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Adam M, Nahzat S, Kakar Q, Assada M, Witkowski B, Tag Eldin Elshafie A, Abuobaida D, Safi N, Khan MA, Nagi M, Mustafa SA, Kohestani K, Muhammad J, Khim N, Al-Hadi M, Elfaki TM, Habib MN, Khairy AKA, Hamid H, Uddin Z, Amer Y, Hassan AH, Elhag MS, Sediqi AW, Kakar I, Abdul-Ghani R, Amran JGH, Abdallrahim TA, Tamim MS, Aljasari A, Rasmussen C, Azkoul L, Warsame M. Antimalarial drug efficacy and resistance in malaria-endemic countries in HANMAT-PIAM_net countries of the Eastern Mediterranean Region 2016-2020: Clinical and genetic studies. Trop Med Int Health 2023; 28:817-829. [PMID: 37705047 DOI: 10.1111/tmi.13929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
INTRODUCTION The World Health Organization recommends regular monitoring of the efficacy of nationally recommended antimalarial drugs. We present the results of studies on the efficacy of recommended antimalarials and molecular markers of artemisinin and partner resistance in Afghanistan, Pakistan, Somalia, Sudan and Yemen. METHODS Single-arm prospective studies were conducted to evaluate the efficacy of artesunate-sulfadoxine-pyrimethamine (ASSP) in Afghanistan and Pakistan, artemether-lumefantrine (AL) in all countries, or dihydroartemisinin-piperaquine (DP) in Sudan for the treatment of Plasmodium falciparum. The efficacy of chloroquine (CQ) and AL for the treatment of Plasmodium vivax was evaluated in Afghanistan and Somalia, respectively. Patients were treated and monitored for 28 (CQ, ASSP and AL) or 42 (DP) days. Polymerase chain reaction (PCR)-corrected cure rate and parasite positivity rate at Day 3 were estimated. Mutations in the P. falciparum kelch 13 (Pfk13) gene and amplifications of plasmepsin (Pfpm2) and multidrug resistance-1 (Pfmdr-1) genes were also studied. RESULTS A total of 1680 (249 for ASSP, 1079 for AL and 352 for DP) falciparum cases were successfully assessed. A PCR-adjusted ASSP cure rate of 100% was observed in Afghanistan and Pakistan. For AL, the cure rate was 100% in all but four sites in Sudan, where cure rates ranged from 92.1% to 98.8%. All but one patient were parasite-free at Day 3. For P. vivax, cure rates were 98.2% for CQ and 100% for AL. None of the samples from Afghanistan, Pakistan and Yemen had a Pfk13 mutation known to be associated with artemisinin resistance. In Sudan, the validated Pfk13 R622I mutation accounted for 53.8% (14/26) of the detected non-synonymous Pfk13 mutations, most of which were repeatedly detected in Gadaref. A prevalence of 2.7% and 9.3% of Pfmdr1 amplification was observed in Pakistan and Yemen, respectively. CONCLUSION High efficacy of ASSP, AL and DP in the treatment of uncomplicated falciparum infection and of CQ and AL in the treatment of P. vivax was observed in the respective countries. The repeated detection of a relatively high rate of Pfk13 R622I mutation in Sudan underscores the need for close monitoring of the efficacy of recommended ACTs, parasite clearance rates and Pfk13 mutations in Sudan and beyond. Registration numbers of the trials: ACTRN12622000944730 and ACTRN12622000873729 for Afghanistan, ACTRN12620000426987 and ACTRN12617001025325 for Pakistan, ACTRN12618001224213 for Somalia, ACTRN12617000276358, ACTRN12622000930785 and ACTRN12618001800213 for Sudan and ACTRN12617000283370 for Yemen.
