The impact of Flexner's report on medical education in Sub-Saharan Africa Sudan as an example

Flexner’s Report 1910 is one of the most important and influential events in the history of medicine worldwide that led to the emergence of modern medical education. reforms of medical education took places as results of this report leading to the establishment of the biomedical model as the gold standard of medical training. Objectives: to identify the impact of Flexner's Report on Medical Education in Sub-Saharan Africa taking Sudan as an example more than 100 years after the report. The health system and medical education in Sub-Saharan Africa during the colonial era and after independence were studied. Conclusion: Medical education in Sub-Saharan Africa has not yet received a holistic review, reforms, and standardization and the health system needs more educational strategic planning. Multiple factors play a role in preventing the modernization of medical education in Sub-Saharan Africa, such as the poor economic status of these countries, inadequate infrastructure, equipment, and educational standards, large annual students intake, and lack of appropriately qualified teaching staff.

Female genital mutilation and urinary incontinence: an analytical comparison with Sudan's prevalent demography

SUMMARY OBJECTIVE: Female genital mutilation/cutting impacts over 200 million women globally and is linked to obstetric complications as well as long-term urogynecological and psychosexual issues that are frequently overlooked and inadequately addressed. This study aimed to assess the impact of female genital mutilation/cutting on urinary incontinence. METHODS: This cross-sectional study was conducted in the gynecology department of the Research Hospital located in the Nyala rural region of Sudan. The participants were interviewed to gather socio-demographic and background information. In addition, they received a thorough gynecological examination to evaluate the presence and type of female genital mutilation/cutting. The Incontinence Impact Questionnaire and the Urogenital Distress Inventory were applied to the group with female genital mutilation/cutting and the control group without female genital mutilation/cutting to evaluate urinary incontinence and related discomfort. Subsequently, the scores of both participant groups were compared. RESULTS: The study compared age, weight, height, BMI, gravida, parity, and sexual intercourse averages between groups. The mean Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire-7 scores of individuals who underwent mutilation were higher than those of individuals who did not undergo mutilation (p<0.001). Notably, participants subjected to infibulation exhibited significantly higher average scores on both measures in contrast with the other groups (p<0.001). CONCLUSION: A higher proportion of mutilated participants, specifically those with infibulation, are afflicted with symptoms of incontinence.

Knowledge, attitude, and practice regarding COVID-19 skin manifestations among doctors working at Khartoum dermatology and venereology teaching Hospital, 2021

Background: COVID-19 is a global pandemic caused by SARS_COV2. The symptoms of covid-19 include: fever, dyspnea, fatigue, a recent loss of smell and taste, sore throat, cough, and cutaneous lesions. In addition, some skin manifestations were reported to be associated with COVID-19. Methods: The study design is a descriptive cross-sectional hospital-based study. The study aimed to evaluate the level of knowledge and practice about skin manifestations of COVID-19 among doctors working at Khartoum dermatology and venereology teaching hospital. A self-administrated questionnaire was used for data collection after an informed consent was taken. Results: Among 140 doctors working in the dermatology and venereology teaching hospital, 75.7% of the doctors had knowledge that COVID-19 can present with skin manifestations. The study results showed that about half of the participants have poor knowledge about COVID-19 skin manifestations while 25% have no knowledge, and that 35 (25%) doctors have good knowledge. From a total of 140 doctors; 46.4% reported that when patients present with COVID-19 skin lesions, they will isolate them in separate rooms and call the epidemiology center, whereas, 61 doctors (43.6%) did not know if they have a protocol for COVID-19 suspected cases. This study reported a significant association between job category and level of knowledge toward COVID-19 skin manifestations measured by Chi-square test, the P-value was 0.003 (significant at 0.05), and the same significant association was found between the year of rotation and knowledge. Conclusion: Half of the doctors covered by this study had poor knowledge about COVID-19 skin manifestations, and therefore, educating doctors in dermatology hospitals about skin manifestations of COVID-19 is recommended, besides clear and precise guidelines and protocols for diagnosis and management.

