Broad antibody and T cell responses to Ebola, Sudan, and Bundibugyo ebolaviruses using mono- and multi-valent adjuvanted glycoprotein vaccines

Currently, there are two approved vaccine regimens designed to prevent Ebola virus (EBOV) disease (EVD). Both are virus-vectored, and concerns about cold-chain storage and pre-existing immunity to the vectors warrant investigating additional vaccine strategies. Here, we have explored the utility of adjuvanted recombinant glycoproteins (GPs) from ebolaviruses Zaire (EBOV), Sudan (SUDV), and Bundibugyo (BDBV) for inducing antibody (Ab) and T cell cross-reactivity. Glycoproteins expressed in insect cells were administered to C57BL/6 mice as free protein or bound to the surface of liposomes, and formulated with toll-like receptor agonists CpG and MPLA (agonists for TLR 9 and 4, respectively), with or without the emulsions AddaVax or TiterMax. The magnitude of Ab cross-reactivity in binding and neutralization assays, and T cell cross-reactivity in antigen recall assays, correlated with phylogenetic relatedness. While most adjuvants screened induced IgG responses, a combination of CpG, MPLA and AddaVax emulsion ("IVAX-1") was the most potent and polarized in an IgG2c (Th1) direction. Breadth was also achieved by combining GPs into a trivalent (Tri-GP) cocktail with IVAX-1, which did not compromise antibody responses to individual components in binding and neutralizing assays. Th1 signature cytokines in T cell recall assays were undetectable after Tri-GP/IVAX-1 administration, despite a robust IgG2c response, although administration of Tri-GP on lipid nanoparticles in IVAX-1 elevated Th1 cytokines to detectable levels. Overall, the data indicate an adjuvanted trivalent recombinant GP approach may represent a path toward a broadly reactive, deployable vaccine against EVD.

Development of Flood Preparedness Behavior Scale: A Methodological Validity and Reliability Study

BACKGROUND

Floods are the most frequent natural disasters with a significant share of their mortality. Preparedness is capable of decreasing the mortality of floods by at least 50%. This paper aims to present the psychometric properties of a scale developed to evaluate the behavior of preparedness to floods in Sudan and similar settings.

METHODS

In this methodological scale development study, experts assessed the content validity of the items of the developed scale. Data were collected from key persons of 413 households living in neighborhoods affected by the 2018 floods in Kassala City in Sudan. A pre-tested questionnaire of sociodemographic data and the Flood Preparedness Behavior Scale (FPBS) were distributed to the participants' houses and recollected. Construct validity of the scale was checked using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency of the scale was checked using Cronbach's alpha. Test-retest reliability was assessed by Pearson's correlation coefficient. Item analyses and tests of significance of the difference in the mean scores of the highest and lowest score groups were carried out to ensure discriminatory power of the scale items.

RESULTS

Experts agreed on the scale items. Construct validity of the scale was achieved using EFA by removing 34 items and retaining 25 items that were structured in three factors, named as: measures to be done before, during, and after a flood. Confirmatory factor analysis confirmed the construct obtained by EFA. The loadings of the items on their factors in both EFA and CFA were all > 0.3 with significant associations and acceptable fit indices obtained from CFA. The three factors were found to be reliable in terms of internal consistency (Cronbach's alpha coefficients for all factors were > 0.7) and test-retest reliability coefficient. In item analysis, the corrected total item correlations for all the items were > 0.3, and significant differences in the means of the highest and lowest score groups indicated good item discrimination power.

CONCLUSION

The developed 25 items scale is an instrument which produces valid and reliable measures of preparedness behavior for floods in Sudan and similar settings.

Aflatoxin profiles of Aspergillus flavus isolates in Sudanese fungal rhinosinusitis

Aspergillus flavus is a commonly encountered pathogen responsible for fungal rhinosinusitis (FRS) in arid regions. The species is known to produce aflatoxins, posing a significant risk to human health. This study aimed to investigate the aflatoxin profiles of A. flavus isolates causing FRS in Sudan. A total of 93 clinical and 34 environmental A. flavus isolates were studied. Aflatoxin profiles were evaluated by phenotypic (thin-layer and high-performance chromatography) and genotypic methods at various temperatures and substrates. Gene expression of aflD and aflR was also analyzed. A total of 42/93 (45%) isolates were positive for aflatoxin B1 and AFB2 by HPLC. When the incubation temperature changed from 28°C to 36°C, the number of positive isolates decreased to 41% (38/93). Genetic analysis revealed that 85% (79/93) of clinical isolates possessed all seven aflatoxin biosynthesis-associated genes, while 27% (14/51) of non-producing isolates lacked specific genes (aflD/aflR/aflS). Mutations were observed in aflS and aflR genes across both aflatoxin-producers and non-producers. Gene expression of aflD and aflR showed the highest expression between the 4th and 6th days of incubation on the Sabouraud medium and on the 9th day of incubation on the RPMI (Roswell Park Memorial Institute) medium. Aspergillus flavus clinical isolates demonstrated aflatoxigenic capabilities, influenced by incubation temperature and substrate. Dynamic aflD and aflR gene expression patterns over time enriched our understanding of aflatoxin production regulation. The overall findings underscored the health risks of Sudanese patients infected by this species, emphasizing the importance of monitoring aflatoxin exposure.

Humanitarian-Development Nexus: strengthening health system preparedness, response and resilience capacities to address COVID-19 in Sudan-case study of repositioning external assistance model and focus

The advent of the COVID-19 pandemic and the establishment of a new transitional government in Sudan with rejuvenated relations with the international community paved the way for external assistance to the EU COVID-19 response project, a project with a pioneering design within the region. The project sought to operationalize the humanitarian-development-peace nexus, perceiving the nexus as a continuum rather than sequential due to the protracted nature of emergencies in Sudan and their multiplicity and contextual complexity. It went further into enhancing peace through engaging with conflict and post-conflict-affected states and communities and empowering local actors. Learning from this experience, external assistance models to low- or middle-income countries (LMICs) should apply principles of flexibility and adaptability, while maintaining trust through transparency in exchange, to ensure sustainable and responsive action to domestic needs within changing contexts. Careful selection and diverse project team skills, early and continuous engagement with stakeholders, and robust planning, monitoring and evaluation processes were the project highlights. Yet, the challenges of political turmoil, changing Ministry of Health leadership, competing priorities and inactive coordination mechanisms had to be dealt with. While applying such an approach of a health system lens to health emergencies in LMICs is thought to be a success factor in this case, more robust technical guidance to the nexus implementation is crucial and can be best attained through encouraging further case reports analysing context-specific practices.

Problems with gestational age estimation by last menstrual period and ultrasound among late antenatal care attendant women in a low-resource setting in Africa, Sudan

INTRODUCTION

Accurate estimation of gestational age is essential to interpret and manage several maternal and perinatal indicators. Last menstrual period (LMP) and ultrasound are the two most common methods used for estimating gestational age. There are few published studies comparing the use of LMP and ultrasound in Sub-Saharan Africa to estimate gestational age and no studies on this topic in Sudan.

