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The management of water resources and the related disposal of wastewater are essential for human existence and the advancement of contemporary society. Collecting and managing wastewater has a significant effect on local and global economies as well as the environment. Innovation in the field of the environment is of utmost importance in reducing the environmental impacts on systems and in making them more sustainable economically, environmentally and socially. Decentralization is considered an appropriate solution to sustainability problems in liquid waste management programs because it focuses on treating liquid waste on-site, recycling it locally, and taking advantage of the local resources available in domestic wastewater. This research analyzes the needs, appropriate technical methods, and support for water management through decentralized systems. Three considerations will be used to support the choice of a decentralized wastewater treatment system in the Khartoum Locality: $106,000,000. According to the BioWin results, the effectiveness of each alternative household wastewater treatment was comparable. Software such as MapInfo, GPS Area Calculator, BioWin, and GIS was used to reach the targets. Additionally, the results revealed that the decentralized wastewater treatment method, considering its costs, land requirements, and slope effects on the environment, is preferable to centralized wastewater treatment systems. These results serve as a guide for choosing the best wastewater treatment option to increase access to safe sanitation and to integrate decentralized wastewater management to upgrade and improve the environment in the Khartoum Locality. [ABSTRACT FROM AUTHOR]

Background: Intestinal parasitic infections (IPIs) are considered to be a major health problem, particularly in the tropical countries, such as Sudan. Due to poor hygiene practices, the psychiatric patients may pick up parasitic infections. Until now, there exists no published data or available information regarding the prevalence rate of intestinal parasitic infections among Sudanese psychiatric patients. Therefore, our present study aimed to determine the prevalence of intestinal parasitic infections and the potential associated risk factors among Sudanese psychiatric patients. Methods: A hospital based cross-sectional study was conducted from September 2021 to March 2022. A total of 422 stool samples were randomly collected from psychiatric patients attending the psychiatric section at Kosti Teaching Hospital in the White Nile State of Sudan. Socio-demographic data were gathered using structured questionnaires. All stool samples were examined using different parasitological techniques. Results: The overall prevalence rate of intestinal parasitic infection among psychiatric patients was 120/211 (56.8%) and among non-psychiatric patients 66/211 (31.3%) The prevalence rate of intestinal parasites (IPs) among psychiatric patients were as follows: Entamoeba histolytica (29.9%), Giardia lamblia (19.4%), Entamoeba coli (5.2%), Ascaris lumbricoides (0.9%), Hymenolepis nana (0.9%), and Enterobius vermicularis (0.5%). There was no relationship between intestinal parasitic infection and age, sociodemographic features, sources of drinking water, contact with domestic animals, washing of hands, eating of raw vegetables/meats, or having psychiatric disorders (p > 0.05). Conclusions: Studying the prevalence rate of intestinal parasitic infections among psychiatric patients may help to assess their health condition or status, leading to better psychiatric healthcare services, diagnoses, and treatments. [ABSTRACT FROM AUTHOR]

Background: Different levels of association between snoring, hypertension, and diabetes mellitus (DM) are reported. There are few published studies on this topic in African countries, and no investigation was conducted in Sudan. This study aimed to assess the prevalence and factors associated with snoring and the association between snoring, hypertension, and type 2 DM (T2DM) in northern Sudan. Methods: A community-based cross-sectional study using a multistage sampling technique was conducted in four villages in the River Nile state of northern Sudan from July to September 2021. Sociodemographic characteristics were collected using a questionnaire. Body mass index (BMI) was measured using standard methods, and a multivariate analysis was conducted using the Statistical Package for the Social Sciences® (SPSS®) for Windows, version 22.0. Results: Of the 384 adults, 193 (50.3%) were males and 191 (49.7%) were females. Of the adults, 38 (9.9%) were underweight, 121 (31.5%) had average weight, 113 (29.4%) were overweight, and 112 (29.2%) were obese. One hundred and six (27.6%) adults were snorers. Multivariate analysis showed that increasing age (adjusted odds ratio [AOR] = 1.02, 95% confidence interval [CI] = 1.01‒1.04), increasing BMI (AOR = 1.04, 95 CI = 1.01‒1.08), obesity (AOR = 2.0, 95% CI = 1.10‒3.69), and alcohol consumption (AOR = 2.32, 95% CI = 1.14‒4.74) were positively associated with snoring. Of the 384 adults, 215 (56.0%) had hypertension. Multivariate analysis showed that increasing age (AOR = 1.04, 95% CI = 1.02‒1.06), increasing BMI (AOR = 1.08, 95% CI = 1.04‒1.13), female sex (AOR = 1.7, 95% CI = 1.08‒2.73), and snoring (AOR = 1.69, 95% CI = 1.02‒2.82) were positively associated with hypertension. One hundred and six (27.6%) adults had T2DM. Multivariate analysis showed that increasing age (AOR = 1.03, 95% CI = 1.01‒1.05) and snoring (AOR = 1.78, 95% CI = 1.09‒2.91) were associated with T2DM. Conclusion: Around one-fourth of the adults in Northern Sudan are snorers. Snoring is more common among obese adults. Snoring is associated with increased odds of hypertension and T2DM. Adults who snore must pay close attention to their blood pressure and blood glucose levels to prevent hypertension and DM. [ABSTRACT FROM AUTHOR]

