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Tobacco is a leading cause of death and illness despite50 years of antitobacco efforts.To establish the determinants of current and former smoking and smokeless tobacco use in Sudan as measured by the STEPwise Survey 2016.A household-based cross-sectional World Health Organization STEPwise Survey was conducted among 7745 Sudanese citizens aged 18-69 years across 11 states in Sudan. A 4-stage stratified cluster sampling design was implemented. The generic STEPS Instrument (version 3.2) was used and questions were tailored to the Sudanese context.Among current male smokers, 63.7% were aged ≤ 35 years, 50.7% were illiterate or did not complete primary school, 84.5% were employed and 52.4% were in the lowest 2 quintiles of income. Among male smokeless tobacco users, 54.8% were aged ≤ 35 years, 48.4% were illiterate or did not complete primary school, 89.7% were employed and 52.2% were in the lowest 2 quintiles of income. Using multivariate logistic regression models, current smoking in men was associated with older age, informal education, unemployment and lower income. Smokeless tobacco use was associated with age 18-25 years, informal education, unemployment and lower income.Both forms of tobacco use were associated with poor socioeconomic status and unemployment. Smokeless tobacco use was associated with age 18-25 years as opposed to smoking tobacco use. These results can inform the target audience of the future tobacco control plans.محدِّدات تعاطي التبغ في السودان: التحليل الثانوي للمسح ذو النهج التدريجي لعام 2016.منى نور، نعيمة وجيالا، مي التيجاني، منال الإمام، نازك إبراهيم، ناهد علي، فاطمة حسن، نازك حسن، نازك نور الهدى.التبغ هو أحد الأسباب الرئيسية للوفاة والمرض بالرغم من جهود مكافحة التبغ المبذولة منذ ما يزيد عن 50 عاماً.هدفت هذه الدراسة إلى الوقوف على محددات التدخين الحالي والسابق وتعاطي التبغ عديم الدخان في السودان، بحسب قياسات المسح ذو النهج التدريجي في عام 2016.أجرت منظمة الصحة العالمية مسحاً منزلياً مقطعياً يتبع النهج التدريجي شمل 7745 مواطناً سودانياً تتراوح أعمارهم بين 18 و 69 عاماً في 11 ولاية بالسودان. ونُفِّذ تصميم الطريقة الشرائحية العنقودية لأخذ العينة على 4 مراحل. واستُخدمت أداة النهج التدريجي العامة (الإصدار 2.3)، وصُممت الأسئلة لتناسب السياق السوداني.من بين الذكور المدخنين حالياً، وُجد أن 63.7٪ منهم يبلغون من العمر 35 عاماً أو أقل، وكان 50.7٪ منهم من غير المتعلمين أو لم يكملوا تعليمهم الابتدائي، وكان 84.5٪ منهم يعملون، بينما كان 52.4٪ منهم في أدنى شريحتيْ خمسيتيْ من شرائح الدخل. ومن بين الذكور المتعاطين للتبغ عديم الدخان، وُجد أن 54.8٪ يبلغون من العمر 35 عاماً أو أقل، وكان 48.4٪ منهم من غير المتعلمين أو لم يكملوا تعليمهم الابتدائي، وكان 89.7٪ منهم يعملون، بينما كان 52.2٪ منهم في أدنى شريحتيْ خمسيتيْ من شرائح الدخل. وباستخدام نماذج تحليل التحوُّف اللوجستي المتعدد المتغيرات، تبيَّ ارتباط التدخين الحالي في صفوف الرجال بتقدم السن، والتعليم غير الرسمي، والبطالة، وانخفاض الدخل. وارتبط تعاطي التبغ عديم الدخان بالأعمار من 18 إلى 25 عاماً، والتعليم غير الرسمي، والبطالة، وانخفاض الدخل.ارتبط كلا هذين الشكلين من أشكال تعاطي التبغ بتدهور الوضع الاجتماعي والاقتصادي والبطالة. وتبين وجود ارتباط بين تعاطي التبغ عديم الدخان وبين تراوُح السن بين 18 و 25 عاماً، على عكس تعاطي التبغ المُدخَّن. ويمكن لتلك النتائج أن توجه الجمهور المستهدف للخطط المستقبلية الموضوعة لمكافحة التبغ.Déterminants de la consommation de tabac au Soudan : analyse secondaire de l’enquête STEPwise 2016.Le tabac est une des principales causes de mortalité et de morbidité malgré les efforts déployés depuis plus de 50 ans en matière de lutte antitabac.Établir les déterminants du tabagisme et de la consommation de tabac sans fumée au moment de l’étude et dans le passé au Soudan, tels que mesurés par l'enquête STEPwise 2016.Une enquête transversale STEPwise menée au sein des ménages par l’Organisation mondiale de la Santé (OMS) a été réalisée auprès de 7745 citoyens soudanais âgés de 18 à 69 ans dans 11 États du Soudan. Un sondage par grappe stratifié à quatre degrés a été mis en œuvre. L’ instrument générique STEPS (version 3.2) a été utilisé et les questions ont été adaptées au contexte soudanais.Parmi les fumeurs masculins au moment de l’étude, 63,7 % avaient un âge inférieur ou égal à 35 ans, 50,7 % étaient analphabètes ou n’avaient pas terminé leurs études primaires, 84,5 % avaient un emploi et 52,4 % se situaient dans les deux quintiles de revenu les plus bas. Parmi les consommateurs de tabac sans fumée, 54,8 % avaient un âge inférieur ou égal à 35 ans, 48,4 % étaient analphabètes ou n'avaient pas terminé leurs études primaires, 89,7 % étaient en emploi et 52,2 % se situaient dans les deux quintiles de revenu les plus bas. À l'aide de modèles de régression logistique multivariée, le tabagisme au moment de l’étude chez les hommes était associé à un âge plus avancé, à une éducation informelle, au chômage et à des revenus plus faibles. Le tabagisme sans fumée est associé à la tranche d’âge 18-25 ans, à l’éducation informelle, au chômage et à une baisse des revenus.Ces deux formes de consommation de tabac sont associées à un statut socio-économique précaire et au chômage. Par opposition à la consommation de tabac fumé, le tabagisme sans fumée est associé à la tranche d’âge des 18-25 ans. Ces résultats pourront éclairer le public cible des futurs plans de lutte antitabac.

