Maternal age and miscarriage: A unique association curve in Sudan

This study's aim was to estimate the prevalence and maternal age and other risk factors of miscarriage among Sudanese women. Across-sectional study was conducted at the Saad Abuelela Tertiary Hospital in Khartoum, Sudan, from February to December 2019. Sociodemographic, obstetric and clinical data were collected. A multivariate logistic regression analysis was performed. Four hundred thirteen (20.5%) women reported experiencing a miscarriage. Risk factors included older age, high parity, histories of caesarean delivery, and obesity. Logistic regression showed that the lowest risk for women aged less than 20 years (adjusted odds ratio [AOR], 0.33) or 20 to 24 years (AOR, 0.57), primiparas (AOR, 0.42) and women educated below the secondary level (AOR, 0.78). Unlike the global age-associated risk of miscarriage, the risk of miscarriage among Sudanese women follows a unique curve in relation to maternal age. Interestingly, the curve showed a lower risk for women less than 20 years and at 40 years. (Afr J Reprod Health 2022; 26 [7]: 15-21).

Thyroid function/antibodies in sudanese women with polycystic ovarian disease

OBJECTIVE: To evaluate thyroid function and hormonal profile in women with polycystic ovary syndrome (PCOS). METHODS: A case-control study was conducted at Saad Abualila Center, Khartoum, Sudan. The cases were women with confirmed PCOS based on Rotterdam criteria. The controls were infertile women with no evidence of PCOS. The socio-demographic characteristics and medical history were gathered using a questionnaire. Thyroid hormones (thyroid-stimulating hormone, free tri-iodothyronine, and free thyroxine), anti-thyroid peroxidase, and anti-thyroglobulin antibodies were measured. RESULTS: While there were no significant differences in the age and haemoglobin levels of the two studied groups (55 women in each arm), body mass index was significantly higher in women with PCOS. There were no significant differences in the levels of thyroid-stimulating hormone, luteinizing hormone, follicle stimulating hormone, luteinizing hormone/follicle stimulating hormone, anti-thyroid peroxidase, anti-thyroglobulin antibodies, cholesterol, triglycerides and low-density lipoprotein cholesterol between the cases and the controls. The mean±standard deviation of free tri-iodothyronine (3.50±0.2 vs. 3.38±0.3 pg/mL, P=0.040) and median (interquartile) high-density lipoprotein cholesterol (37.0 [34.0 to 42.0] vs. 35.80 [29.0 to 41.0] mg/dL, P=0.015) were significantly higher in PCOS patients compared with the control group. In linear regression, PCOS (0.151 pg/mL, P=0.023) and anti-thyroid peroxidase levels (-0.078 pg/mL, P=0.031) were significantly associated with free tri-iodothyronine. CONCLUSION: Free tri-iodothyronine was a significantly higher among PCOS patients compared with the control group.

Poor Adherence To Antiretroviral Therapy And Associated Factors Among People Living With Hiv In Omdurman City, Sudan

Adherence to antiretroviral therapy (ART) plays an important role in the treatment outcomes of human immunodeficiency virus (HIV) infection. Poor adherence would result in failure to prevent viral replication as well as an increased risk of developing drug resistance. Adherence to a life long treatment such as antiretroviral therapy is usually a complicated issue that requires careful and continuous collaboration of patient, family and healthcare provider. The objective of this study was to assess adherence to antiretroviral therapy and its associated factors among people living with HIV. This is a health facility-based cross sectional study conducted among adults’ people living with HIV in Omdurman HIV/AIDS centre, Sudan. Data was collected through direct interview using semi-structured questionnaire. There were only 144/846 (17.02%) who adhered to antiretroviral therapy as prescribed by their doctors. The remaining 51.18% were taking the therapy but not regularly, 31.21% were taking it but currently not and 0.59% stated that they have never taken any antiretroviral therapy. Factors associated with poor adherence that have been identified include female gender (Adj. OR = 3.46 (95%CI: 1.46–8.21), P = 0.005), younger age (Adj. OR = 1.14 (95%CI: 1.02–1.28), P = 0.022), being unemployed (Adj. OR = 5.94 (95%CI: 1.51–23.40), P = 0.011), those who were divorced, separated or widowed (Adj. OR = 11.35 (95%CI: 1.74–73.96), P = 0.011) and respondents who perceived that their health status is poor (Adj. OR = 5.21 (95%CI: 1.44–18.81), P = 0.012) or very poor (Adj. OR = 4.04 (95%CI: 1.27–12.81), P = 0.018). Educational level and social support against HIV-related stigma and discrimination were not significantly associated with adherence. Adherence to antiretroviral therapy among the respondents is very poor. Urgent interventions based on modifiable factors and mainly targeting females and younger age group are needed to improve adherence to antiretroviral therapy among people living with HIV.