MATERIAL AND METHODS

A cross-sectional study was conducted in Gadarif Maternity Hospital in Sudan during November through December 2022. Sociodemographic information was collected, and the date of the first day of each participant's LMP was recorded. Ultrasound examinations were performed (measuring crown-rump length in early pregnancy and biparietal diameter and femur length in late pregnancy) using a 3.5-MHz electronic convex sector probe. Bland-Altman analysis was performed.

RESULTS

Four-hundred seventy-six pregnant women were enrolled. The median (interquartile range [IQR]) age and gravidity was 24.0 (20.0‒29.0) years and 2 (1‒4), respectively. There was a strong positive correlation between gestational age determined by LMP and ultrasound (r = 0.921, P < 0.001). The mean gestational age estimate according to LMP was higher than that determined by ultrasound, with a difference, on average, of 0.01 week (95% confidence interval [CI]: - 0.05, 0.07). Bland-Altman analysis showed the limits of agreement varied from - 1.36 to 1.38 weeks. A linear regression analysis showed proportional bias. The coefficient of difference of the mean was equal to 0.26 (95% CI: 0.01, 0.03, P < 0.001).

CONCLUSION

Based on our results, there was a bias in LMP-based gestational age estimates when compared with the reproducible method (ultrasound).

Examining the use, confidence, and barriers to follow Advanced Life Support in Obstetrics (ALSO) course guides in managing obstetric emergencies in Sudan

BACKGROUND

The Advanced Life Support in Obstetrics (ALSO) course is a globally recognized interprofessional training program designed to assist healthcare professionals in acquiring and sustaining the necessary knowledge and skills to handle obstetric emergencies effectively. This survey aimed to assess the use, barriers, and confidence in using the ALSO course guidelines in managing obstetric emergencies in Sudan.

METHODS

This descriptive cross-sectional study involved 103 physicians from the Sudan ALSO group in Sudan. A structured, close-ended questionnaire was distributed electronically to the participants. Data analysis was conducted using Statistical Package of Social Sciences Software version 26.

RESULTS

More than half of the participants were specialists (54.4%). Although all respondents claimed to adhere to the ALSO guidelines for managing shoulder dystocia, a lower percentage followed them for neonatal resuscitation (75.0%) and maternal venous thrombosis management (68.9%). Only 62.1% of participants felt confident performing neonatal resuscitation. The main barriers to implementing the ALSO course guidelines were the respondents' preference for other guidelines and their belief that the guidelines were not applicable in their specific settings.

CONCLUSION

The majority of participants displayed a high level of confidence, indicating a positive perception of the guide's effectiveness. However, there is room for improvement, particularly in areas such as neonatal resuscitation and forceps-assisted births, where confidence levels were lower. Addressing barriers, including the preference for other guidelines and the applicability of the guide in specific settings, is crucial to ensure widespread adoption. Refresher training programs, contextual adaptations, and the integration of guidelines may help overcome these barriers and enhance the overall implementation of the ALSO guide in managing obstetric emergencies in Sudan.

Direct evidence of plant consumption in Neolithic Eastern Sudan from dental calculus analysis

The Neolithic communities of Eastern Sudan combined intensive pastoralism with plant exploitation as their main subsistence strategies. However, to date, it remains unclear which plant species were part of the human diet during the Neolithic. This contribution presents direct data on plant consumption in Eastern Sudan from the Early to Late Neolithic, obtained through the analysis of microdebris inclusions in the dental calculus of 37 individuals, integrated by dentoalveolar pathology analysis of 78 individuals, from the sites UA53 (4th millennium BCE) and Mahal Teglinos (3rd-2nd millennium BCE), located in the Gash Delta/Kassala region. Dental calculus inclusions indicate a diverse intake of cereals, legumes, and tubers during the Middle Neolithic, thus supporting the hypothesis of high reliance on plant resources. Dentoalveolar pathologies, possibly related to the consumption of carbohydrate-rich foods, have also been recorded. For the Late Neolithic, consistent with the shift towards aridity that occurred in the Middle/Late Holocene, dental calculus exclusively indicates the exploitation of sorghum and tubers-species well adapted to arid conditions-showing how the Neolithic communities modified their subsistence in response to environmental changes. Evidence of plant processing techniques, such as cooking/heating, was also revealed from the dental calculus analysis.

Exploring genetic diversity and variation of Ovar-DRB1 gene in Sudan Desert Sheep using targeted next-generation sequencing

INTRODUCTION

The Ovar-DRB1 gene, a crucial element of the Major Histocompatibility Complex (MHC) Class II region, initiates adaptive immunity by presenting antigens to T-cells. Genetic diversity in sheep, particularly in MHC Class II genes like Ovar-DRB1, directly influences the specturm of presented antigens impacting immune responses and disease susceptability. Understanding the allelic diversity of Ovar-DRB1 gene in Sudan Desert Sheep (SDS) is essential for uncovering the genetic basis of immune responses and disease resistance, given the the breeds significance in Sudan's unique environment.

METHODS

Utilizing Targeted Next-Generation Sequencing (NGS) we explore allelic diversity in Ovar-DRB1 gene within SDS. Successfully ampliying and and sequencing the second exon of this gene in 288 SDS samples representing six breeds provided a comprehensive allelic profile, enabling a detalied examination of the gene's genetic makeup.

RESULTS

We identifed forty-six alleles, including four previously unreported, enrichness the genetic diversity of SDS breeds. These alleles exhibiting non-uniform distribution, varying frequencies across breeds, indicating a breed-specific genetic landscape. Certain alleles, known and novel, show higher frequencies in specific populations, suggesting potential associations with adaptive immune responses. Identifying these alleles sets the stage for investigating their functional roles and implications for disease resistance. Genetic differentiation among SDS breeds, as indicated by FST values and clustering analyses, highlights a unique genetic makeup shaped by geographic and historical factors. These differentiation patterns among SDS breeds have broader implications for breed conservation and targeted breeding to enhance disease resistance in specific populations.

CONCLUSION

This study unveils Ovar-DRB1 gene allelic diversity in SDS breeds through targeted NGS and genetic analyses, revealing new alleles that underscore the breeds' unique genetic profile. Insights into the genetic factors governing immune responses and disease resistance emerge, promising for optimization of breeding strategies for enhanced livestock health in Sudan's unique environment.