Molecular Detection of Plasmid-Mediated Quinolone Resistance Genes (qnrA and aac(6?)-Ib-cr) in Drug Resistant Escherichia coli, Sudan

Background: The quinolone group, a synthetic antimicrobial, is widely used worldwide to treat many diseases, including those caused by Gram-negative bacteria. Escherichia coli and others are among the bacteria that produce quinolone resistance genes (qnr) such as qnrA and aac(6?)-Ib-cr. Objective: The present study aimed to the isolate Escherichia coli from patients attending some Hospitals in Wad Medani city, identification of drug resistance patterns and detection of the frequency of quinolones resistance genes; qnrA and aac(6?)-Ib-cr among isolated strains. Methods: A cross-sectional descriptive, hospital-based study included 119 Escherichia coli strains was conducted. A designed questionnaire used for demographic data collection and the attitude toward antimicrobials usage. Clinical specimens were processed for aerobic bacterial isolation and identification. Antimicrobial sensitivity performed by Kirby Bauer disc diffusion technique according to the CLSI guidelines. Presence of qnrA and aac(6?)-Ib-cr genes was assessed by multiplex PCR. Results: Most strains of Escherichia coli originated from urine 53.8% (64/119) and wounds 42.9% (51/119) specimens. Meropenem had the best effect against tested strains with susceptibility of 85% (101/119). Multiplex PCR assay, using specific primers, demonstrated that 41.2% (49/119) and 37.8% (45/119) of isolated Escherichia coli possessed qnrA and aac(6?)-Ib-cr genes respectively. Conclusion: The high rate of qnrA and aac (6)-Ib-cr genes among Escherichia coli necessitate the usage of molecular tools in detecting the genetic determinants of drug resistance microorganisms in countries such as Sudan.

Relationship between the occlusal plane and three different levels of ala-tragus line in a sample of sudanese adults / Relación entre el plano oclusal y tres niveles diferentes de la línea ala-trago en una muestra de adultos sudaneses

Aim: Correct orientation of the occlusal plane plays a vital role in achieving the perfect occlusal balance and function of complete dentures. This study aimed to evaluate the most reliable posterior reference point of the ala-tragus line (ATL) concerning occlusal plane (OP) in a sample of the dentate Sudanese population. Materials and Methods: A total of 150 subjects with healthy and well-aligned permanent teeth were randomly selected. Right lateral profile photographs were taken with subjects having a fox plane placed intra-orally, contacting the occlusal plane. Reference points corresponding to inferior, middle, and superior borders of the tragus and inferior border of the ala of the nose were marked on photographs. The angles between the lines were measured using the Auto-CAD software program, and the most parallel relationship was determined. Descriptive statistics in terms of means and standard deviations were presented. Independent t-test and one-way ANOVA tests were used to compare as appropriate. A p-value < 0.05 was considered significant. Results: The mean angle formed by the OP and ATL was 8.5±3.69º for the superior level, 4.68±3.13º for the middle line, and 2.89±2.57º for the inferior line. A significant difference was found between the means of the three angles (p< 0.001), while no significant difference (p> 0.05) was found between both genders regarding the measured angles. Conclusions: The line joining the inferior border of the ala of the nose with the inferior border of the tragus of the ear was the most reliable line in terms of parallelism to determine the occlusal plane orientation.

Antecedentes: La orientación correcta del plano oclusal juega un papel vital para lograr el equilibrio oclusal perfecto y la función de las prótesis completas. Este estudio tuvo como objetivo evaluar el punto de referencia posterior más confiable de la línea ala-trago (ATL) con respecto al plano oclusal (OP) en una muestra de la población dentada de Sudán. Materiales y Métodos: Se seleccionaron aleatoriamente un total de 150 sujetos con dientes permanentes sanos y bien alineados. Se tomaron fotografías de perfil lateral derecho de sujetos a los que se les colocó un plano de zorro intraoralmente, en contacto con el plano oclusal. En las fotografías se marcaron los puntos de referencia correspondientes a los bordes inferior, medio y superior del trago y al borde inferior del ala de la nariz. Los ángulos entre las líneas se midieron utilizando el programa de software Auto-CAD y se determinó la relación más paralela. Se presentaron estadísticas descriptivas en términos de medias y desviaciones estándar. Se utilizaron prueba-t independiente y prueba ANOVA unidireccional para las comparaciones, según correspondiera. Se consideró significativo un valor de p<0,05. Resultados: El ángulo medio formado por OP y ATL fue de 8,5±3,69º para el nivel superior, 4,68±3,13º para la línea media y 2,89±2,57º para la línea inferior. Se encontró una diferencia significativa entre las medias de los tres ángulos (p< 0,001), mientras que no se encontró diferencia significativa (p>0,05) entre ambos sexos con respecto a los ángulos medidos. Conclusión: La línea que une el borde inferior del ala de la nariz con el borde inferior del trago de la oreja fue la línea más confiable en términos de paralelismo para determinar la orientación del plano oclusal.