Background Shielding of high-risk groups from coronavirus disease (COVID-19) has been suggested as a realistic alternative to severe movement restrictions during the COVID-19 epidemic in low-income countries. The intervention entails the establishment of ‘green zones’ for high-risk persons to live in, either within their homes or in communal structures, in a safe and dignified manner, for extended periods of time during the epidemic. To our knowledge, this concept has not been tested or evaluated in resource-poor settings. This study aimed to explore the acceptability and feasibility of strategies to shield persons at higher risk of severe COVID-19 outcomes, during the COVID-19 epidemic in six communities in Sudan. Methods We purposively sampled participants from six communities, illustrative of urban, rural and forcibly-displaced settings. In-depth telephone interviews were held with 59 members of households with one or more members at higher risk of severe COVID-19 outcomes. Follow-up interviews were held with 30 community members after movement restrictions were eased across the country. All interviews were audio-recorded, transcribed verbatim, and analysed using a two-stage deductive and inductive thematic analysis. Results Most participants were aware that some people are at higher risk of severe COVID-19 outcomes but were unaware of the concept of shielding. Most participants found shielding acceptable and consistent with cultural inclinations to respect elders and protect the vulnerable. However, extra-household shielding arrangements were mostly seen as socially unacceptable. Participants reported feasibility concerns related to the reduced socialisation of shielded persons and loss of income for shielding families. The acceptability and feasibility of shielding strategies were reduced after movement restrictions were eased, as participants reported lower perception of risk in their communities and increased pressure to comply with social commitments outside the house. Conclusion Shielding is generally acceptable in the study communities. Acceptability is influenced by feasibility, and by contextual changes in the epidemic and associated policy response. The promotion of shielding should capitalise on the cultural and moral sense of duty towards elders and vulnerable groups. Communities and households should be provided with practical guidance to implement feasible shielding options. Households must be socially, psychologically and financially supported to adopt and sustain shielding effectively.

BackgroundOral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the four oral health-related quality of life (OHRQoL) dimensions (4D) or areas in which oral disorders impact pediatric patients. Using their dentists' assessment, the study aimed to evaluate whether pediatric dental patients' oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct.MethodsDentists who treat children from 32 countries and all WHO regions were selected from a web-based survey of 1580 international dentists. Dentists were asked if their pediatric patients with current or future oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct. Proportions of all pediatric patients’ oral health problems and prevention needs were computed.FindingsData from 101 dentists treating children only and 523 dentists treating children and adults were included. For 90% of pediatric patients, their current oral health problems fit well in the four OHRQoL dimensions. For 91% of oral health problems they intended to prevent in the future were related to these dimensions as well. Both numbers increased to at least 96% when experts analyzed dentists´ explanations of why some oral health problems would not fit these four categories.ConclusionsThe study revealed the four fundamental components of dental patients, i.e., the four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact) are also applicable for pediatric patients, regardless of whether they have current or future oral health concerns, and should be considered when measuring OHRQoL in the pediatric dental patient population.