Population genetic structure of Aedes aegypti subspecies in selected geographical locations in Sudan

Although knowledge of the composition and genetic diversity of disease vectors is important for their management, this is limiting in many instances. In this study, the population structure and phylogenetic relationship of the two Aedes aegypti subspecies namely Aedes aegypti aegypti (Aaa) and Aedes aegypti formosus (Aaf) in eight geographical areas in Sudan were analyzed using seven microsatellite markers. Hardy-Weinberg Equilibrium (HWE) for the two subspecies revealed that Aaa deviated from HWE among the seven microsatellite loci, while Aaf exhibited departure in five loci and no departure in two loci (A10 and M201). The Factorial Correspondence Analysis (FCA) plots revealed that the Aaa populations from Port Sudan, Tokar, and Kassala clustered together (which is consistent with the unrooted phylogenetic tree), Aaf from Fasher and Nyala populations clustered together, and Gezira, Kadugli, and Junaynah populations also clustered together. The Bayesian cluster analysis structured the populations into two groups suggesting two genetically distinct groups (subspecies). Isolation by distance test revealed a moderate to strong significant correlation between geographical distance and genetic variations (p = 0.003, r = 0.391). The migration network created using divMigrate demonstrated that migration and gene exchange between subspecies populations appear to occur based on their geographical proximity. The genetic structure of the Ae. aegypti subspecies population and the gene flow among them, which may be interpreted as the mosquito vector's capacity for dispersal, were revealed in this study. These findings will help in the improvement of dengue epidemiology research including information on the identity of the target vector/subspecies and the arboviruses vector surveillance program.

Thermostable bivalent filovirus vaccine protects against severe and lethal Sudan ebolavirus and marburgvirus infection

Although two vaccines for Zaire ebolavirus (EBOV) have been licensed and deployed successfully to combat recurring outbreaks of Ebolavirus Disease in West Africa, there are no vaccines for two other highly pathogenic members of the Filoviridae, Sudan ebolavirus (SUDV) and Marburg marburgvirus (MARV). The results described herein document the immunogenicity and protective efficacy in cynomolgus macaques of a single-vial, thermostabilized (lyophilized) monovalent (SUDV) and bivalent (SUDV & MARV) protein vaccines consisting of recombinant glycoproteins (GP) formulated with a clinical-grade oil-in-water nanoemulsion adjuvant (CoVaccine HT™). Lyophilized formulations of the vaccines were reconstituted with Water for Injection and used to immunize groups of cynomolgus macaques before challenge with a lethal dose of a human SUDV or MARV isolate. Sera collected after each of the three immunizations showed near maximal GP-binding IgG concentrations starting as early as the second dose. Most importantly, the vaccine candidates (monovalent or bivalent) provided 100% protection against severe and lethal filovirus disease after either SUDV or MARV infection. Although mild, subclinical infection was observed in a few macaques, all vaccinated animals remained healthy and survived the filovirus challenge. These results demonstrate the value that thermostabilized protein vaccines could provide for addressing an important gap in preparedness for future filovirus outbreaks.

Tuberculosis in Sudan: systematic review and meta analysis

Every year, 10 million people fall ill with tuberculosis (TB). Despite being a preventable and curable disease, 1.5 million people die from TB each year -making it the world's top infectious disease. TB is the leading cause of death of people with HIV and also a major contributor to antimicrobial resistance. Its presumed that TB was the cause of 1% of the total deaths among inpatients in Sudan in 2017. The current study is aimed to provide pooled prevalence of Mycobacterium tuberculosis among Sudanese as well as to determine any socio-cultural risk factors associated. A systematic review of the literature was conducted and regulated in accordance with the PRISMA Statement. After abstract and full text screening only twenty-six articles met our inclusion criteria and passed the quality assessment procedure. Pulmonary tuberculosis prevalence was assessed in sixteen included studies among participants from Khartoum, Gezira, Kassala, Blue Nile, River Nile, White Nile, Gadarif, Red sea, North Kordofan, Northern State, Sennar and West Darfur States, representing a total sample size of 11,253 participants of suspected individuals such as febrile outpatients, TB patients' contacts and other groups such as HIV/AIDS patients, hemodialysis patients, School adolescents as well as pregnant women. The pooled prevalence was 30.72% [CI: 30.64, 30.81]. Moreover, Khartoum State recorded the highest pooled prevalence as 41.86% [CI: 14.69, 69.02] based on a total sample size of 2,737 participants. Furthermore, male gender and rural residence were found to be significantly associated with TB infection. Further research with larger sample sizes targeting prevalence and risk factors of TB among Sudanese population is needed to be conducted.

Natural Radioactivity of Granitic Rocks and Their Health Risk around Ingesana Mountains, Sudan

ABSTRACT

This work was carried out mainly to analyze radioactive elements 40 K, 232 Th, and 226 Ra and non-radioactive elements in some granitic rocks and study their health risk for humans and non-humans. Radioisotope activity was evaluated using a high-purity germanium (HPGe) detector, and various radiological hazard indices were calculated. We also measured some non-radioactive elements using x-ray fluorescence analysis and performed Pearson correlation analysis to examine the relationships between the radionuclides and the non-radioactive elements. Furthermore, we used the ERICA software to estimate the total dose rate per organism for some non-human biota. The means of 226 Ra, 232 Th, and 40 K are 25.13 ± 5.22 Bq kg -1 , 29.01 ± 6.95 Bq kg -1 , and 323.07 ± 97.83 Bq kg -1 , respectively. Hence, 226 Ra, 232 Th, and 40 K radioactivities were lower than the worldwide average limits. The 226 Ra, 232 Th, and 40 K levels were under the global average values. The hazardous radiometric variables were computed, and the findings observed that the mean absorbed dosage was 23.48 ± 7.36 nGy h -1 , the yearly effective dose rate was 29.82 ± 10.46 μSv y -1 , and the radium equivalent activity was 88.88 ± 18.64 Bq kg -1 . The average dose and yearly effective dose rates were lower than the global average absorbed dose rate of 60 nGy h -1 and the ICRP standard of 1.0 mSv y -1 . The results of Ra-equivalent activity were lower than the recommended maximum criterion for building materials limit of Ra-equivalent activity (370 Bq kg -1 ) proposed by UNSCEAR. Tests of Pearson correlation coefficients indicate a substantial positive relationship between 226 Ra and 232 Th and a modest correlation between 226 Ra and 40 K. Meanwhile, no association between 226 Ra and 40 K and non-radioactive components has been identified. Thorium-232 exhibits a moderately favorable connection with Ti, Fe, and Ni. The estimated total dose rate per organism for the studied non-human is less than the ambient dose rate. However, the total dose rate for small burrowing mammals and reptiles exceeds the background exposure rate. In accordance with the findings, granite rocks may be safe to use as construction materials and pose no threat to human health.

