Impact of MiraNet® long-lasting insecticidal net against Anopheles arabiensis wild population of Northern Tanzania.

Despite high levels of pyrethroid resistance reported in malaria vectors, long-lasting insecticidal nets (LNs) still play a key role in controlling malaria transmission. This study tested the efficacy of MiraNet®, a pyrethroid-based LN against a wild population of Anopheles arabiensis in northern Tanzania. DuraNet® was used as a positive control in this evaluation. Standard WHO laboratory bioefficacy evaluations of MiraNet and DuraNet that were unwashed or had been washed 20 times indicated optimal knockdown and mortality for both net types against a susceptible strain of Anopheles gambiae s.s. Standard experimental hut evaluations were conducted to evaluate the efficacy of both nets against a wild population of An. arabiensis. The killing effect of MiraNet was 54.5% for unwashed and 50% for 20 times washed while DuraNet achieved 44.4% mortality for unwashed and 47.4% for 20 times washed against wild An. arabiensis. Both DuraNet and MiraNet exhibited significantly higher killing effects (> 44.4%). There was no significant difference in deterrence or induced exophily detected between the treatment arms for either net. Additionally, there were no adverse effects reported among hut sleepers. The results of this study indicate that the pyrethroid net MiraNet can be used effectively against wild populations of An. gambiae s.l. of low to moderate resistant levels from Northern Tanzania.

Bio-efficacy of deltamethrin based durable wall lining against wild populations of Anopheles gambiae s.l. in Northern Tanzania.

BACKGROUND: Indoor residual spraying (IRS) is one of the preferred tools used for control of malaria in many settings in the world. However, this control tool still faces challenges that include lack of long lasting active ingredient, limited number of well-trained personal, and need of repeated treatment which increases operational costs and reduces acceptability by residents. As a result there is need to develop and validate other methods which can complement the existing controls. The current study compared the bio-efficacy of durable wall lining (DL) (treated with deltamethrin 265 mg/m2) and IRS (with deltamethrin 5% WP at 20 mg/m2) on indoor mosquitoes densities and biting behaviour of mosquitoes in comparison with control houses without either DL or IRS. METHODS: A study with two treatment arms and a control was conducted in Magugu ward, Northern Tanzania. Overall, a total of 60 houses were selected for the study with 20 houses per treatment arm and control. From each arm and control five houses were selected for mosquitoes trapping. Mosquitoes were sampled from 18:00 to 07:00 hourly every month for a period of 6 months. Mosquitoes were sampled using CDC miniature light traps. RESULTS: A total of 14,400 female wild mosquitoes were used for contact bioassays in the control arm. 20 houses were sprayed, additionally walls of 20 houses were installed with wall liners, and walls of 20 unsprayed houses were used as control. Also, a total of 946 mosquitoes were sampled with traps in 60 houses during the hourly sampling for 6 months. A total of 3000 unfed females of An. gambiae s.l. wild population raised from larvae were collected from natural habitats in the same village for bioassays. The decline in indoor mosquitoes densities observed in this study did not lead to a shift in the biting cycles (P = 0.712). The number of mosquitoes caught indoors in houses with DL and IRS was significantly lower (P < 0.001) compared to control houses. When the comparisons were done between DL and IRS houses, the densities were significantly lower in DL houses compared to IRS houses (P = 0.021). In the DL installed houses, indoor mosquito density declined notably and sustained throughout the 6 months of the study. However, in those houses sprayed with deltamethrin 5% WP (PALI™5 WP), the density noted to start to increase within four months after spraying(do you mean to say that the densities declined up to 4 months post spraying and thereafter increased. CONCLUSIONS: Considering the efficacy duration of DL against IRS with deltamethrin 5% WP on mosquito densities decline indoors. The results of this study suggest that DL is more effective in malaria control as its efficacy lasted more than that of IRS.

Characterisation of larval habitats, species composition and factors associated with the seasonal abundance of mosquito fauna in Gezira, Sudan.