Assessing Measles Vaccination Coverage in Children Under Five Years of Age in Developing Country

This is a cross-sectional descriptive study conducted in the River Nile State, Sudan; known with increasing morbidity of Measles. The objective is assess Measles vaccination and possibly other factors leading to abnormal high level of cases. A community-based cross-sectional, descriptive study using a questionnaire was designed to collect data, a sample of 183 was collected, vaccination cards were viewed to obtain information about vaccination status directors of Epidemiology and Immunization departments in the state was interviewed to collect data regarding Measles vaccination coverage and cases reports. The study clarified that, according to the state reports Measles vaccination coverage in children under five years old was 92% of the targeted population. While only 73.8% of the study group was vaccinated by the routine immunization system, the availability of measles vaccination service at the centers was 98.4%.78.7% of vaccination services were provided by static centers. Barriers discovered were suboptimal access to measles immunization represented in distant health center 19.7% (more than 5 km), on foot access to center 44.3%, rejection of vaccination from mothers7%).study recommended increasing the number of static and sub-centers, activating the health education programs to raise awareness, using simple attractive message to educate the public about the disease, and the importance of vaccination and encouraging mothers to vaccinate their children.

Emergency Care Capacity in Pediatric Hospitals, Khartoum, Sudan

@#Introduction: Critical pediatric patients have specific needs, which require special skills, training, equipment, supplies, personnel, and medications. While the knowledge related to enhance survival rate of newborn and children has improved over the past few decades. This study conducted to assess the emergency care capacity in pediatric hospitals at Khartoum state, Sudan. Methods: This is a descriptive cross-sectional hospital-based study, it was conducted in three hospitals at Khartoum, Sudan 2017-2018, to assess emergency care capacity in pediatric hospitals. Data was collected using open-ended questionnaire, and observational checklist. The data scored using dichotomous indicators (absent or present). Results: The study showed that there is shortage in human resources necessary to provide emergency care. However, much essential equipment for emergency care of children was absent in most hospitals, moreover, only 33% of hospitals had Triage system staffed by a trained person. Further, the clinical practice protocols for managing dehydration, neonatal sepsis, and neonatal resuscitation were not traced at the three hospitals. There are a limited laboratory services in one hospital. Conclusion: It is concluded that pediatric specialized hospitals, in Khartoum state, Sudan, have low capacity to provide emergency care for children. Further efforts are needed to improve the emergency care capacity in Khartoum hospitals.

Hepatitis B chronic infection among pregnant women attending the antenatal care in Bor State Referral Hospital, South Sudan

Introduction: Hepatitis B virus (HBV) is a major public health problem affecting 400 million people worldwide, and is a common cause of chronic liver failure (cirrhosis) and hepatocellular carcinoma. Sixty-eight percent of infected people are from the African and Pacific regions. Vertical transmission from mother to newborn baby is one of the mechanisms by which chronic hepatitis virus infection spreads, besides infections from contaminated needles and syringes and sexual contact. Hepatitis B chronic infection is endemic in many poor countries, especially in Africa. Method: A cross-sectional study was conducted between July and August 2021. Pregnant women attending the antenatal care (ANC) in Bor State referral hospital, South Sudan, were interviewed to collect information on their socio-demographic characteristics and risk factors for hepatitis B infection. The objective was to determine the seroprevalence of hepatitis B chronic infection through blood testing. Prevalence ratios for certain risk factors were calculated. Results: Two hundred pregnant women were enrolled. The Prevalence Rate for chronic infection with hepatitis B virus, diagnosed using the rapid immune-chromatographic assay for Hepatitis B surface antigen (HBsAg), was 8.5%. (95% CI; 4.7% - 12.3%). None of the suspected risk factors studied were found to be significantly associated with testing positive for HBV, except for a history of previous jaundice. Conclusion: The prevalence of HBV chronic infection among pregnant women in Bor, Jonglei State, is high hence there is a need for established public health interventions that can lead to a reduction of HBV vertical transmission. Treatment of pregnant women with HBV chronic infection using anti-viral medications during pregnancy might curb the vertical transmission rates.