aima Abdel Majeed Mohamed Salih,2,* Tarteel Abbas Abaker Joda,3,* Mai Fathi Awadalla Alsedig,3,* Alaa T Omer,3,* Hayat A Ahmed,3,* Lina Hemmeda,3,* Mariam Alazraa M Esmaeel,3,* Khabab Abbasher Hussien Mohamed Ahmed3,*1Asthma Clinic Mohammed Alamin Hamid Pediatric Hospital, Omdurman, Sudan; 2Departments of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Omdurman, Sudan; 3Faculty of Medicine, University of Khartoum, Khartoum, Sudan *These authors contributed equally to this work Correspondence: Mariam Alazraa M Esmaeel, Faculty of Medicine, University of Khartoum, ElQasr Avenue, Khartoum, Khartoum State, 11111, Sudan, Tel +249915077027, Email [email protected] Background and Aims: It is essential to have proper treatment and management for asthma in order to minimise symptoms, lessen the burden, and lower the chance of exacerbations. To better control asthma, the purpose of this study was to evaluate and enhance paediatric registrars' understanding and application of asthma treatment. Methods: The Sudan Medical Specialisation Board (SMSB) paediatric registrars provided data for this quasi-interventional study between April and September of 2021. Twice, both before to and following the intervention education sessions, the questionnaire was delivered. SPSS version 28 was used to analyse the data after it had been cleaned up in an Excel document. Results: 203 (or 77.8%) of the 261 were women. A substantial rise from 8.1 ± 4.12 SD to 18 ± 5.03 SD in the mean overall knowledge score of registrars between the pre-and post-intervention periods. A significant difference (p=0.001) was observed in the post-intervention phase, with first-year registrars (R1) demonstrating higher scores than their senior colleagues. The registrars' total knowledge scores did not differ significantly from one another during the pre-intervention period. The Global Initiative of Asthma (GINA) guidelines of management were implemented to a certain extent, according to the study. Of the registrars, 148 (56.7%) and 203 (77.8%) evaluated step one management in children ages 5 and under; 66 (25.3%) and 213 (81.6%) evaluated step one management in children ages 6 to 11; and 66 (25.3%) and 213 (81.6%) evaluated step one management in children ages 6 to 11 in pre- and post-intervention, respectively. Conclusion: Given that the intervention in this study greatly increased registrars' knowledge, doctors should obtain training on the GINA 2019 recommendations through conferences, workshops, and academic programmes. To find out why R1 outperforms their older counterparts, more investigation has to be done. [ABSTRACT FROM AUTHOR]

Background: Anti-retroviral therapy-related adverse drug events are accounted as a main cause of anti-retroviral therapy non-adherence. In Sudan, pharmacovigilance studies are relatively rare and obstructed by the problem of under-reporting. It is a well-defined issue worldwide and is highly reported in developing countries. This study aimed to evaluate the prevalence of adverse events associated with anti-retroviral therapy among adult patients with immunodeficiency virus at Omdurman Voluntary Counselling and Testing and Anti-retroviral Therapy Center. Methods: The study was a descriptive cross-sectional study conducted through direct interviews with 429 patients at the selected center using the Adverse Drug Events (ADEs) reporting form. The collected data were analyzed by The Statistical Package for Social Sciences. Results: More than half (55.5%) of the participants experienced adverse events, with 48.7% having experienced them at the beginning of treatment. Central nervous system manifestations were the most common adverse events. By using the Naranjo scale, most adverse events showed a "probable" relationship to anti-retroviral medicines. Based on the chi-square test, medication regimen was significantly associated with the presence of ADEs (namely abdominal pain and jaundice) (p values = 0.03 and 0.001), respectively. Conclusion: This study clearly stated that ART-related ADEs are common among Sudanese PLHIV and with central nervous system being the main adverse events. More pharmacovigilance studies and efforts by healthcare providers should be applied targeting ART-related ADEs under-reporting in Sudanese healthcare facilities. [ABSTRACT FROM AUTHOR]

Teacher action research is in the emergent stages in Sudanese schools and needs to be well disseminated and actively supported from the Ministry of education. Although the teacher-as-researcher movement has been in existence for some twenty years, there is a reason to think that the majority if not all, of Sudanese class teachers remain uninvolved. What lies behind their reluctance? This paper looks at the complexities in the role of a teacher engaging in action research. This includes the need to explore further the principles and practice of action research. This study puts forward explanations in four main areas: teachers' perception of action research; teachers' professional status, teachers' confidence, and teachers' difficulty engaging in action research. For this purpose a workshop was held and representatives from seven Universities and 25 school teachers participated in a thorough discussion and further investigation was carried out based on the workshop discussion. The data was analyzed statistically and the results showed that the Sudanese teachers have no idea about action research it is not part of their culture as well as the institutions culture. Teachers are reluctant to do an action research and that due to the lack of knowledge which was an important factor. Teachers are not certain about the adequacy of doing an action research. There are other factors such as time and the over load. Based on these findings recommendations are drawn, it is suggested that classroom teaching is an all-demanding and all-involving task which is excluding of an activity as exacting as research. However, it is argued that with appropriate support more teachers may become involved in an action research.