BACKGROUND: Larval source management (LSM), which requires an understanding of the ecology and composition of the local mosquito fauna, is an important parameter in successful vector control programmes. The present study was conducted to understand the distribution of larval habitats, species composition and factors associated with the seasonal abundance of mosquito larvae in Gezira irrigation Scheme in Gezira state, central Sudan. METHODS: Cross-sectional larval surveys were carried out in the communities of Barakat (urban) and El-Kareiba (semi-urban), in Wad Madani, Gezira. A standard dipper was used for sampling larvae in all possible breeding sites and enamel bowls were employed for larvae sorting. Habitats were characterised using physical features and all larvae specimens were identified morphologically. RESULTS: A total of 331 larval habitats were surveyed, out of which 166 were found to be positive breeding sites for Anopheles (56.78%), Culicinae (29.67%) and Aedes (13.55%) species. A total of 5 525 larvae collected were categorised as Culex (2 617, 47.37%), Anopheles (2 600, 47.06%) and Aedes (308, 5.57%). There was a high number of positive habitats during the rainy season, while the lowest proportion was reported during the hot dry season, in both study sites (Barakat [χ 2 = 10.641, P = 0.0090], El-Kareiba [χ 2 = 23.765, P = 0.0001]). The main breeding site for Anopheles larvae was leaking water pipes (51.5%), followed by irrigation channels (34.2%), hoof prints (6.4%), tyre tracks (5.5%) and water tanks (2.4%). A logistic regression analysis showed that the abundance of Anopheles larvae was reduced by the presence of predators (backswimmers, tadpoles) and grass cover. Adult productivity (number of adult females emerged/m2) was not homogeneousfor all habitats; the highest productivity was found in irrigation channels (0.78 females/m2) for Anopheles, and in septic tanks (2.86 females/m2) for Culicinae and (0.86 females/m2) for Aedes. Anopheles arabiensis was found to be the dominant Anopheles species. This study documented the presence of An. funestus in central Sudan for the first time. CONCLUSIONS: Maintaining leaking water pipes and adopting intermittent irrigation are recommended for LSM, as these surveyed habitats represent the main source of maintaining the local mosquito population during the hot dry season.

Rift Valley fever: current challenges and future prospects.

Rift Valley fever (RVF) is a zoonotic, mosquito-borne viral disease that affects human health and causes significant losses in the livestock industry. Recent outbreaks have led to severe human infections with high mortality rates. There are many challenges to applying effective preventive and control measures, including weak infrastructure of health facilities, lack of capacity and support systems for field logistics and communication, access to global expert organizations, and insufficient information on the epidemiological and reservoir status of the RVF virus. The health systems in East African countries are underdeveloped, with gaps in adaptability to new, more accurate and rapid techniques, and well-trained staff that affect their capacity to monitor and evaluate the disease. Surveillance and response systems are inadequate in providing accurate information in a timely manner for decision making to deal with the scope of interrupting the disease transmission by applying mass animal vaccination, and other preventive measures at the early stage of an outbreak. The historical vaccines are unsuitable for use in newborn and gestating livestock, and the recent ones require a booster and annual revaccination. Future live-attenuated RVF vaccines should possess lower safety concerns regardless of the physiologic state of the animal, and provide rapid and long-term immunity after a single dose of vaccination. In the absence of an effective vaccination program, prevention and control measures must be immediately undertaken after an alert is generated. These measures include enforcing and adapting standard protocols for animal trade and movement, extensive vector control, safe disposal of infected animals, and modification of human-animal contact behavior. Directing control efforts on farmers and workers who deal with, handle, or live close to livestock, and focusing on areas with populations at high risk of an epidemic are desirable. Consideration of prevention methods as a first-line strategy against RVF is practical owing to the absence of a human vaccine, particularly under the current high environmental risks and expanding global travel and animal trade. Universal platforms are needed to support coordinated efforts; alert and response operations; exchange of expertise; and disease detection, diagnosis, control, and prevention.

Recent outbreaks of rift valley Fever in East Africa and the middle East.

Rift Valley fever (RVF) is an important neglected, emerging, mosquito-borne disease with severe negative impact on human and animal health. Mosquitoes in the Aedes genus have been considered as the reservoir, as well as vectors, since their transovarially infected eggs withstand desiccation and larvae hatch when in contact with water. However, different mosquito species serve as epizootic/epidemic vectors of RVF, creating a complex epidemiologic pattern in East Africa. The recent RVF outbreaks in Somalia (2006-2007), Kenya (2006-2007), Tanzania (2007), and Sudan (2007-2008) showed extension to districts, which were not involved before. These outbreaks also demonstrated the changing epidemiology of the disease from being originally associated with livestock, to a seemingly highly virulent form infecting humans and causing considerably high-fatality rates. The amount of rainfall is considered to be the main factor initiating RVF outbreaks. The interaction between rainfall and local environment, i.e., type of soil, livestock, and human determine the space-time clustering of RVF outbreaks. Contact with animals or their products was the most dominant risk factor to transfer the infection to humans. Uncontrolled movement of livestock during an outbreak is responsible for introducing RVF to new areas. For example, the virus that caused the Saudi Arabia outbreak in 2000 was found to be the same strain that caused the 1997-98 outbreaks in East Africa. A strategy that involves active surveillance with effective case management and diagnosis for humans and identifying target areas for animal vaccination, restriction on animal movements outside the affected areas, identifying breeding sites, and targeted intensive mosquito control programs has been shown to succeed in limiting the effect of RVF outbreak and curb the spread of the disease from the onset.