Overuse of cesarean delivery at Al-Saudi Hospital, Hajjah, Yemen

The prevalence of cesarean section delivery continues to rise in most of the settings including the developing countries. Different indications for cesarean delivery might be responsible for this rise. The study was conducted during one year period of first May 2012 through 30 of April 2013 at Al-Saudi Hospital in Hajjah city, Yemen to investigate incidence, indications and type of cesarean delivery. The medical files were reviewed and medical and obstetrics data were retrieved from the files [age, parity, education, and mode of delivery]. Out of 1728 deliveries, 1211 [70%] were vaginal [include 1.3% instrumental deliveries] and 517 [30%] were cesarean deliveries. The vast majority of the cesarean deliveries were emergency ones [410; 79.3%]. The different indications of cesarean deliveries were; hypertensive disorder of pregnancy [27.1%]; repeated cesareans [22.8%], antepartum hemorrhage [14.5%], obstructed labor [10.6%], cephalopelvic disproportion [10.6%], bad obstetric history [1.4%], others [2.5%] and combined indications [5%]. There is a high incidence of cesarean deliveries in this setting. Measures have to be taken [increase instrumental delivery, trial of labour and trial of scar] to reduce this high incidence of cesarean deliveries

Drugs use during pregnancy at Medani Maternity Hospital, Sudan

There is a limited knowledge on use of drugs during pregnancy including beneficial and possible adverse effects of drugs on both the mother and the fetus. To investigate epidemiology of use of drugs during pregnancy. A cross sectional hospital based study at Medani Hospital during the period December 2011. After signing an informed consent, a pre-tested questionnaire was used to gather data from each parturient mother on her age, parity, level of education, antenatal care visits and use of drug during the index pregnancy. The vast majority [334; 98.2%] of the interviewed women used drugs during the index pregnancy. Around ten percent [35; 10.5%] of these women used the drugs in the first trimester of pregnancy. The majority [266; 78.2%] used the drugs in third trimester and the rest used it in the second trimester. The most common drugs used were antibiotics, tonics, antimalarials and antiemetic. There is a very high rate of drug use in this setting. Antibiotics and antimalarials drugs were the most used drugs

Blood group and rhesus antigens among blood donors attending the central blood bank, Sudan

It is well known that the Rhesus system remains the second most clinically important blood group system after the ABO. There is no published work regarding the frequency of various Rhesus antigens among Sudanese population. In order to minimize Rhesus allo-immunization among blood recipients a cross sectional study was conducted to determine the frequency of various Rhesus antigens among the blood donors attending the Central Blood Bank in Khartoum. Two hundred male blood donors were enrolled in the study. ABO and Rhesus typing were performed using the classical slide method and gel micro typing system. The frequency percentage of ABO blood phenotypes in the total samples were as follows: O[51.5%], A [29.5%], B [16%], and AB [6%]; whereas the frequency percentage of Rh antigens were D [93%], e [79.5%], c [68.5%], C, [27%], E [18.5%]. We concluded that the frequency of the Rh antigens can be shown in this order D > e > c > C > E. Special precautions need to be undertaken to minimize any possible allo-immunization by such antigens

Provider-initiated HIV testing and counseling among tuberculosis patients in Kassala, Eastern Sudan

Because of the overlapping global incidence of tuberculosis [TB] and human immunodeficiency virus [HIV] infections, collaborative efforts are required for successful TB and HIV control programs. The current study was conducted at Kassala Hospital in Eastern Sudan and investigated the implementation of provider-initiated HIV testing and counseling [PITC] for patients infected with TB. Using a cross-sectional study design, patients who had been recently diagnosed with TB between January and December 2010 were consecutively enrolled. A total of 858 newly infected TB patients were enrolled in the study. Of these patients, 152 patients [17.7%] were given counseling, and 109 patients [12.7%] underwent HIV testing. The overall HIV infection rate among those tested was 18.3%. From a multivariate analysis, female sex [OR =17.0, 95% Cl = 8.7-33.1; P< 0.001], education level below secondary education [OR = 2.6, 95% Cl = 1.6-4.1; P< 0.001], rural residency [OR = 1.7, 95% Cl = 1.3-2.9; P = 0.001], and non-governmental employee status [OR=10.4, 95% Cl = 6.7-16.3; P<0.001] were each associated with lower rates of PITC. Thus, in this setting, the frequency of PITC is low among TB-infected patients and is especially low for females, those of low educational status, and non-governmental employees. 2011 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved

