Mothers' knowledge of mother-to-child transmission of HIV and infant feeding practices in Juba, South Sudan

Introduction: While exclusive breastfeeding for the first six months of life is recommended for HIV-infected mothers, this may not be practiced fully in South Sudan; exclusive formula feeding, which is the best alternative to breastfeeding, may not be practical. Objective: To assess the knowledge of mother-to-child transmission of HIV (MTCT) and practices of feeding infants in the first six months of life among HIV-infected mothers attending Antiretroviral Therapy Centres in Juba Teaching Hospital (JTH) and Juba Military Hospital (JMH). Method: A cross-sectional study in which 304 HIV-infected mothers with children aged 6-18 months were interviewed between October and December 2016 using structured questionnaires. Key informant interviews (KIIs) and focus group discussions (FGDs) were also conducted using interview guides. Quantitative data was analysed using Statistics Package for Social Sciences software. Chi-square test was used to test the presence of significant association between the variables and the association is statistically significant when the p-value is < 0.05. Multiple logistic regression analysis was used to identify which predictor variables have major effect on the dependent variable. Qualitative data was transcribed in English and summarized according to the key themes, and the information obtained was used to supplement and interpret the findings of the quantitative data. Results: Only 120 (40%) of the HIV-infected mothers had a good knowledge of MTCT; 213 mothers (70.1%) practiced mixed feeding, 70 (23.0%) practiced exclusive breastfeeding and 20 (6.6%) practiced exclusive formula feeding. The factors that were found to have a positive effect on choice of infant feeding methods were having more than one child (odds ratio = 0.303, 95% Confidence interval: 0.161-0.571, p = 0.001) and participation in the prevention of motherto-child transmission of HIV programme (PMTCT) (odds ratio = 2.260, 95% Confidence interval: 1.251-4.084, p = 0.007). Stigma (p = 0.248) and mothers' knowledge of MTCT (p = 0.072) were not statistically significantly associated with the mothers' infant feeding practices. Conclusion: Knowledge of MTCT is low. Mixed feeding before six months of age is predominant among the HIV-infected mothers. It is therefore recomm;ended that HIV-infected mothers receive adequate information from counsellors regarding MTCT and exclusive breastfeeding for the first six months of an infant's life

Prevention of mother-to-child transmission of HIV: knowledge, attitudes and practice among pregnant women at Juba Teaching Hospital

Introduction: Mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) accounts for 90% of infancy and childhood HIV infections; hence prevention has a big impact in controlling the spread of HIV within this group. Objectives: To assess knowledge, attitude and practice of prevention of MTCT of HIV among pregnant women attending antenatal care at Juba Teaching Hospital, South Sudan. Method: A hospital-based cross-sectional study was conducted during November and December 2015. Data were collected using a structured questionnaire; frequency distribution and two-way tables were used to present and summarize the data. A p-value of <0.05 was considered as indicating statistical significance. Results: Two hundred and fifty-one pregnant women consented to participate in the study and were enrolled and interviewed at the Maternal and Child Health Clinic (MCHC) in Juba Teaching Hospital. The mean age of the mothers was 25.67 years (range 15 ­ 41 years), with the standard deviation of ±5.52 years. The majority (88%) were married, 39.1% had no formal education, and 53.4% were unemployed. One-third (30.7%) of the participants had sufficient knowledge on when to start prophylaxis of MTCT (PMTCT). Half of the pregnant women (51%) showed positive attitudes toward PMTCT measures. Two hundred and thirty-one pregnant women (92%) had received counselling for HIV, with 78.4% of them reported being tested for HIV. Conclusion: The pregnant women's knowledge on HIV/AIDS, specific knowledge on MTCT, MTCT risk factors during breastfeeding, and PMTCT were found to be moderate. Half of the participants showed positive attitude towards PMTCT services utilization

Too hot to handle? Heat resilience in urban South Sudan

South Sudan is at risk from the impact of climate change. This paper reviews the climate change issues faced by South Sudan, and the strategy as outlined to the United Nations. The author argues that the policy overlooks a key potential cause of future morbidity and mortality: increased ambient temperatures, particularly in urban centres due to the urban heat island effect. The capital is especially susceptible to heat-related mortality as it faces a 'triple threat': rapidly rising temperatures, an at-risk population profile, and inadequate planning for the pressures of urbanisation. Four low-cost, evidence-based recommendations are given to mitigate the impact of heatwaves on human health, and it is concluded that South Sudan has great potential to become a regional leader in heat resilience

Integrated Primary Health Care (iPHC) for developing countries: a practical approach in South Sudan

