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Izzoddeen A, Abosror S, Magbol M, Khalil A, Abasher M, Albadri O, Osman HA, Esmail Mohamed E, Abdalla Mohamed A, Gamal Elgurashi S, Osman MM, Amin T, Mohamed E, Magboul B, Siedahmed A, Malik EM. COVID-19 surveillance report for Sudan, 2020 to 2021. Heliyon 2024; 10:e27965. [PMID: 38560161 PMCID: PMC10981027 DOI: 10.1016/j.heliyon.2024.e27965] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/24/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
Background Following the World Health Organization declaration, COVID-19 was first appearance in Sudan was in March 2020. Cases were reported to the Sudan Federal Ministry of Heath through the surveillance system from different sources. This study used surveillance data from 2020 to 2021 to describe the epidemiologic patterns of COVID-19 occurrence in Sudan and provide insight for better preparedness and response. Methods Through a retrospective descriptive study, COVID19 cases records obtained from the national surveillance line-list in Surveillance and Information Directorate in Federal Ministry of Health. The analysis of data was done with SPSS version 21. Descriptive analysis done by frequencies and percentages, and further analysis through performing multivariate logistic regression. Results Out of 48,545 suspected cases tested for COVID-19 using RT-PCR, 27,453 (56.5%) tested positive with case fatality ratio of 6.5%. Higher death rate among elderly (78% > 60-year-old) and males (70.1%). From the reported cases, 53.8% showed no symptoms, while the common symptoms among symptomatic patients were; fever (26.4%), cough (19.1%), shortness of breath (16.8%) with small proportion (4.5%) reported loss of smell and taste. Specific states, Khartoum, Gezira and Red Sea showed highest prevalence. The disease peaked four times during 2020-2021, with a proposed alert threshold of 200-250 cases per week acting as an explosion point nationwide. Conclusions The high case fatality rate in the country requires further analysis, as well as the high proportion of asymptomatic infection. This will be ensured by improving the quality and completeness of surveillance data. A proposed threshold of 200-250 cases per week should be an alert to augment the measures of controlling the pandemic over the country, including providing enough supplies to decrease mortality.
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Affiliation(s)
| | | | - Mustafa Magbol
- Alzaiem Alazhari University, Faculty of Medicine, Khartoum, Sudan
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Marzoug OA, Anees A, Malik EM. Assessment of risk factors associated with surgical site infection following abdominal surgery: a systematic review. BMJ Surg Interv Health Technol 2023; 5:e000182. [PMID: 37529828 PMCID: PMC10387634 DOI: 10.1136/bmjsit-2023-000182] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/20/2023] [Indexed: 08/03/2023] Open
Abstract
Objective Surgical site infections (SSIs) are among the most common healthcare-associated infections occurring following 1%-3% of all surgical procedures. Their rates are the highest following abdominal surgery. They are still associated with increased morbidity and healthcare costs despite the advancement in the medical field. Many risk factors for SSIs following abdominal surgery have been identified. The aim of this study is to comprehensively assess these risk factors as published in peer-reviewed journals. Design A systematic review was conducted with accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Setting The databases for search were PubMed and Cochrane Library, in addition to reference lists. Studies were retrieved and assessed for their quality. Data were extracted in a designed form, and a stratified synthesis of data was conducted to report the significant risk factors. Participants Patients undergoing general abdominal surgery. Intervention The intervention of general abdominal surgery. Main outcome measures To identify and assess the risk factors for SSI following abdominal surgery. Results Literature search yielded 813 articles, and the final screening process identified 11 eligible studies. The total number of patients is 11 996. The rates of SSI ranged from 4.09% to 26.7%. Nine studies were assessed to be of high quality, the remaining two studies have moderate quality. Stratified synthesis of data was performed for risk factors using summary measures (OR/risk ratio, 95% CI, and p value). Male sex and increased body mass index (BMI) were identified as significant demographic risk factors, and long operative time was among the major significant procedure-related risk factors. Conclusions Male sex, increased BMI, diabetes, smoking, American Society of Anesthesiologists classification of >2, low albumin level, low haemoglobin level, preoperative hospital stay, long operative time, emergency procedure, open surgical approach, increased wound class, intraoperative blood loss, perioperative infection, perioperative blood transfusion, and use of drains are potential independent risk factors for SSI following abdominal surgery.
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Affiliation(s)
- Omer A Marzoug
- Department of Anatomy, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Ahmed Anees
- Department of Anatomy, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Elfatih M Malik
- Department of Community Medicine, University of Khartoum, Khartoum, Sudan
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Khairy A, Elhussein N, Elbadri O, Mohamed S, Malik EM. Epidemiology of COVID-19 among Children and Adolescents in Sudan 2020-2021. Epidemiologia (Basel) 2023; 4:247-254. [PMID: 37489496 PMCID: PMC10366901 DOI: 10.3390/epidemiologia4030025] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/30/2023] [Accepted: 05/08/2023] [Indexed: 07/26/2023] Open
Abstract
Children and adolescents account for a small proportion of confirmed COVID-19 cases, with mild and self-limiting clinical manifestations. The distribution and determinants of COVID-19 among this group in Sudan are unclear. This study used national COVID-19 surveillance data to study the epidemiology of COVID-19 among children and adolescents in Sudan during 2020-2021. A cross-sectional study was performed to estimate the reported incidence of children and adolescents with COVID-19; the clinical features; and the mortality among those who tested positive for COVID-19. A total of 3150 suspected cases of COVID-19 infection fulfilled the study criteria. The majority of cases were above 10 years of age, 52% (1635) were males, and 56% (1765) were asymptomatic. The reported incidence rates of COVID-19 among children and adolescents in Sudan was 1.3 per 10,000 in 2021. Fever, cough, and headache were the most frequent symptoms reported among the suspected cases. The case fatality rate was 0.2%. Binary logistic regression revealed that loss of smell was the most significantly associated symptom with a positive test. We recommend further study to identify risk factors. Additionally, we recommend including these age groups in the vaccination strategy in Sudan.
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Affiliation(s)
- Amna Khairy
- Sudan FETP Graduates, Federal Ministry of Health, Khartoum 11111, Sudan
- FETP Technical Coordinator, EMPHNET, Khartoum 11111, Sudan
| | - Narmin Elhussein
- Sudan FETP Graduates, Blue Nile National Institute for Communicable Disease, Gezira 21111, Sudan
| | - Omer Elbadri
- Sudan FETP Graduates, Federal Ministry of Health, Khartoum 11111, Sudan
| | - Sanad Mohamed
- Sudan FETP Graduates, Federal Ministry of Health, Khartoum 11111, Sudan
| | - Elfatih M Malik
- Sudan FETP Graduates, Blue Nile National Institute for Communicable Disease, Gezira 21111, Sudan
- Associate Professor of Community Medicine, Department of Community Medicine, Faculty of Medicine, University of Khartoum and GHD/EMPHNET Consultant for EBS in Sudan, Khartoum 11111, Sudan
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Abbas AA, Sulieman BI, Malik EM. Management of Helicobacter pylori among medical doctors working in Khartoum, Sudan 2019: a cross-sectional study. Afr Health Sci 2022; 22:125-134. [PMID: 36407387 PMCID: PMC9652685 DOI: 10.4314/ahs.v22i2.15] [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] [Indexed: 12/02/2022] Open
Abstract
Background Various international guidelines have been developed regarding Helicobacter pylori (H. pylori) management, as it is infecting more than half of the world's population. Sudan's health system lacks guidelines regarding H. pylori management, leading to a discrepancy in practice. Investigating the current approach could be a step forward in the formulation of a national consensus in the management of H. pylori. Methods A cross-sectional study was conducted among medical doctors currently working in Khartoum, Sudan. Participants were enrolled from platforms of medical associations through an online questionnaire. The questionnaire was scored out of 25 points, and scoring 13 or above considered a good approach. Data analysis was carried out using Statistical Package for Social Sciences (SPSS). Results A total of 358 medical doctors participated in the study. The mean (±SD) score was 12.9(±4.5). Those who were using textbooks, campaigns, symposiums or general medical information to their primary Source of knowledge significantly scored higher. The most selected indication for both diagnosis (76.8%) and treatment (67.6%) was an active peptic ulcer. Stool antigen test (SAT) was the most preferred test (70.7%). The majority of respondents selected triple therapy (82.1%) as a first-line regimen. Only 37.7% confirmed the eradication after four weeks of stopping the treatment. They ensure eradication mainly through SAT (29%). Conclusion A suboptimal approach was noted among medical doctors of Khartoum, Sudan, regarding H. pylori management. Efforts should be invested in forming national guidelines and the implementation of continuous medical education programs.
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Affiliation(s)
- Azza A Abbas
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Qasr Avenue, P.O. Box 11111, Khartoum, Sudan
| | - Bushra I Sulieman
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Qasr Avenue, P.O. Box 11111, Khartoum, Sudan
| | - Elfatih M Malik
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Qasr Avenue, P.O. Box 11111, Khartoum, Sudan
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Hasabo EA, Ayyad FA, Alam Eldeen SAM, Noureldaim MK, Abdallah TA, Ahmed YT, Badi S, Khalid WK, Mirghani HA, Mohammed YA, Alkhider LA, Hamad SA, Tagelseed AM, Elsheikh EHA, Khalid NH, Mohammed SA, Elmobark SO, Ali OO, Mohammed Ali DA, Muneer MS, Awadalla H, Malik EM. Clinical manifestations, complications, and outcomes of patients with COVID-19 in Sudan: a multicenter observational study. Trop Med Health 2021; 49:91. [PMID: 34776007 PMCID: PMC8590864 DOI: 10.1186/s41182-021-00382-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 11/02/2021] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a pandemic caused by a newly discovered coronavirus. Although clinical manifestations of COVID-19 are mainly pulmonary, some patients have other systemic manifestations. This study aimed to describe the clinical finding and outcomes in Sudanese patients diagnosed with COVID-19. METHODS This retrospective observational study is based on documented files that included patients diagnosed with COVID-19 in seven selected hospitals inside Khartoum. Clinical manifestations, complications and outcomes were extracted from patients' records using an extraction form designed for this study. RESULTS Data of 243 patients diagnosed with COVID-19 were analyzed. The mean (SD) age in years was 55.8 (18.4). Out of 116 participants, 27 of them (23.3%) had severe disease, 15 (12.9%) were critically ill. 67.5% of patients were admitted to the hospital within 7 days from onset of symptoms; most of them were admitted to the wards (n = 140,72.5%). Fever (83.2%), cough (70.7%), and shortness of breath (69.2%) were the most commonly recorded clinical manifestations. Sepsis (9.8%) and acidosis (7.8%) were the most frequently reported complications. Death was the final outcome in 21.4% (56/243). Older age and presence of diabetes were found significantly associated with in-hospital death. The laboratory results showed high CRP in 85.6% (119/139), high ferritin in 88.9% (24/27), lactate dehydrogenase had a median of 409.0 (359-760), D-dimer had a median of 3.3 (1.2-16. 6), and 53/105 (50.5%) had low albumin. CONCLUSIONS Fever was the most mentioned sign among the participants, followed by fatigue. Cough and shortness of breath were the most commonly recorded pulmonary symptoms manifested. Our study showed multiple variables were associated with in-hospital death. The mortality rate was high among severe and critically ill patients diagnosed with COVID-19.