A perspective of the epidemiology of malaria and anaemia and their impact on maternal and perinatal outcomes in Sudan

Introduction: Both malaria and anaemia have adverse effects on maternal and perinatal outcomes. Thus there is an urgent need to investigate the co-epidemiology of malaria and anaemia and their combined impact on maternal and perinatal outcomes in the different regions of Sudan.Methodology: Various cross-sectional and case control studies conducted during the years 2003-2010 to investigate the epidemiology of malaria and anaemia and their impact on maternal and perinatal outcomes in different regions of Sudan were compared. Results: While 13.7of antenatal attendants in New Halfa had peripheral microscopically detected Plasmodium falciparum malaria; placental malaria (using histological examinations) was prevalent in 32.0-40and 19.5of parturient women in New Halfa and Gadarif Hospitals; respectively. Malaria was a risk factor for anaemia in New Halfa and for stillbirths in Omdurman Maternity Hospital. Anaemia was present in 52.5; 62.6and 80.2of pregnant women in Medani; New Halfa; and Gadarif Hospitals; respectively. In Gadarif; 57.3of pregnant women had a folate deficiency; while 1had a vitamin B12; deficiency. In Medani; zinc and copper deficiencies were detected in 45.0and 4of pregnant women; respectively. Anaemia was a risk factor for low birth weight in Al-Fashir; for fetal anaemia in New Halfa; and for stillbirth in Kassala Hospital. Conclusion: More care should be taken to ensure proper nutrition and malaria prevention such as bed nets and intermittent preventive treatments to avoid these diseases and their effects on maternal and perinatal outcomes

Morbidity and mortality pattern of neonates admitted into nursery unit in Wad Medani Hospital, Sudan

Neonatal outcome is an important indicator of obstetrics and health care. Few of no published data are available concerning neonatal morbidity and mortality in Sudan. To study morbidity and mortality pattern amongst inborn neonates admitted into nursery unit in Wad Medani Hospital, Sudan during the period Jan-June. 2009. A total of 1211 [29.5%] out of 4098 in-born neonates were admitted during study period. The major indications for neonatal admission were; infections 300 [24.8%, low birth weight [LBW] 307 [25.4%] and asphyxia 130 [10.7]. There were 133 [11%] neonatal deaths; preterm delivery, LBW and birth asphyxia were the major causes of death among these neonates. Neonatal infection, preterm birth and LBW we the common causes of neonatal morbidity and mortality. There is an urgent need for more research throughout the country concerning these common causes of morbidity and mortality

Peripheral, placental and cord cytokines profile in spontaneous labor and elective caesarean section

Cesarean section delivery can lead to much maternal morbidity. Different cytokines have been reported to be influenced by the mode of delivery. To investigate the influence of mode of delivery on maternal, placental and cord sera of interferon gamma [IFN-gamma], interleukin-4 [IL-4] and interleukin-10 [IL-10] levels. These three cytokines were measured using ELISA in peripheral, placental and cord sera of two groups of women [38 in each group], either delivering vaginally or by elective cesarean section. Concentrations of IFN-gamma, IL-4 and IL-10 in the peripheral and placental sera were higher in vaginal delivery, while cord cytokines were not significantly different in the two groups. Cord sera contained significantly less concentrations of these cytokines than the peripheral and placental sera. It appears that the levels of IFN-gamma, IL-4 and IL-10 are influenced by the mode of delivery

Maternal death due to severe pulmonary edema caused by scorpion sting: a case report

A 29 years old women parar 3 in her 32 weeks gestational age died a few hours after she had been stung by a scorpion. She presented with pulmonary oedema that probably associated with the sympathetic storm induced by scorpion envenomation. This might have contributed to respiratory failure and death

Care-seeking behavior for fever in children under five years in an 25 urban area in eastern Sudan