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. [ABSTRACT FROM AUTHOR]

Background: Several countries poorly adhere to the World Health Organization's recommendation of folic acid supplementation in the periconceptional period, especially in limited-resource settings. Objective: The objective of this study was to investigate the prevalence of and the factors associated with folic acid usage in the periconceptional period among pregnant women at Gadarif Maternity Hospital in eastern Sudan. Study design: This is a cross-sectional study. Methods: This study was conducted in eastern Sudan from April to September 2022. A total of 720 pregnant women in their first trimester were enrolled. The sociodemographic characteristics and clinical and obstetrical data of pregnant women in their first trimester were assessed using a face-to-face questionnaire. In addition, multivariate regression analysis was performed. Results: In this study, the median (interquartile range) of the age and gravidity of the enrolled women was 26.3 (24.14–29.52) years and 2 (1–4), respectively. Of these 720 women, 423 (58.8%) used folic acid during the periconceptional period, while 27 (3.7%) women used folic acid in the preconceptional period. None of the investigated factors (age, residence, education, employment, body mass index, or gravidity) were associated with periconceptional use of folic acid. Conclusion: The study revealed a low prevalence of folic acid usage in preconceptional period among pregnant women in eastern Sudan. Additional efforts are needed to promote folic acid usage in the preconceptional period as well as in the first trimester. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) is a major public health issue worldwide. Red cell distribution width (RDW) has been reported to have predictive value in several diseases, including DM. Few data exist on the association between RDW and the prediabetic stage. Thus, the present study aimed to investigate the association between RDW and prediabetes in adults in Sudan. This case–control study was conducted in Northern Sudan in 2022. The cases (n = 107) were prediabetic patients categorized according to the level of glycated hemoglobin (HbA1c), which ranged from 5.7% to 6.4%, while the controls (n = 107) were healthy participants. A questionnaire was used to collect the data. Standard methods were used to measure the HbAIc level and RDW. Logistic regression analysis was performed. The median (interquartile range (IQR)) of the RDW was significantly higher in prediabetic patients than in the controls (14.5% [13.8–15.3%] vs. 14.1% [13.6–14.7%], p = 0.003). Sex, educational level, occupational status, marital status, cigarette smoking, alcohol consumption, family history of DM, and body mass index were not associated with prediabetes. In the multivariate-adjusted model, higher age and higher RDW were associated with prediabetes. A positive correlation was found between RDW and HbA1c levels (r = 0.19, p = 0.006). In conclusion, this study supports the use of RDW as a predictor of DM. [ABSTRACT FROM AUTHOR]

Visceral leishmaniasis (VL, kala azar), caused by Leishmania donovani, transmitted by Phlebotomus orientalis, is a serious systemic disease that causes high morbidity and mortality rates in Sudan and other parts of East Africa and the world. Despite progress in understanding the epidemiology of the disease in East Africa, little is known about the host preference of P. orientalis in kala azar endemic villages of Sudan, which have some of the highest VL incidence rates in the world. The present study used host choice experiments and blood‐meal identification approaches to determine the host preference of P. orientalis in kala azar endemic villages in Gedarif state, eastern Sudan. In the host choice experiment, tent traps were used to compare the attractiveness of cows, donkeys, sheep and goats for host‐seeking P. orientalis. In the blood‐meal identification study, blood‐fed P. orientalis females, captured inside houses and peri‐domestic habitats, were subjected to molecular typing using cytochrome b gene (cyt b) amplification and sequence analysis. Cows and donkeys were the most attractive to blood‐seeking P. orientalis, followed by goats. Similarly, the blood‐meal analysis of P. orientalis showed that the vector preferentially feeds on cows, followed by donkeys, humans and goats. The human blood index of P. orientalis was 19.4% (42/216), indicating a high zoophilic habit of the vector, both inside and outside the houses. Although the order of host preference varied by location, it was clear that cows are the most preferred host of P. orientalis in the area. Results are discussed in relation to the role of domestic/livestock animals in VL zoopotentiation and zooprophylaxis. Inference is made on the potential impact of insecticide treatment of cows in control of the vector and the transmission of VL in Sudan and other parts of East Africa. [ABSTRACT FROM AUTHOR]