Physician experiences with teleconsultations amidst conflict in Sudan

The current conflict in Sudan severely hinders the accessibility of health services across the country. To address this, several initiatives were proposed including offering services using teleconsultations. This study aimed to assess Sudanese doctors' teleconsultation experience, perception, and concerns during the recent conflict. This cross-sectional survey focused on Sudanese medical officers, residents, specialists, and consultants living inside or outside the country having a practice license from the Sudan Medical Council and conducting teleconsultations with Sudanese patients during the conflict period. The questionnaire was distributed to personal and professional contacts and via social media platforms in the English language among doctors who provided teleconsultation during the conflict. Data analysis was performed using the Statistical Package for Social Sciences software version 26. The study enrolled 2463 clinicians from 17 different specialties, and females represented more than half the sample (56.8%). Internal medicine was the most frequent specialty (36.1%) and the majority (68.7%) of clinicians had less than 5 years of work experience. Voice call was the most frequent platform (50.1%) used for teleconsultation during the conflict and had the highest convenience score (p < 0.01), whereas messaging platforms had the lowest score. Most clinicians (73.3%) agreed that teleconsultations created a trusted patient-physician relationship and provided good-quality care (61.8%). However, 85.1% highlighted the importance of physical touch in medical practice. Clinicians were concerned that incomplete information (81.4%), missed diagnosis (76.8%), medicolegal problems (71.0%), and prescription errors (68.4%) could arise with teleconsultations. Most respondents (70.7%) emphasized the importance of continuing to offer teleconsultation even after the war abated. In conclusion, physicians who participated in the current study agreed that teleconsultation provided quality care even in this dire crisis in Sudan. Based on our study findings, we recommend upscaling telemedicine interventions including teleconsultations at the national level. This would require unified coordination efforts of a wide mix of stakeholders to address concerns identified in the current study.

Readiness of managers and health care workers for e-Health: a cross-sectional study in Khartoum primary health care centers, Sudan

BACKGROUND

e-Health is defined as "the use, in the health sector, of digital data- transmitted, stored and retrieved electronically-for clinical, educational and administrative purposes, both at the local site and at a distance". In Primary health care (PHC), the role of e-Health in promoting PHC systems defines its need to achieve the PHC aims. This literary work aims to study the readiness of managers and healthcare workers for e-Health at Khartoum state PHC centers.

METHODS

This was a facility-based cross-sectional study that took place between February and August 2022. A sample size of 327 was calculated, and multistage cluster sampling was used. A validated questionnaire was used, and the generated data were analyzed using the Statistical Package for Social Sciences (SPSS). Variables were described as n (%) and mean ± SD. Non-parametric tests and Spearman's correlation were used to investigate the association of readiness scores with different categorical and numerical variables, respectively. A standard multiple regression model was used to model the associations.

RESULTS

A total of 262 forms were completed. The overall readiness percentages were low for both managers (52.8%) and healthcare workers (55.3%). Factors associated with e-Health readiness included occupation, doctors' level of expertise, PHC center, and PHC center type.

CONCLUSIONS

This study reports low levels of e-Health readiness as reflected by managers and HCWs in Khartoum State PHC. Project planners need to be aware of the obstacles and threats faced by e-Health initiatives if they are not carefully planned, executed, and monitored. Special attention must be given to addressing health inequities and inequalities to ensure that these projects will contribute to fostering accessibility to health services and narrowing the digital divide.

Progress and challenges in implementing non-communicable disease policies in Sudan

Non-communicable diseases (NCD) pose a substantial global public health challenge, representing the leading cause of morbidity and mortality worldwide. This study investigates the progress and challenges in implementing NCD policies in Sudan. Document analysis following the ready your materials, extract data, analyse data and distil your findings (READ) approach, was utilized to review published literature and reports. Data from the NCD Progress Monitor showed that the percentage of NCD-related mortality had increased from 32% in 2015 to 54% in 2022. Sudan's progress in implementing NCD policies has been slow and challenging; eight of the 19 NCD target indicators had never been fully achieved, and only five targets were fully achieved in the year 2022. However, these figures may be underestimated due to the lack of robust NCD information systems. Like many countries, Sudan faces challenges in implementing NCD policies, particularly those targeting healthy diets, medications and data management systems. This may be linked to the prolonged history of conflict, shortage of trained health personnel, limited resources and lack of robust NCD surveillance systems in the country. The ongoing devastating war and destruction of the healthcare system infrastructure in Sudan further intensified these challenges. Prioritizing NCD policies and programmes during the anticipated post-conflict health system reforms is crucial for enhancing NCD prevention and outcomes in Sudan.

Knowledge, attitudes, and practices toward depression among physicians in Sudan

OBJECTIVES

The present study assessed the knowledge, attitudes, and practices of physicians in Sudan regarding depression.

METHODS

A cross-sectional study was conducted among physicians who practiced at public and private health facilities in Sudan in December of 2022. An online Google form questionnaire was administered that included knowledge, practice, and sociodemographic sections of the depression attitude questionnaire. The link to the questionnaire was sent to a convenience sample of physicians through a variety of methods including social media.

RESULTS

A total of 407 physicians completed the questionnaire. The majority (81.1%) had no formal training on mental health after graduation. A total of 43.0% reported difficulties in differentiating between unhappiness and clinical depression, although 48.6% indicated that they could differentiate between chemical and psychological causes for depression. Half (50.4%) did not feel comfortable dealing with depressed patients. Nearly 70% indicated that psychotherapy was a better option for treating these patients than antidepressants, but only 45.7% had any mental health services at their health facility. Physicians with prior mental health training (both pre- and postgraduate training) were more likely to provide treatment options for depressed patients.

CONCLUSIONS

This study indicates a moderate knowledge among physicians about depression, but also significant concern regarding poor attitudes and practices held toward the treatment of depression, and a lack of training. These findings highlight the urgent need for the training of physicians in the diagnosis and treatment of depression in Sudan.

Survival of women with cervical cancer in East Africa: a systematic review and meta-analysis

BACKGROUND

The prognosis for cervical cancer varies greatly between nations. The disparity in cancer survival rates within nations is largely a result of disparities in public knowledge, the accessibility of cancer services, diagnosis and treatment. The purpose of this systematic review and meta-analysis is to assess the survival rate and associated factors among cervical cancer patients in East Africa.

METHODS

Literature search was carried out using Google scholar, PubMed/Medline, Embase and CINHAL. Covidence, a web-based program, was used to import studies for review process. PRISMA guidelines were followed. A total of 110 abstracts were identified from electronic sources. There were five duplicate articles removed. We looked at 105 papers' abstracts and titles, and we excluded 78 of them because they did not fit our inclusion criteria. We conducted a full-text analysis of the remaining 27 papers, leaving out 14 researches that did not fit our inclusion requirements. For final review, 13 studies were included. Using the Joanna Briggs Institute (JBI) assessment checklist, methodological quality was evaluated.

RESULTS

The included articles were cohort studies. They were conducted in Ethiopia, Uganda, Zimbabwe, Kenya, Sudan, Tanzania and Rwanda. One-year, two-year, three-year, four-year and five-year overall survival rates ranged from 67% to 92%, 55% to 84%, 44% to 53%, 32% to 47%, and 26% to 43%, respectively.