Introduction: The founding vision of Primary Health Care (PHC) adopted in Alma Atta in 1978 has not worked as a result a number of countries have sought to re-engineer their own healthcare systems. Healthcare model in most developing countries needs to change from that inherited from the colonial era, which is predominantly hospital-based. Objective: To describe an integrated primary health care (iPHC) model which encompasses public health services with enhanced basic diagnostic and curative services as a cost-effective delivery of healthcare in the rural areas where 95% of the population resides.Method: A descriptive study of a proposed iPHC model following situational analyses and literature review of primary healthcare experiences from around the world with a view to inform a practical approach in South Sudan.Results: The iPHC model consists of five pillars: (1) public health services (2) clinical services (3) universal registration of population in the catchment areas; (4) a standard building infrastructure; and (5) training of multi-disciplinary healthcare workforce. Once operational, within five years it is envisaged that one fully functioning iPHC centre can provide universal access to healthcare service to 10,000 population resident in a geographical catchment area.Conclusion: South Sudan has a unique opportunity to improve the health of its population by embracing a new model of delivering health care: the iPHC. This model is simple, and can be the basis of delivering a health service for the rural population

Using livelihoods to support primary health care for South Sudanese refugees in Kiryandongo, Uganda

Introduction: Conflict in South Sudan has displaced 2.3 million people, of whom 789,098 (35%) have taken refuge in Uganda ­ a country that allows refugees to work, own property, start their own businesses and access public health services. In this context, refugees have identified livelihoods and primary health care as key priorities for their wellbeing. Objective: Building on previous research in South Sudan and Uganda, the objective of our current work is exploring how income-generating livelihood activities and other interventions can be used to support primary health care for South Sudanese refugees in Kiryandongo District, Uganda. Methods: We drew on existing secondary data and five scoping visits to the refugee settlements in Kiryandongo and northern Uganda to formulate our approach. Results: In Kiryandongo District, primary health care and livelihoods can best be supported by an integrated combination of 1) providing standardised training to local Village Health Teams (VHTs); 2) helping organise VHTs into village savings and loan association groups; and 3) supporting VHTs with training to establish sustainable income-generating activities. Conclusions: Integrated interventions that address income-generating activities for community health workers can meet the basic needs of front-line volunteer primary health care staff and better enable them to improve the health of their communities

Analysis of trends in SMART Nutrition Survey datafrom South Sudan between 2004 and 2016

Introduction: Emergency levels of Global Acute Malnutrition (GAM) persist in former Northern Bar el Ghazal State in South Sudan despite ongoing interventions. Reasons for long-term trends in GAM in South Sudan have not been explored despite decades of nutrition and health interventions. Objective: This project aimed to identify and analyse changes in patterns of malnutrition and key factors associated with malnutrition from 2004 to 2016.Methods: Secondary data analysis was carried out using Standardized Monitoring and Assessment of Relief and Transitions (SMART) nutrition surveys. Anthropometric data collected from children under five years of age from 2004 to 2016 were analysed to estimate seasonal differences in the prevalence of GAM (weight-for-height z-score (WHZ) <-2) and severe acute malnutrition (WHZ <-3). Risk factors for GAM were explored using data collected in 2014 and 2015 and analysed using logistic regression. Adjusted Wald tests investigated which variables were associated with GAM (p<0.05).Results: In Aweil West and North a reduction in GAM was observed between September 2004 (21.0%, CI 18.2-23.9) and November 2009 (16.2%, CI: 13.7-18.9). However, this apparent decline likely reflects a seasonal difference because the 5-year overall mean GAM was 20.4% (SD: 0.403) and 17.5% (SD: 0.380) in pre- and post-harvest seasons respectively. In multivariable linear regression modelling, not having been sick in the past two weeks (aOR 0.78, 95% CI 0.61, 0.99, p=0.047), and not having consumed juice (aOR 0.67, 95% CI 0.45, 0.99, p=0.045) were protective against GAM after adjusting for all potential confounders.Conclusion: This study highlights the impact of instability on the nutritional status of a generation, with the high prevalence of GAM and severe acute malnutrition remaining unchanged since 2004. Regular collection of representative nutrition data is useful to inform decision making. The results of this study suggest that a focus on care seeking behaviours and hygiene practices would be beneficial. The persistent prevalence of GAM identifies a need, not just for nutrition programmes but also effective prevention programmes

Nurses' knowledge of the management of diabeticpatients at Juba Teaching Hospital