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Affiliation(s)
- Elfatih A Hasabo
- Faculty of Medicine, University of Khartoum, ElQasr Avenue, Khartoum, Khartoum state, 11111, Sudan.
| | - Fatima A Ayyad
- School of Medicine, Ahfad University for Women, Khartoum, Sudan
| | - Sara A M Alam Eldeen
- Faculty of Medicine, University of Khartoum, ElQasr Avenue, Khartoum, Khartoum state, 11111, Sudan
| | | | - Tibyan A Abdallah
- Faculty of Medicine, University of Khartoum, ElQasr Avenue, Khartoum, Khartoum state, 11111, Sudan
| | - Yousra T Ahmed
- Faculty of Medical Laboratory, University of Alzaiem Alazhari, Khartoum, Sudan
| | - Safaa Badi
- Faculty of Pharmacy, Omdurman Islamic University, Khartoum, Sudan
| | | | - Hind A Mirghani
- School of Medicine, Ahfad University for Women, Khartoum, Sudan
| | | | - Lubaba A Alkhider
- Faculty of Medicine, University of Khartoum, ElQasr Avenue, Khartoum, Khartoum state, 11111, Sudan
| | - Saada A Hamad
- Faculty of Medicine, University of Khartoum, ElQasr Avenue, Khartoum, Khartoum state, 11111, Sudan
| | - Amna M Tagelseed
- Faculty of Medicine, University of Khartoum, ElQasr Avenue, Khartoum, Khartoum state, 11111, Sudan
| | - Ethar H A Elsheikh
- Faculty of Medicine, University of Khartoum, ElQasr Avenue, Khartoum, Khartoum state, 11111, Sudan
| | - Noon H Khalid
- Faculty of Medicine, University of Khartoum, ElQasr Avenue, Khartoum, Khartoum state, 11111, Sudan
| | - Samia A Mohammed
- Faculty of Medicine, University of Khartoum, ElQasr Avenue, Khartoum, Khartoum state, 11111, Sudan
| | - Sara O Elmobark
- Faculty of Medicine, University of Khartoum, ElQasr Avenue, Khartoum, Khartoum state, 11111, Sudan
| | - Ola O Ali
- Faculty of Medicine, University of Khartoum, ElQasr Avenue, Khartoum, Khartoum state, 11111, Sudan
| | - Duaa A Mohammed Ali
- Faculty of Medicine, University of Khartoum, ElQasr Avenue, Khartoum, Khartoum state, 11111, Sudan
| | - Mohamed S Muneer
- Faculty of Medicine, University of Khartoum, ElQasr Avenue, Khartoum, Khartoum state, 11111, Sudan
| | - Heitham Awadalla
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Elfatih M Malik
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Ogunleye OO, Basu D, Mueller D, Sneddon J, Seaton RA, Yinka-Ogunleye AF, Wamboga J, Miljković N, Mwita JC, Rwegerera GM, Massele A, Patrick O, Niba LL, Nsaikila M, Rashed WM, Hussein MA, Hegazy R, Amu AA, Boahen-Boaten BB, Matsebula Z, Gwebu P, Chirigo B, Mkhabela N, Dlamini T, Sithole S, Malaza S, Dlamini S, Afriyie D, Asare GA, Amponsah SK, Sefah I, Oluka M, Guantai AN, Opanga SA, Sarele TV, Mafisa RK, Chikowe I, Khuluza F, Kibuule D, Kalemeera F, Mubita M, Fadare J, Sibomana L, Ramokgopa GM, Whyte C, Maimela T, Hugo J, Meyer JC, Schellack N, Rampamba EM, Visser A, Alfadl A, Malik EM, Malande OO, Kalungia AC, Mwila C, Zaranyika T, Chaibva BV, Olaru ID, Masuka N, Wale J, Hwenda L, Kamoga R, Hill R, Barbui C, Bochenek T, Kurdi A, Campbell S, Martin AP, Phuong TNT, Thanh BN, Godman B. Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future. Front Pharmacol 2020; 11:1205. [PMID: 33071775 PMCID: PMC7533592 DOI: 10.3389/fphar.2020.01205] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/23/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has already claimed considerable lives. There are major concerns in Africa due to existing high prevalence rates for both infectious and non-infectious diseases and limited resources in terms of personnel, beds and equipment. Alongside this, concerns that lockdown and other measures will have on prevention and management of other infectious diseases and non-communicable diseases (NCDs). NCDs are an increasing issue with rising morbidity and mortality rates. The World Health Organization (WHO) warns that a lack of nets and treatment could result in up to 18 million additional cases of malaria and up to 30,000 additional deaths in sub-Saharan Africa. OBJECTIVE Document current prevalence and mortality rates from COVID-19 alongside economic and other measures to reduce its spread and impact across Africa. In addition, suggested ways forward among all key stakeholder groups. OUR APPROACH Contextualise the findings from a wide range of publications including internet-based publications coupled with input from senior-level personnel. ONGOING ACTIVITIES Prevalence and mortality rates are currently lower in Africa than among several Western countries and the USA. This could be due to a number of factors including early instigation of lockdown and border closures, the younger age of the population, lack of robust reporting systems and as yet unidentified genetic and other factors. Innovation is accelerating to address concerns with available equipment. There are ongoing steps to address the level of misinformation and its consequences including fines. There are also ongoing initiatives across Africa to start addressing the unintended consequences of COVID-19 activities including lockdown measures and their impact on NCDs including the likely rise in mental health disorders, exacerbated by increasing stigma associated with COVID-19. Strategies include extending prescription lengths, telemedicine and encouraging vaccination. However, these need to be accelerated to prevent increased morbidity and mortality. CONCLUSION There are multiple activities across Africa to reduce the spread of COVID-19 and address misinformation, which can have catastrophic consequences, assisted by the WHO and others, which appear to be working in a number of countries. Research is ongoing to clarify the unintended consequences given ongoing concerns to guide future activities. Countries are learning from each other.
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Affiliation(s)
- Olayinka O. Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Debashis Basu
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Debjani Mueller
- Charlotte Maxeke Medical Research Cluster, Johannesburg, South Africa
| | | | - R. Andrew Seaton
- Healthcare Improvement Scotland, Glasgow, United Kingdom
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
- University of Glasgow, Glasgow, United Kingdom
| | | | - Joshua Wamboga
- Uganda Alliance of Patients’ Organizations (UAPO), Kampala, Uganda
| | - Nenad Miljković
- Institute of Orthopaedic Surgery “Banjica”, University of Belgrade, Belgrade, Serbia
| | - Julius C. Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Department of Internal Medicine, University of Botswana and Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Amos Massele
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Okwen Patrick
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon
- Faculty of Health and Medical Sciences, Adelaide University, Adelaide, SA, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon
- Department of Public Health, University of Bamenda, Bambili, Cameroon
| | | | | | | | - Rehab Hegazy
- Pharmacology Department, Medical Division, National Research Centre, Giza, Egypt
| | - Adefolarin A. Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Eswatini
| | | | | | | | | | | | | | | | | | | | - Daniel Afriyie
- Pharmacy Department, Ghana Police Hospital, Accra, Ghana
| | - George Awuku Asare
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Seth Kwabena Amponsah
- Department of Medical Pharmacology, University of Ghana Medical School, Accra, Ghana
| | - Israel Sefah
- Ghana Health Service, Pharmacy Department, Keta Municipal Hospital, Keta-Dzelukope, Ghana
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Hohoe, Ghana
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Anastasia N. Guantai
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Sylvia A. Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Tebello Violet Sarele
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Westville-campus, Durban, South Africa
| | | | - Ibrahim Chikowe
- Pharmacy Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Felix Khuluza
- Pharmacy Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Mwangana Mubita
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University , Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Laurien Sibomana
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gwendoline Malegwale Ramokgopa
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Carmen Whyte
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Tshegofatso Maimela
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Johannes Hugo
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
- Department of Family Medicine, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
| | - Johanna C. Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Natalie Schellack
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Enos M. Rampamba
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacy, Tshilidzini Hospital, Shayandima, South Africa
| | - Adel Visser
- Eugene Marais Hospital, Pretoria, South Africa
| | - Abubakr Alfadl
- National Medicines Board, Federal Ministry of Health, Khartoum, Sudan
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Elfatih M. Malik
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
- Community Medicine Council, SMSB, Khartoum, Sudan
| | - Oliver Ombeva Malande
- Department of Child Health and Paediatrics, Egerton University, Nakuru, Kenya
- East Africa Centre for Vaccines and Immunization (ECAVI), Kampala, Uganda
| | | | - Chiluba Mwila
- Department of Pharmacy, University of Zambia, Lusaka, Zambia
| | - Trust Zaranyika
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | - Ioana D. Olaru
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Nyasha Masuka
- Zimbabwe College of Public Health Physicians, Harare, Zimbabwe
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | | | - Regina Kamoga
- Uganda Alliance of Patients’ Organizations (UAPO), Kampala, Uganda
- Community Health and Information Network (CHAIN), Kampala, Uganda
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Tomasz Bochenek
- Department of Nutrition and Drug Research, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Antony P. Martin
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- HCD Economics, The Innovation Centre, Daresbury, United Kingdom
| | - Thuy Nguyen Thi Phuong
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Binh Nguyen Thanh
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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7
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Abdel Hamid MM, Abdallah WME, Hussien M, Mohammed NM, Malik EM, Ahmed ME, Mohamed AO. Absence of K13 gene mutations among artesunate/sulfadoxine-pyrimethamine treatment failures of Sudanese Plasmodium falciparum isolates from Damazin, southeast Sudan. Trans R Soc Trop Med Hyg 2020; 113:428-430. [PMID: 31034031 DOI: 10.1093/trstmh/trz027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/08/2019] [Accepted: 03/27/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The emergence of resistant parasites to artemisinin poses a threat to malaria treatment. The study aimed to investigate K13 gene mutations in Plasmodium falciparum artesunate (AS)/sulfadoxine-pyrimethamine (SP) efficacy study in Sudan. METHODS A total of 31 (14 failures and 17 adequate clinical and parasitological response [ACPR]) pretreatment dried blood samples from patients with uncomplicated P. falciparum malaria treated with AS/SP were examined. Nested polymerase chain reaction (PCR) and DNA sequencing of the K13 gene was performed. RESULTS PCR products were obtained from 30 (96.8%) samples and sequencing was successful in 28 (90.3%). No mutation of the K13 gene was recorded in the treatment failure group. A single mutation (C>T; A621V) in one ACPR patient sample was detected. CONCLUSION There is no evidence of K13 mutation among AS/SP treatment failure patients. A single mutation of the K13 gene not linked to treatment failure has been detected.