Objective The dimensions of oral health–related quality of life (OHRQoL) Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the major areas where patients are impacted by oral diseases and dental interventions. The aim of this study was to evaluate whether dental patients' reasons to visit the dentist fit the 4 OHRQoL dimensions. Methods Dentists (N = 1580) from 32 countries participated in a web-based survey. For their patients with current oral health problems, dentists were asked whether these problems were related to teeth, mouth, and jaws' function, pain, appearance, or psychosocial impact or whether they do not fit the aforementioned 4 categories. Dentists were also asked about their patients who intended to prevent future oral health problems. For both patient groups, the proportions of oral health problems falling into the 4 OHRQoL dimensions were calculated. Results For every 100 dental patients with current oral health problems, 96 had problems related to teeth, mouth, and jaws' function, pain, appearance, or psychosocial impact. For every 100 dental patients who wanted to prevent future oral health problems, 92 wanted to prevent problems related to these 4 OHRQoL dimensions. Both numbers increased to at least 98 of 100 patients when experts analyzed dentists' explanations of why some oral health problems would not fit the four dimension. For the remaining 2 of 100 patients, none of the dentist-provided explanations suggested evidence against the OHRQoL dimensions as the concepts that capture dental patients' suffering. Conclusion Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact capture dental patients' oral health problems worldwide. These 4 OHRQoL dimensions offer a psychometrically sound and practical framework for patient care and research, identifying what is important to dental patients.

Out-migration of physicians and urban-rural maldistribution are two of the most serious challenges facing the health sector.To determine the preference of junior doctors for rural postings in Sudan, and estimate how much junior doctors are willing to trade off from their salaries for nonmonetary incentives.The study targeted junior doctors who had completed their internship training and were taking their Medical Licensing Examination at the Sudan Medical Council for permanent registration. Focus group discussions were conducted to identify potentially valued incentives. A computer-based discrete choice experiment and accompanying questionnaire were administered between September and October 2012 at the two licence examination centres in Sudan.Four hundred and fifty-five doctors completed the survey. More than one third of the respondents intended to emigrate from Sudan immediately and another 30% within the next two years. The findings showed that providing scholarships to train abroad, improving the standard of health facilities to an advanced level, and providing on-site supervision were the attributes most preferred by the respondents and they were willing to trade off SDG 3650 (US$ 608), SDG 1997 (US$ 333) and SDG 1948 (US$ 325) of their salaries for these, respectively. Less-preferred attributes were availability of supervision by telephone, followed by a scholarship in family medicine and a 2-year commitment, post-training.Authorities may consider the above preferences to enhance human resources for attraction strategies in rural areas. Addressing the supervision issue may be more feasible for policy-makers in the short term, when compared to improving salaries and infrastructure.تشجيع الأطباء حديثي التخرج على العمل في الأرياف في السودان: تجربة اختيار منفصلة.نازك نورالهدى، أمال بشير، سارة الكوجلي، منى مصطفى، مارجريت كروك، منى عبد العزيز.تمثل هجرة الأطباء إلى خارج البلاد وسوء توزيعهم بين المناطق الريفية والحضرية أخطر التحديات التي تواجه القطاع الصحي اليوم.تحديد مدى تفضيل الأطباء حديثي التخرج للعمل في الريف في السودان، وتقدير عدد الأطباء الشباب الذين يرحبون بمقايضة جزء من مرتباتهم مقابل حوافز غير مالية.استهدفت الدراسة الأطباء حديثي التخرج الذين أتموا سنة الامتياز، واجتازوا امتحان التراخيص الطبية في المجلس الطبي السوداني للتسجيل الدائم. فأجريت مناقشات ضمن مجموعات بؤرية لتحديد الحوافز التي قد تلقى التقدير لديهم. أجرينا تجربة اعتمدت على الاختيار المنفصل القائم على الحاسوب مع إعطاء استبانة مصاحبة في الفترة بين سبتمبر/أيلول وأكتوبر/تشرين الأول 2012 في مركزَيْ امتحان الترخيص في السودان.