CONCLUSIONS

The pooled one-year, two-year, three-year, four-year and five-year survival rates of cervical cancer patients in East Africa were 84%, 71%, 50%, 39% and 36%, respectively. HIV status, late presentation, treatment modalities, older age and presence of comorbidities were the most commonly mentioned prognostic factors for survival.

PROSPERO REGISTRATION NUMBER

CRD42023402551.

Social networking and fear of missing out (FOMO) among medical students at University of Khartoum, Sudan 2021

BACKGROUND

With students becoming more involved in the internet and social networking sites, they become more prone to their consequences. This study focuses on measuring the social networking intensity and the fear of missing out among the medical students of University of Khartoum, then examining the association between them.

METHODS

Facility-based, descriptive, cross-sectional study was conducted at Faculty of Medicine, Khartoum University between January and March 2021. A total of 333 students were selected by simple random sampling. Data was collected from the participants using a structured self-administered questionnaire that involved the social networking intensity (SNI) scale and fear of missing out (FOMO) scale. The data was analyzed by the Statistical Package for Social Science (SPSS) software version 26.

RESULTS

Moderate positive correlation between social networking intensity and fear of missing out was found (p-value < 0.01). Of the total participants; 51 participants (15.4%) experienced low SNI and low FOMO. Another 78 participants (23.6%) had moderate SNI and moderate FOMO and only 16 Participants (4.8%) showed high SNI and high FOMO. There were no significant differences in SNI or FOMO scores among the different socio-demographic variables, except for the SNI score which was positively correlated to the monthly income.

CONCLUSION

An association between SNI and FOMO was found. SNI was not affected by socio-demographic factors except for the monthly income.

A Relational Approach to the Drivers of Child Acute Malnutrition

BACKGROUND

This article presents a new analytical approach to acute malnutrition causal analysis that is different from the orthodox approach in 2 respects. First, it engages with basic causes, that is, beyond the usual focus on individuals and households. Second, it uses a relational view in the causal analysis. The orthodox approach identifies the malnourished and their individual and household characteristics. In contrast, a relational approach explores the ways in which the relationships between people, their livelihoods, and the environment, mediated by systems and institutions, create the underlying drivers associated with acute malnutrition for some, while simultaneously creating better conditions for others.

METHODS

The article draws on 2 case study communities in West Darfur, Sudan, first considering the Darfur context and the inequitable policies and weakened institutions that have led to ethnic polarization, multilayered conflict, and humanitarian crises. The article explores how this context has played out differently in each community, contrasting their livelihood specializations, conflict-related losses, and livelihood diversification over time.

FINDINGS

This analysis shows how the relative vulnerability of some people versus others is strongly influenced by their social, economic, and political relationships, as reflected in their shifting power relations and uneven control over livelihood resources.

CONCLUSIONS

Shifting the focus to the basic drivers, especially the institutional structures, processes, and relationships, will deepen the causal analysis of child acute malnutrition, make it more meaningful, and provide a new direction for engagement, learning, and action to address the deepening problem of child acute malnutrition.

Safety, tolerability, and immunogenicity of the Ebola Sudan chimpanzee adenovirus vector vaccine (cAd3-EBO S) in healthy Ugandan adults: a phase 1, open-label, dose-escalation clinical trial

BACKGROUND

Sudan Ebola virus can cause severe viral disease, with an average case fatality rate of 54%. A recent outbreak of Sudan Ebola virus in Uganda caused 55 deaths among 164 confirmed cases in the second half of 2022. Although vaccines and therapeutics specific for Zaire Ebola virus have been approved for use during outbreak situations, Sudan Ebola virus is an antigenically distinct virus with no approved vaccines available.

METHODS

In this phase 1, open-label, dose-escalation trial we evaluated the safety, tolerability, and immunogenicity of a monovalent chimpanzee adenovirus 3 vaccine against Sudan Ebola virus (cAd3-EBO S) at Makerere University Walter Reed Project in Kampala, Uganda. Study participants were recruited from the Kampala metropolitan area using International Review Board-approved written and electronic media explaining the trial intervention. Healthy adults without previous receipt of Ebola, Marburg, or cAd3 vectored-vaccines were enrolled to receive cAd3-EBO S at either 1 × 1010 or 1 × 1011 particle units (PU) in a single intramuscular vaccination and were followed up for 48 weeks. Primary safety and tolerability endpoints were assessed in all vaccine recipients by reactogenicity for the first 7 days, adverse events for the first 28 days, and serious adverse events throughout the study. Secondary immunogenicity endpoints included evaluation of binding antibody and T-cell responses against the Sudan Ebola virus glycoprotein, and neutralising antibody responses against the cAd3 vector at 4 weeks after vaccination. This study is registered with ClinicalTrials.gov, NCT04041570, and is completed.

FINDINGS

40 healthy adults were enrolled between July 22 and Oct 1, 2019, with 20 receiving 1 × 1010 PU and 20 receiving 1 × 1011 PU of cAd3-EBO S. 38 (95%) participants completed all follow-up visits. The cAd3-EBO S vaccine was well tolerated with no severe adverse events. The most common reactogenicity symptoms were pain or tenderness at the injection site (34 [85%] of 40), fatigue (29 [73%] of 40), and headache (26 [65%] of 40), and were mild to moderate in severity. Positive responses for glycoprotein-specific binding antibodies were induced by 2 weeks in 31 (78%) participants, increased to 34 (85%) participants by 4 weeks, and persisted to 48 weeks in 31 (82%) participants. Most participants developed glycoprotein-specific T-cell responses (20 [59%, 95% CI 41-75] of 34; six participants were removed from the T cell analysis after failing quality control parameters) by 4 weeks after vaccination, and neutralising titres against the cAd3 vector were also increased from baseline (90% inhibitory concentration of 47, 95% CI 30-73) to 4 weeks after vaccination (196, 125-308).

INTERPRETATION

The cAd3-EBO S vaccine was safe at both doses, rapidly inducing immune responses in most participants after a single injection. The rapid onset and durability of the vaccine-induced antibodies make this vaccine a strong candidate for emergency deployment in Sudan Ebola virus outbreaks.

FUNDING

National Institutes of Health via interagency agreement with Walter Reed Army Institute of Research.

Medical students in Sudan: an urgent need for support

Medical students are smart enough to be dismissed for academic reasons. Unfortunately, without support, they do. In Sudan, the statistics are deficient on how medical schools provide support to their students, and as the country marches towards an exciting new future of development, it is important to ensure launching in the right direction. Based on the literature search and the author's experience as a medical student, clinician, and medical educator, the difficulties facing medical students in Sudan were explored; and the required roadmap for support is suggested. Under-resourced facilities, staff migration, lack of robust student support service, and limited access to authentic databases are major problems facing medical students in Sudan. The support roadmap should come at three complementary levels: governmental, institutional, and community. National interventions need to be established to impose standards that universities must observe to ensure that students receive minimal support. The suggestions discussed in this article provide a roadmap for any medical school in Sudan whether it is facing these challenges or simply wants to improve its students' educational environment.