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Affiliation(s)
- Muzamil M Abdel Hamid
- Institute of Endemic Diseases, Medical Campus, University of Khartoum, Khartoum, Sudan
| | - Walla M E Abdallah
- Institute of Endemic Diseases, Medical Campus, University of Khartoum, Khartoum, Sudan
| | - Maazza Hussien
- Institute of Endemic Diseases, Medical Campus, University of Khartoum, Khartoum, Sudan
| | - Niven M Mohammed
- Institute of Endemic Diseases, Medical Campus, University of Khartoum, Khartoum, Sudan
| | - Elfatih M Malik
- Faculty of Medicine, Medical Campus, University of Khartoum, Khartoum, Sudan
| | | | - Abdelrahim O Mohamed
- Institute of Endemic Diseases, Medical Campus, University of Khartoum, Khartoum, Sudan.,Faculty of Medicine, Medical Campus, University of Khartoum, Khartoum, Sudan
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Mohamed AO, Hussien M, Mohamed A, Suliman A, Elkando NS, Abdelbagi H, Malik EM, Abdelraheem MH, Hamid MMA. Assessment of Plasmodium falciparum drug resistance molecular markers from the Blue Nile State, Southeast Sudan. Malar J 2020; 19:78. [PMID: 32070355 PMCID: PMC7029593 DOI: 10.1186/s12936-020-03165-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/13/2020] [Indexed: 12/03/2022] Open
Abstract
Background Plasmodium falciparum malaria is a public health problem worldwide. Malaria treatment policy has faced periodic changes due to emergence of drug resistant parasites. In Sudan chloroquine has been replaced by artesunate and sulfadoxine/pyrimethamine (AS/SP) in 2005 and to artemether–lumefantrine (AL) in 2017, due to the development of drug resistance. Different molecular markers have been used to monitor the status of drug resistant P. falciparum. This study aimed to determine the frequency of malaria drug resistance molecular markers in Southeast Sudan. Methods The samples of this study were day zero dried blood spot samples collected from efficacy studies in the Blue Nile State from November 2015 to January 2016. A total of 130 samples were amplified and sequenced using illumina Miseq platform. The molecular markers included were Pfcrt, Pfmdr1, Pfdhfr, Pfdhps, Pfk13, exonuclease and artemisinin resistant (ART‐R) genetic background (Pfmdr2, ferroredoxine, Pfcrt and Pfarps10). Results Resistance markers for chloroquine were detected in 25.8% of the samples as mutant haplotype Pfcrt 72-76 CVIET and 21.7% Pfmdr1 86Y. Pfdhfr mutations were detected in codons 51, 59 and 108. The ICNI double-mutant haplotype was the most prevalent (69%). Pfdhps mutations were detected in codons 436, 437, 540, 581 and 613. The SGEGA triple-mutant haplotype was the most prevalent (43%). In Pfdhfr/Pfdhps combined mutation, quintuple mutation ICNI/SGEGA is the most frequent one (29%). Six of the seven treatment failure samples had quintuple mutation and the seventh was quadruple. This was significantly higher from the adequately responsive group (P < 0.01). Pfk13 novel mutations were found in 7 (8.8%) samples, which were not linked to artemisinin resistance. Mutations in ART‐R genetic background genes ranged from zero to 7%. Exonuclease mutation was not detected. Conclusion In this study, moderate resistance to chloroquine and high resistance to SP was observed. Novel mutations of Pfk13 gene not linked to treatment failure were described. There was no resistance to piperaquine the partner drug of dihydroartemisinin/piperaquine (DHA-PPQ).
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Affiliation(s)
- Abdelrahim O Mohamed
- Department of Biochemistry, Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
| | - Maazza Hussien
- Department of Medical Parasitology and Entomology, Faculty of Medical Laboratory Sciences, Al Neelain University, Khartoum, Sudan.,Institute of Endemic Diseases, Medical Campus, University of Khartoum, P. O. Box 102, Khartoum, Sudan
| | - Amal Mohamed
- Department of Accreditation, General Directorate of Quality, Development and Accreditation, Khartoum, Sudan
| | | | - Nuha S Elkando
- State Ministry of Health, Blue Nile State, Damazin, Sudan
| | - Hanadi Abdelbagi
- Institute of Endemic Diseases, Medical Campus, University of Khartoum, P. O. Box 102, Khartoum, Sudan
| | - Elfatih M Malik
- Department of Community Medicine Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Mohammed H Abdelraheem
- Institute of Endemic Diseases, Medical Campus, University of Khartoum, P. O. Box 102, Khartoum, Sudan
| | - Muzamil Mahdi Abdel Hamid
- Department of Medical Parasitology and Entomology, Faculty of Medical Laboratory Sciences, Al Neelain University, Khartoum, Sudan. .,Institute of Endemic Diseases, Medical Campus, University of Khartoum, P. O. Box 102, Khartoum, Sudan.
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Adam I, Mutabingwa TK, Malik EM. Red cell distribution width and preeclampsia: a systematic review and meta-analysis. Clin Hypertens 2019; 25:15. [PMID: 31338207 PMCID: PMC6628484 DOI: 10.1186/s40885-019-0119-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/10/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Preeclampsia is a serious pregnancy-related disease which may lead to adverse health effects to the mother and fetus. Besides many publications on the association of red cell distribution width (RDW) and preeclampsia, there has been no published meta-analysis. This necessitated the present systemic review and met-analysis to assess the RDW in relation to preeclampsia. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. Relevant published studies were searched in PubMed, Cochrane library, Google scholar, Scopus, Embase and CINAHL using the term "Preeclampsia OR eclampsia AND red cell distribution width OR red blood cells). Modified Newcastle - Ottawa quality assessment scale was used for critical appraisal of retrieved studies. Pooled Meta logistic regression was computed using OpenMeta Analyst software. Subgroup and meta-regression methods were performed to analyse the heterogeneity. RESULTS Eleven case control studies were included in the met-analyses with a total of 951 cases (preeclampsia) and 2024 controls. The mean (SD) of the RDW level was significantly higher in women with preeclampsia compared to controls [15.10 (2.48) % vs. 14.26(1.71) %, P < 0.001]. The mean difference was 0.85, 95% CI = 0.26-1.43. Due to a high heterogeneity (I2 = 90.45, P < 0.001), the continuous random effect model was used.Eight studies compared RDW level in the mild (N = 360) with severe cases (N = 354) of preeclampsia. The RDW level was significantly higher in women with severe preeclampsia compared to those with mild preeclampsia [15.37 (2.48) % vs. 14.037(1.79) %, P < 0.001]. The mean difference was 1.07, 95% CI = 0.45-1.70. Since there is a high heterogeneity [I2 = 76.67, P < 0.001], the continuous random effect model was used.Through the met-regression model, except for the region of the study (P < 0.001), none of investigated variables (age, parity, quality of the study) was significantly associated with the investigated heterogeneity. The outliers (3studies) were removed to reduce the heterogeneity. The pooled meta-analysis of the remaining 8 studies showed a significant difference in the RDW between preeclamptic women compared with the controls. The mean difference was 0.93, 95% CI = 0.56-1.31, P < 0.001. Because of heterogeneity [I2 = 69.6, P = 0.002], the continuous random effect model was used. CONCLUSION RDW level was significantly higher in women with preeclampsia compared to controls. Similarly, women with severe preeclampsia had significantly higher RDW than those with the mild form.
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Affiliation(s)
- Ishag Adam
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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10
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Elnour FA, Alagib MEA, Bansal D, Farag EABA, Malik EM. Severe malaria management: current situation, challenges and lessons learned from Gezira State, Sudan. Malar J 2019; 18:170. [PMID: 31088466 PMCID: PMC6515598 DOI: 10.1186/s12936-019-2805-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 05/07/2019] [Indexed: 12/19/2022] Open
Abstract
Background The present study aimed to evaluate the management of severe malaria at Gezira State hospitals in Sudan by assessing hospital readiness, health care provider knowledge and the care received by severe malaria patients. Methods A cross-sectional descriptive study was performed to assess the severe malaria management practices at hospitals level in Gezira State. The study population included hospitals, health care providers and patients. Data was collected using checklists and structured questionnaires. Results A total of 20 hospitals, 158 health care providers and 370 patients were included in the study. Out of the total hospitals, 95% (19/20) were providing 24 h outpatient services, 65% (13/20) had ICU units, while triage system was found in only 35% (7/20) of hospitals. From all hospitals evaluated, 90% (18/20) were suffering from shortage of staff, especially doctors. About half of the health care providers (46.7%) did not receive severe malaria management training. The average knowledge score among health care providers was 55.4%. Microscopy was available in all hospitals (100%), while rapid diagnostic test, complete blood count and renal function test were available in 15 hospitals (75%). Fever was the most presenting symptom (97.8%) followed by repeated vomiting (51.4%), convulsion in children (24.3%) and prostration in adult (57.9%). Correctly diagnosed patients were 68.9%. Essential tests were done for only 11.1% of patients. Majority of patients (91.7%) were treated with quinine, 5.9% received artemether, while 2.4% were treated with artemether–lumefantrine. Those who received both the correct dose and dosing regimen were 53.8%. The overall compliance to guidelines was 2.2%. Conclusion This study highlights the fact that management of severe malaria at hospital level was suboptimal with serious shortcomings in the different aspects of care particularly in specialized hospitals. Technical staff was inadequate, hospitals were anguish from defective emergency services, and most patients were not treated according to the national guidelines. Electronic supplementary material The online version of this article (10.1186/s12936-019-2805-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fahad A Elnour
- Communicable & Non Communicable Diseases Control Directorate, Federal Ministry of Health, Nile St, Khartoum, Sudan
| | - Mohammed E A Alagib
- Planning and International Health Directorate, Federal Ministry of Health, Nile St, Khartoum, Sudan
| | - Devendra Bansal
- Communicable Diseases Control Programmes, Public Health Department, Ministry of Public Health, Doha, Qatar
| | | | - Elfatih M Malik
- Planning and International Health Directorate, Federal Ministry of Health, Nile St, Khartoum, Sudan.
