Health workers' adherence to malaria case management protocols in Northern Sudan: a qualitative study.

BACKGROUND: Nonadherence to national standards for malaria diagnosis and treatment has been reported in Sudan. In this study, qualitative research examined the clinical domains of nonadherence, factors influencing nonadherent practices and health workers' views on how to improve adherence. METHODS: In September 2023, five Focus Group Discussions (FGDs) were undertaken with 104 health workers from 42 health facilities in Sudan's Northern State. The participants included medical assistants, doctors, nurses, laboratory personnel, pharmacists and public health officers. The FGDs followed a semi-structured guide reflecting the national malaria case management protocol. Qualitative thematic analysis was performed. RESULTS: Nonadherent practices included disregarding parasitological test results, suboptimal paediatric artemether-lumefantrine (AL) dosing, lack of counselling, use of prohibited artemether injections for uncomplicated and severe malaria, artesunate dose approximations and suboptimal preparations, lack of AL follow on treatment for severe malaria; and rare use of primaquine for radical Plasmodium vivax treatment and dihydroartemisinin-piperaquine as the second-line treatment for uncomplicated malaria. Factors influencing nonadherence included stock-outs of anti-malarials and RDTs; staff shortages; lack of training, job aids and supervision; malpractice by specialists; distrust of malaria microscopy and RDTs; and patient pressure for diagnosis and treatment. Health workers recommended strengthening the supply chain; hiring personnel; providing in-service protocol training including specialists; establishing external quality assurance for malaria diagnosis; and providing onsite supportive supervision and public health campaigns. CONCLUSIONS: This study revealed a broad spectrum of behavioural and systemic challenges in malaria management among frontline health workers in Northern Sudan, including nonadherence to protocols due to resource shortages, training gaps, a lack of supportive supervision and patient pressure. These insights, including health workers' views about improvements, will inform evidence-based interventions by Sudan's National Malaria Control Programme to improve health systems readiness and the quality of malaria case management.

Diabetic ketoacidosis: knowledge and practice among patients with diabetes attending three specialized diabetes clinics in Khartoum, Sudan.

Introduction: diabetic Ketoacidosis is the leading cause of mortality in children and adolescents with T1DM and accounts for about 50% of all deaths in patients younger than 24 years with diabetes. It affects 8 out of 1000 people with diabetes annually, with a worldwide mortality rate of 2-10%. The purpose of this study is to assess the knowledge and practice towards DKA among patients with diabetes attending three diabetes clinics in Khartoum. Methods: we conducted a cross-sectional institution-based study. It included all patients with diabetes attending three diabetes clinics in Khartoum state over the period July - September 2016. A self-administered questionnaire was used to assess and score knowledge and practice towards DKA among patients with diabetes. Data were analyzed using SPSS 23.0. Results: one hundred and ten patients participated in the study, of whom 86 had heard of DKA and were questioned further. Fifty-six point nine percent of participants had poor knowledge (0-8 out of 24) and low practice scores (0-2 out of 6). There was a strong association between knowledge scores and attended clinics. Conclusion: there was an evident lack of knowledge and poor practice towards DKA among patients with diabetes attending diabetes clinics in Khartoum, Sudan.

Impact of type 1 diabetes mellitus on the academic performance of diabetic school children in Khartoum, Sudan.

Type 1 diabetes mellitus (T1DM) is the most common endocrine disorder in children. The glycated haemoglobin (HbA1C) level was found to be correlated with the academic skills and classroom attention in children with T1DM. This study aimed to assess the impact of T1DM status and control on the academic performance of school children. A cross-sectional survey was conducted among diabetic children attending two secondary care hospitals in Khartoum, Sudan. We applied the total coverage sampling method to include all T1DM patients who presented in the period from July to October 2016. A total of 122 T1DM children aged 6-18 years, who were registered as formal school students were included. Most of the participants (63.1%) had HbA1C levels more than 9.5% and near half of them (47.5%) had chronic T1DM-related complications. Academic performance was negatively correlated with higher HbA1C levels (rs = -0.192, p > 0.001) and longer duration of the illness (rs = -.362, p = 0.034). However, academic scores did not differ significantly between diabetic children with chronic complications and those without chronic complications (χ 2 = 8.01, p = 0.091). This study showed that T1DM influenced the academic performance of school children.

Immunisation of children under 5 years: mothers' knowledge, attitude and practice in Alseir locality, Northern State, Sudan.

Mothers are the major role players with regard to their children's immunisation. The aim of this study is to assess the knowledge, attitude and practice of mothers of children below 5 years of age with regard to immunisation in Northern State, Sudan. This was a cross-sectional survey which was conducted in three villages in 2016. All mothers having at least one child below the age of 5 years were included. Data were collected by interviews using a self-structured questionnaire. Descriptive statistics were displayed and chi-square test was used to assess associations. A total of 127 mothers of 191 children were included. The mean knowledge score about the names of vaccines/diseases prevented was 3.47 out of 10. The most correctly named vaccines by the mothers were measles (87.4%) and polio (86.6%), whereas the least ones were hepatitis (7.1%) and diphtheria (8.7%). The majority (99.2%) of the mothers had a positive attitude. The mean knowledge score about the timing of doses was 4.12 out of 5. The most correctly timed dose by the mothers was the dose at 6 weeks 'dose 1' (96.1%) and the least one was the dose at birth 'dose 0' (60.6%). About half (48.7%) of the children were completely immunised, 46% were only missing their 'dose 0', mostly because of closed vaccination units on the day of birth (73.6%), and 5.3% were incompletely immunised. Hospital delivery, availability of vaccination card and good socioeconomic status were associated with complete immunisation status, with p-values equal to 0.00, 0.00 and 0.03, respectively. Educating mothers about immunisation, increasing the days of immunisation and providing outreach services for home-delivered newborns are important interventions to increase the immunisation coverage.

Incidence and prevalence of type 1 diabetes mellitus in children and adolescents aged 6 months-19 years in Khartoum State, Sudan.

The aim of this study is to measure the incidence and prevalence of type 1 diabetes mellitus in children and adolescents in Khartoum State, Sudan. Records of all patients aged 6 months-19 years, living in Khartoum State and who were known to have or newly diagnosed with type 1 diabetes in all health institutes (both governmental and private) during the period January to December 2015, were reviewed. In addition to the records, interviews with patients and caregivers attending the clinics were conducted. Names were double-checked with the Sudanese Childhood Diabetes Association's central registry. Data were analysed using the Statistical Package for the Social Sciences software (SPSS 20). A total of 2,393 children were identified. Males were 1,117 (46.6%) and females were 1,276 (53.3%) with a ratio of 1:1.4, with no significant difference. The prevalence rate was 0.74/1,000. The overall incidence rate was 10.1/100,000. The peak incidence age was between 11 and 15 years (15.9/100,000). The incidence rates in below 5 years and 16-19 years were 8.4 and 7.7/100,000, respectively. There was no significant difference between males and females. In most of the cases, the onset was in the winter months. The commonest month of birth was June.The incidence of type 1 diabetes in Sudan is still considered among the high rate group in the world and in the region. There was an obvious increase in the incidence among the below-5 years age group (8.4/100,000) compared to a figure of 3.5 which was reported earlier from Sudan. For the first time, we report the incidence among the 16-19 age group (7.7/100,000).