Radiation survey of aircraft and heavy machinery scrap.

This study was conducted primarily to survey aircraft and heavy machinery at 30 locations within Khartoum State using handheld radiation survey meters to detect and identify any radiation sources that might be present and to estimate radiation dose levels. The survey has resulted in detection of 16 sealed sources of (90)Sr and one of (226)Ra in aircraft scrap. Of course, (90)Sr sources are used in military aircraft as temperature sensors while (226)Ra is used for indicating fuel levels. These sources were found intact without spreading radioactivity contamination; however, none was detected in heavy machine scrap. The levels of radiation dose measured at 0.1m from the source fall within the range of 25.1-40.2 µSv/h with an average value of 33.52 ± 4.06 µSv/h. These orphan sources have been separated from the scrap, tested for possible leakage, conditioned and stored in waste management facility. The result of this study has revealed without doubt that the scrap constitute a serious source of public exposure and highlights the importance of legislation making radiation monitoring of scrap in the country mandatory before it is sold to metal industry for reprocessing.

Malaria in East African highlands during the past 30 years: impact of environmental changes.

East African highlands are one of the most populated regions in Africa. The population densities in the highlands ranged between 158 persons/km(2) in Ethiopia and 410 persons/km(2) in Rwanda. According to the United Nations Population Fund, the region has the world's highest population growth rate. These factors are likely behind the high rates of poverty among the populations. As there were no employment opportunities other than agricultural, this demographic pressure of poor populations have included in an extensive unprecedented land use and land cover changes such as modification of bushland, woodland, and grassland on hillsides to farmland and transformation of papyrus swamps in valley bottoms to dairy pastures and cropland and changing of fallows on hillsides from short or seasonal to longer or perennial. Areas harvested for food crops were therefore increased by more than 100% in most of the highlands. The lost of forest areas, mainly due to subsistence agriculture, between 1990 and 2010 ranged between 8000 ha in Rwanda and 2,838,000 ha in Ethiopia. These unmitigated environmental changes in the highlands led to rise temperature and optimizing the spread and survival of malaria vectors and development of malaria parasites. Malaria in highlands was initially governed by low ambient temperature, trend of malaria transmission was therefore increased and several epidemics were observed in late 1980s and early 2000s. Although, malaria is decreasing through intensified interventions since mid 2000s onwards, these environmental changes might expose population in the highlands of east Africa to an increase risk of malaria and its epidemic particularly if the current interventions are not sustained.

Durability associated efficacy of long-lasting insecticidal nets after five years of household use.

BACKGROUND: Long-lasting insecticidal nets (LLINs) have been strongly advocated for use to prevent malaria in sub-Saharan Africa and have significantly reduced human-vector contact. PermaNet® 2.0 is among the five LLINs brands which have been given full approval by the WHO Pesticide Evaluation Scheme (WHOPES). The LLINs are expected to protect the malaria endemic communities, but a number of factors within the community can affect their durability and efficacy. This study evaluated the durability, efficacy and retention of PermaNet® 2.0 after five years of use in a Tanzanian community. METHOD: Two to three day- old non blood-fed female mosquitoes from an insectary susceptible colony (An. gambiae s.s, this colony was established at TPRI from Kisumu, Kenya in 1992) and wild mosquito populations (An. arabiensis and Culex quinquefasciatus) were used in cone bioassay tests to assess the efficacy of mosquito nets. FINDINGS: The knockdown effect was recorded after three minutes of exposure, and mortality was recorded after 24 hours post-exposure. Mortality of An. gambiae s.s from insectary colony was 100% while An. arabiensis and Cx.quinquefasciatus wild populations had reduced mortality. Insecticide content of the new (the bed net of the same brand but never used before) and used PermaNet® 2.0 was determined using High Performance Liquid Chromatography (HPLC). CONCLUSION: The results of this study suggest that, in order to achieve maximum protection against malaria, public health education focusing on bed net use and maintenance should be incorporated into the mass distribution of nets in communities.