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Kleinschmidt I, Bradley J, Knox TB, Mnzava AP, Kafy HT, Mbogo C, Ismail BA, Bigoga JD, Adechoubou A, Raghavendra K, Cook J, Malik EM, Nkuni ZJ, Macdonald M, Bayoh N, Ochomo E, Fondjo E, Awono-Ambene HP, Etang J, Akogbeto M, Bhatt RM, Chourasia MK, Swain DK, Kinyari T, Subramaniam K, Massougbodji A, Okê-Sopoh M, Ogouyemi-Hounto A, Kouambeng C, Abdin MS, West P, Elmardi K, Cornelie S, Corbel V, Valecha N, Mathenge E, Kamau L, Lines J, Donnelly MJ. Implications of insecticide resistance for malaria vector control with long-lasting insecticidal nets: a WHO-coordinated, prospective, international, observational cohort study. Lancet Infect Dis 2018; 18:640-649. [PMID: 29650424 PMCID: PMC5968369 DOI: 10.1016/s1473-3099(18)30172-5] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/13/2018] [Accepted: 02/26/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Scale-up of insecticide-based interventions has averted more than 500 million malaria cases since 2000. Increasing insecticide resistance could herald a rebound in disease and mortality. We aimed to investigate whether insecticide resistance was associated with loss of effectiveness of long-lasting insecticidal nets and increased malaria disease burden. METHODS This WHO-coordinated, prospective, observational cohort study was done at 279 clusters (villages or groups of villages in which phenotypic resistance was measurable) in Benin, Cameroon, India, Kenya, and Sudan. Pyrethroid long-lasting insecticidal nets were the principal form of malaria vector control in all study areas; in Sudan this approach was supplemented by indoor residual spraying. Cohorts of children from randomly selected households in each cluster were recruited and followed up by community health workers to measure incidence of clinical malaria and prevalence of infection. Mosquitoes were assessed for susceptibility to pyrethroids using the standard WHO bioassay test. Country-specific results were combined using meta-analysis. FINDINGS Between June 2, 2012, and Nov 4, 2016, 40 000 children were enrolled and assessed for clinical incidence during 1·4 million follow-up visits. 80 000 mosquitoes were assessed for insecticide resistance. Long-lasting insecticidal net users had lower infection prevalence (adjusted odds ratio [OR] 0·63, 95% CI 0·51-0·78) and disease incidence (adjusted rate ratio [RR] 0·62, 0·41-0·94) than did non-users across a range of resistance levels. We found no evidence of an association between insecticide resistance and infection prevalence (adjusted OR 0·86, 0·70-1·06) or incidence (adjusted RR 0·89, 0·72-1·10). Users of nets, although significantly better protected than non-users, were nevertheless subject to high malaria infection risk (ranging from an average incidence in net users of 0·023, [95% CI 0·016-0·033] per person-year in India, to 0·80 [0·65-0·97] per person year in Kenya; and an average infection prevalence in net users of 0·8% [0·5-1·3] in India to an average infection prevalence of 50·8% [43·4-58·2] in Benin). INTERPRETATION Irrespective of resistance, populations in malaria endemic areas should continue to use long-lasting insecticidal nets to reduce their risk of infection. As nets provide only partial protection, the development of additional vector control tools should be prioritised to reduce the unacceptably high malaria burden. FUNDING Bill & Melinda Gates Foundation, UK Medical Research Council, and UK Department for International Development.
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Affiliation(s)
- Immo Kleinschmidt
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - John Bradley
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Hmooda Toto Kafy
- Federal Ministry of Health, Khartoum, Sudan; School of Biological Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Charles Mbogo
- KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya
| | - Bashir Adam Ismail
- School of Biological Sciences, Universiti Sains Malaysia, Penang, Malaysia; Khartoum Malaria Free Initiative, Khartoum, Sudan
| | - Jude D Bigoga
- National Reference Unit (NRU) for Vector Control, The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | - Alioun Adechoubou
- Programme National de Lutte contre le Paludisme (PNLP), Ministère de la Santé, Cotonou, Benin
| | - Kamaraju Raghavendra
- National Institute of Malaria Research, Indian Council of Medical Research, Department of Health Research, New Delhi, India
| | - Jackie Cook
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Elfatih M Malik
- University of Khartoum, Faculty of Medicine, Department of Community Medicine, Khartoum, Sudan
| | | | | | - Nabie Bayoh
- KEMRI/CDC Research and Public Health Collaboration, Kisumu, Kenya
| | - Eric Ochomo
- KEMRI/CDC Research and Public Health Collaboration, Kisumu, Kenya
| | - Etienne Fondjo
- National Malaria Control Program, Ministry of Public Health, Yaoundé, Cameroon
| | - Herman Parfait Awono-Ambene
- Organisation de Coordination pour la lutte contre les Endemies en Afrique Centrale (OCEAC), Yaoundé, Cameroon
| | - Josiane Etang
- Organisation de Coordination pour la lutte contre les Endemies en Afrique Centrale (OCEAC), Yaoundé, Cameroon; Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Martin Akogbeto
- Centre de Recherche Entomologique de Cotonou, Cotonou, Benin
| | - Rajendra M Bhatt
- National Institute of Malaria Research, Indian Council of Medical Research, Department of Health Research, New Delhi, India
| | - Mehul Kumar Chourasia
- National Institute of Malaria Research, Indian Council of Medical Research, Department of Health Research, New Delhi, India
| | - Dipak K Swain
- National Institute of Malaria Research, Indian Council of Medical Research, Department of Health Research, New Delhi, India
| | - Teresa Kinyari
- University of Nairobi, School of Medicine, College of Health Sciences, Department of Medical Physiology, Nairobi, Kenya
| | | | | | - Mariam Okê-Sopoh
- Programme National de Lutte contre le Paludisme (PNLP), Ministère de la Santé, Cotonou, Benin
| | | | - Celestin Kouambeng
- National Malaria Control Program, Ministry of Public Health, Yaoundé, Cameroon
| | | | - Philippa West
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Sylvie Cornelie
- Maladies Infectieuses et Vecteurs, Ecologie, Génétique, Evolution et Contrôle (MIVEGEC), Institut de Recherche pour le Développement (IRD), CNRS, University of Montpellier, Montpellier, France
| | - Vincent Corbel
- Maladies Infectieuses et Vecteurs, Ecologie, Génétique, Evolution et Contrôle (MIVEGEC), Institut de Recherche pour le Développement (IRD), CNRS, University of Montpellier, Montpellier, France
| | - Neena Valecha
- National Institute of Malaria Research, Indian Council of Medical Research, Department of Health Research, New Delhi, India
| | - Evan Mathenge
- KEMRI Eastern and Southern Africa Centre of International Parasite Control, Nairobi, Kenya
| | - Luna Kamau
- KEMRI Centre for Biotechnology and Research Development, Nairobi, Kenya
| | - Jonathan Lines
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Martin James Donnelly
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK; Malaria Programme, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
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Mohamed AO, Abdel Hamid MM, Mohamed OS, Elkando NS, Suliman A, Adam MA, Elnour FAA, Malik EM. Efficacies of DHA-PPQ and AS/SP in patients with uncomplicated Plasmodium falciparum malaria in an area of an unstable seasonal transmission in Sudan. Malar J 2017; 16:163. [PMID: 28427409 PMCID: PMC5399425 DOI: 10.1186/s12936-017-1817-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/09/2017] [Indexed: 12/03/2022] Open
Abstract
Background Artemisinin-based combination therapy (ACT), together with other control measures, have reduced the burden of falciparum malaria in sub-Saharan countries, including Sudan. Sudan adopted ACT in 2004 with a remarkable reduction in mortality due to falciparum malaria. However, emergence of resistance to the first-line treatment artesunate and sulfadoxine/pyrimethamine (AS/SP) has created new challenges to the control of malaria in Sudan. A search for an alternative drug of choice for treating uncomplicated malaria has become inevitable. The objective of this study was to evaluate the therapeutic efficacies of dihydroartemisinin/piperaquine (DHA–PPQ) and AS/SP in an area of unstable transmission in Blue Nile State, Sudan in 2015–16. Methods A total of 148 patients with uncomplicated malaria were recruited in the study from November 2015 to end of January 2016. Seventy-five patients received DHA–PPQ while 73 received AS/SP. Patients were monitored for clinical and parasitological outcomes following the standard WHO protocol for a period of 42 days for DHA–PPQ and 28 days for AS/SP; nested PCR (nPCR) was performed to confirm parasite re-appearance from day 7 onwards. Results Fifty-five patients completed the DHA–PPQ arm protocol with success cure rate of 98.2% (95% CI 90.3–100%) and one late clinical failure 1.8% (95% CI 0.0–9.7%). The AS/SP showed adequate clinical and parasitological response (ACPR) of 83.6% (95% CI 71.9–91.8%), early treatment failure was 1.6% (95% CI 0.0–8.8%) and late parasitological failure (LPF) was 14.8% (95% CI 7–26.2%). The respective PCR uncorrected LPF was 20%. Conclusion DHA–PPQ is an efficacious ACT and candidate for replacement of first-line treatment in Sudan while AS/SP showed high treatment failure rate and must be replaced. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1817-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abdelrahim O Mohamed
- Department of Biochemistry, Faculty of Medicine, University of Khartoum, Khartoum, Sudan. .,Neelain Institute for Medical Research, Alneelain University, Khartoum, Sudan.
| | | | - Omer S Mohamed
- Neelain Institute for Medical Research, Alneelain University, Khartoum, Sudan
| | | | | | - Mariam A Adam
- Communicable & Non Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Fahad Awad Ali Elnour
- Communicable & Non Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Elfatih M Malik
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Mannan AA, Elmardi KA, Idris YA, Spector JM, Ali NA, Malik EM. Do frontline health care providers know enough about artemisinin-based combination therapy to rationally treat malaria? A cross-sectional survey in Gezira State, Sudan. Malar J 2015; 14:131. [PMID: 25889428 PMCID: PMC4377190 DOI: 10.1186/s12936-015-0652-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 03/16/2015] [Indexed: 12/18/2022] Open
Abstract
Background In 2004, artemisinin-based combination therapy (ACT) was introduced in Sudan for the treatment of malaria. The role of health care providers working in first-level health care facilities is central for the effective implementation of this revised malaria treatment policy. However, information about their level of ACT knowledge is inadequate. This study sought to describe frontline health care providers’ knowledge about the formulations and dose regimens of nationally recommended ACT in Sudan. Methods This cross-sectional study took place in Gezira State, Sudan. Data were gathered from five localities comprising forty primary health care facilities. A total of 119 health care providers participated in the study (72 prescribers and 47 dispensers). The primary outcome was the proportion of health care providers who were ACT knowledgeable, a composite indicator of health care providers’ ability to (1) define what combination therapy is; (2) identify the recommended first- and second-line treatments; and (3) correctly state the dose regimens for each. Results All prescribers and 95.7% (46/47) of dispensers were aware of the new national malaria treatment policy. However, 93.1% (67/72) of prescribers compared to 87.2% (41/47) of dispensers recognized artesunate-sulphadoxine/pyrimethamine as the recommended first-line treatment in Sudan. Only a small number of prescribers and dispensers (9.4% and 13.6%, respectively) were able to correctly define the meaning of a combination therapy. Overall, only 22% (26/119, 95% CI 14.6-29.4) of health care providers were found to be ACT knowledgeable with no statistically significant difference between prescribers and dispensers. Conclusion Overall, ACT knowledge among frontline health care providers is very poor. This finding suggests that efforts are needed to improve knowledge of prescribers and dispensers working in first-level health care facilities, perhaps through implementing focused, provider-oriented training programmes. Additionally, a system for regularly monitoring and evaluating the quality of in-service training may be beneficial to ensure its responsiveness to the needs of the target health care providers.