Background: The existing evidence regarding the link between blood groups and obesity remains inconclusive, and there is a noticeable lack of data on the potential association between blood groups and obesity during pregnancy. Consequently, this study aimed to investigate the association between blood groups, body mass index (BMI), and obesity among pregnant women receiving care at Gadarif Maternity Hospital in eastern Sudan. Methods: This cross-sectional study was conducted in eastern Sudan during the period from April to September 2022. A questionnaire was employed to gather sociodemographic information from pregnant women. BMI was computed based on weight and height. Blood groups determinations were made using the agglutination method which is commonly used in the study's region. Multinominal and multiple linear regression analyses were performed, and adjusted for covariates in the regression models. Results: Eight hundred and thirty-three pregnant women were enrolled with a median (interquartile range, IQR) gestational age of 10.0 (9.3‒11.0) weeks. The median (IQR) BMI of the women was 26.3(24.2‒29.4) kg/m2. Of these women, 11(1.3%) were underweight, 268(32.2%) were of normal weight, 371(44.5%) were overweight, and 183(22.0%) were obese. One hundred eighty-three (22.0%) women had blood group A, 107 (12.8%) had blood group B, 56 (6.7%) had blood group AB, and 487(58.5%) had blood group O. While 798 (95.8%) of the women were Rhesus factor positive, only 35 (4.2%) were Rhesus factor negative. Multinominal regression showed that only urban residency (adjusted odds ratio, AOR = 2.46, 95% confidence interval, CI = 1.47‒4.13) was associated with overweight. Blood groups and Rhesus factors were not associated with overweight. Age (AOR = 1.06, 95% CI = 1.01‒1.11), urban residence (AOR = 2.46, 95%, CI = 1.47‒4.13), and blood group O (AOR = 1.60, 95%, CI = 1.06‒2.40), were associated with obesity. Rhesus factors were not associated with obesity. In the multiple linear regression, age (coefficient = 0.07, P = 0.028), gravidity (coefficient = 0.25, P = 0.014), urban residence (coefficient = 1.33, P = 0.001), and blood group O (coefficient = 0.68, P = 0.035) were associated with BMI. Conclusions: Blood group O was associated with obesity and high BMI among pregnant women in eastern Sudan. Rhesus factors were not associated with obesity. [ABSTRACT FROM AUTHOR]

Background: Antibiotics play an important role in decreasing morbidity and mortality worldwide. However, inappropriate use of them by patients or healthcare professionals contributes to their resistance rendering them less efficacious. Community pharmacists (CPs) have a significant part in reducing antibiotic resistance. Therefore, this study aimed to investigate the dispensing of antibiotics without prescription in community pharmacies with an emphasis on cefixime dispensing.Methods: A cross-sectional, simulated patient (SP) study was conducted in the Khartoum locality. A total of 238 community pharmacies were randomly chosen using simple random sampling. One scenario of uncomplicated urinary tract infection was designed, and six female pharmacy students who were trained to act as SPs presented the scenario. Descriptive statistics were applied to report the study outcomes.Results: In the 238 pharmacy visits, at least one antibiotic was dispensed without a prescription in 69.3% of the simulated visits. Among the dispensed antibiotics, ciprofloxacin was the most dispensed antibiotic followed by cefixime representing 51.5% and 41.8%, respectively, of total dispensed antibiotics. Cefixime was dispensed as a first choice by CPs in 29% of the visits, and in the rest of the visits, only 37.3% of CPs refused to dispense cefixime after SP demand.Conclusion: The findings revealed a high rate of antibiotics dispensing without prescription by CPs in Khartoum state, and cefixime was obtained with ease before and after the patient's demand. Urgent corrective actions such as imposing strict regulations, monitoring pharmacists' practice, and endorsing educational programs for pharmacists are needed to prevent inappropriate antibiotic dispensing practices. [ABSTRACT FROM AUTHOR]

Background: Health-care workers' psychological status is essential to Preventive control measures in a weak and unstable health system with poor infrastructural constraints. This study examines the psychological impact of the ongoing coronavirus disease 2019 (COVID-19) pandemic on the health-care providers working in primary health-care settings in Sudan. Materials and Methods: This is a health facility–based cross-sectional study conducted in primary health-care units in White Nile State, Sudan. The psychological impact of stress and anxiety was determined using the Depression Anxiety Stress Scale 21 (DASS-21). A self-administered questionnaire measured depression, anxiety, and stress. The population of this study included health professionals working in health centers, including physicians, nurses, technicians, pharmacists, and other support staff. Results: A total of 167 health professionals were systematically recruited. The mean anxiety score in the study population was 8.26 & 9.0 (corresponding to mild anxiety). Participants without anxiety constituted 26.35% (n = 44) of the participants. Women were significantly more likely to be affected than men (P = 0.0). Age (21–40 years), female nurses, and other health-care workers (anesthesiology, public health, health education, occupational health, psychiatry, etc.) could be strong predictors of psychological disorders (P-value of 0.0). Conclusion: This study provided evidence for primary health care at its preparatory levels, as they are the first line of protection against the COVID-19 pandemic. Addressing the high-risk population is a high priority in the preliminary phase. [ABSTRACT FROM AUTHOR]