Extensive permethrin and DDT resistance in Anopheles arabiensis from eastern and central Sudan.

BACKGROUND: The distribution of insecticide treated nets (ITN) has been dramatically scaled up in eastern and central Sudan. Resistance to insecticides has already been reported in this region and there is an urgent need to develop appropriate resistance management strategies, which requires detailed information on the extent and causes of resistance. This study assessed resistance to permethrin and DDT in seven populations of Anopheles arabiensis from Sudan. RESULTS: Three out of the seven populations were defined as resistant to permethrin and five of six populations resistant to DDT according to WHO criteria. The 1014F kdr allele was present in all six populations tested and the presence of this allele was significantly correlated with resistance to permethrin (P = 0.0460). While homozygous 1014F individuals were statistically not more likely to survive (53.7%) permethrin than to be killed (38.6%) by the diagnostic dose, there was no difference in the likelihood of permethrin survival in heterozygotes (P = 0.7973). The susceptible genotypes were more likely to be killed by permethrin exposure than to survive (P = 0.0460). The 1014F allele failed to confer a survival advantage to the WHO diagnostic dose of DDT in either the homozygous or heterozygous state. The 1014S allele was not detected in any of the populations tested. CONCLUSION: The kdr allele is certainly contributing to the extensive resistance to permethrin and DDT in Sudan but the high number of DDT (43%) and permethrin (16.7%) survivors that did not contain either kdr alleles suggests that other resistance mechanisms are also present in these populations. The high frequency of permethrin resistance throughout central and eastern Sudan is a cause of great concern for malaria control activities.

Changing patterns of malaria epidemiology between 2002 and 2010 in Western Kenya: the fall and rise of malaria.

BACKGROUND: The impact of insecticide treated nets (ITNs) on reducing malaria incidence is shown mainly through data collection from health facilities. Routine evaluation of long-term epidemiological and entomological dynamics is currently unavailable. In Kenya, new policies supporting the provision of free ITNs were implemented nationwide in June 2006. To evaluate the impacts of ITNs on malaria transmission, we conducted monthly surveys in three sentinel sites with different transmission intensities in western Kenya from 2002 to 2010. METHODS AND FINDINGS: Longitudinal samplings of malaria parasite prevalence in asymptomatic school children and vector abundance in randomly selected houses were undertaken monthly from February 2002. ITN ownership and usage surveys were conducted annually from 2004 to 2010. Asymptomatic malaria parasite prevalence and vector abundances gradually decreased in all three sites from 2002 to 2006, and parasite prevalence reached its lowest level from late 2006 to early 2007. The abundance of the major malaria vectors, Anopheles funestus and An. gambiae, increased about 5-10 folds in all study sites after 2007. However, the resurgence of vectors was highly variable between sites and species. By 2010, asymptomatic parasite prevalence in Kombewa had resurged to levels recorded in 2004/2005, but the resurgence was smaller in magnitude in the other sites. Household ITN ownership was at 50-70% in 2009, but the functional and effective bed net coverage in the population was estimated at 40.3%, 49.4% and 28.2% in 2010 in Iguhu, Kombewa, and Marani, respectively. CONCLUSION: The resurgence in parasite prevalence and malaria vectors has been observed in two out of three sentinel sites in western Kenya despite a high ownership of ITNs. The likely factors contributing to malaria resurgence include reduced efficacy of ITNs, insecticide resistance in mosquitoes and lack of proper use of ITNs. These factors should be targeted to avoid further resurgence of malaria transmission.

Pattern of malaria transmission along the Rahad River basin, Eastern Sudan.