Early diagnosis and prompt treatment are the basic elements of malaria control. The mother's perceptions about the cause of the fever, duration of sickness, accessibility and the anticipated cost of treatment, frequent use of traditional medicine, and judgement of the severity of the fever are the most important determinants for effective treatment of fever in children. This cross-sectional study was conducted in Kassala city, in Eastern Sudan to investigate the caregivers' care-seeking behaviour related to fever among children < 5 years. Data was collected by trained social workers using a structured questionnaire and was analysed by means of SPSS. Three-hundred fifty housewives were interviewed. The majority [85.7%] had had at least basic education and 244 [69.7%] were full-time housewives. A total of 237 [67.7%] mothers were found to have adequate knowledge about malaria. Malaria was perceived by only 143 [40.9%] of the respondents as a cause of low grade fever and this percentage was almost doubled in the case of high fever. There were similar findings with respect to the selection of treatment sources and the use of antimalarial drugs. High fever urged 319 [91.1%] to seek advice from health workers and 281 [80.3%] to take drugs other than chloroquine. The intensity of fever [low/ high] governed the respondent's perceived causes of fever, decision about available treatment options and the type of antimalarial drugs they used. Health education programmes should focus on the importance of seeking early advice, compliance with prescribed treatment and awareness and handling of danger signs before presenting at health facility

Knowledge and attitude of women towards malaria during pregnancy in central Sudan

Malaria infection during pregnancy has important adverse effects on both mother and fetus and it is the leading cause of maternal mortality in Sudan. This study was conducted to assess the knowledge and attitude of 579 pregnant Sudanese women attending the antenatal clinic of Omdurman Maternity Hospital, towards malaria. The age of the interviewed women ranged between 15-45 years with a mean of 27.1 years, 85.8% of them were housewives and 34.0% were primigravidae. There was high knowledge about cause, and symptoms of malaria among pregnant women. The pregnant women had little knowledge about the complications of malaria during pregnancy, the effect of malaria treatment on the fetus and malaria prevention methods. Parts of socio-demographic [parity and education] profiles were found to play an important role in determining this knowledge

Antimalarials During Pregnancy: a Review Article

Plasmodium falciparum malaria in pregnancy poses substantial risk to pregnant women and their neonates. The WHO recommended that pregnant women with demonstrable malaria illness should he treated with effective and safe antimalarial drugs. Safety to the pregnant woman and her unborn child might be hampered by the spread of mutlidrug resistant falciparum malaria and limited literature concern their usage during pregnancy. Chloroquine is generally considered safe in all trimesters of pregnancy; sulfadoxine- pyrimethamine appears safe in the second and third trimesters of pregnancy. Quinine is the drug of choice for severe malaria and has been reported to be safe even in the first trimester of pregnancy. Few reports are available concerning artemisinins usage during pregnancy although the World Health Organization recommended their usage during pregnancy. While tetracyclines and primaquine are absolutely contraindicated during pregnancy, halofantrine, amodiaquine, mefloquine are of questionable safety during pregnancy. The first trimester of pregnancy [the period of organogenesis] is the critical period: only chloroquine and quinine were reported recently to have safely profile in this period. However, due to chloroquine resistance, quinine remains the drug of choice

ecology of anopheles arabiensis and insecticide resistance/susceptibility status in kassala area, Eastern Sudan

The study was carried out to investigate the ecology of A. arabiensis and their susceptibility to insecticides in Kassala area, eastern Sudan. Both adult anopheline mosquitoes and immature stages were sampled monthly following the standard WHO procedures during the period November 2000 through January 2002. The susceptibility of A. arabiensis to insecticides was conducted using the WHO standard technique. A. arabiensis was the main malaria vector; its density fluctuated throughout the year with bimodal peaks during the rainy [6.1 females/room and 56.1 larvae/dip] and the cool dry seasons [4.8 females/room and 47.5 larvae/dip]. The difference was not statistically significant [P>0.05]. An indication of partial aestivation of A. arabiensis to adapt the harsh environmental conditions of the dry season was confirmed in the area. Adult populations like to cluster around breeding sites in an area of less than 200 m. The susceptibility to DDT and fenitrothion was 88.3% and 100% respectively. A. arabiensis is the sole malaria vector in Kassala area and it was highly susceptible to the insecticides tested and these should be considered for malaria vector control in the area