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Affiliation(s)
| | - Sami Nahzat
- National Malaria and Leishmania Control Programme, Ministry of Public Health, Kabul, Afghanistan
| | | | - Methaq Assada
- National Malaria Control Programme, Ministry of Health, Sana'a, Yemen
| | - Benoit Witkowski
- Malaria Research Unit, Pasteur Institute of Cambodia, Phnom Penh, Cambodia
| | | | - Duha Abuobaida
- Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | | | - Munir Ahmed Khan
- Provincial Malaria and VBDs Control Programme, Quetta, Balochistan, Pakistan
| | - Mustafa Nagi
- National Malaria Control Programme, Ministry of Health, Sana'a, Yemen
| | - Sayed Ali Mustafa
- Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Khalilahmad Kohestani
- National Malaria and Leishmania Control Programme, Ministry of Public Health, Kabul, Afghanistan
| | - Jamil Muhammad
- Provincial Malaria and VBDs Control Programme, Khyber Pakhtunkhwa, Pakistan
| | - Nimol Khim
- Malaria Research Unit, Pasteur Institute of Cambodia, Phnom Penh, Cambodia
| | - Mohammed Al-Hadi
- National Malaria Control Programme, Ministry of Health, Sana'a, Yemen
| | - Tarig Mohamed Elfaki
- Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Muhammad Naeem Habib
- Malaria & Other Vector Borne Disease Program, Ministry of Public Health, Kabul, Afghanistan
| | | | - Hamida Hamid
- Malaria & Other Vector Borne Disease Program, Ministry of Public Health, Kabul, Afghanistan
| | - Zain Uddin
- District Headquarter Hospital, Zhob, Pakistan
| | - Yahya Amer
- Almarawiah Hospital Ministry of Health, Al Mahrah, Yemen
| | | | - Mousab Siddig Elhag
- Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Ahmad Walid Sediqi
- Global Fund Programme, United Nations Development Programme, Kabul, Afghanistan
| | - Inamullah Kakar
- Directorate of Malaria Control, Common Management Unit Global Fund grant for Malaria Control, Ministry of National Health Services Regulations and Coordination, Islamabad, Pakistan
| | - Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | | | | | - Mohammad Shoaib Tamim
- Malaria & Other Vector Borne Disease Program, Ministry of Public Health, Kabul, Afghanistan
| | | | | | | | - Marian Warsame
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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Kabbashi M, Khairy A, Mohamed A, Abuobaida D, Malik E. The proportion and determinants of COVID-19 infection among medical doctors in Sudan, 2020: A cross-sectional survey. PLoS One 2022; 17:e0268037. [PMID: 36331915 PMCID: PMC9635736 DOI: 10.1371/journal.pone.0268037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 04/21/2022] [Indexed: 11/06/2022] Open
Abstract
Globally, frontline health care providers are among the most affected population group by the COVID-19 pandemic. Knowing the factors contributing to the transmission of COVID-19 infection among frontline health care providers is essential for implementing tailored control measures and protecting this vital population group. This study aimed to estimate the proportion and to identify factors associated with COVID-19 infection among medical doctors in Sudan. A web-based survey was used to collect data from medical doctors who were working in Sudan during the study period. Data were analyzed using SPSS® version 25; Descriptive analysis in terms of means (SD) for continuous variables, frequencies, and percentages with 95% CI for the categorical variable was conducted. Chi-square test and binary logistic regression for associations between the outcome variables (risk of exposure to COVID-19 infection and ever tested positive for COVID-19 infection) and independent variables (socio-demographic and infection control standards) were also performed. Out of 352 valid responses, 13.6% had tested positive for COVID-19 infection at least once during the pandemic. More than one-third have identified colleagues as the main sources of infection compared to 21% of patients (p-value < 0.04). Doctors who received training on COVID-19 were 60% less likely to have positive tests for COVID-19 (p-value <0.03), while lack of PPE and hand hygiene utilities had no statistically significant associations with testing positive for COVID-19 infection. In conclusion, a significant proportion of doctors have contracted COVID-19 infection from their colleagues. This calls for restricting infection control practices at hospitals, doctor’s doormats, and any other shared places that allow day-to-day interaction between doctors and their colleagues. Also, urgent need for training doctors on COVID-19 infection control practices as it has been identified as the key protective factor.
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Affiliation(s)
- Maan Kabbashi
- Head of Quality Department, Central Ambulance Administration, General Directorate of Curative Medicine, Khartoum State Ministry of Health, Khartoum, Sudan
- * E-mail:
| | - Amna Khairy
- Expanded Program of Immunization, Maternal and Child Health Directorate, Directorate General of Primary Health Care, Federal Ministry of Health, Khartoum, Sudan
| | - Amal Mohamed
- Head of Maternal Deaths Surveillance and Response Unit, National Reproductive Health Program, Mother and Child Health Directorate, General Directorate of Primary Health Care, Federal Ministry of Health, Khartoum, Sudan
| | - Duha Abuobaida
- Malaria and NTDs Unit, Case Management Department, Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Elfatih Malik
- Faculty of Medicine Community Medicine Department, University of Khartoum, Khartoum, Sudan
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Lohiniva AL, Elwali E, Abuobaida D, Abdulrahim A, Bukuluki P, Talaat M. A theory-based exploration of antibiotic use in primary healthcare in Gezira state, Sudan. Implement Sci Commun 2021; 2:132. [PMID: 34863311 PMCID: PMC8642910 DOI: 10.1186/s43058-021-00229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/15/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Inappropriate use of antibiotics is a major contributing factor to the emergence of antimicrobial resistance globally, including in Sudan. OBJECTIVES The project aimed to develop a theory-driven behaviour change strategy addressing both prescribers and patients based on factors that are driving antibiotic use in primary healthcare settings in Gezira state in Sudan. METHODS The strategy was designed based on the Theoretical Domains Framework (TDF) to identify behavioural domains and the Behaviour Change Wheel (BCW) to select appropriate intervention functions. The process included (1) a formative qualitative research study and (2) a knowledge co-production workshop that utilized the results of the qualitative study to design a salient, appropriate, and credible behaviour change strategy. RESULTS The TDF domains related to prescribers that emerged from the study included knowledge, skills, and intention. The selected BCW intervention functions included education, training, modelling, and persuasion. The main TDF domains related to patients included social influences and intention. The selected BCW intervention functions included enablement and education. CONCLUSION Using the TDF and BCW intervention functions, the study identified behavioural domains that influence antibiotic prescription and consumption in rural primary healthcare settings in Gezira state in Sudan and appropriate intervention functions to modify these behaviours. Knowledge co-production ensured that the evidence-based strategy was acceptable and practical in the local context.
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Affiliation(s)
| | | | | | | | | | - Maha Talaat
- WHO Eastern Mediterranean Regional Office, Cairo, Egypt
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