وقد استكمل الاستبانة 455 طبيبًا، وتبين أن أكثر من ثلث المستجيبين يعتزمون الهجرة خارج السودان فورًا، وأن 30 % آخرين منهم يعتزمون الهجرة خارج السودان خلال العامين المقبلين. أظهرت النتائج أن السمات الأكثر تفضيلاً لدى المستجيبين هي تقديم منح دراسية ليتدربوا في الخارج، فهم على استعداد للتنازل عن 3650 جنيهًا سودانيًا (يعادل 608 دولارات أمريكية) مقابل ذلك، وتحسين مستوى المرافق الصحية لتصبح ذات مستوى متقدم، فهم على استعداد للتنازل عن 1997 جنيهًا سودانيًا (يعادل 333 دولارًا أمريكيًا) مقابل ذلك، وتوفير الإشراف في مواقع الخدمة، فهم على استعداد للتنازل عن 1948 جنيهًا سودانيًا (يعادل 325 دولارًا أمريكيًا) مقابل ذلك. أما السمات الأقل تفضيلً لديهم فهي توافر المشرف عبر الاتصال الهاتفي، تليها المنحة الدراسية في طب الأسرة، والالتزام بالخدمة لمدة سنتين بعد استكمالهم التدريب.قد تأخذ السلطات الصحية بعين الاعتبار التفضيلات المذكورة أعلاه لتعزيز استراتيجيات اجتذاب الموارد البشرية من أجل الصحة إلى المناطق الريفية. وقد تصبح معالجة مسألة الإشراف ممكنة أكثر لدى واضعي السياسات على المدى القصير، إذا ما قورنت بتحسين الرواتب والبنية التحتية.Encourager les jeunes médecins à travailler en zones rurales au Soudan : une expérience en choix discret.L’exode des médecins et la répartition déséquilibrée entre zones urbaines et rurales comptent actuellement parmi les difficultés les plus importantes auxquelles se voit confronté le secteur de la santé.Déterminer le degré de préférence des jeunes médecins en faveur de postes en zones rurales au Soudan et estimer à quel point ils sont prêts à échanger une partie de leurs salaires contre des incitations non monétaires.L’étude a ciblé des jeunes médecins ayant terminé leur internat et se préparant à l’examen d’homologation en tant que médecin auprès du Conseil des médecins du Soudan afin d’obtenir leur inscription définitive. Des discussions ont été menées en groupes de travail afin de définir des incitations dont la valeur serait susceptible d’être reconnue. Une méthode d’expérimentation des choix, discrète, informatisée et accompagnée d’un questionnaire a été appliquée entre septembre et octobre 2012 dans les deux centres d’examen d’homologation soudanais.Quatre cent cinquante-cinq médecins ont terminé l’enquête. Plus d’un tiers des répondants a déclaré avoir l’intention de quitter immédiatement le Soudan et 30 % de plus prévoyaient de le faire dans les deux années suivantes. Les conclusions ont montré que l’attribution de bourses de formation à l’étranger, l’amélioration des normes des établissements de santé afin d’atteindre un niveau avancé et le contrôle par un médecin responsable sur place constituaient les avantages les plus cités par les répondants ; ces derniers se sont également déclarés prêts à échanger, respectivement, SDG 3650 (608 dollars des États-Unis [USD]), SDG 1997 (USD 333) et SDG 1948 (USD 325) de leurs salaires pour bénéficier de ces avantages. Les avantages les moins populaires étaient les suivants : disponibilité du médecin responsable au téléphone, suivi par une bourse d’étude en médecine générale et engagement de deux ans après la formation.Les autorités pourraient envisager de tenir compte des choix préférentiels décrits ci-dessus afin de valoriser les stratégies d’attraction vers les zones rurales auprès des ressources humaines. À court terme, les décideurs politiques pourraient éprouver moins de difficultés à traiter le problème du contrôle par des médecins responsables que celui de l’amélioration des salaires et des infrastructures.

The burden of oral diseases and need for dental care are high among refugees and asylum seekers (humanitarian migrants). Canada’s Interim Federal Health Program (IFHP) provides humanitarian migrants with limited dental services, however, this program has seen several fluctuations over the past decade. An earlier study on the experiences of humanitarian migrants in Quebec, Canada, developed the dental care pathways of humanitarian migrants model, which describes the care-seeking processes that humanitarian migrants follow, further, this study documented shortfalls in IFHP coverage. The current qualitative study tests the pathway model in another Canadian province. We purposefully recruited 27 humanitarian migrants from 13 countries in four global regions, between April and December 2019, in two Ontario cities (Toronto and Ottawa). Four focus group discussions were facilitated in English, Arabic, Spanish, and Dari. Analysis revealed barriers to care similar to the Quebec study: Waiting time, financial, and language barriers. Further, participants were unsatisfied with the IFHP’s benefits package. Our data produced two new pathways for the model: transnational dental care and self-medication. In conclusion, the dental care needs of humanitarian migrants are not currently being met in Canada, forcing participants to resort to alternative pathways outside the conventional dental care system.