Introduction: Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycaemia and is a major health problem. The International Diabetes Federation (IDF) estimated that there were 425 million people with diabetes in the world in 2017 with the number rising most rapidly in middle- and low-income countries. The prevalence of DM in Juba City in 2017 was reported to be 11.8%.Objective: To assess nurses' knowledge of the management of diabetic patients and factors associated with it in Juba Teaching Hospital - the only referral hospital in South Sudan.Method: This was descriptive cross-sectional study, carried out in March 2018, in which 40 nurses were randomly selected. Data were collected using a pre-tested questionnaire and analysed using SPSS version 20 for Windows software. Results: Of the 40 participants 31(77.5%) were females. The mean age was 35.6±10.7 years and median work experience was 9 years and 10 months; overall 57.6% of the participants correctly answered the questions on diabetic care. The factors cited for poor management of diabetic patients included lack of hospital guidelines (47.5%), insufficient salary to motivate staff (77.5%), inadequate nurse to patient ratio for good patient care (60.0%), and no resources for special training (57.5%). Conclusion: Many nurses in JTH have inadequate knowledge for diabetic management and most are interested in receiving more training

Mothers' knowledge on essential newborn care at Juba Teaching Hospital, South Sudan

Introduction: Globally neonatal mortality remains high and in South Sudan is estimated at 52/1000 live births. Objective: To identify the gaps in the knowledge and practices of essential newborn care among postnatal mothers at Juba Teaching Hospital and to determine the socio-demographic factors that influenced these.Methodology: A hospital-based cross-sectional study among 384 postnatal mothers using consecutive sampling, a pretested questionnaire to assess knowledge and a three point Likert scale to find out to which practices mothers did, or did not, agree. Results: 45% of mothers were aged between 25-34 years; 23.9% had some secondary school education; 70% were multiparous and 82% had attended an antenatal care clinic. 90% knew about breastfeeding on demand and 74% about exclusive breastfeeding. Only 18.2% of mothers knew the cord should be cared for while uncovered; 90% used warm clothing and 33% kangaroo care for thermoregulation. Only 20.8% identified BCG and OPV as birth vaccines; 3.4% believed vaccines were harmful.Hypothermia was the danger sign least frequently identified by the mothers (41.4%). Conclusion: Adequate knowledge was found regarding breastfeeding, with knowledge gaps existing in cord care, immunization, eye care and thermoregulation. Positive practice was found about breastfeeding, cord care, eye care and immunization. Socio-demographic factors were not found to be associated with maternal knowledge on newborn care

Midwives' knowledge and use of partographs at Juba Teaching Hospital, South Sudan

Background:Evidence shows that good knowledge of partographs and proper application of this knowledge results in a remarkable reduction in prolonged and obstructed labour and reduces maternal mortality. Obstructed labour can be prevented by a simple and cost-effective health intervention tool, the partograph. A partograph is a graphical record of the progress of labour and salient conditions of the mother and foetus plotted against time in hours. This provides an opportunity for early identification of deviation from normal progress. Early detection of prolonged labour greatly contributes to prevention of obstructed labour and related complications.Objective:To assess midwives' knowledge and use of partographs in the maternity ward of Juba Teaching Hospital, South Sudan.Methods:A cross-sectional descriptive study was conducted to assess utilisation of partographs among healthcare providers in Juba Teaching Hospital. All providers working at the time of the study were included. An interviewer administered questionnaire prepared in English was used to assess socio-demographic and other related variables of respondents as well as knowledge and practice. Ethical procedures were followed at every step. Results:Only 20% of the 30 respondents were registered midwives, 67% knew the components -of a partograph, and 93% could differentiate between normal and abnormal labour with the use of a partograph. The factors affecting the use of partographs included; shortage of partographs in the ward, lack of protocols on partograph use, understanding semantics of the English language, absence of refresher training, late reporting of mothers to the ward, and a shortage of staff. Conclusions: Despite good knowledge of the partograph, about half of the providers do not use them. We recommend training and recruitment of more qualified midwives, a continuous supply of partographs to improve use of partographs continuous supportive supervision, mentoring of staff and motivation schemes

Knowledge, attitude, and practice and service barriers in a tuberculosis programme in Lakes State, South Sudan: a qualitative study

