ≥ 140 mmHg and ≥ 90 mmHg for systole and diastole blood pressure respectively. Body Mass Index (BMI) was calculated and the cutoff points were derived from World Health Organization (WHO) reference criteria to classify BMI as normal, overweight and obese. Chi square test was used to assess the association of socio demographic characteristics and risk factors with hypertensive population.Results: The prevalence of hypertensive accounted to 216 (36.8%). Thirty seven hypertensive participants (17%) were not aware about having hypertension, 86 (40%) were not aware about at least one complication of HTN and 117(54%) were not aware about the normal measures of blood pressure. The hypertensive participants were significantly high in the age group 25-64 years of age and above. Females were significantly having hypertension more than males, 155 (72%) versus 61 (28%). Married participants were significantly having hypertension more than non-married, 169(78%)and 47(22%) respectively. Unemployed participants were significantly having hypertension more than employed ones, 168 (77.8%) and 48 (22.2%) respectively.Risk factors among hypertensive participants were significantly found among overweight 67 (31%) and obese 115 (53%), positive family history of hypertension 139 (65%), increase salt in food149 (69.3%) and physical inactivity 166 (77%). Conclusion: The prevalence of hypertension among Khartoum locality was high. Hypertensive population awareness was low. Age, sex, marital status, education andemployment weresignificantly associated with hypertensive population. Obesity and overweight, family history of hypertension, increase salt in food and physical inactivity were risk factors among hypertensive study population.Keywords: Socio-demographic;awareness;risk factors;hypertension;Khartoum locality.1. INTRODUCTIONHypertension is positioning the first rank of causes of deaths worldwide [1]. It is a public health problem with an increasing global prevalence, especially in low and middle income countries [2,3]. Attributable factors related to the increasing prevalenceof hypertension includefast population growth and ageing, consumption of unhealthy diets, lack of physical exercise, obesity and increasing life stresses[2]. In sub-Saharan Africa, the burden of hypertension has been increasing continuously with prevalence varying widely between 15% and 70 % [4-6].Sudan witnessed rising prevalence of hypertension during the past few years [7,8]. Hypertension is the silent killer that screening and early detection could prevent or reduce its serious complications, including stroke, ischemic heart disease, congestive cardiac failure, sudden cardiac death, peripheral vascular disease and renal insufficiency [9].Most persons with hypertension are not aware of their hypertensive disease, which increase the chance of being presented for the first time to health institution by complications [10,11]. Awareness of population about hypertension is high in developed countries compared to developing nations. Awareness of population about their hypertensive status is an important determinant of adherence to anti-hypertensive medication as well as increasing the knowledge regarding the risk factors and modifying the negative lifestyle habits [11-13]. The increase prevalence of hypertension in Sub-Saharan Africa could be related to inadequate information about the disease that contributes to low awareness of population about their hypertensive status [14]. It was found thatawareness about hypertensive status was low among hypertensive population with low socio-demographic characteristics [15]. Few recent studies in Sudan were carried and did not emphasize the association of socio demographic characteristics to hypertensivestatus and the awareness of hypertensive adults about their hypertensiondisease.The aim of the study was to identify the prevalence of hypertension, socio demographic characteristics, risk factor and awareness of the study population about hypertensionin Khartoum Locality.2.POPULATION AND METHODS2.1 Study DesignThis was a descriptive community-based cross-sectional study.2.2 Study AreaThe study was carried out in Khartoum locality which spread approximately across 176 square kilometers area and inhibited by 639,598 of the population. Khartoum locality is one of the seven localities in Khartoum State. It consists of six local administrative units and 157 blocks.

