Assessment of initiation of breastfeeding practice in Kassala, Eastern Sudan: a community-based study.

BACKGROUND: The World Health Organization (WHO) encourages early initiation of breastfeeding within the first hour after birth with the objective of saving children's lives. There are few published research papers about factors associated with the initiation of breastfeeding in Sudan.The aim of this study was to investigate the prevalence of and factors associated with the timely initiation of breastfeeding among mothers with children two years and under in Kassala, Eastern Sudan. METHODS: A community-based cross-sectional study was conducted from December 2016 to March 2017. Mothers were interviewed using a structured questionnaire. RESULTS: A total of 250 mother-child pairs participated in the study. The mean (standard deviation) of maternal age and children's age was 27.1 (5.68) years and 11.9 (6.9) months, respectively.Of the 250 mothers, 218 (87.2%) initiated breastfeeding within the first hour. In multivariable logistic regression analysis, factors associated with the delay of breastfeeding initiation were having a male baby (Adjusted Odds Ratio [AOR] 3.90, 95% Confidence Interval [CI]1.33, 11.47), and mothers with medical disorders (AOR 5.07, 95% CI 1.22, 21.16). CONCLUSION: There was a high prevalence of early initiation of breastfeeding. An association with delayed initiation of breastfeeding was found amongst mothers who had medical disorders and those who had a male infant. Wherever possible, early initiation of breastfeeding should be promoted for all infants, regardless of gender.

Factors associated with perinatal mortality in Kassala, Eastern Sudan: a community-based study 2010-2011.

This study investigated the factors associated with perinatal mortality in eastern Sudan from 2010 to 2011. Among 808 deliveries, there were 15 pairs of twins, giving 823 babies at risk of perinatal deaths. There were 761 live births and 62 perinatal deaths. Of the 62 perinatal deaths, 25 (40.3%) were stillbirths and 37 (59.7%) were early neonatal deaths. The stillbirth risk, early neonatal mortality risk and perinatal mortality rate were 30.9 per 1000 pregnancies, 48.6 per 1000 live births and 75.3 per 1000 births, respectively. In the logistic regression model, home delivery [odds ratio (OR) = 5.1; confidence interval CI = 1.8-14; p = 0.001] and parity ≥3 (OR = 4.5; CI = 2.2-8.8; p < 0.001) were predictors for perinatal deaths, whereas use of antenatal care (OR = 0.3; CI = 0.1-0.6; p = 0.002), use of a mosquito net (OR = 0.07; CI = 0.03-0.1; p < 0.001) and antenatal iron supplementation for at least 3 months (OR = 0.06; CI = 0.02-0.1; p < 0.001) were significant protective factors of perinatal deaths.

Factors affecting unmet need for family planning in Eastern Sudan.

BACKGROUND: In the developing countries millions of women in the reproductive age who don't use contraceptives prefer to postpone or limit their birth. This indicates their failure to take necessary decision to prevent and avoid unwanted pregnancy. METHODS: A community-based cross sectional household survey was conducted to investigate unmet need for family planning and associated factors and total demand for family planning in Kassala, Eastern Sudan between 1st May and 31st July 2012. RESULTS: A total of 812 married women were enrolled in this study. Their mean age and parity was 31.8 (7.3) and 3.4 (1.8) respectively. Ever use of contraception was 25.4% (206/812) and 26.2% (213/812) were currently using contraception. Unmet need for spacing was 15.1% while unmet need for limiting was 0.7%. The pregnant and amenorrheic women whose the pregnancy or birth was unwanted and mistimed were 105 (13%) and 130 (16%) respectively. Using Westoff model the total unmet need was estimated as 44.8%. The total demand for family planning was 71%.In logistic regression model, while age, age at marriage, parity, residence and experience of child death were not associated with total unmet need for family planning, women education < secondary level (OR=7.8; CI=5.6-10.9; P=0.00), husband education < secondary level (OR=1.9; CI=1.3-2.6, P = 0.00) and woman's occupation; housewife (OR=4.3; CI=2.5-7.2; P=0.00) were associated with the total unmet need. CONCLUSIONS: Unmet need for family planning in Eastern Sudan was significantly higher among women with less than secondary education. Also; it is influenced by couple's educational status and woman's occupation. The results of this study necessitate the need for the programme managers to take into account the concept of reproductive health education.

Efficacy of artemether-lumefantrine as a treatment for uncomplicated Plasmodium vivax malaria in eastern Sudan.