Measuring nurses' satisfaction in primary health care centers at Khartoum, Sudan

Background: The primary healthcare sector has experienced significant growth globally, and the nursing workforce has also expanded in recent decades in response to health system reforms. This study aims to assess job satisfaction among primary healthcare nurses in Khartoum, Sudan. Methods: This descriptive cross-sectional study was conducted in 10 primary healthcare centers on 50 nurses who were selected using simple random sampling. Data were collected using an online questionnaire and it was analyzed using SPSS. Results: The findings of this study indicate that the job satisfaction level among nurses working at primary healthcare centers in Khartoum was high (4.4/5). Most nurses reported high satisfaction with all items including protocols, salary, environment, and relationships. The study also found a significant correlation between nurses' sex and experience with their level of job satisfaction. Female nurses reported significantly higher job satisfaction (4.4/5) compared to male nurses (3.6/5), (p-value = 0.04). Additionally, nurses with fewer years of experience reported significantly higher job satisfaction compared to those with more years of experience (p-value = 0.03). Conclusion: The study concludes that nurses working at primary healthcare centers in Khartoum have high job satisfaction, particularly regarding the working environment, salary, relationships, and availability of guidelines. Female nurses and those with less experience have significantly higher job satisfaction.

Phenomenology of Obsessive-Compulsive Disorder in Sudan and its association with Socio-demographic Factors

Background: Symptoms of Obsessive-Compulsive Disorder OCD tend to be shaped by socio-cultural context. There are very few studies related to OCD in Sudan. Aim: This study aimed to explore the phenomenology of obsessive-compulsive disorder in a sample of Sudanese patients in relation to socio-demographic factors. Methods: We reviewed the case notes of Sudanese patients with Obsessive-Compulsive Disorder who presented to a psychiatry clinic in Khartoum, Sudan during a period of two years. Data was collected using a checklist of obsessive and compulsive features, subtypes of Obsessive-Compulsive Disorder, comorbidities, as well as socio-demographic data. Results: Eighty-nine Sudanese patients were included in this study. The mean age of the first onset of the disorder was 21.72 years (SD ±7.51). The most common obsession among participants was doubting followed by Religious thoughts while the most common compulsion was washing, then checking. Obsession of contamination was significantly higher in females while religious obsessions were more common in males. Obsession of contamination and compulsive washing was significantly associated with younger age of onset. Conclusion: Common features of obsessive-compulsive disorder in Sudanese patients are doubts, religious thoughts, contamination obsession, and washing compulsion which is likely to be related to the strong emphasis on traditional values and religiosity in Sudanese culture.

Isolation of Bacterial Contaminants from Operating Theatres in EnNahud City, West Kordofan State – Sudan

Background: The prevalence of nosocomial infections has continued to rise due to microbial contamination of the hospital environment. Operating room contamination, on the other hand, is one of the most common and life-threatening sources of nosocomial infections. Objective: The goal of this research is to isolate and identify bacterial contaminants in operating rooms and equipment in EnNahud, West Kordofan. Methods: A total of 45 samples (from three hospitals) were collected from various operating theatre sites between September and December 2020. Using the accepted bacteriological methods (ISO/TC 147/SC 4 Microbiological techniques), all isolated bacteria were identified. S. Escherichia coli ATCC 25922 and Staphylococcus aureus ATCC 25923 were employed as control bacterial strains to track the entire bacteriological process. Results: Five kinds of bacteria were recovered from the 45 (100%) positive specimens in three hospitals in this study. The number of polluted hospitals is on the rise (100%). The most prevalent bacterial pollutants identified from operation theaters were Staphylococcus aureus 24 (53.3%), Pseudomonas aeruginosa 13 (28.8%), Bacillus spp 6 (13.3%), Proteus spp 1 (2.2%), and Salmonella spp 1 (2.2%), according to the findings (2.2%). All of the places where samples were taken were found to be completely contaminated. Conclusion: The relatively high degree of bacterial contamination in hospital operating rooms highlights the need for ongoing microbiological surveillance aimed at detecting bacterial contamination levels and their impact on nosocomial infection early.