BACKGROUND: Understanding malaria vector mosquitoes and their infectivity dynamics is of importance in setting up intervention and control programmes. Patterns of malaria transmission have been shown to differ between non-irrigated and irrigated semi-arid areas of eastern Sudan. However, very little information is available regarding malaria transmission dynamics along the seasonal river's basin. Such information is required for the design of effective vector control strategies. METHODS: A longitudinal study for mosquito sampling using pyrethrum spray catch (PSC) was conducted in two villages (Koka & Um Salala) along the Rahad River basin from December 2005 to October 2006. The Plasmodium falciparum circumsporozoite (CSP) and human blood index (HBI) were detected by ELISA. Three seasons were considered and the surveys represented cool dry, hot dry and rainy seasons were November - February, March - June, July - October, respectively. The CSP was compared between the seasons and populations using Chi-square test. The differences between the seasons and the populations in the other entomological indices, including Entomological Inoculation Rates (EIR), were measured using Tukey-Kramer HSD and Student T-test, respectively. The association between An. arabiensis density and monthly total rainfall was examined using regression analysis. RESULTS: A total of 1,402 adult female anopheline mosquitoes were sampled, of which 98% were An. gambiae complex; the rest were An. rufipes. All specimens of An. gambiae complex identified by the PCR were An. arabiensis. Bimodal annual peaks of An. arabiensis densities were observed following the peak of rainfall and recess of the Rahad River after a time- lag of two months (Koka r = 0.79, d.f. = 1, P = 0.05; Um Salala, r = 0.88, d.f. = 1, P = 0.02). The CSP differed significantly among the seasons only in Koka (P = 0.0009) where the mean was nine times higher than in Um Salala (P = 0.0014). Active transmission was observed in Koka during the hot, dry season (CSP = 6.25%) and the EIR was observed to be 0.01 ib/p/n during this time. The EIR peaked to 0.71 ib/p/n during the rainy season and decreased to 0.18 ib/p/n during the minor peak of the cool dry season (P = 0.54). The combined annual average of the EIR for both populations was 55.48 ib/p/y and, typically, it would take approximately 192.7 days for an individual to receive an infective bite from An. arabiensis. CONCLUSION: The bimodal annual peaks and the active transmission observed during the hot dry season suggested low to moderate perennial malaria transmission pattern. Infectivity and transmission rates increased with proximity to the river following the peak of rainfall and the subsequent recession in the flow of the Rahad River. Current vector interventions can be integrated with larval control and should be formatted in accordance with targeted according to the time and space.

Habitat stability and occurrences of malaria vector larvae in western Kenya highlands.

BACKGROUND: Although the occurrence of malaria vector larvae in the valleys of western Kenya highlands is well documented, knowledge of larval habitats in the uphill sites is lacking. Given that most inhabitants of the highlands actually dwell in the uphill regions, it is important to develop understanding of mosquito breeding habitat stability in these sites in order to determine their potential for larval control. METHODS: A total of 128 potential larval habitats were identified in hilltops and along the seasonal streams in the Sigalagala area of Kakamega district, western Kenya. Water availability in the habitats was followed up daily from August 3, 2006 to February 23, 2007. A habitat is defined as stable when it remains aquatic continuously for at least 12 d. Mosquito larvae were observed weekly. Frequencies of aquatic, stable and larvae positive habitats were compared between the hilltop and seasonal stream area using chi2-test. Factors affecting the presence/absence of Anopheles gambiae larvae in the highlands were determined using multiple logistic regression analysis. RESULTS: Topography significantly affected habitat availability and stability. The occurrence of aquatic habitats in the hilltop was more sporadic than in the stream area. The percentage of habitat occurrences that were classified as stable during the rainy season is 48.76% and 80.79% respectively for the hilltop and stream area. Corresponding frequencies of larvae positive habitats were 0% in the hilltop and 5.91% in the stream area. After the rainy season, only 23.42% of habitat occurrences were stable and 0.01% larvae positive habitats were found in the hilltops, whereas 89.75% of occurrences remained stable in the stream area resulting in a frequency of 12.21% larvae positive habitats. The logistic regression analysis confirmed the association between habitat stability and larval occurrence and indicated that habitat surface area was negatively affecting the occurrence of An. gambiae larvae. While An. gambiae and An. funestus larvae occurred throughout the study period along the streams, a total of only 15 An. gambiae larvae were counted in the hilltops, and no An. funestus were found. Moreover, no larvae managed to develop into adults in the hilltops, and the density of adult An. gambiae was consistently low, averaging at 0.06 females per house per survey. CONCLUSION: The occurrence of malaria vector larvae in the hilltop area was uncommon as a result of the low availability and high instability of habitats. To optimize the cost-effectiveness of malaria interventions in the western Kenya highlands, larval control should be focused primarily along the streams, as these are likely the only productive habitats at high altitude.

Investigation of natural radioactivity levels in water around Kadugli, Sudan.