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Affiliation(s)
- Abeer A Mannan
- Al Neelain University, Steen Street, P.O. Box 7294, Code: 11123, Khartoum, Sudan.
| | | | | | - Jonathan M Spector
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Nahid A Ali
- Federal Ministry of Health, Khartoum, Sudan.
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Bilal JA, Gasim GI, Abdien MT, Elmardi KA, Malik EM, Adam I. Poor adherence to the malaria management protocol among health workers attending under-five year old febrile children at Omdurman Hospital, Sudan. Malar J 2015; 14:34. [PMID: 25627166 PMCID: PMC4318364 DOI: 10.1186/s12936-015-0575-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 01/18/2015] [Indexed: 11/11/2022] Open
Abstract
Background In spite of the World Health Organization recommendations for the treatment of malaria, febrile patients are still infrequently tested and erroneously treated for malaria. This study aimed to investigate the adherence to malaria national protocol for the management of malaria among under five years old children. Methods A cross sectional hospital-based study was conducted during the period from September through December 2013 among febrile children below the age of five years attending the outpatient department of Omdurman Children Hospital, Sudan. Demographic, clinical and laboratory data [blood film, rapid diagnostic test (RDTs), haemoglobin, WBCs and chest X ray] and anti-malarials and/or antibiotics prescription were recorded. Results A total of 749 febrile children were enrolled. The mean (SD) age was 37.51 (41.6) months. Less than a half, (327, 43.7%) of children were investigated for malaria using microscopy (271, 82.9%), RDT (4, 1.2%) or both (52, 15.9%). Malaria was not investigated for more than a half, (422, 56.3%) however investigations targeting other causes of fever were requested for them. Malaria was positive in 72 (22%) of the 327 investigated children. Five (1.6%) out of 255 with negative malaria tests were treated by an anti-malarials. Quinine was the most frequently prescribed anti-malarials (65, 72.2%) then artemisinin-based combination therapy (ACT) (2, 27.8%). The majority of the 749 children (655, 87.4%) were prescribed an antibiotic. Conclusion There is a poor adherence to malaria management protocol in Sudan among physicians treating children below five years of age. There was a high rate of antibiotic prescription needs.
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Affiliation(s)
- Jalal A Bilal
- College of Medicine, Qassim University, Qassim, Saudi Arabia.
| | - Gasim I Gasim
- College of Medicine, Qassim University, Qassim, Saudi Arabia.
| | - Mohamed T Abdien
- Faculty of Medicine, University of Khartoum, PO Box 102, Khartoum, Sudan.
| | | | - Elfatih M Malik
- Ministry of Health, Gezira State, PO Box 492, Medani, Sudan.
| | - Ishag Adam
- Faculty of Medicine, University of Khartoum, PO Box 102, Khartoum, Sudan.
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Mohamed KG, Hunskaar S, Abdelrahman SH, Malik EM. Scaling up family medicine training in Gezira, Sudan - a 2-year in-service master programme using modern information and communication technology: a survey study. Hum Resour Health 2014; 12:3. [PMID: 24443978 PMCID: PMC3900464 DOI: 10.1186/1478-4491-12-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 01/09/2014] [Indexed: 05/14/2023]
Abstract
BACKGROUND In 2010 the Gezira Family Medicine Project (GFMP) was initiated in Gezira state, Sudan, designed as an in-service training model. The project is a collaboration project between the University of Gezira, which aims to provide a 2-year master's programme in family medicine for practicing doctors, and the Ministry of Health, which facilitates service provision and funds the training programme. This paper presents the programme, the teaching environment, and the first batch of candidates enrolled. METHODS In this study a self-administered questionnaire was used to collect baseline data at the start of the project from doctors who joined the programme. A checklist was also used to assess the health centres where they work. A total of 188 out of 207 doctors responded (91%), while data were gathered from all 158 health centres (100%) staffed by the programme candidates. RESULTS The Gezira model of in-service family medicine training has succeeded in recruiting 207 candidates in its first batch, providing health services in 158 centres, of which 84 had never been served by a doctor before. The curriculum is community oriented. The mean age of doctors was 32.5 years, 57% were males, and 32% were graduates from the University of Gezira. Respondents stated high confidence in practicing some skills such as asthma management and post-abortion uterine evacuation. They were least confident in other skills such as managing depression or inserting an intrauterine device. The majority of health centres was poorly equipped for management of noncommunicable diseases, as only 10% had an electrocardiography machine (ECG), 5% had spirometer, and 1% had a defibrillator. CONCLUSIONS The Gezira model has responded to local health system needs. Use of modern information and communication technology is used to facilitate both health service provision and training. The GFMP represents an example of a large-volume scaling-up programme of family medicine in Africa.
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Affiliation(s)
- Khalid G Mohamed
- Department of Family and Community Medicine, University of Gezira, Medani, Sudan
- Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, NO-5020 Bergen, Norway
- Ministry of Health, Medani, Gezira State, Sudan
| | - Steinar Hunskaar
- Department of Family and Community Medicine, University of Gezira, Medani, Sudan
- Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, NO-5020 Bergen, Norway
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Mohamed AO, Eltaib EH, Ahmed OA, Elamin SB, Malik EM. The efficacies of artesunate–sulfadoxine–pyrimethamine and artemether–lumefantrine in the treatment of uncomplicated,Plasmodium falciparummalaria, in an area of low transmission in central Sudan. Annals of Tropical Medicine & Parasitology 2013; 100:5-10. [PMID: 16417707 DOI: 10.1179/136485906x86239] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In an efficacy trial of artemisinin-based combination treatments (ACT) in central Sudan, cases of uncomplicated, Plasmodium falciparum malaria were given artesunate-sulfadoxine-pyrimethamine (ASP) or artemether-lumefantrine (AL) as first-line treatment. On enrolment, the 71 patients given ASP were similar to the 72 given AL, apart from having generally lower parasitaemias (geometric mean counts of 4893 nu. 10,215 asexual parasites/microl) and having a lower mean age (15 nu. 23 years). Each patient was treated on days 0, 1 and 2, and all 137 who completed follow-up without further, unscheduled treatment were found aparasitaemic and afebrile from day 2 until the last follow-up, on day 28. No moderate or severe adverse side-effects, clinical failures or parasitological failures were observed among these 137 patients. ACT therefore appear both efficacious and safe for the treatment of uncomplicated malaria in central Sudan.
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Affiliation(s)
- A O Mohamed
- Department of Biochemistry, Faculty of Medicine and Health Sciences, University of El Imam El Mahdi, P.O. Box 209, Kosti, Sudan.
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Adam I, A-Elbasit IE, Idris SM, Malik EM, Elbashir MI. A comparison of the efficacy of artesunate plus sulfadoxine–pyrimethamine with that of sulfadoxine–pyrimethamine alone, in the treatment of uncomplicated,Plasmodiumfalciparummalaria in eastern Sudan. Annals of Tropical Medicine & Parasitology 2013; 99:449-55. [PMID: 16004704 DOI: 10.1179/136485905x36299] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In an open, randomized, clinical trial, conducted in New Halfa, eastern Sudan, in September-October 2004, the efficacies and adverse effects of artesunate plus sulfadoxine-pyrimethamine (SP), in the treatment of uncomplicated, Plasmodium falciparum malaria, were compared with those of SP alone. Patients were randomized to receive either artesunate (4 mg/kg. day) on days 0-2 plus SP (25 mg sulfadoxine/kg) on day 0 or the SP alone, and then followed-up for 28 days. Sixty patients completed follow-up. Compared with the 30 given artesunate plus SP (ASP), the 30 given SP alone were much more likely to be febrile (30% v. 3.3%; P=0.006) and parasitaemic (50% v. 6.7%; P<00001) on day 1. By day 3, 16.7% of the patients given SP alone were still febrile and 6.7% of them were still parasitaemic, although all the patients given ASP were then afebrile (P=0.02) and aparasitaemic (P=0.1). Five (16.7%) of the patients treated with SP alone but none of those given ASP appeared to be treatment failures (P<0.05). Parasite genotyping revealed that four of the five apparent treatment failures were true recrudescences but the other represented a re-infection detected on day 28. The true frequencies of cure by day 28 were therefore 100% for ASP and 86.7% for SP alone (P=0.02). Adverse effects of treatment (nausea, itching and giddiness) were observed with similar frequencies in the two treatment arms (10.0% of the patients given ASP v. 13.3% of the patients given SP alone; P>0.05). The frequencies of gametocytaemia during follow-up were, however, much lower in the ASP arm than in the SP-only (0.0% v. 23.3%; P=0.005).Thus, although the problems posed by adverse effects were similar in the two treatment arms, ASP appeared markedly better, in terms of fever- and parasite-clearance times and the prevalence of post-treatment gametocytaemia, than SP alone.
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Affiliation(s)
- I Adam
- New Halfa Teaching Hospital, Sudan.
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Hassan SEDH, Haggaz AED, Mohammed-Elhassan EB, Malik EM, Adam I. Fluorescence microscope (Cyscope) for malaria diagnosis in pregnant women in Medani Hospital, Sudan. Diagn Pathol 2011; 6:88. [PMID: 21943212 PMCID: PMC3189106 DOI: 10.1186/1746-1596-6-88] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 09/24/2011] [Indexed: 11/10/2022] Open
Abstract
Background Accuracy of diagnosis is the core for malaria control. Although microscopy is the gold standard in malaria diagnosis, its reliability is largely dependent on user skill. We compared performance of Cyscope® fluorescence microscope with the Giemsa stained light microscopy for the diagnosis of malaria among pregnant women at Medani Hospital in Central Sudan. The area is characterized by unstable malaria transmission. Methods Socio-demographic characteristics and obstetrics history were gathered using pre-tested questionnaires. Blood samples were collected from febrile pregnant women who were referred as malaria case following initial diagnosis by general microscopist. Results During the study period 128 febrile pregnant women presented at the hospital. Among them, Plasmodium falciparum malaria was detected in 82 (64.1%) and 80 (62.5%) by the Giemsa-stained light microscopy and the Cyscope® fluorescence microscope, respectively. The sensitivity of the Cyscope® fluorescence microscope was 97.6% (95% CI: 92.2%-99.6%). Out of 46 which were negative by Giemsa-stained light microscopy, 5 were positive by the Cyscope® fluorescence microscope. This is translated in specificity of 89.1% (95% CI: 77.5%-95.9%). The positive and negative predictive value of Cyscope® fluorescence microscope was 94.1% (95% CI: 87.4% -97.8%) and 95.3% (95% CI: 85.4% - 99.2%), respectively. Conclusion This study has shown that Cyscope® fluorescence microscope is a reliable diagnostic, sensitive and specific in diagnosing P. falciparum malaria among pregnant women in this setting. Further studies are needed to determine effectiveness in diagnosing other Plasmodium species and to compare it with other diagnostic tools e.g. rapid diagnostic tests and PCR.