The cagA, cagE, vacA, dupA and iceA1 genes of Helicobacter pylori in Sudanese gastritis patients: Distribution and relationship with clinical outcomes and histological alterations

Aims@#Helicobacter pylori is a gastrointestinal bacterium that causes peptic ulcers and stomach cancer in nearly half of the world’s population. Many virulence factors influence the outcome of H. pylori related disorders. The purpose of this study was to see if there was a relationship between H. pylori virulence factors and histological and endoscopic findings in stomach biopsy specimens from Sudanese gastritis patients.@*Methodology and results@#In the period between March 2018 and January 2020, a total of 290 gastric biopsies were taken from patients in Khartoum State hospitals. Histopathology and polymerase chain reaction (PCR) assays were performed on all specimens. Histological investigation revealed H. pylori in 103/290 (35.5%) samples, while PCR revealed H. pylori 16S rRNA positivity in 88/290 (30.3%) samples. Eighty-eight positive PCR specimens were subjected to PCR for genotypic detection of cagA, cagE, vacA, dupA and iceA1 genes. All of strains were vacA positive 100% (88/88) followed by dupA 50.0% (44/88), cagA 40.9% (36/88), cagE gene 38.6% (34/88) and iceA1 gene was detected in only 15.9% (14/88). The vacA s1/m1 68.2% (60/88) was the most prevalent vacA subtype.@*Conclusion, significance and impact of study@#Helicobacter pylori virulence genes were widespread and diversified in Sudanese gastritis patients. Helicobacter pylori cagA and iceA1 were significantly in association with gastric mucosa inflammation degree, whereas the dupA gene was found to be associated with the clinical outcomes.

Management of Helicobacter pylori among medical doctors working in Khartoum, Sudan 2019: a cross-sectional study

Background: Various international guidelines have been developed regarding Helicobacter pylori (H. pylori) management, as it is infecting more than half of the world's population. Sudan's health system lacks guidelines regarding H. pylori management, leading to a discrepancy in practice. Investigating the current approach could be a step forward in the formulation of a national consensus in the management of H. pylori. Methods: A cross-sectional study was conducted among medical doctors currently working in Khartoum, Sudan. Participants were enrolled from platforms of medical associations through an online questionnaire. The questionnaire was scored out of 25 points, and scoring 13 or above considered a good approach. Data analysis was carried out using Statistical Package for Social Sciences (SPSS). Results: A total of 358 medical doctors participated in the study. The mean (±SD) score was 12.9(±4.5). Those who were using textbooks, campaigns, symposiums or general medical information to their primary Source of knowledge significantly scored higher. The most selected indication for both diagnosis (76.8%) and treatment (67.6%) was an active peptic ulcer. Stool antigen test (SAT) was the most preferred test (70.7%). The majority of respondents selected triple therapy (82.1%) as a first-line regimen. Only 37.7% confirmed the eradication after four weeks of stopping the treatment. They ensure eradication mainly through SAT (29%). Conclusion: A suboptimal approach was noted among medical doctors of Khartoum, Sudan, regarding H. pylori management. Efforts should be invested in forming national guidelines and the implementation of continuous medical education programs.

Roles of local healthcare workers in the humanitarian response in South Sudan: a literature review

Introduction: Armed conflict is devastating to the health system, is a public health concern and recovery is an enormous challenge. The independence of South Sudan in 2011 brought much hope. However, eight years later, the country is still at conflict with itself. Although rich in resources, it is ranked among the poorest in the world and depends on donor funding for most service delivery, especially health. In an international context, promoting the localisation of humanitarian aid and the integration of health services, there is a lot to learn from the roles being played by healthcare workers (HCWs) throughout the conflict in South Sudan. Method: A literature review was conducted to identify the roles of local HCWs in South Sudan since 2011. Four databases were searched, grey literature sourced, and snowballing done to capture additional documents for a comprehensive analysis. Questions were adapted from the Critical Appraisal Skills Programme for qualitative and systematic reviews guided appraisals of the articles. Results were systematically coded, synthesised and summarised using a priori and emergent themes. Results: The health system in South Sudan is very fragmented with heavy dependence on humanitarian aid. There is serious shortage in health workforce with heavy reliance on unskilled workers to fill in the gaps, mainly in rural settings. Although close collaboration exists among different stakeholders to deliver integrated services, poor infrastructure, insecurity, lack of capacity and donor dependency still poses a challenge towards localisation of aid and sustainability. Conclusions: The literature reviewed for this study indicates that the road towards localisation of health care is possible but will depend highly on continued collaboration between the different contributors, integration of services, building capacity of the nationals, increased government funding and infrastructural development. Local involvement of HCWs by international agencies is paramount in ownership and sustainability of services.