Canada received over 140,000 refugees and asylum seekers between 2015 and 2017. This paper presents a protocol with the purpose of generating robust baseline data on the oral health of this population and build a long-term program of research to improve their access to dental care in Canada. The three-phase project uses a sequential mixed methods design, with the Behavioral Model for Vulnerable Populations as the conceptual framework. In Phase 1a, we will conduct five focus groups (six to eight participants per group) in community organizations in Ontario, Canada, to collect additional sociocultural data for the research program. In Phase 1b, we will use respondent-driven sampling to recruit 420 humanitarian migrants in Ontario and Quebec. Participants will complete a questionnaire capturing socio-demographic information, perceived general health, diet, smoking, oral care habits, oral symptoms, and satisfaction with oral health. They will then undergo dental examination for caries experience, periodontal health, oral pain, and traumatic dental injuries. In Phase 2, we will bring together all qualitative and quantitative results by means of a mixed methods matrix. Finally, in Phase 3, we will hold a one-day meeting with policy makers, dentists, and community leaders to refine interpretations and begin designing future oral health interventions for this population.

Background Although oral health care is a vital component of overall health, it remains one of the greatest unattended needs among the disabled. The aim of this study was to assess the oral health status and oral health-related quality of life (Child-OIDP in 11-13-year-old) of the visually challenged school attendants in Khartoum State, the Sudan. Methods A school-based survey was conducted in Al-Nour institute [boys (66.3%), boarders (35.9%), and children with partial visual impairment (PVI) (44.6%)]. Two calibrated dentists examined the participants (n=79) using DMFT/dmft, Simplified Oral Hygiene Index (OHI-S), dental care index, and traumatic dental injuries (TDI) index. Oral health related quality of life (C-OIDP) was administered to 82 schoolchildren. Results Caries experience was 46.8%. Mean DMFT (age≥12, n=33) was 0.4 ± 0.7 (SiC 1.6), mean dmft (age Conclusions Visually impaired schoolchildren are burdened with oral health problems, especially caries. Furthermore, the 11-13 year olds' burden with caries showed a significant impact on their quality of life.

Background Information on oral health-related quality of life, in addition to clinical measures, is essential for healthcare policy makers to promote oral health resources and address oral health needs. Objectives This paper aimed at evaluating the psychometric properties of the Arabic version of Child-OIDP, estimating the prevalence, severity and causes of oral impacts on daily performances in 12-year-old public and private school attendees in Khartoum State and to identify socio-demographic and clinical correlates of oral impacts as assessed by the Child-OIDP inventory. Methods The Child-OIDP questionnaire was translated into Arabic was administered to a representative sample of 1109 schoolchildren in Khartoum state. Clinical measures employed in this study included DMFT index, Gingival index, Plaque index and Dean's index. A food frequency questionnaire was used to study the sugar-sweetened snack consumption. Results The instrument showed acceptable psychometric properties and is considered as a valid, reliable (Cronbach's alpha 0.73) and practical inventory for use in this population. An impact was reported by 54.6% of the schoolchildren. The highest impact was reported on eating (35.5%) followed by cleaning (28.3%) and the lowest impacts were on speaking (8.6%) and social contact (8.7%). Problems which contributed to all eight impacts were toothache, sensitive teeth, exfoliating teeth, swollen gums and bad breath. Toothache was the most frequently associated cause of almost all impacts in both private and public school attendees. After adjusting for confounders in the 3 multiple variable regression models (whole sample, public and private school attendees), active caries maintained a significant association with the whole sample (OR 2.0 95% CI 1.4-2.6) and public school attendees (OR 3.5 95% CI 2.1-5.6), and higher SES was associated with only public school attendees' Child-OIDP (OR 1.9 95% 1.1-3.1). Conclusion This study showed that the Arabic version of the Child-OIDP was applicable for use among schoolchildren in Khartoum. Despite the low prevalence of the dental caries pathology (24%), a significant relationship, with an average moderate intensity was found with OHRQoL. Focus in this population should be on oral health education, improving knowledge of the prospective treatment opportunities and provision of such services.