Body image dissatisfaction and its relation to body mass index among female medical students in Sudan: across-sectional study 2020-2021

BACKGROUND

Body image is mainly determined by biological, social, psychological and cultural factors thus it is a multifaceted vigorous construct. Body image is an essential aspect of girls' self-definition and individual identity. Excessive concern about body image and body image misconceptions leads to dissatisfaction, disturbed eating patterns, affecting the nutritional status and also leading to depression and anxiety disorder.

METHODS

This is a descriptive cross-sectional university-based study aiming to investigate body image dissatisfaction and its relation to BMI among female medical students at the University of Khartoum, faculty of medicine. The study was carried out between December 2020 and January 2021. Simple random sampling was applied and a two-sectioned questionnaire was used. The first part consisted of socio-demographic data and the second part contained questions to assess body image the data was. A total of 277 participants were enrolled in the study. Data was analyzed using SPSS version 20.

RESULTS

We enrolled 277 female medical students the majority of participants (53%) were considered of normal weight according to BMI, 7% considered obese, and 18% underweight. Large number of participants thought that they are not in the ideal weight according to their height (62%). (21% to 17%) of participants always feel pressure from people or society to get to a certain weight. With respect to attitude towards weight, (29%) of participants always wear clothes that don't reveal their body shape, (35%) of them always tend to wear clothes that hide their excess weight.

CONCLUSIONS

The study concluded that participants who were overweight, obese or underweight have significant increase risk for poor body image perception with odd ratio of 39, 11, and 59 respectively. Thus early and proper interventions are necessary to circumvent the impact and future repercussion of body image distortion.

Needs assessment study of postgraduate surgical education in Sudan: Trainees perspective

INTRODUCTION

Global interest has increased in improving the quality and increasing the number of graduates from surgical training programmes in countries with limited resources. Needs assessment of stakeholders in the training programmes represent the backbone of such process. The aim of this study was to assess the surgical training in Sudan from trainees' perspective in order to inform training delivery.

METHODS

We adopted mixed methods design using focus group discussion for qualitative data collection and questionnaire survey for quantitative data. NVivo 20 Pro was used to organize qualitative data and SPSS 24.0 was used for quantitative data analysis.

RESULTS

Thematic analysis of qualitative data identified three themes. Trainees were overall satisfied that they will make good surgeons after completion of the programme. They identified case volume and collaborations with colleagues as the main strengths of the programme and lacking clear objectives for each year of training and academic activities as the main weaknesses. They suggested motivation of trainers and utilization of online resources and meeting platforms as solutions to improve supervision and academic activities during training.

CONCLUSION

The gaps in training and their suggested solutions highlighted by trainees in this study should form the base for reforming the surgical training in Sudan and countries with similar circumstances.

A cluster-randomised controlled equivalence trial of the Surprise Soap handwashing intervention among older children living in a refugee settlement in Sudan

INTRODUCTION

Increasing handwashing with soap (HWWS) among older children in emergency settings can have a large public health impact, however, evidence on what works is limited. One promising approach is the 'Surprise Soap' intervention in which a novel soap with an embedded toy is delivered to children in a short, participatory household session that includes a glitter game and HWWS practice. Here, we evaluate this intervention against a standard intervention in a complex emergency setting.

METHODS

A cluster-randomised controlled equivalence trial was conducted in Naivasha refugee settlement, Sudan. Blinding was not possible. 203 randomly selected households, with at least one child aged 5-12, were randomised to receive the Surprise Soap intervention (n=101) or a standard intervention comprising a short household session with health messaging and plain soap distribution (n=102). The primary outcome was the proportion of prespecified potential HWWS events observed for children aged 5-12, accompanied by HWWS, at baseline, 4, 12 and 16 weeks post intervention delivery.

RESULTS

200 households were included in the analyses: 101 intervention and 99 control. No difference in intervention effectiveness was observed at any follow-up (4 weeks: adjusted rate ratio (RR) 1.2, 95% CI 0.8 to 1.7; 12 weeks: RR 0.8, 95% CI 0.5 to 1.1; 16 weeks: RR 1.1, 95% CI 0.8 to 1.5). However, we observed increased HWWS in both arms at 4 weeks (27 and 23 percentage point increase in the intervention and control arm, respectively) that was sustained at 16 weeks.

CONCLUSIONS

We find that the Surprise Soap intervention is no more effective at increasing older children's HWWS than a standard, household-level, health-based intervention in this complex humanitarian emergency. There appears to be no marginal benefit in terms of HWWS that would justify the additional cost of implementing the Surprise Soap intervention. Further trials that include a passive control arm are needed to determine the independent effects of each intervention and guide future intervention design.

Measuring hope: psychometric properties of the children's Hope Scale among South Sudanese refugee children

We investigated the psychometric properties of the Children's Hope Scale among a sample of 1,118 South Sudanese refugee children (570 girls, 548 boys) aged 9 to 14 years displaced in Uganda. We assessed the underlying factor structure and model fit through exploratory and confirmatory factor analyses and measurement invariance by sex and developmental stage. Confirmatory factor analysis revealed good fit for a one-factor model with the error terms of items 1 and 3 and items 4 and 6 allowed to covary. There was no evidence of differential item functioning by group. Evidence from this study supports the use of a unidimensional model of hopefulness across groups and signifies the importance of confirming these properties for measures used to evaluate humanitarian interventions.

Investigating mobility and pastoralism in Kerma-period communities upstream of the fourth cataract, Sudan

OBJECTIVES

The Kingdom of Kush in today's northern Sudan and southern Egypt (ancient Nubia) is often depicted as a secondary state relative to ancient Egypt. More recent investigations have set aside Egyptocentric and western, colonialist perspectives of state development focused on control of land and agricultural surplus, examining Kushites through the lens of African-based models of mobile pastoralism in which power and authority were achieved through control of herds and alliance-building. Here, analyses of radiogenic strontium isotopes in human dental enamel are used to investigate diachronic shifts in mobility patterns linked to pastoralism and state development during the Kerma period (ca. 2500-1100 BCE).

MATERIALS AND METHODS

From five cemetery sites around al Qinifab, Sudan, upstream of the capital at Kerma, we analyzed the strontium isotope ratios of 50 teeth from 27 individuals dating from the Early through Late Kerma phases.

RESULTS

Individuals from the Early and Middle Kerma phases demonstrated considerable 87 Sr/86 Sr ratio variability (mean = 0.70835 ± 0.00109), with 50% falling outside the locally bioavailable strontium range. Conversely, most Classic (0.70756 ± 0.00043) and Late Kerma (0.70755 ± 0.00036) individuals exhibited ratios consistent with the local region.