Waist Circumference, Blood Pressure and Lifestyle of Sudanese Population, Khartoum Locality, Sudan 2016

Aims:To measure the waist circumference of Sudanese adults in Khartoum Locality and its relationship to blood pressure and lifestyle during celebration of international day of hypertension in May 2016 .Study Design:It was a descriptive cross-sectional study.Place of the Celebration:Khartoum Locality at Alsahaa Alkhadraa (The Green Park).Methodology:A total of 364 adult participants, 196 men and 168 women were interviewed using structured questionnaire. Blood pressure (BP) was measured considering hypertension as ≥ 140 mmHg and ≥ 90 mmHg for systole and diastole BP respectively. Waist circumference was measured using an anthropometric measuring tape at cut-off point of 94 cm and 80 cm for men and women respectively. Data was managed by SPSS version 20 and Chi-square test at 95% CL was used to test the association between waist circumference, blood pressure and life style characteristics.Results: Age distribution of the study population showed 48.2% females and 45.4% males in the middle age group (38-57 years). Two thirds of the study population were hypertensive, 62.8% of males and 64.3% of females. The mean waist circumference of men was 97.82 cm+16.7, mean Systolic BP was 127 +22 and mean Diastolic BP was 85 +15. The mean waist circumference of women was 99.31 +16.2, mean Systolic was 128 +24 and mean Diastolic BP was 84 +17.Abnormal waist circumference was found in 61.2% of males and 86.9% of females. Fifty nine (30.1%) of the males and 86 (51.2%) of the females with abnormal waist circumference were hypertensive. The association between abnormal waist circumference and high blood pressure was significant among both sexes, P value= 0.001.Physical exercise and fat and salt foods were not significantly associated waist circumference in both men and women.Conclusion: Two thirds of women and men in the celebrating areas were hypertensive. Half of women and one third of men were significantly hypertensive and having abnormal waist circumference. Doing physical exercise, avoiding fat and salt foods was insignificantly associated with normal waist circumference. Large survey with representative sample is needed to estimate the real Sudanese waist circumference.

Factors Related to Deaths of under 5 Years Old Children in Dar Alsalam Area-Khartoum-Sudan

Aims: This study is done to identify factors affecting under five mortality in Dar Alsalam area, Khartoum.Study Design:This is a community based cross-sectional study.Place and Duration of Study:The study was carried out in block 25 in Dar Alsalam area in Khartoum State during March-April 2012.Methodology: A total of 240 women in reproductive age who had an experienceof child death were interviewed. The data was collected by semi-final medical students using structured questionnaire. Two stage cluster sampling was used to select the households. Data was summarized using descriptive statistics and logistic regression analysis was carried out to identify factors associated with under-five mortality.Results: Age of 156 (65%) of the deceased children was less than one year, while the age of 84 (35%) was between one and five years. The age of (25%) of the motherat the time of their child birth was below 18 years. The majority of the mothers (70.8%) were illiterate, 74.2% were working and 80% were married. Of the children 51.7 were males and for 74.2% of them the birth interval was less than 2 years. Only 16.7% were breast fed for more than two years while the rest (83.3%) were breast fed up to 2years. Only 34.2% of the deceased children had completed their vaccination, and 68.3% had been admitted to hospital more than once before death.Half of the families have piped water in their houses, in 75.8% of the houses there are pit latrines andin68.3% there is electricity supply. Logistic regression analysis identified incomplete vaccination, not employed mothers and having no latrines in the house as the factors related to the death of children between 1-5 years than those below one year.Conclusion: Under-five mortality in low socioeconomic areas is associated with Low family income, mother’s illiteracy, early marriage and absence of latrines in the houses.

Prevalence of Anti-HBcore Total and HBsAg among Health Care Workers in Public Hospitals, White Nile State, Sudan; 2013.

Background: HBV infection is an occupational disease where health care workers (HCW) are at high risk. Aim: To measure the sero-prevalence of Anti-HBcore Total and HBsAg among HCWs in Public Hospitals, White Nile State, Sudan; 2013. Methods: A cross-sectional, hospital- based study was conducted among health care workers in Public Hospitals in White Nile State, Sudan; 2013. A sample of 385 HCWs was selected using two stage cluster sampling. A pre-tested structured questionnaire was used. The HCWs signed the informed consent to fill the questionnaire and to draw 5 ml venous blood sample for HBV tests. Blood samples were investigated for Anti-HBcore Total. Positive blood specimens for Anti-HBcore Total were further investigated for HBsAg. Data was processed using statistical package for social sciences (SPSS), version 16. Descriptive statistics and non-parametric Z test for single proportion was used at 95% CL. Results: Out of 385 HCWs, 230 (60%) were positive for Anti-HBcore Total. Out of 230 HCWs, 62 (27%) were positive for HBsAg. Prevalence for Anti-HBcore Total and HBsAg is significantly different from the expected values, P=0.001 Conclusion: Sero-prevalence of Anti-HBcore Total and HBsAg is high among HCWs in Public Hospitals in White Nile State, Sudan.