BACKGROUND: Artemisinin-based combination therapy (ACT) is the treatment of choice for uncomplicated Plasmodium falciparum malaria in most areas of the world, where malaria is endemic, including Sudan. However, few published data are available on the use of ACT for treatment of P. vivax malaria. METHODS: This study was conducted at a health centre in Kassala, eastern Sudan, from October to December 2011. Patients with uncomplicated P. vivax malaria received artemether-lumefantrine (AL) tablets (containing 20mg artemether and 120 mg lumefantrine) and were monitored for 28 days. RESULTS: Out of the 43 cases enrolled in this study, 38 completed the 28-day follow-up. Their mean age was 25.1 years (SD: 1.5). On day 3 following AL treatment, all of the patients were afebrile and aparasitaemic. By day 28, all 38 patients exhibited adequate clinical and parasitological responses to AL treatment. The cure rate was 100% and 88.4% for the per protocol analysis andfor the intention to treat analysis, respectively. Mild adverse effects (nausea, vomiting, abdominal pain, dizziness and/or rash) that resolved spontaneously were observed in four (10.5%) of the patients. CONCLUSION: AL combination therapy was fully effective for treatment of P. vivax malaria in the study in eastern Sudan. TRIAL REGISTRATION: Trial. Gov: NCT01625871.

Knowledge and attitudes of female genital mutilation among midwives in Eastern Sudan.

BACKGROUND: Female Genital Mutilation (FGM) or cutting caries legal and bioethical debates and it is practiced in many developing countries. METHODS: Random selection of 154 midwives was used for the study during June 2012 and through July 2012 aiming to assess knowledge and attitudes of the midwives towards FGM in Eastern Sudan. RESULTS: A total of 157 midwives enrolled in this study. They had been practicing for 3-44 years (mean SD 19.2±10.3). More than two third of them experienced practicing FGM sometime in their life (127/157, 80.9%). There was low level of awareness of types of FGM practice since only 7% (11/157) identified the four types correctly. 53.5% (84/157) identified type 1 correctly while 18.5% (29/157), 17.8% (28/157) and 15.9% (25/157) identified type 2, 3 and 4 as correct respectively. While 30 (19.1%) of the midwives claimed that all types of FGM are harmful, 76.4% (120/157) were of the opinion that some forms are not harmful and 7 (4.5%) reported that all types of FGM are not harmful. Likewise while 74.5% (117/157) of the interviewed midwives mentioned that the FGM is a legal practice only 25.5% (40/117) were of the opinion that FGM is illegal practice. The vast majority of the respondents (64.3%, 101/157) have an opinion that FGM decreases the sexual pleasure. More than half (53.5%, 84/157) of the participants affirmed that FGM does not increase the risk of HIV transmission. High proportion of the respondents (71.3%, 112/157) did not know whether or not infertility could complicate FGM. CONCLUSIONS: Thus a substantial effort should be made to discourage the continuation of FGM practice among midwives in Sudan. This might be achieved by improving knowledge and awareness among the midwives and the community.

Epidemiology of dengue infections in Kassala, Eastern Sudan.

Eighty-one (71.7%) out of 113 patients had confirmed dengue infection (using ELISA IgM serology) at Kassala, Eastern Sudan during the period of August through November 2010. According to the WHO criteria, dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) were observed in 30.9, 58, and 11.1% of these patients, respectively. The mean age of these 81 patients was 25.5 years. Male:female ratio was 1.8:1. Various symptoms including fever (100%), headache (75.3%), vomiting (55.6%), nausea (53.1%), and backache (30.9%) were observed among these patients. Thrombocytopenia (<100/10(9) platelets/L), and leucopenia (WBC count <4,000 × 10(9) cells/L) and hemoconcentration (hematocrit >45) were reported in 86.4, 69.1, and 67.9% of the patients, respectively. High alanine aminotransferase (ALT, >65 U/L) and aspartate aminotransferase (AST >37 U/L) were seen in 9.9 and 14.8% of the patients, respectively. There were five (6.1%) deaths, three of them had DHF and the other two patients had DSS.

Epidemiology of tuberculosis in Eastern Sudan.