Background and Objectives: HIV disease is recognized to cause inconsistencies in coagulation via various pathways during infection. Some studies have indicated that HIV-infected patients are prone to developing thrombocytopenia, thrombosis, or autoantibodies that may cause difficulties in diagnosis. This study is intended to measure the trend of coagulation parameters in Sudanese patients with HIV. Materials and Methods: A cross-sectional study was carried out in patients with HIV admitted to the Sudan National AIDS Program (SNAP) from January 2018 to December 2019. Prothrombin time (PT), partial thromboplastin time (PTT), thrombin time (TT), D-dimer (DD), hemoglobin (HB), total lymphocyte count (TLC), platelet count (PLT), and a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13 (ADAMTS13), were evaluated among HIV Sudanese patients. Results: Out of the 44 HIV patients included, 6 (13.6%) were found to have thrombotic thrombocytopenic purpura-like events and 12 (27.2%) had antiphospholipid antibodies, of whom 8 (66.6%) showed anticardiolipin antibody (1gG (75%) and IgM (25%)) and 4 showed lupus anticoagulants. The HB, TLC, and PLT values were found to be significantly lower in HIV patients than in control (p = 0.000, 0.000, and 0.050, respectively). The PT and ADAMTS13 values showed no significant difference between HIV patients and control (p = 0.613 and 0.266, respectively). The PTT, TT, and DD values were found to be augmented in HIV patients versus the control (p = 0.000). Conclusions: Thrombotic thrombocytopenic purpura-like events among HIV Sudanese patients were explored. In addition, antiphospholipid antibodies were strikingly seen in these patients. Additional research is anticipated to confirm these diagnoses. [ABSTRACT FROM AUTHOR]

Background: One of the most common surgical emergencies, intestinal obstruction is rarely the result of an inadvertently retained foreign object (also known as a gossypiboma), which may not present symptoms for a lifetime. It also carries additional legal burdens, which may account for the rarity of its reports. Case presentation: We report a 24-year-old Sudanese female with a history of emergency Caesarean section two years before the admission presented with abdominal distension and absolute constipation, which was diagnosed as intestinal obstruction with a retained gauzed found within the small intestine. Moreover, a review of recent African-reported cases was done to find relatively similar cases. Conclusion: Adhering to the standard of care in surgical theaters and integrating new methods of prevention like tagged gauze could help to decrease the rate of such cases in the future. [ABSTRACT FROM AUTHOR]

Background: Waste disposal and management is a global concern affecting both high- and low-income countries. This research assessed the health impact of burning household waste in Khartoum State, Sudan. Methods: An online community-based cross-sectional study was implemented on a sample of 844 participants selected through a stratified random sampling technique across Khartoum State. The data were collected through a standardized pre tested online questionnaire. The data file was georeferenced through Google Earth Pro and analysed with SPSS 23 and ArcGIS 10.3. The data were summarized numerically and graphically. The appropriate frequency tables were used in ArcGIS to generate geographical distribution maps of household waste burning and predictive health risk maps of waste burning in Khartoum State. Statistical tests performed for association carried out were Chi-square and ANOVA. A binary regression analysis established the relationship between burning of household waste and its associated factors. All statistical tests were considered significant when p < 0.05. Results: The practice of burning household waste was performed by 74.5% (619/831) of the participants with 50.8% (311/612) who reported burning the waste weekly. The health conditions related to household waste burning were predominately asthma (57.0%) and respiratory manifestations (38.0%). Of the ten contributing factors of health risks related to burning household waste, the two statistically significant were the frequency of waste collection (OR = 0.720, 95% [CI: 0.593– 0.875], p = 0.001) and the place of waste disposal (OR = 0.791, 95% [CI: 0.651– 0.961], p = 0.018). Conclusion: The practice of burning household waste in Khartoum State was a public health concern. Sociodemographic and managerial factors exposing residents to health risks appeal political, health authorities and communities to establish a partnership to manage household waste for public safety and good quality of life. [ABSTRACT FROM AUTHOR]

