ABSTRACT
Routine infectious diseases screening of Sudanese pregnant women has been patchy due to scarcity of healthcare resources and social stigma. We sought to determine the seroprevalence of HIV, hepatitis B, and syphilis among pregnant women attending antenatal care (ANC) at El Obeid Maternity Hospital in western Sudan. We also explored the association between these infections and a set of socio-demographic and maternal variables. Unlinked anonymous testing for HIV-1/2 antibodies, hepatitis B surface antigen, and Treponema pallidum antibodies was performed on residual blood samples collected during routine ANC (August 2016-March 2017). Seroprevalence of HIV was 1.13% (5/444; 95% CI 0.37-2.61%), hepatitis B 2.93% (13/444; 95% CI 1.57-4.95%), and syphilis 7.43% (33/444; 95% CI 5.17-10.28%). On bivariate analysis, there were no statistically significant associations between hepatitis B, syphilis, or a composite outcome including any of the three infections and age, stage of pregnancy, gravidity, parity, previous mode of delivery, history of blood transfusion, or husband polygamy. Urgent action is needed to scale up routine maternal screening for HIV, hepatitis B, and syphilis on an opt-out basis. Further research into the socio-demographic and behavioural determinants of these infections as well as their clinical outcomes is needed.
Subject(s)
Anonymous Testing , HIV Antibodies/blood , HIV Infections/epidemiology , Hepatitis B Antibodies/blood , Hepatitis B/epidemiology , Pregnancy Complications, Infectious/epidemiology , Syphilis/epidemiology , Adolescent , Adult , Cross-Sectional Studies , Female , Fluorescent Treponemal Antibody-Absorption Test , HIV Infections/blood , HIV Infections/diagnosis , Hepatitis B/blood , Hepatitis B/diagnosis , Hospitals, Maternity , Humans , Pregnancy , Pregnancy Complications, Infectious/blood , Pregnancy Complications, Infectious/diagnosis , Pregnant Women , Prevalence , Seroepidemiologic Studies , Sudan/epidemiology , Syphilis/blood , Syphilis/diagnosis , Young AdultABSTRACT
Malaria is the leading cause of illness and death in Sudan. The entire population is at risk of malaria epidemics with a very high burden on government and population. The usefulness of forecasting methods in predicting the number of future incidences is needed to motivate the development of a system that can predict future incidences. The objective of this paper is to develop applicable and understood time series models and to find out what method can provide better performance to predict future incidences level. We used monthly incidence data collected from five states in Sudan with unstable malaria transmission. We test four methods of the forecast: (1) autoregressive integrated moving average (ARIMA); (2) exponential smoothing; (3) transformation model; and (4) moving average. The result showed that transformation method performed significantly better than the other methods for Gadaref, Gazira, North Kordofan, and Northern, while the moving average model performed significantly better for Khartoum. Future research should combine a number of different and dissimilar methods of time series to improve forecast accuracy with the ultimate aim of developing a simple and useful model for producing reasonably reliable forecasts of the malaria incidence in the study area.
ABSTRACT
Recombinant human erythropoietin has proved to be effective to treat anemia of end-stage renal disease (ESRD). The aim of this study was to assess the efficacy and safety profile of Epotin, a rHuEPO produced in the Middle East. One hundred thirty patients with Hct = 27%; Hb = 9 g/dL maintained on hemodialysis thrice weekly from 19centers in eight countries in the Middle East were recruited into this 13-week study. Depleted iron stores (TSTAT <20% and/or Serum ferritin < 100 microg/dL) were replenished prior to initiation of Epotin therapy, which was delivered intravenously in a dose of 150 U/kg body weight/week in three equal doses postdialysis and titrated according to hemoglobin (Hb) and hematocrit (Hct) response. Efficacy was assessed in terms of Hb/Hct response. Epotin raised the mean Hb level from 7.7 (+/- 1.2) g/dL to 12.0 (+/- 1.7) g/dL and Hct from 22.7 (+/- 4.1) % to 36.2 (+/- 5.7) % by week 13. The increase started to show significance at week 3. Targeting an absolute increase in Hb of 2.5 g/dL (Hct 7.5%) over a 13-week period, the success rate was of <85.71%. Segregating patients into subgroups of men and women and chronic ESRD versus recent ESRD failed to reveal a significant differences in either the severity of the anemia or the response to Epotin. Side effects were similar to other erythropoietins; no dropouts were reported. In conclusion, Epotin is effective to treat anemia in patients on maintenance hemodialysis with an acceptable safety profile. No difference in response was observed between men and women, nor between patients with different levels of chronicity of ESRD.