Background: The World Health Organisation (WHO) estimates the incidence of tuberculosis (TB) in South Sudan to be 79 per 100,000 for new sputum smear positive TB and 140 per 100,000 for all forms of TB cases. The case detection rate of 53% for all forms of TB in South Sudan is below the WHO target of 70%.Objective: To explore knowledge, attitude, and practice barriers as well as service barriers to implementing TB programme in Lakes State, South Sudan.Method: This was a qualitative study conducted in May 2015.Results: Despite some understanding of the symptoms, causes, and consequences of TB, the stigma for TB and lack of disclosure of the disease, is very high among the local community. The limited network of TB facilities for case detection, lack of community distribution of TB drugs and lack of food at hospitals when patients were admitted for treatment, are key barriers to TB service delivery.Conclusion: To overcome barriers it is recommended that the local community worldview should be incorporated into TB awareness, testing, and treatment, and attention should be paid to areas where traditional practices, such as elimination of maize, clash with modern treatments

HIV/AIDS: Knowledge, attitudes and practices among adolescents in Nimule, South Sudan

Background: HIV is an infectious virus commonly transmitted through body fluids mostly semen and blood. It causes a serious and non-curable disease with grave consequences especially in sub-Saharan Africa. In South Sudan the prevalence rate of HIV was estimated at 2.6% in 2016. The treatment options are scarce and educational programs limited. This is of great concern since limited knowledge and awareness of HIV is a major risk factor particularly, among young people.Method: A cross-sectional survey using self-administered questionnaires among adolescents was carried out in November 2016.Results: Sixty-five students participated in the study. In general they had good knowledge about HIV/AIDS with the majority having heard of HIV. Majority stated that HIV spreads through sex (82%), blood transfusion (95%), and from mother to child during pregnancy and delivery (66%). Several misconceptions were present with 43% responding that HIV can be transmitted through mosquito bites and 18% stating that the virus can be spread through shaking hands, hugging and living in the same house.Conclusion: Though the respondents showed fair knowledge about HIV/AIDS, there are still some areas in which they lack knowledge especially regarding spread of the disease and practice. More information about HIV/AIDS and sexual education should be made available

HIV/AIDS: Knowledge, attitudes and practices among adolescents in Nimule, South Sudan

Background: HIV is an infectious virus commonly transmitted through body fluids mostly semen and blood. It causes a serious and non-curable disease with grave consequences especially in sub-Saharan Africa. In South Sudan the prevalence rate of HIV was estimated at 2.6% in 2016. The treatment options are scarce and educational programs limited. This is of great concern since limited knowledge and awareness of HIV is a major risk factor particularly, among young people.Method: A cross-sectional survey using self-administered questionnaires among adolescents was carried out in November 2016.Results: Sixty-five students participated in the study. In general they had good knowledge about HIV/AIDS with the majority having heard of HIV. Majority stated that HIV spreads through sex (82%), blood transfusion (95%), and from mother to child during pregnancy and delivery (66%). Several misconceptions were present with 43% responding that HIV can be transmitted through mosquito bites and 18% stating that the virus can be spread through shaking hands, hugging and living in the same house.Conclusion: Though the respondents showed fair knowledge about HIV/AIDS, there are still some areas in which they lack knowledge especially regarding spread of the disease and practice. More information about HIV/AIDS and sexual education should be made available

Eye diseases in Akon payam, South Sudan

Objectives: To determine the prevalence and causes of blindness and visual impairment among patients in Akon payam, Warrap State, South Sudan.Methods and materials: This was a cross-sectional study of 862 patients conducted at Akon in the period 18 ­ 31 September 2015. The Snellen E chart was used to measure visual acuity, and all patients had a basic eye examination. Their vision status was categorized according to the World Health Organization classification. Data were entered and analyzed using SPSS version 22(IBM).Results: The age range of the study population was 3 - 86 years; 81.9% were aged 41-80 years. 50.8% were males and 49.2% were females. There were 1483 bilaterally blind eyes giving a prevalence of blindness of 86% (95% CI: 3.2497-3.3531) with prevalence of visual impairment of 3.9 %( 95% CI: 2.5001-3.0944.Cataract (59.7%) was the commonest eye disease, followed by glaucoma (15.1%), corneal dystrophy (9.3%), allergic conjunctivitis (5.5%), corneal scar (1.9%), refractive errors(1.8%) and others(6.7%). Among those who are blind cataract (66%) was the major agent with females affected more than males .It was followed by glaucoma (16.7%), corneal dystrophy (10%), corneal scar(1.8%) and the rest of agents(5.4%). The main age group affected by blindness was the 41- 80 years age group (87%) and the least was below 20 years (1.1%). There was a strong association between age and sex with the causes of blindness.Conclusion: There was equal sex preponderance with more blindness in those aged 41 years or above. Cataract and glaucoma still remained major cause of blindness in this payam. More effort is needed by the government to reduce the burden of these diseases