Background: Ward rounds are a cornerstone in the educational experience of junior doctors and an essential part of teaching patient care. Here, we aimed to assess the doctors' perception of ward rounds as an educational opportunity and to identify the obstacles faced in conducting a proper ward round in Sudanese hospitals. Method: A cross-sectional study was conducted from the 15th to the 30th of January 2022 among house officers, medical officers, and registrars in about 50 teaching and referral hospitals in Sudan. House officers and medical officers were considered the learners, while specialist registrars were considered the teachers. Doctors' perceptions were assessed using an online questionnaire, with a 5-level Likert scale to answer questions. Results: A total of 2,011 doctors participated in this study (882 house officers, 697 medical officers, and 432 registrars). The participants were aged 26.9 ± 3.2 years, and females constituted about 60% of the sample. An average of 3.1 ± 6.8 ward rounds were conducted per week in our hospitals, with 11.1 ± 20.3 h spent on ward rounds per week. Most doctors agreed that ward rounds are suitable for teaching patient management (91.3%) and diagnostic investigations (89.1%). Almost all the doctors agreed that being interested in teaching (95.1%) and communicating appropriately with the patients (94.7%) make a good teacher in ward rounds. Furthermore, nearly all the doctors agreed that being interested in learning (94.3%) and communicating appropriately with the teacher (94.5%) make a good student on ward rounds. About 92.8% of the doctors stated that the quality of ward rounds could be improved. The most frequently reported obstacles faced during ward rounds were the noise (70%) and lack of privacy (77%) in the ward environment. Conclusion: Ward rounds have a special value in teaching patient diagnosis and management. Being interested in teaching/learning and having good communication skills were the two major criteria that make a good teacher/learner. Unfortunately, ward rounds are faced with obstacles related to the ward environment. It is mandatory to ensure the quality of both ward rounds' teaching and environment to optimize the educational value and subsequently improve patient care practice. [ABSTRACT FROM AUTHOR]

Background: The medical profession is one of the most highly respected and desired professions among students worldwide, most likely because it provides opportunities for both a financially and socially rewarding career. However, while it has been quite established that factors such as self-interest, family pressure, friend pressure, and socioeconomic status do influence the choice of medicine among students worldwide, the exact reasons for an individual to join a medical school may actually vary worldwide. The aim of this study was to comprehensively explore factors influencing medical students to opt in/out medical careers in Sudan. Methods: An institutional based descriptive cross-sectional study was conducted at University of Khartoum in the year 2022 with a random sample of 330 students that was obtained from the medical students at the The University of Khartoum, Faculty of Medicine using stratified random sampling. Results: Self-interest was the most common factor influencing opting in (choosing) medical profession (70.6%) (n = 233), followed by getting a very high score in high-school that qualifies into the faculty (55.5%) (n = 183). Regarding the factors affecting medical students' choices, parental pressure was the main factor (37.0%) (n = 122), followed by other relatives' pressure (12.4%) (n = 41), and 4.2% (n = 14) chose Peer pressure. 59.7% (n = 197) of the participants stated that they were not affected by any of these factors. Most of the participants felt that the general perception of the medical profession by society is that it is prestigious and has good career opportunities, only 5.8% (n = 19) believed that it is "Not appreciated at all" by the society. A statistically significant association was found between the type of admission & parent pressure (p value 0.01). out of 330 participants, (56.1%) (n = 185) have opted out i.e. lost their interest or regretted their choice of medical career. Academic difficulties was the most common factor causing students to opt-out of the medical career (37%) (n = 122) followed by Multiple suspensions of education (35.2%) (n = 116), Current political & security conflicts in Sudan (29.7%) (n = 98), Poor quality of education (24.8%). The proportion of students having regrets for the medical profession was significantly higher among females. Over one third of the participants reported having depressive symptoms more than half days of the week. No statically significant correlation was established between the academic level and having these depressive symptoms and no statistically significant correlation was established between the decision to opt-out and the academic level (class) of the individuals (P = 0.105). Conclusions: Over half of Sudanese medical students at the University of Khartoum have already lost their interest or regretted their choice of medical career choice. Whether these future doctor chose to drop out or continue their path in the medical career suggests that they are more prone to serious hardships in their future careers. A careful comprehensive approach should further explore and try to offer solutions for problems like "Academic difficulties", "multiple suspension of education", and "poor quality of education" for they were the most common factors that caused medical students to opt out of the medical career. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine foreign direct investment (FDI) in the context of Sudan between the years 1990 and 2020 by using the bounds testing method of cointegration and the error-correction model. As per the results, it can be understood that the variables considered for the study are combined on a long-term basis if FDI remains a dependent variable. Further, a significant equilibrium correction was found, which supports the existence of a longterm relationship. A number of internal and external factors (especially gross domestic product (GDP), trade openness, inflation, exchange rate, and growth rate, as well as additional macroeconomic indicators such as investment/GDP) were found to impact the state of FDI in Sudan. The variables showed no causalities as per the outcomes of the Granger causality test. Moreover, as per the variance decomposition results, the forecast error variance of FDI, in addition to that of GDP, investment/GDP, and inflation, was found to be self-explanatory. Additionally, as per the impulse response functions, the results demonstrated a short-term negative association between GDP and FDI, suggesting that Sudan possesses inadequate absorptive capacity for promoting its economy using FDI. The results of this research emphasized how selective public policies can be utilized to promote FDI and consequently facilitate short- and long-term economic growth. Therefore, it is useful to recommend some policy implications to promote the application of FDI in Sudan. [ABSTRACT FROM AUTHOR]