OBJECTIVE: To investigate the epidemiological factors of tuberculosis (TB) in eastern Sudan. METHODS: The socio-demographic and clinical data was retrieved from the database at Kassala hospital during the year of 2011. The medical file of consequent patients who was discharged from the same ward in the hospital was reviewed to act as control for the TB patients. RESULTS: A total of 670 patients were registered at Kassala hospital with clinical, laboratory and radiological evidence proven TB. Pulmonary TB accounted for 73.4% while extra-pulmonary TB was reported in 26.6% of all TB patients. The mean age (SD) was not significantly different between the cases and controls (670 in each arm). TB patients were those who had less education, and the infection more likely common among male patients. CONCLUSIONS: Intervention from outside the health field in particular awareness of associated risk factors and improvement of the educational level potentially will strengthen TB control.

Maternal near-miss in a rural hospital in Sudan.

BACKGROUND: Investigation of maternal near-miss is a useful complement to the investigation of maternal mortality with the aim of meeting the United Nations' fifth Millennium Development Goal. The present study was conducted to investigate the frequency of near-miss events, to calculate the mortality index for each event and to compare the socio-demographic and obstetrical data (age, parity, gestational age, education and antenatal care) of the near-miss cases with maternal deaths. METHODS: Near-miss cases and events (hemorrhage, infection, hypertensive disorders, anemia and dystocia), maternal deaths and their causes were retrospectively reviewed and the mortality index for each event was calculated in Kassala Hospital, eastern Sudan over a 2-year period, from January 2008 to December 2010. Disease-specific criteria were applied for these events. RESULTS: There were 9578 deliveries, 205 near-miss cases, 228 near-miss events and 40 maternal deaths. Maternal near-miss and maternal mortality ratio were 22.1/1000 live births and 432/100 000 live births, respectively. Hemorrhage accounted for the most common event (40.8%), followed by infection (21.5%), hypertensive disorders (18.0%), anemia (11.8%) and dystocia (7.9%). The mortality index were 22.2%, 10.0%, 10.0%, 8.8% and 2.4% for infection, dystocia, anemia, hemorrhage and hypertensive disorders, respectively. CONCLUSION: There is a high frequency of maternal morbidity and mortality at the level of this facility. Therefore maternal health policy needs to be concerned not only with averting the loss of life, but also with preventing or ameliorating maternal-near miss events (hemorrhage, infections, hypertension and anemia) at all care levels including primary level.

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 13.7% of antenatal attendants in New Halfa had peripheral microscopically detected Plasmodium falciparum malaria, placental malaria (using histological examinations) was prevalent in 32.0-40% and 19.5% of 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%, 62.6% and 80.2% of pregnant women in Medani, New Halfa, and Gadarif Hospitals, respectively. In Gadarif, 57.3% of pregnant women had a folate deficiency, while 1% had a vitamin B12, deficiency. In Medani, zinc and copper deficiencies were detected in 45.0% and 4% of 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.

Use of family planning methods in Kassala, Eastern Sudan.

BACKGROUND: Investigating use and determinants of family planning methods may be instructive in the design of interventions to improve reproductive health services. FINDINGS: Across sectional community-based study was conducted during the period February-April 2010 to investigate the use of family planning in Kassala, eastern Sudan. Structured questionnaires were used to gather socio-demographic data and use of family planning. The mean ± SD of the age and parity of 613 enrolled women was 31.1 ± 7 years and 3.4 ± 1.9, respectively. Only 44.0% of these women had previously or currently used one or more of the family planning methods. Combined pills (46.7%) and progesterone injection (17.8%) were the predominant method used by the investigated women. While age, residence were not associated with the use of family planning, parity (> five), couple education (≥ secondary level) were significantly associated with the use of family planning. Husband objection and religious beliefs were the main reasons of non-use of family planning. CONCLUSION: Education, encouragement of health education programs and involvement of the religious persons might promote family planning in eastern Sudan.

Lack of antenatal care, education, and high maternal mortality in Kassala hospital, eastern Sudan during 2005-2009.

The aim of this study was to investigate the incidence and causes of maternal deaths at Kassala maternity hospital, eastern Sudan during 2005-2009. All maternal deaths during this period were reviewed and classified retrospectively. The medical file of consequent women who were discharged from the same ward in the hospital was reviewed to act as control for the maternal death. There were 132 maternal deaths and 20,485 (644/100,000) live births. Septicemia, preeclampsia/eclampsia, hemorrhage, anemia, viral hepatitis, and malaria were the causes for maternal mortality. Primipare (OR = 3.3, CI = 1.6-6.9, p = 0.001), lack of antenatal care (OR = 3.9, CI = 1.6-9.5, p = 0.002), illiteracy (OR = 2.6, CI = 1.4-4.8, p = 0.002), and rural residence (OR = 2.2, CI = 1.2-4.1; p = 0.008) were the predictors for maternal death. The levels of maternal education and antenatal attendance should be raised to reduce the high maternal mortality.