DISCUSSION

These changes indicate a potential transformation in subsistence strategies and social organization as early communities engaged in a more mobile lifestyle than later groups, suggesting a greater degree of pastoralism followed by declining mobility with Kushite state coalescence and a shift to agropastoralism. Because 87 Sr/86 Sr ratios from enamel reflect childhood geographic residence, these findings indicate that mobility likely involved extended family groups, and not just transhumant adults.

HLA alleles and haplotypes in Sudanese population and their relationship with Mediterraneans

The contribution of migrated people from once green Sahara (about 10,000-6000 years BC) towards Mediterranean area had probably a double effect: both genetic and cultural connections have been described between Western Europe and North Africa. Sudanese populations from different ethnicities have been studied for HLA-A, -B, -DRB1 and -DQB1 antigens by a standard microlymphotoxicity method. Results found show that Nubians are genetically related with African Sub-Saharan populations and distant from other Sudanese tribes, who are closer to Mediterranean populations than to Sub-Saharan ones. This is concordant with other authors and meta-analysis data. Our present work is, to our knowledge, the first and only one HLA research that studies Sudanese people according to different Sudan ethnic groups: samples were collected before Sudan partition between North and South. A prehistoric genetic and peoples exchange between Africa and the Mediterranean basin may be observed and is supported with the results obtained in this Sudanese HLA study. However, demic diffusion model of agriculture and other anthropological traits from Middle East to West Europe/Maghreb do not exist: a more detailed Sahel and North African countries ancient and recent admixture studies are also being carried out which may clearer explain pastoralists/agriculture innovations origins in Eurafrican Mediterranean and Atlantic façade.

The C-terminus of Sudan ebolavirus VP40 contains a functionally important CXnC motif, a target for redox modifications

The Ebola virus matrix protein VP40 mediates viral budding and negatively regulates viral RNA synthesis. The mechanisms by which these two functions are exerted and regulated are unknown. Using a high-resolution crystal structure of Sudan ebolavirus (SUDV) VP40, we show here that two cysteines in the flexible C-terminal arm of VP40 form a stabilizing disulfide bridge. Notably, the two cysteines are targets of posttranslational redox modifications and interact directly with the host`s thioredoxin system. Mutation of the cysteines impaired the budding function of VP40 and relaxed its inhibitory role for viral RNA synthesis. In line with these results, the growth of recombinant Ebola viruses carrying cysteine mutations was impaired and the released viral particles were elongated. Our results revealed the exact positions of the cysteines in the C-terminal arm of SUDV VP40. The cysteines and/or their redox status are critically involved in the differential regulation of viral budding and viral RNA synthesis.

The state of health and health services in Sudan as a result of the war

No abstract available.

A survey of frequency of virulence and aminoglycoside antibiotic-resistant genotypes and phenotypes in Escherichia coli in broilers in Khartoum State, Sudan

BACKGROUND

Although Escherichia coli (E. coli) is considered a normal microflora in the poultry intestine, certain strains namely, Avian Pathogenic E. coli (APEC), cause colisepticaemia (fatal disease) in poultry. The aim of this study was to determine the prevalence of the virulence genes, i.e. (iroN, ompT, iss, iutA, and hlyF) and aminoglycoside-modifying enzyme (AME) genes, i.e. (strA and strB) in Escherichia coli strains in broilers in Khartoum State.

METHODS AND RESULTS

A total of 25 E. coli isolates were collected from broilers farms. All isolates were screened for antimicrobial susceptibility tests using Kirby-Bauer disc diffusion method. In addition, all isolates were tested for the presence of virulence genes and modifying enzyme genes using the polymerase chain reaction (PCR). The results showed that the prevalence of positive strains to virulence genes were 14 (56%), 21 (84%), 14 (56%), 0 (0%) and 0 (0%) to iroN, iutA, hlyF, ompT and iss, respectively. Combined virulence genes include iroN, hlyF and iutA were detected in 14 (56%). The rates of resistance were as follows: Gentamycin: (32%), Kanamycin: (20%) and Streptomycin (16%). Of the genes tested, strA (72%) was the most commonly recognized gene followed by strB (56%).

CONCLUSIONS

It could be concluded that this is the first report of molecular survey of virulence and aminoglycoside-modifying enzyme (AME) resistant genes in APEC isolates from broiler in Sudan. Therefore, prohibition of non-curative application of antibiotic, dishearten their abuse and to be frequently observant by suppling suitable research-based policy for the poultry industry is warranted.

The associations between religiosity and the Big-Five personality traits in college students from Sudan

Research on the association between religiosity and personality with Arab participants is rare. The aim of the present study was to explore this association using a sample (N = 623) of college students from Sudan. They responded to the Arabic Scale of Intrinsic Religiosity and the Arabic Big-Five Personality Inventory. The results indicated that men obtained a significantly higher mean score than did women for extraversion, whereas women obtained higher mean total scores for religiosity and neuroticism than did men. For both genders, religiosity was significantly and positively associated with agreeableness and conscientiousness. In college men only, religiosity was significantly correlated with extraversion. A principal components analysis of the combined sample of men and women retained two components and labeled "Positive traits" and "Neuroticism and Introversion". Predictors of religiosity were Agreeableness and Conscientiousness. The model explains 42% of the variance. It was concluded that the associations observed in the Sudanese sample reflect the general pattern observed in other international samples.

On the occurrence and distribution of Synodontis nigrita and Synodontis violaceus (Siluriformes: Mochokidae) in the Nilo-Sudan, and Upper and Lower Guinea ichthyofaunal provinces

Examination of the holotype of Synodontis nigrita, the type specimens of both its (potential) junior synonyms, Synodontis fascipinna and Synodontis ornatus, and an additional 306 specimens, previously identified as S. nigrita, confirmed that the interorbital width is the most important diagnostic character to distinguish S. nigrita from its Nilo-Sudanic (N-S), and Upper and Lower Guinea ichthyofaunal province congeners. Results revealed that this species has a typical N-S distribution. In addition, the occurrence of Synodontis violaceus in the Cross River is not corroborated. Therefore, it should be considered a typical West African species.

Lessons Learned from Sudan Ebola Virus Disease (SUDV) Preparedness in Rwanda: A Comprehensive Review and Way Forward

BACKGROUND

Ebola Virus Disease (EVD) is a severe and often fatal illness that affects humans and has significant public health implications, including high mortality rates, strain on healthcare systems, and social and economic disruption. On 20 September 2022, Uganda declared an Ebola disease outbreak caused by the Sudan ebolavirus species. The neighboring countries of Uganda were classified by World Health Organization (WHO) as being at high risk of Sudan Ebola Virus Disease (SUDV) importation. The country of Rwanda implemented different sustainable strategies and activities to prepare and ensure a timely and effective response to SUDV outbreaks once it has arrived in the country. We aimed to highlight the sustainable strategies and activities implemented for SUDV preparedness and the subsequent lessons learnt in Rwanda.