Perception of Educators about Quality of Diabetes Education Services at Primary Health Care Level in Khartoum State, Sudan.

Introduction: Promoting positive life style is a strategy for delaying and reducing the incidence of diabetes complications. Objective: To determine the perception of educators about the quality of education services provided to diabetic patients at the health centers in Khartoum State. Methods: A qualitative descriptive study carried out among 22 educators working at governmental and non-governmental health centers. Mini focus groups of discussion were moderated by a qualified social researcher and a trained note taker. The guiding questions included general information and several questions about education services for diabetic patients. Ethical clearance was obtained from relevant ethical committees. Informed consent was obtained from educators. Content analysis of data was carried and organized in to themes. The themes were organized according to the dimensions of quality of care, structure, process and outcome. Results: All educators were females. Their ages were between 25-55 years. The majority were holders of a university degree with different basic disciplines. The working duration ranged between 3 to 25 years. Ten of them were working in governmental health centers and 12 in non-governmental ones. Few educators were trained on diabetes education (structural quality care). Most of them agreed on the lack of diabetes education materials and specific education program (structural quality care). The majority agreed on the absence of team work and their role is to weight the patients. Most of educators educate individuals rather than groups (process quality care). The majority was not satisfied with education services at the health centers and most of educators reflected the poor knowledge and negative behaviour of the diabetic patients (outcome quality care). Conclusions: Diabetes education services at primary health care are insufficient. Most of educators were not certified educators. Education services lack team work and strategic plans. Diabetic patients have poor knowledge and behaviour regarding diabetes management.

Adherence of Diabetic Patients to Education Information Provided at Primary Health Care Level in Khartoum State, Sudan.

Introduction: Diabetes mellitus needs medical care and education. Adherence of the diabetic patients to education information provided at primary care level have been scantly documeneted. Objective: To measure the adherence of diabetic patients to education information provided at health centers. Methods: A cross sectional study was carried out in 25 governmental health centers (Gov.HCs) and 15 non-governmental health centers (Non-Gov.HCs). Study population was 419 adult diabetic males /females known beneficiaries of the services in the study centers. Patients were interviewed by structured questionnaire. Descriptive statistic presented the patients profile, as well as the education information received by the patients and the levels of patients’ adherence. Fisher exact test at 95% confidence level used to test differences in education information services. Adherence of patients to education information was measured by three points Likert scale. Chi square test used to test the difference in adherence. Ethical clearance and written consent were obtained. Results: The mean age was 55.2±10.2 years. Males and females were 44.6% and 55.4% respectively. Education accounted to 76.4%. Family income above 1000 Sudanese Geneh (SDG) accounted to 64.2%. Doctors provided education information about physical activities to 64.6% and 46.2% patients in Gov.HCs and Non-Gov.HCs respectively, P-value 0.014. Diet plan received by 73.6% and 55.8% of patients in Gov.HCs and Non-Gov.HCs respectively, P-value 0.013. Information on how to measure blood glucose at home received by 48.2% and 25.0% of patients in Gov.HCs and Non-Gov.HCs respectively, P-value 0.002. Very few patients received information from educators, 0.2% and 3.4% of patients in Gov.HCs and Non-Gov.HCs respectively. Foot care education information provided to 25.3% of patients. Adherence of diabetic patients to education information provided was adequate but does not significantly differ between the types of the health centers Conclusions: Education information services were significantly high in Gov.HCs. Adherence of diabetic education information was adequate.