Anaemia and stillbirth in Kassala Hospital, Eastern Sudan.

BACKGROUND: Globally, the reduction of stillbirths is a high priority, especially in view of the targets set by the Millennium Development Goals. It is crucial that health policy-makers and programme managers are aware of the epidemiology of stillbirths. OBJECTIVES: This was a case-control study conducted in Kassala hospital in Eastern Sudan to investigate the prevalence and risk factors for stillbirth. Cases were women who delivered stillbirths; two consecutive women who delivered a live-born neonate per case were used as controls. RESULTS: Among 1342 singleton deliveries, there were 44 stillbirths (33 per 1000 deliveries). Over half (54.5%) of these stillbirths were macerated stillbirths. While maternal socio-demographic characteristics were not associated with stillbirth, maternal anaemia was the main risk factor for stillbirth (Odds ratio = 8.4, 95% CI = 2.5-29.4; P = 0.001). CONCLUSION: Thus, greater focus on maternal nutrition and prevention of anaemia may prevent stillbirth in this setting.

Zinc, parity, infection, and severe anemia among pregnant women in Kassla, eastern Sudan.

The study was conducted to investigate determinants (clinical, nutritional, and nonnutritional factors) of anemia among pregnant women in Kassala, eastern Sudan. Sociodemographic characteristics were gathered; serum ferritin, zinc, albumin, and C-reactive protein were measured using different laboratory methods in a cross-sectional study of 250 pregnant women. Of the 250 women, 58.4% had anemia (hemoglobin (HB) <11 g/dl), 6.8% had severe anemia (HB < 7 g/dl), 19.6% had iron deficiency (S-ferritin <15 µg/l), 14.8% had iron deficiency anemia (<11 g/dl and S-ferritin <15 µg/l), and 38% had zinc deficiency (<80 µg/ml). S-albumin, zinc, and ferritin were significantly lower in patients with severe anemia. While age, gestational age, ferritin, and C-reactive protein were not predictors for anemia, primigravidae (OR = 2.7, 95% CI = 1.1-6.7, P = 0.02), low S-albumin (OR = 5.9, 95% CI = 1.4-25.2, P = 0.01), and low S-zinc (OR = 2.6, 95% CI = 1.0-6.6, P = 0.03) were the predictors for anemia. While there was no significant correlation between hemoglobin, S-zinc, and S-ferritin, there was a significant positive correlation between hemoglobin and S-albumin (r = 0.308, P = 0.001) and significant inverse correlation between hemoglobin and C-reactive protein (r = 0.169, P = 0.007). Thus, the role of chronic inflammation and zinc as possible contributing factors to anemia in pregnancy has important implications for the clinical evaluation and treatment of these women.

Use of antenatal care services in Kassala, eastern Sudan.

BACKGROUND: Antenatal care is named as one of the four pillars initiatives of the Safe Motherhood Initiative. While many of routine antenatal care procedure have little effect on maternal mortality and morbidity, some of these have been ascertained as beneficial. The aim of this study was to investigate coverage of antenatal care and identify factors associated with inadequacy of antenatal care in Kassala, eastern Sudan. METHODS: A cross-sectional community-based study was carried out in Kassala, eastern Sudan during September-October 2009. Household surveys were conducted. Structured questionnaires were used to gather data from women who had been pregnant within the last year, or pregnant more than 14 weeks. RESULTS: Out of 900 women investigated for antenatal care coverage, 811(90%) women had at least one visit. Only 11% of the investigated women had ≥ four antenatal visits, while 10.0% had not attended at all. Out of 811 women who attended at least one visit, 483 (59.6%), 303 (37.4%) and 25 (3.1%) women attended antenatal care in the first, second and third trimester, respectively. In logistic regression analyses, while maternal age and residence were not associated with inadequacy of antenatal care (<2 visits), high parity (OR = 2.0, CI = 1.1-3.5; P = 0.01) and husband education ≤ secondary level (OR = 2.4, CI = 1.3-4.2; P = 0.002) were associated with inadequacy of antenatal care. CONCLUSIONS: Antenatal care showed a low coverage in Kassala, eastern Sudan. This low coverage was associated with high parity and low husband education.