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Elmardi KA, Noor AM, Githinji S, Abdelgadir TM, Malik EM, Snow RW. Self-reported fever, treatment actions and malaria infection prevalence in the northern states of Sudan. Malar J 2011; 10:128. [PMID: 21575152 PMCID: PMC3115918 DOI: 10.1186/1475-2875-10-128] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 05/15/2011] [Indexed: 11/03/2022] Open
Abstract
Background The epidemiology of fevers and their management in areas of low malaria transmission in Africa is not well understood. The characteristics of fever, its treatment and association with infection prevalence from a national household sample survey in the northern states of Sudan, an area that represents historically low parasite prevalence, are examined in this study. Methods In October-November 2009, a cluster sample cross-sectional household malaria indicator survey was undertaken in the 15 northern states of the Sudan. Data on household assets and individual level information on age, sex, whether the individual had a fever in the last 14 days and on the day of survey, actions taken to treat the fever including diagnostic services and drugs used and their sources were collected. Consenting household members were asked to provide a finger-prick blood sample and examined for malaria parasitaemia using a rapid diagnostic test (RDT). All proportions and odds ratios were weighted and adjusted for clustering. Results Of 26,471 respondents 19% (n = 5,299) reported a history of fever within the last two weeks prior to the survey and 8% had fever on the day of the survey. Only 39% (n = 2,035) of individuals with fever in last two weeks took any action, of which 43% (n = 875) were treated with anti-malarials. About 44% (n = 382) of malaria treatments were done using the nationally recommended first-line therapy artesunate+sulphadoxine-pryrimethamine (AS+SP) and 13% (n = 122) with non-recommended chloroquine or SP. Importantly 33.9% (n = 296) of all malaria treatments included artemether monotherapy, which is internationally banned for the treatment of uncomplicated malaria. About 53% of fevers had some form of parasitological diagnosis before treatment. On the day of survey, 21,988 individuals provided a finger-prick blood sample and only 1.8% were found positive for Plasmodium falciparum. Infection prevalence was higher among individuals who had fever in the last two weeks (OR = 3.4; 95%CI = 2.6 - 4.4, p < 0.001) or reported fever on the day of survey (OR = 6.2; 95%CI = 4.4 - 8.7, p < 0.001) compared to those without a history of fever. Conclusion Across the northern states of the Sudan, the period prevalence of fever is low. The proportion of fevers that are likely to be malaria is very low. Consequently, parasitological diagnosis of all fevers before treatment is an appropriate strategy for malaria case-management. Improved regulation and supervision of health workers is required to increase the use of diagnostics and remove the practice of prescribing artemisinin monotherapy.
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Affiliation(s)
- Khalid A Elmardi
- National Malaria Control Programme, Federal Ministry of Health, PO Box 1204 Khartoum, Sudan
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Menegon M, Talha AA, Severini C, Elbushra SM, Mohamedani AA, Malik EM, Mohamed TA, Wernsdorfer WH, Majori G, Nour BYM. Frequency distribution of antimalarial drug resistance alleles among Plasmodium falciparum isolates from Gezira State, central Sudan, and Gedarif State, eastern Sudan. Am J Trop Med Hyg 2010; 83:250-7. [PMID: 20682863 DOI: 10.4269/ajtmh.2010.09-0514] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In 2004, Sudan adopted artesunate + sulfadoxine/pyrimethamine (SP) combination as the first-line drug, in response to the high level of falciparum resistance to antimalarials. In 2007, a molecular study on antimalarial resistance linked genes, pfcrt, pfmdr1, pfdhfr, pfdhps, and pfATPase6, was conducted on 198 isolates from central and eastern Sudan. We observed a high frequency of point mutations at almost all loci analyzed, mainly of pfcrt 76T (72.7%), pfdhfr 51I (75.3%), and pfdhfr 108N (72.7%) alleles. The MARK III in vitro test for chloroquine sensitivity in 45 P. falciparum isolates showed that 37.8% of the isolates were low resistant and 6.7% were fully resistant. This study represents the most recent molecular investigation on antimalarial resistance in this area after the adoption of artemisinin-based combination therapy (ACT), and underlines the importance of the analysis of SP resistance evolution to monitor the efficacy of ACT therapy in endemic areas.
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Affiliation(s)
- Michela Menegon
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
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Ahmed AAM, Afifi AA, Malik EM, Adam I. Intestinal protozoa and intestinal helminthic infections among schoolchildren in Central Sudan. ASIAN PAC J TROP MED 2010. [DOI: 10.1016/s1995-7645(10)60071-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
The global malaria situation, especially in Africa, and the problems frequently encountered in chemical control of vectors such as insecticide resistance, emphasize the urgency of research, development and implementation of new vector control technologies that are applicable at regional and local levels. The successful application of the sterile insect technique (SIT) for the control of the New World screwworm Cochliomyia hominivorax and several species of fruit flies has given impetus to the use of this method for suppression or elimination of malaria vectors in some areas of Africa including Northern State of Sudan. The research and development phase of the Northern State feasibility study has been started. Sudanese stakeholders are working side-by-side with the International Atomic Energy Agency in the activities of this important phase. Several ethical, legal and social issues associated with this approach arose during this phase of the project. They need to be seriously considered and handled with care. In this paper, these issues are described, and the current and proposed activities to overcome potential hurdles to ensure success of the project are listed.
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Affiliation(s)
- Badria B El Sayed
- Tropical Medicine Research Institute, National Centre for Research. P.O. Box 1304, Khartoum, Sudan
| | - Colin A Malcolm
- School of Biological Sciences, Queen Mary, University of London, UK
| | - Ahmed Babiker
- Tropical Medicine Research Institute, National Centre for Research. P.O. Box 1304, Khartoum, Sudan
| | - Elfatih M Malik
- National Malaria, Schistosomiasis & Leishmaniasis Administration, Federal Ministry of Health. P.O. Box 1204, Khartoum, Sudan
| | - Mohammed AH El Tayeb
- Sudan Atomic Energy Commission, Ministry of Science and Technology, P.O. Box 3001, Khartoum, Sudan
| | - Nageeb S Saeed
- National Health Laboratory, Ministry of Health, P.O. Box 287, Khartoum, Sudan 1
| | | | - Bart GJ Knols
- Div. Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, F4-217, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands and K&S Consulting, Kalkestraat 20, 6669 CP Dodewaard, The Netherlands
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Mustafa HS, Malik EM, Tuok HT, Mohamed AA, Julla AI, Bassili A. Malaria preventive measures, health care seeking behaviour and malaria burden in different epidemiological settings in Sudan. Trop Med Int Health 2009; 14:1488-95. [PMID: 19788718 DOI: 10.1111/j.1365-3156.2009.02394.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To provide information about preventive measures and treatment seeking behaviour as well as an estimate of the malaria burden in different epidemiological settings for effective monitoring and evaluation of the ongoing efforts. METHODS Cross-sectional survey carried out in four areas representing different levels of transmission to explore the use of preventive measures, care-seeking behaviour and accessibility in addition to point prevalence was followed by a follow-up phase in which the health workers registered and reported all fever cases including malaria. The relation between the reported malaria incidence, the product of symptomatic/asymptomatic ratio and the prevalence of confirmed malaria cases was used to develop the equation that could predict the true malaria incidence. RESULTS Thousand households and 3628 individuals were surveyed. The presence of any net varied between 6.6% and 40%; the percentage of people who reportedly slept under mosquito nets in the previous night varied between 35 and 80. Prompt use of medications ranged between 14 and 48% with a delay of more than 24 h noticed in different areas. The mean number of individuals per household who reported use of anti-malarial drugs in the last 2 weeks ranged between 0.6 (SD = 0.92) and 1.2 (SD = 1.1), with variable cost per treatment and affordability. The prevalence of asymptomatic parasitaemia, fever and confirmed malaria at time of the survey differed by area. The incidence of malaria during the follow-up period was estimated to be 8.5, 178.6, 23.7 and 10.3 episodes per 1000 population in Malakal, Elrank, Elhosh and El Matama, respectively. Based on this, a prediction equation was developed. CONCLUSION We found suboptimal health care seeking behaviour, coverage and use of preventive measures with a high malaria burden. We developed a model for future estimation of malaria episodes.
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Affiliation(s)
- H S Mustafa
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Elmardi KA, Malik EM, Abdelgadir T, Ali SH, Elsyed AH, Mudather MA, Elhassan AH, Adam I. Feasibility and acceptability of home-based management of malaria strategy adapted to Sudan's conditions using artemisinin-based combination therapy and rapid diagnostic test. Malar J 2009; 8:39. [PMID: 19272157 PMCID: PMC2660358 DOI: 10.1186/1475-2875-8-39] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Accepted: 03/09/2009] [Indexed: 11/24/2022] Open
Abstract
Background Malaria remains a major public health problem especially in sub-Saharan Africa. Despite the efforts exerted to provide effective anti-malarial drugs, still some communities suffer from getting access to these services due to many barriers. This research aimed to assess the feasibility and acceptability of home-based management of malaria (HMM) strategy using artemisinin-based combination therapy (ACT) for treatment and rapid diagnostic test (RDT) for diagnosis. Methods This is a study conducted in 20 villages in Um Adara area, South Kordofan state, Sudan. Two-thirds (66%) of the study community were seeking treatment from heath facilities, which were more than 5 km far from their villages with marked inaccessibility during rainy season. Volunteers (one per village) were trained on using RDTs for diagnosis and artesunate plus sulphadoxine-pyrimethamine for treating malaria patients, as well as referral of severe and non-malaria cases. A system for supply and monitoring was established based on the rural health centre, which acted as a link between the volunteers and the health system. Advocacy for the policy was done through different tools. Volunteers worked on non-monetary incentives but only a consultation fee of One Sudanese Pound (equivalent to US$0.5). Pre- and post-intervention assessment was done using household survey, focus group discussion with the community leaders, structured interview with the volunteers, and records and reports analysis. Results and discussion The overall adherence of volunteers to the project protocol in treating and referring cases was accepted that was only one of the 20 volunteers did not comply with the study guidelines. Although the use of RDTs seemed to have improved the level of accuracy and trust in the diagnosis, 30% of volunteers did not rely on the negative RDT results when treating fever cases. Almost all (94.7%) the volunteers felt that they were satisfied with the spiritual outcome of their new tasks. As well, volunteers have initiated advocacy campaigns supported by their village health committees which were found to have a positive role to play in the project that proved their acceptability of the HMM design. The planned system for supply was found to be effective. The project was found to improve the accessibility to ACTs from 25% to 64.7% and the treatment seeking behaviour from 83.3% to 100% before- and after the HMM implementation respectivly. Conclusion The evaluation of the project identified the feasibility of the planned model in Sudan's condition. Moreover, the communities as well as the volunteers found to be satisfied with and supportive to the system and the outcome. The problem of treating other febrile cases when diagnosis is not malaria and other non-fever cases needs to be addressed as well.