Background and Objectives: Little is known regarding the 5C psychological antecedents to COVID-19 vaccination among pharmacists in low- and middle-income countries. This study aimed to assess the acceptance of COVID-19 vaccination and its psychological antecedents among community pharmacists in Khartoum State, Sudan. Materials and Methods: A cross-sectional study was conducted from July to September 2022. A self-administered questionnaire was used to collect data about sociodemographic and health status characteristics, vaccine acceptance, and the 5C psychological antecedents to vaccination. Stepwise logistic regression analysis was conducted, and results were presented using odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). Results: A total of 382 community pharmacists participated in the current study, with a mean age of 30.4 ± 5.6 years. Nearly two-thirds of the participants (65.4%) were females, and the majority (74.9%) have received or intended to receive the COVID-19 vaccination. Vaccine acceptance was significantly associated with the following psychological antecedents to vaccination: confidence, complacency, constraints, and calculation (p < 0.001). Results of the logistic regression showed that confidence in vaccines [OR = 6.82 (95% CI = 3.14–14.80)], conspiracy beliefs [OR = 0.44 (95% CI = 0.23–0.85)], and constraints to vaccination [OR = 0.18 (95% CI = 0.06–0.56)] were the significant determinants of vaccine acceptance. Conclusion: The study revealed important predictors of COVID-19 vaccine acceptance that can be used to guide policymakers in designing target-oriented interventions that can improve the vaccine acceptance rate among community pharmacists in Sudan. These findings suggest that interventions to promote vaccine acceptance among pharmacists should focus on building confidence in vaccines and providing accurate information about the safety and efficacy of the COVID-19 vaccine, and reducing constraints to vaccination. [ABSTRACT FROM AUTHOR]

Background: Community pharmacists are uniquely positioned at the heart of communities, and their patient counseling role is the cornerstone for achieving the required therapeutic goals. Therefore, the main objective of this study is to explore the perceptions of community pharmacists regarding patient counseling, and their perception towards continuing pharmacy education programs. Methods: A descriptive, cross-sectional design was performed among randomly selected 238 community pharmacies in Khartoum locality (Sudan) from September 2022 to December 2022. The data were collected using a self-administered questionnaire adopted from a previous study with few minor modifications, which was adding three sociodemographic questions. Descriptive statistics were carried out according to the study objective to analyze the pharmacists' responses. Results: The majority of the community pharmacists gave counseling and understood its importance to the patients, most of them (70.6%) took 1– 5 minutes during the dispensing process. The dose was the most provided information by community pharmacists (26.7%) followed by administration (23.7%) and duration (22.4%). Few (28.2%) of the patients ask the pharmacists about the cost of the medication. Lack of patients' interest (55%) was the major barrier to effective counseling followed by lack of time (47.9%). Almost all (96.2%) pharmacists in this study were interested in continuing pharmacy education programs, and they preferred programs focusing on common diseases (36.6%), and common drugs (30.3%). Conclusion: This study showed that the majority of community pharmacists in the Khartoum locality had positive perceptions toward patient counseling and they were interested in continuing pharmacy education programs. [ABSTRACT FROM AUTHOR]

The current study evaluated the efficacy of indigenous isolates of entomopathogenic fungi against the third larval instar of tomato leaf miner (Tuta absoluta Meirick; Lepidoptera: Gelechiidae). Four virulent isolates were subject to morphological and molecular identification and they were identified as; Beauveria bassiana isolate Hammad-R7 (Sudan) accession (MN598666); Beauveria bassiana isolate-Sud-afro-18ITS accession (MK046654); Beauveria bassiana isolate Sud-afro-2oITS accession (MK046652) and Purpureocillium lilacinum isolate Khartoum accession (MK046655). Efficacy test was done by larval dipping in the fungal suspension along with the commercial product Eco-Bb®. Mycosis test was performed to confirm the growth of fungus from the cadaver. Treated larvae died within three days after the appearance of the symptoms. The four indigenous isolates showed medium mortality responses (LT50 ranged between 4.1–4.3 days) close to or slightly even better than that induced by the commercial product ECO-Bb (LT50 4.2 days) however three of them induced superior responses (LT90 ranged between 9.5–11.7 days) to the commercial product ECO-Bb (LT90 14.4 days) at higher doses measured at the LT90. Endophytic capability of the isolates was tested by seed dipping and soil drenching methods and the fungal mycelia was detected microscopically in the leaves and stems without apparent negative effects on plant growth. The current results indicate the promising potential of these isolates in the regulation of T. absoluta. [ABSTRACT FROM AUTHOR]