Surface water from Miri Lake and groundwater from around Kadugli (West-Central Sudan) obtained by means of hand-pumps was analysed for (238)U, (226)Ra, (222)Rn, and (232)Th activity concentrations. The surface water showed very low levels of radionuclide concentrations: <1.0-7.5, 8.5-16.5, <1.6, and <0.1-0.39 mBq L(-1) for (238)U, (226)Ra, (222)Rn, and (232)Th, respectively. Groundwater revealed a significant amount of natural radioactivity (16.1-1720, 7.7-14.3, 3000-139,000, <0.1-39 mBq L(-1)) respectively. The overall annual effective dose was below the WHO reference dose level of 0.1 mSv yr(-1) except in one groundwater sample with an associated dose of 0.7 mSv yr(-1).

Use of the Internet by Sudanese doctors and medical students.

Patterns of use of the Internet were investigated by a questionnaire survey of 102 hospital doctors and 123 medical students in Khartoum, Sudan, in January 2005. More doctors (84.3%) had used the Internet than had students (78.9%). Half of consultants (55.0%) used the Internet daily, compared with only 18.2% of junior doctors. Many consultants and junior doctors rated their abilities as poor (60.0% and53.1%). One-third of students (33.3%) used the Internet only for personal and not for academic purposes. Barriers to greater use of the Internet by doctors included: time constraints (80.2%), poor skills (54.6%), no access to full texts of journal articles (53.4%), difficulty in verifying the quality of information (47.6%) and high costs (41.8%). Students faced similar barriers but also listed poor knowledge of the English language.

Use of the Internet by Sudanese doctors and medical students

Patterns of use of the Internet were investigated by a questionnaire survey of 102 hospital doctors and 123 medical students in Khartoum, Sudan, in January 2005. More doctors [84.3%] had used the Internet than had students [78.9%]. Half of consultants [55.0%] used the Internet daily, compared with only 18.2% of junior doctors. Many consultants and junior doctors rated their abilities as poor [60.0% and 53.1%]. One-third of students [33.3%] used the Internet only for personal and not for academic purposes. Barriers to greater use of the Internet by doctors included: time constraints [80.2%], poor skills [54.6%], no access to full texts of journal articles [53.4%], difficulty in verifying the quality of information [47.6%] and high costs [41.8%]. Students faced similar barriers but also listed poor knowledge of the English language

Short report: permethrin and DDT resistance in the malaria vector Anopheles arabiensis from eastern Sudan.

Assessment of resistance to DDT and permethrin insecticides and molecular detection of knockdown resistance (kdr) alleles were conducted in three populations of Anopheles arabiensis from eastern Sudan. Bioassay mortalities ranged from 96.9% to 99.6% for 4% DDT and from 98.4% to 100% for 1% permethrin. The L1014F and L1014S alleles were detected in 25 of 498 mosquitoes. The overall kdr frequencies ranged from 7.0% in the area where insecticide-treated nets were used to 3.0% in the area with agricultural insecticide use. The presence of the kdr alleles in An. arabiensis in Sudan emphasizes the need to develop appropriate resistance monitoring and management strategies for An. arabiensis.

Deficiencies in medical prescriptions in a Sudanese hospital.

We determined the quality of medical prescription in Ribat University Hospital, Khartoum through detecting errors in doctors' prescriptions. We randomly selected 1000 medical prescriptions and checked them for completeness and legibility. The total number of doctors responsible for writing the prescriptions was 46. The patient's full name was written on only 18.8% of prescriptions and that of the doctor on only 6.7%. In only 19.5% of prescriptions were drugs prescribed by their generic names, 59.7% lacked the quantity of the drug, 25.7% lacked the duration of treatment and 15.8% were difficult to read. The quality of drug prescriptions written by our hospital doctors is seriously deficient.

Deficiencies in medical prescriptions in a Sudanese hospital

We determined the quality of medical prescription in Ribat University Hospital, Khartoum through detecting errors in doctors' prescriptions. We randomly selected 1000 medical prescriptions and checked them for completeness and legibility. The total number of doctors responsible for writing the prescriptions was 46. The patient's full name was written on only 18.8% of prescriptions and that of the doctor on only 6.7%. In only 19.5% of prescriptions were drugs prescribed by their generic names, 59.7% lacked the quantity of the drug, 25.7% lacked the duration of treatment and 15.8% were difficult to read. The quality of drug prescriptions written by our hospital doctors is seriously deficient