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Affiliation(s)
- Khalid A Elmardi
- National Malaria Control Programme, Federal Ministry of Health, Khartoum, Sudan.
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Adam I, Elmardi KA, Malik EM. Predictors of antimalarial treatment failure in an area of unstable malaria transmission in eastern Sudan. Trans R Soc Trop Med Hyg 2009; 103:21-4. [DOI: 10.1016/j.trstmh.2008.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 07/11/2008] [Accepted: 07/11/2008] [Indexed: 11/26/2022] Open
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Mannan AA, Malik EM, Ali KM. Antimalarial prescribing and dispensing practices in health centres of Khartoum state, 2003-04. East Mediterr Health J 2009; 15:122-128. [PMID: 19469434] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This indicator-based study assessed the antimalarial drug prescribing and dispensing practices of health care providers in health centres of Khartoum state, and compared these with national guidelines for malaria treatment. A total of 720 patients and their prescriptions in 24 health centres were included. Prescribers adhered to national treatment guidelines for only 278 (38.6%) of patients. Although all were treated for malaria, only 77.6% patients had fever or history of fever and only 64.6% had fever and positive blood films. More than 90% of prescriptions prescribed antimalarial drugs by generic names but dosage forms were correctly written in only 23.5%. There was a high rate of prescribing antimalarial injections. Only half the patients had adequate knowledge of their treatment.
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Affiliation(s)
- A A Mannan
- National Malaria Control Programme, Federal Ministry of Health, Khartoum, Sudan.
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Hassan SEDH, Malik EM, Okoued SI, Eltayeb EM. Retention and efficacy of long-lasting insecticide-treated nets distributed in eastern Sudan: a two-step community-based study. Malar J 2008; 7:85. [PMID: 18492258 PMCID: PMC2412894 DOI: 10.1186/1475-2875-7-85] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Accepted: 05/20/2008] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In order to assess the effectiveness of long-lasting insecticide-treated nets (LLINs) as a method for malaria control, there is a need to determine how high is the retention of bed nets, how they are utilized, and how efficacious they are against the mosquitoes that transmit the disease. This is especially important in case of Sudan after emergence of resistance to pyrethroids in use. METHODS This two-step study aimed to assess the retention and efficacy of LLINs (Olysettrade mark) distributed in the year 2006 in Kassala district in eastern Sudan. In the first step, using a cluster sample technique, heads of 210 households (30 by 7) were interviewed, and six LLINs were collected and later tested for efficacy. In the second step, eight focus group discussion sessions were conducted to complement the results from the first step. RESULTS Results showed that the retention of LLINs was 92.9% one-and-half years after distribution. Some bed nets were distributed against a price. Utilization of bed nets by children under five years of age and by pregnant women was found to be 55% and 42.1% respectively. For the bioassay efficacy tests, mean knock down after 60 minutes was 91.1%, while mortality after 24 hours was 99.4%. CONCLUSION LLINs (Olysettrade mark) were efficacious at the time of the study. People appreciated the usefulness but were not fully aware of their importance and were not motivated enough to use them. The retention of the bed nets was quite high but the utilization of the nets needs more focus from the National Malaria Control Programme. Bed net distribution activities should be accompanied by wide health education campaigns and followed up with tracking surveys to evaluate their effectiveness.
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Affiliation(s)
| | - Elfatih M Malik
- Communicable Disease Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Somia I Okoued
- Communicable Disease Control Directorate, State Ministry of Health, Kassala, Sudan
| | - Elsadig M Eltayeb
- Expanded Programme of Immunization, Federal Ministry of Health, Khartoum, Sudan
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Elkhalifa SM, Mustafan IO, Wais M, Malik EM. Malaria control in an urban area: a success story from Khartoum, 1995-2004. East Mediterr Health J 2008; 14:206-215. [PMID: 18557470] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Khartoum is an urban area with low malaria transmission. Early control efforts were successful in reducing the risk but malaria has resurged in recent years. In 2002, the Government of Sudan, with support of the World Health Organization, embarked on an initiative aimed at freeing Khartoum of malaria. The initiative's prevention strategy has focused on larval control interventions. The results indicate a significant reduction in malaria prevalence, confirmed and clinically diagnosed malaria cases among outpatient attendance and the number of malaria-associated deaths. It is proposed information be collected on parity rates and that a sub-sample of the adult mosquito collections be subjected to ELISA or PCR for identification of malaria parasite infections in mosquitoes in areas showing active foci.
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Affiliation(s)
- S M Elkhalifa
- State Malaria Control Programme, Khartoum State, Khartoum, Sudan
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Abdalla SI, Malik EM, Ali KM. The burden of malaria in Sudan: incidence, mortality and disability--adjusted life--years. Malar J 2007; 6:97. [PMID: 17662153 PMCID: PMC1995207 DOI: 10.1186/1475-2875-6-97] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [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: 04/19/2007] [Accepted: 07/28/2007] [Indexed: 12/03/2022] Open
Abstract
Background Estimating the burden of malaria in Sudan is important for evidence-based planning of malaria control. Estimates of malaria burden in terms of DALYs (Disability Adjusted Life Years) were not developed locally. This study synthesized information from different sources to calculate malaria incidence, mortality and DALYs lost in Sudan in 2002. Methods A search for local studies and reports providing epidemiological data on malaria in Sudan was conducted. Preliminary estimates of incidence rate, case fatality rate and mortality rate were developed from the data found. The preliminary estimates were processed in the disease modelling computer software, DisMod II, to produce internally consistent mortality and incidence rates, which were used to calculate DALYs lost due to malaria. Results Malaria incidence in Sudan was estimated to be about 9 million episodes in 2002 and the number of deaths due to malaria was about 44,000. 2,877,000 DALYs were lost in Sudan in 2002 due to malaria mortality, episodes, anaemia and neurological sequelae. Children under five years of age had the highest burden. Males had the highest incidence and mortality, but females lost more DALYs. Conclusion Formal health system data underestimated malaria burden. The burden estimates can be useful in informing decision making, although uncertainty around them needs to be quantified. Epidemiological research is needed to fill data gaps and update the estimates.
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Affiliation(s)
- Safa I Abdalla
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Elfatih M Malik
- National Malaria Control Programme, Federal Ministry of Health, Khartoum, Sudan
| | - Kamil M Ali
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Ibrahium AM, Kheir MM, Osman ME, Khalil IF, Alifrangis M, Elmardi KA, Malik EM, Adam I. Efficacies of artesunate plus either sulfadoxine-pyrimethamine or amodiaquine, for the treatment of uncomplicated, Plasmodium falciparum malaria in eastern Sudan. Ann Trop Med Parasitol 2007; 101:15-21. [PMID: 17244406 DOI: 10.1179/136485907x156924] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Artemisinin-based combination therapy (ACT) is increasingly being adopted as the first-line treatment for malaria in sub-Saharan Africa. In September-November 2005, in New Halfa, eastern Sudan, the efficacy of artesunate-sulfadoxine-pyrimethamine (AS-SP) for the treatment of uncomplicated, Plasmodium falciparum was compared with that of artesunate-amodiaquine (AS-AQ). The artesunate was given at 4 mg/kg. day on days 0-2, with either a single dose of SP (25 mg sulfadoxine/kg) given on day 0, or AQ, at 10 mg/kg. day, given on days 0-2. Eighty-two of the patients treated (40 given AS-SP and 42 given AS-AQ) completed the 28 days of follow-up. On day 3 all the patients were afebrile and only one patient, in the AS-AQ group, was still parasitaemic. AS-SP appeared slightly more efficacious than AS-AQ but the differences were not statistically significant. Only one patient (2.5%) given AS-SP but four (9.5%) of those given AS-AQ were initially considered to be late treatment and parasitological failures, with all other patients showing an adequate treatment response. The PCR-corrected frequencies of cure were 97.5% for AS-SP and 95.2% for AS-AQ (P>0.05). No gametocytaemias were observed during the follow-up and, although mild adverse effects (nausea, vomiting, abdominal pain, dizziness and/or rash) were detected in 14 patients, they occurred at the same frequency in each treatment arm. It therefore appears that the AS-SP and AS-AQ combinations were both effective and safe for the treatment of uncomplicated, P. falciparum malaria in eastern Sudan.
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Affiliation(s)
- A M Ibrahium
- Faculty of Medicine, University of Khartoum, P.O. Box 102, Khartoum, Sudan
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Salah MT, Adam I, Malik EM. Care-seeking behavior for Fever in children under five years in an urban area in eastern Sudan. J Family Community Med 2007; 14:25-8. [PMID: 23012140 PMCID: PMC3410115] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Early diagnosis and prompt treatment are the basic elements of malaria control. The mother's perceptions about the cause of the fever, duration of sickness, accessibility and the anticipated cost of treatment, frequent use of traditional medicine, and judgement of the severity of the fever are the most important determinants for effective treatment of fever in children. SUBJECTS AND METHODS This cross-sectional study was conducted in Kassala city, in Eastern Sudan to investigate the caregivers' care-seeking behaviour related to fever among children < 5 years. Data was collected by trained social workers using a structured questionnaire and was analysed by means of SPSS. RESULTS Three-hundred fifty housewives were interviewed. The majority (85.7%) had had at least basic education and 244 (69.7%) were full-time housewives. A total of 237 (67.7%) mothers were found to have adequate knowledge about malaria. Malaria was perceived by only 143 (40.9%) of the respondents as a cause of low grade fever and this percentage was almost doubled in the case of high fever. There were similar findings with respect to the selection of treatment sources and the use of antimalarial drugs. High fever urged 319 (91.1%) to seek advice from health workers and 281 (80.3%) to take drugs other than chloroquine. CONCLUSION The intensity of fever (low/ high) governed the respondent's perceived causes of fever, decision about available treatment options and the type of antimalarial drugs they used. Health education programmes should focus on the importance of seeking early advice, compliance with prescribed treatment and awareness and handling of danger signs before presenting at health facility.