Association between serum lipid profile, body mass index and osteoporosis in postmenopausal Sudanese women

Background: Epidemiological observations suggest links between osteoporosis and the risk of acute cardiovascular events. Whether the two clinical conditions are linked by common pathogenic factors or atherosclerosis per se remains incompletely understood. The reduction of bone density and osteoporosis in postmenopausal women contributes to elevated lipid parameters and body mass index (BMI). Objective: To investigate the relationship between serum lipid profile, BMI and osteoporosis in postmenopausal women. Materials and Methods: A prospective analytical case control-study conducted in Khartoum north hospital at Khartoum city, capital of the Sudan from April 2017 to March 2018 after ethical approval obtained from the local Research Ethics Committee of Faculty of Medical Laboratories, Alzaeim Alazhary University on the committee meeting number (109) on Wednesday 15th February 2017. A written informed consent was obtained from all participants to participate in the study.Two hundred postmenopausal women were enrolled in the study. The age was studied in one hundred osteoporosis postmenopausal women as a case group and one hundred non-osteoporosis postmenopausal women as control group. The serum lipid profiles were estimated using spectrophotometers (Mandry) and BMI calculated using Quetelet index formula. The data were analysed using SPSS version 16. Results: The BMI, serum total cholesterol, triglyceride, HDL and LDL in case group respectively were (24.846±2.1647, 251.190±27.0135 mg/dl, 168.790 ±45.774 mg/dl, 50.620 ± 7.174 mg/dl, 166.868 ±28.978 mg/dl). While the BMI, serum total cholesterol, triglyceride, HDL and LDL in control group respectively were (25.378 ±3.8115, 187.990 ± 26.611 mg/dl, 139.360±20.290 mg/dl, 49.480 ±4.659 mg/dl, 111.667 ±28.0045 mg/dl). All serum lipid profiles significantly increased (p=0.000) in the case group compared to the control group, except serum HDL was insignificant different between the case and control group and also BMI was insignificant different between the case and control group. There was a positive Pearson's correlation between BMD and serum total cholesterol (r= 0.832, P<0.01), serum LDL (r = 0.782, P<0.01) and serum triglyceride (r = 0.72, P<0.01). Conclusions: Osteoporotic postmenopausal women had a significant increase in serum lipid profile and BMI. Moreover, we found a positive link between women with cardiovascular diseases and stroke

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).

Misconceptions and associated factors of COVID-19 infection among internally displaced persons in Sudan

Coronavirus disease 2019 (COVID-19) is a global public health threat that has spread rapidly and caused morbidity and mortality worldwide. Reducing the myths about infectious diseases is vital for controlling transmission. This study explored the level of misconceptions and associated factors of COVID-19 among internally displaced persons in Sudan. This study is a cross-sectional, descriptive design and community-based study. We collected the data using a self-administered questionnaire via the convenience sampling technique among internally displaced persons in the camps of Zalingei town in the central Darfur region of Sudan. The total mean score of the respondents' misconception was 3.1725 (SD=0.59) with 63.2%, indicating moderate misunderstanding of COVID-19. Multiple linear regression revealed the independent variables together had a significant impact on a misconception, F(14,116)=2.429, p<0.005. The regression model explains 22.7% of the variance in misunderstanding. Analysis of the influence of single factors on the dependent variable showed that people aged 31­40 years had significantly higher levels of misconception, 0.381 (t=2.116, p<0.037), than those aged over 60 years, and university graduates had considerably lower levels of misunderstanding, −0.061 (t=−2.091, p<0.03) than non-graduates. This study found a moderate level of misconception of COVID-19. Non-graduates had higher levels of misunderstanding than graduates. The results suggest that an education campaign should focus on people with low levels of education to correct their misconceptions regarding the prevention of COVID-19 infection