METHODS

This paper reviewed the documentation on activities implemented for SUDV preparedness, with a focus on lessons learned from different countries. The paper analyzed the common themes and highlighted the key components of EVD preparedness in Rwanda after declaration of SUDV outbreak in Uganda.

RESULTS

The key components of SUDV preparedness include its readiness assessment in Rwanda, effective coordination, collaboration and leadership mechanisms, enhancing the early detection and surveillance system, effective risk communication and community engagement, capacity building of healthcare providers on case management and infection prevention and control (IPC), and continual preparedness. These components were essential to ensure timely and effective preparation and response to SUDV related outbreaks.

CONCLUSION

A multi-sectoral approach involving all stakeholders was necessary to ensure timely and effective preparation and response. Continuous investment in preparedness, strengthening of health systems, and the review of preparedness components provided insights into the best practices for SUDV preparedness, which were essential to prevent future outbreaks and minimize their impact. This will inform other countries about the role of timely development of preparedness plans.

Seroepidemiological Survey of Cytomegalovirus Infection among Pregnant Women in Sudan

Human Cytomegalovirus (HCMV) is a leading healthcare problem associated with stillbirth and congenital abnormalities. Determining the seroprevalence and the possible risk factors related to HCMV infections may be a cornerstone in preventing its complications. This cross-sectional study was conducted in Kassala and River Nile States to determine the seroprevalence and risk factors associated with HCMV infection in pregnant women. One hundred eighty-four (n = 184) blood specimens were collected from pregnant women from February 2018 to January 2020. Enzyme-linked immunosorbent assay (ELISA) was used to detect HCMV-specific IgG and IgM antibodies. Socio-demographical characteristics of the women were collected using structured questionnaires. The results showed that HCMV IgG was detected in 170 (92.4%) of the blood specimens, and IgM was detected in 29/93 (31.2%). There was a significant relationship between the history of miscarriage and the presence of IgG and IgM with a p-value = 0.001 and between HCMV IgM and gestational stage (p-value = 0.028). The study found a strikingly high seroprevalence of HCMV infections among pregnant women in the investigated States. This high percentage of illiterate housewives living in rural areas makes it possible to reduce the incidence of HCMV infection in pregnant women by improving their knowledge, attitude, and practice regarding the route of viral transmission, which may reflect in lowering the rate of congenital diseases in their infants.

Preparations for sustainability and transition from Global Fund support in the Eastern Mediterranean Region

Background

HIV, tuberculosis and malaria (HTM) services receive financial support from the Global Fund and need to plan for sustainability and transition from external funding.

Aim

To recommend actions for addressing key sustainability and transition issues in 15 countries receiving Global Fund grants in the WHO Eastern Mediterranean (EMR) Region.

Methods

We reviewed documents, interviewed key informants, and conducted case studies in Sudan and Tunisia to highlight key considerations for sustainability and transition from Global Fund that is tailored to the EMR and the health system building blocks. Sustainability considerations should align with the health system building blocks, including governance, financing, service delivery, workforce and health product management, with the addition of considerations for key and vulnerable populations because of their particular importance for HIV and tuberculosis services.

Conclusion

While hoping for economic growth and reduction of the burden of HTM, EMR countries need to prepare for transition from Global Fund support. Proactive steps that are tailored to the health system building blocks and address the needs of key and vulnerable populations should progressively increase national capabilities as well as resources dedicated to HTM.

Mapping, intensities and future prediction of land use/land cover dynamics using google earth engine and CA- artificial neural network model

Mapping of land use/ land cover (LULC) dynamics has gained significant attention in the past decades. This is due to the role played by LULC change in assessing climate, various ecosystem functions, natural resource activities and livelihoods in general. In Gedaref landscape of Eastern Sudan, there is limited or no knowledge of LULC structure and size, degree of change, transition, intensity and future outlook. Therefore, the aims of the current study were to (1) evaluate LULC changes in the Gedaref state, Sudan for the past thirty years (1988-2018) using Landsat imageries and the random forest classifier, (2) determine the underlying dynamics that caused the changes in the landscape structure using intensity analysis, and (3) predict future LULC outlook for the years 2028 and 2048 using cellular automata-artificial neural network (CA-ANN). The results exhibited drastic LULC dynamics driven mainly by cropland and settlement expansions, which increased by 13.92% and 319.61%, respectively, between 1988 and 2018. In contrast, forest and grassland declined by 56.47% and 56.23%, respectively. Moreover, the study shows that the gains in cropland coverage in Gedaref state over the studied period were at the expense of grassland and forest acreage, whereas the gains in settlements partially targeted cropland. Future LULC predictions showed a slight increase in cropland area from 89.59% to 90.43% and a considerable decrease in forest area (0.47% to 0.41%) between 2018 and 2048. Our findings provide reliable information on LULC patterns in Gedaref region that could be used for designing land use and environmental conservation frameworks for monitoring crop produce and grassland condition. In addition, the result could help in managing other natural resources and mitigating landscape fragmentation and degradation.

Public health impact of the spread of Anopheles stephensi in the WHO Eastern Mediterranean Region countries in Horn of Africa and Yemen: need for integrated vector surveillance and control

BACKGROUND

Anopheles stephensi is an efficient vector of both Plasmodium falciparum and Plasmodium vivax in South Asia and the Middle East. The spread of An. stephensi to countries within the Horn of Africa threatens progress in malaria control in this region as well as the rest of sub-Saharan Africa.

METHODS

The available malaria data and the timeline for the detection of An. stephensi was reviewed to analyse the role of An. stephensi in malaria transmission in Horn of Africa of the Eastern Mediterranean Region (EMR) in Djibouti, Somalia, Sudan and Yemen.

RESULTS

Malaria incidence in Horn of Africa of EMR and Yemen, increased from 41.6 in 2015 to 61.5 cases per 1000 in 2020. The four countries from this region, Djibouti, Somalia, Sudan and Yemen had reported the detection of An. stephensi as of 2021. In Djibouti City, following its detection in 2012, the estimated incidence increased from 2.5 cases per 1000 in 2013 to 97.6 cases per 1000 in 2020. However, its contribution to malaria transmission in other major cities and in other countries, is unclear because of other factors, quality of the urban malaria data, human mobility, uncertainty about the actual arrival time of An. stephensi and poor entomological surveillance.

CONCLUSIONS

While An. stephensi may explain a resurgence of malaria in Djibouti, further investigations are needed to understand its interpretation trends in urban malaria across the greater region. More investment for multisectoral approach and integrated surveillance and control should target all vectors particularly malaria and dengue vectors to guide interventions in urban areas.