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Affiliation(s)
| | - Ishag Adam
- Faculty of Medicine, University of Khartoum and The Academy of Medical Sciences and Technology, Sudan
| | - Elfatih M. Malik
- National Malaria Control Programme, Federal Ministry of Health, Sudan,Correspondence to: Dr. Elfatih M. Malik, National Malaria Control Programme, Federal Ministry of Health, P.O. Box 1204, Khartoum, Sudan E-mail:
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Malik EM, Mohamed TA, Elmardi KA, Mowien RM, Elhassan AH, Elamin SB, Mannan AA, Ahmed ES. From chloroquine to artemisinin-based combination therapy: the Sudanese experience. Malar J 2006; 5:65. [PMID: 16879742 PMCID: PMC1590042 DOI: 10.1186/1475-2875-5-65] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [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: 03/05/2006] [Accepted: 07/31/2006] [Indexed: 11/18/2022] Open
Abstract
Background In Sudan, chloroquine (CQ) remains the most frequently used drug for falciparum malaria for more than 40 years. The change to artemisinin-based combination therapy (ACT) was initiated in 2004 using the co-blister of artesunate + sulfadoxine/pyrimethamine (AS+SP) and artemether + lumefantrine (ART+LUM), as first- and second-line, respectively. This article describes the evidence-base, the process for policy change and it reflects the experience of one year implementation. Relevant published and unpublished documents were reviewed. Data and information obtained were compiled into a structured format. Case description Sudan has used evidence to update its malaria treatment to ACTs. The country moved without interim period and proceeded with country-wide implementation instead of a phased introduction of the new policy. The involvement of care providers and key stakeholders in a form of a technical advisory committee is considered the key issue in the process. Development and distribution of guidelines, training of care providers, communication to the public and provision of drugs were given great consideration. To ensure presence of high quality drugs, a system for post-marketing drugs surveillance was established. Currently, ACTs are chargeable and chiefly available in urban areas. With the input from the Global Fund to fight AIDs, Tuberculosis and Malaria, AS+SP is now available free of charge in 10 states. Conclusion Implementation of the new policy is affected by the limited availability of the drugs, their high cost and limited pre-qualified manufacturers. Substantial funding needs to be mobilized by all partners to increase patients' access for this life-saving intervention.
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Affiliation(s)
- EM Malik
- National Malaria Control Programme, P.O. Box: 1204, Tel +249 183 776809, Khartoum, Sudan
| | - TA Mohamed
- National Malaria Control Programme, P.O. Box: 1204, Tel +249 183 776809, Khartoum, Sudan
| | - KA Elmardi
- National Malaria Control Programme, P.O. Box: 1204, Tel +249 183 776809, Khartoum, Sudan
| | - RM Mowien
- National Malaria Control Programme, P.O. Box: 1204, Tel +249 183 776809, Khartoum, Sudan
| | - AH Elhassan
- National Malaria Control Programme, P.O. Box: 1204, Tel +249 183 776809, Khartoum, Sudan
| | - SB Elamin
- National Malaria Control Programme, P.O. Box: 1204, Tel +249 183 776809, Khartoum, Sudan
| | - AA Mannan
- National Malaria Control Programme, P.O. Box: 1204, Tel +249 183 776809, Khartoum, Sudan
| | - ES Ahmed
- College of Medicine, University of Juba, Sudan
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Elamin SB, Malik EM, Abdelgadir T, Khamiss AH, Mohammed MM, Ahmed ES, Adam I. Artesunate plus sulfadoxine-pyrimethamine for treatment of uncomplicated Plasmodium falciparum malaria in Sudan. Malar J 2005; 4:41. [PMID: 16162284 PMCID: PMC1242247 DOI: 10.1186/1475-2875-4-41] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [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: 06/19/2005] [Accepted: 09/14/2005] [Indexed: 11/10/2022] Open
Abstract
Background Early diagnosis and effective treatment with an appropriate drug form the main components of the World Health Organization's strategy to reduce malaria related mortality. The few available drugs might be safeguarded if combined with artesunate. The addition of artesunate to a standard antimalarial treatment substantially reduces treatment failure, recrudescence and gametocyte carriage. Methods During late 2004, the efficacy of artesunate (4 mg/kg. day, on days 0–2) plus sulfadoxine-pyrimethamine (25 mg/kg, on day 0) for the treatment of uncomplicated Plasmodium falciparum malaria was investigated in four sentinel areas in Sudan, with different malaria transmission (Damazin, Kassala, Kosti, and Malakal). Results Two hundreds and sixty-nine patients completed the 28-day follow-up. On day one, 60 (22.3%) patients were febrile and 15 (5.5%) patients were parasitaemic. On day three, all the patients were afebrile and aparasitaemic. While two patients (0.7%, Kassala) showed late Clinical and Parasitological Failures, the rest (99.3%) of the patients demonstrated Adequate Clinical and Parasitological Response. A gametocytaemia were detected during the follow-up in one patient (0.37%, Kassala). Adverse drug effects were detected in 32 (11.9%) patients Conclusion The study showed that AS plus SP is an effective, safe drug in the treatment of uncomplicated P. falciparum malaria in Sudan.
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Affiliation(s)
- Sakina B Elamin
- NationalMalaria Control, Ministry of Health, Khartoum, Sudan
| | - Elfatih M Malik
- NationalMalaria Control, Ministry of Health, Khartoum, Sudan
| | | | - Ammar H Khamiss
- Albayan College for Science, Sudan University for Science and Technology, Sudan
| | | | | | - Ishag Adam
- Faculty of Medicine University of Khartoum, The Academy of Medical Sciences and Technology, Department of Obstetrics & Gynecology, Faculty of Medicine University of Khartoum, P. O. Box 102, Khartoum, Sudan
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Malik EM, Eltahir HG, Ahmed ES. Clinical and laboratory aspects of malaria among children with fever in a low transmission area of Sudan. East Mediterr Health J 2005; 11:753-61. [PMID: 16700392] [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] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
A cross-sectional study explored the clinical and laboratory aspects of malaria among children presenting with fever to 2 paediatric hospitals in Khartoum state during the low transmission season. Out of 655 febrile patients, 35.9% were recorded as having malaria based on hospital laboratory results. However, re-examination of slides at the National Malaria Control Programme referral laboratory confirmed malaria in only 32.8% of those diagnosed with malaria at hospital level. Analysis of symptoms and signs revealed great variability in clinical presentation. Although some findings were associated with malaria, developing a sensitive clinical algorithm was difficult. Further investment is needed to improve microscopic diagnosis facilities in local hospitals to overcome the problem of over-diagnosis of malaria.
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Affiliation(s)
- E M Malik
- National Malaria Control Programme, Khartoum, Sudan.
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Salah MT, Mohammed MM, Himeidan YE, Malik EM, Elbashir MI, Adam I. A randomized comparison of sulphadoxine-pyrimethamine and combination of sulphadoxine pyrimethamine with chloroquine in the treatment of uncomplicated falciparum malaria in Eastern Sudan. Saudi Med J 2005; 26:147-8. [PMID: 15756376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
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Malik EM, Nour SM, Hamid IK, Elmardi KA, Mohamed TA, Ahmed ES. From home to hospital: beliefs and practices related to severe malaria in Sudan. J Family Community Med 2005; 12:85-90. [PMID: 23012081 PMCID: PMC3410127] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
PURPOSE To develop effective measures of reducing the proportion of severe malaria presentation and deaths attributed to malaria, an adequate understanding of beliefs and practices in households and at the level of primary health care is necessary. The objectives of this paper are to explore beliefs and practices related to the management of severe malaria, and to identify barriers to early consultation. SUBJECTS AND METHODS A cross-sectional hospital-based study was conducted in five hospitals in Sudan in 2003. All malaria cases admitted, or their care givers were interviewed by a medical doctor using pre-coded and pre-tested questionnaire. RESULTS Enrolled in this study, were a total of 482 patients, 62.9% of whom were female. Almost 75.0% of the respondents perceived that malaria had serious complications. Anaemia as a complication was mentioned by 115 (32.0%) respondents. A total of 418 (86.7%) patients sought advice from health personnel. Of these, 305 (73.0%) did so more than 24 hours after the onset of the illness. Distance, lack of money, unavailability of transportation or all were the reasons mentioned as barriers to seeking care at hospitals. More than 70.0% of the patients received anti-malarial drugs before admission with a clear preference for the injectable form of chloroquine. Multivariate analysis revealed that "cost of services" and "not seeking help from health personnel" were the determinants for late consultation. CONCLUSION The study revealed that late consultation was a feature in many parts of Sudan. Among the barriers mentioned by the respondents, the cost of services was of the greatest concern.
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Affiliation(s)
- Elfatih M. Malik
- National Malaria Control Program, Federal Ministry of Health, Sudan,Correspondence to: Dr. Elfatih M. Malik, National Roll Back Malaria Coordinator, Federal Ministry of Health, P.O. Box 1204, Khartoum, Sudan E-mail: /
| | - Sabah M. Nour
- National Malaria Control Program, Federal Ministry of Health, Sudan
| | - Inas K. Hamid
- National Malaria Control Program, Federal Ministry of Health, Sudan
| | | | - Tarig A. Mohamed
- National Malaria Control Program, Federal Ministry of Health, Sudan
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Malik EM, Ahmed ES, Elkhalifa SM, Hussein MA, Sulieman AMN. Stratification of Khartoum urban area by the risk of malaria transmission. East Mediterr Health J 2003; 9:559-69. [PMID: 15748053] [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] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
A cross-sectional community-based study was carried out in Khartoum urban area aimed at stratifying the area by risk of malaria transmission. Two thousand households (8092 individuals) were surveyed during the cold, dry and rainy seasons of 2002. Households with screened windows, using bednets or both were 5.0% (95% CI: 4.1-6.0), 10.9% (95% CI: 9.5-12.3) and 1.8% (95% CI: 1.2-2.5) respectively. Access to health services was high. Only 3.8% (95% CI: 2.9-4.7) of households kept antimalarial drugs at home. The parasite rate, spleen rate and fever rate were very low (0.21%, 0.17% and 0.97% respectively). Overall, people in Greater Bahry suffer a greater burden of malaria than those in Greater Khartoum or Greater Omdurman, with a seasonal pattern of transmission.
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Affiliation(s)
- E M Malik
- National Malaria, Schistosomiasis and Lieshmaniasis Control Programme, Federal Ministry of Health, Khartoum State, Sudan
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