Adherence to Immunosuppressive Medications in Kidney Transplant Patients at Three Centers in Khartoum State, Sudan: A Cross-sectional Hospital Study

Background: Graft survival post-kidney transplantation is of paramount importance to patients and nephrologists. Nonadherence to immunosuppressive therapy can be associated with deterioration of renal function and graft rejection. This study aimed to evaluate the adherence to immunosuppressive medications in kidney transplant patients at three centers in Khartoum, Sudan. Methods: In this descriptive cross-sectional hospital-based survey, 277 post-kidneytransplant patients were recruited. Data were collected using a questionnaire and analyzed using the SPSS v.23. Our scoring method was calculated based on Morisky Medication Adherence Scale (MMAS-8) related to immunosuppressive medications and was expressed as questions in the questionnaire; every correct answer was given one mark, then the marks were gathered and their summation was expressed. Results: Overall, 33% ,45%, and 22% of the studied participants reported high, medium, and low adherence, respectively. The major factor for nonadherence was forgetfulness affecting 36.1% of those who did not adhere. The cost of the immunosuppressive medications did not negatively affect any of the participants' adherence (100%). However, a significant association was seen between adherence and occupational status, duration of transplantation, shortage of immunosuppressants, recognizing the name of immunosuppressant, side effect, and forgetfulness (P-values = 0.002, 0.01, 0.006 , 0.000, 0.022, and 0.000, respectively). Logistic regression analysis showed a significant association with occupational status, side effects, and forgetfulness.

Assessment of Variation in Clinical Presentation of Visceral Leishmaniasis Among Patients Attending the Tropical Diseases Teaching Hospital in Sudan

Background: Visceral leishmaniasis (also known as Kala-azar) is a systemic parasitic infection with many clinical presentations. The present study assesses the variation in presentations among patients who attended the Tropical Diseases Teaching Hospital (TDTH) in Khartoum, Sudan. Methods: This analytical cross-sectional, hospital-based study was conducted at the TDTH between November 2019 and September 2020. Medical records of patients who presented at the TDTH were reviewed using a structured data extraction checklist. The Chi-square test was used to determine the associations between sociodemographic and clinical presentations of patients. P-value < 0.05 was considered as statistically significant. Results: Out of 195 patients, 79.5% were male and 48.2% were <31 years old. Fever was the main clinical presentation (90.2%) while 53.3% presented with weight loss and 72.3% and 39% presented, respectively, with splenomegaly and hepatomegaly. HIV was detected in 4.6% of the patients. RK39 was the main diagnostic test. We found a significant association between the abdominal distention and the age of the patients (P < 0.05) ­ age groups 11­20 and 41­50 years were more likely to present with abdominal distention than other age groups. Conclusion: There is no exact clinical presentation or routine laboratory findings that are pathognomonic for visceral leishmaniasis; therefore, it should be considered in the differential diagnosis of any patient with fever, weight loss, and abdominal distention, and among patients with HIV.

Sero-molecular Epidemiology of Hepatitis E Virus in Blood Donors, Gezira State, Sudan: A Cross-sectional Study

Background: Hepatitis E virus (HEV) is a hepatotropic pathogen that causes significant morbidity and mortality in humans. It is an important causative agent of viral hepatitis outbreaks. This study investigates the serological and molecular prevalence of HEV in blood donors attending the Central Blood Bank in Wad Medani City in Gezira State, Sudan. Methods: The study adopted a cross-sectional descriptive design. A structured questionnaire was used to collect data concerning demographic information and risk factors associated with HEV transmission. All enrolled participants (N = 300) were screened for HEV IgG antibodies using commercial ELISA kits, then strong positive samples (N = 84) were selected and rescreened for HEV IgM and HEV RNA by RT PCR. SPSS version 24.0 was used for analysis. Results: Out of 300 male participants, 36.3% (109/300) were positive for HEV IgG. However, only one participant was IgM positive, while the HEV RNA was negative. The highest prevalence rates of the virus were 42 (44.6%) among the age group of 31­40 years, 20 (48.8%) in those who consumed food from outside, 13 (50%) in three to four multiple blood donations, and 5 (62.5%) in those who consumed water from the river source. A significant association of HEV IgG prevalence concerning the occupation of the participants being students or farmers was detected using univariate and multivariate analysis (P-value = 0.007).