Malnutrition is the major cause of mortality and morbidity globally with undernutrition contributing about 45% of all deaths of under five children. Besides the direct effects of protracted conflicts, the macroeconomic crisis that has greatly increased the national inflation rate hence devastating the purchasing power, the COVID-19 outbreak, flooding, and the Desert Locusts have contributed to a food security emergency. Besides being among the most under resourced states, South Kordofan has experienced years of conflict resulting in displacement of people and extensive infrastructure destruction with high rates of malnutrition. The state currently has 230 health facilities and out of these, only 140 are providing outpatient therapeutic programme centres with 28.6% (40) of these being operated by the state ministry of health and the rest by the international non-governmental organizations. Limited resources leading to donor dependence, limited accessibility due to insecurity and floods, poor referral system and gaps in continuity of care, lack of operational and implementation research data and limited integration of management of malnutrition in other health services have negatively affected effective implementation. Ensuring effective and efficient community based management of acute malnutrition, implementation needs action beyond the health sector with a multi-sectoral and integration approach. Federal and state development frameworks should ensure a comprehensive multi-sectoral nutrition policy with strong political commitment and allocation of adequate resources to ensure integrated and quality implementation. [ABSTRACT FROM AUTHOR]

More than 400 million sheep are raised on the African continent, the majority of which are indigenous and are primarily reared for sustenance. They have effectively adapted to various climatic and production environments, surviving and flourishing. The genetic relationships among these sheep populations remain understudied. Herein, we sequenced the entire mitochondrial DNA control region of 120 animals from Hamary and Kabashi and their crossbreed (Hamary x Kabashi) of Sudan desert sheep (SDS) to understand their maternal-inherited genetic variation and demographic history profiles and relate those to the history of sheep pastoralism on the African continent. The results show a diversified and predominant D- loop haplogroup B (n = 102, 85%), with all other sequences belonging to haplogroup A. Most of the maternal genetic variation was partitioned between haplogroup (76.3%) while within haplogroup accounted for 23.7% of the variation. However, little genetic differentiation was observed among the two breeds and their crosses, with our results supporting a Hamari maternal origin for the crossbreed. Bayesian coalescent-based analysis reveals distinct demographic history between the two haplogroups, two breeds and their crosses. Comparison of the two haplogroup showed that haplogroup B experienced an earlier expansion than haplogroup A. Unlike the breed-based comparison, the expansion of the two breeds started roughly at the same time, around 6500 years ago, with Kabashi having a slightly greater effective population size. The maternal ancestors of SDS may have diverged before their introduction to the African continent. This study provides novel insights into the early history of these two main breeds of Sudan desert sheep and their crosses. [ABSTRACT FROM AUTHOR]

Background: Self-medication with antibiotics (SMA) is one of the common factors which precipitate antimicrobial resistance, yet if effective implementations are amended it can be effortlessly controlled. The present study aimed to estimate the prevalence and predictors of SMA in Sudan. Methods: The study adopted a cross-sectional study design conducted in all Sudan states between June and December 2021. Multi-stage stratified cluster sampling was used. A semi-structured questionnaire was used for data collection. Descriptive statistics were used to present the data. Binary logistic regression was computed to investigate the possible factors which associated with SMA. Results: Out of 1492 participants surveyed, 71.3% utilize antibiotics as self-medication. The derived reasons for SMA were convenience (63.3%) and cost-saving (34.8%). Tonsillitis was the most common ailment behind SMA (55.5%). Log-binominal regression revealed that non-insured and low level of education participants were more likely to predict SMA. Regarding the practice, 40% changed the dose and/or antibiotics mainly owing to improvement (53.7%) or worsening of the condition (37.9%). The most commonly used antibiotic was amoxicillin/clavulanic acid (32.5%). Conclusions: Two out of three individuals in Sudan practice SMA mainly to manage upper respiratory tract ailments. Thus, the necessity of implementing an antimicrobial stewardship program throughout the country, as well as implementing effective legislation to prohibit dispensing antibiotics without prescription is urgently required. [ABSTRACT FROM AUTHOR]

Background: After its emergence in Wuhan in December 2019, the COVID-19 virus disseminated around the globe creating an incredible panic and outweighing the healthcare system's capacities. As a result of this hazardous situation, healthcare workers were placed at an unprecedented challenge making them vulnerable to a wide spectrum of mental health issues including anxiety and depression. This was a cross-sectional health facility-based study aiming to explore the psychological impact of the COVID-19 pandemic on Sudanese healthcare workers in COVID-19 treatment centers. Convenience sampling was applied. And two-part self-administered online questionnaire was used: the first part consisted of the demographic data and concerns related to COVID-19, and the second part consisted of the Hospital Anxiety and Depression Scale (HADS) standardized questionnaire. Ethical clearance was obtained from the Ministry of Health. Results: One-hundred thirty-three healthcare workers of different job titles were enrolled in this study. A total of 54% were females, and 46% were males. Most of the participants had borderline depression (44%) or anxiety scores (47%). Females had significantly a higher mean anxiety score than males. There was no significant difference between participants with and without chronic disease on both anxiety and depression scores. Conclusions: Healthcare workers at the forefront of the fight against COVID-19 pandemic are facing critical mental health challenges. An immediate intervention from the decision-makers is needed to mitigate this deleterious impact and to strengthen the healthcare system's capacity in the face of healthcare emergencies in general. [ABSTRACT FROM AUTHOR]

Background: One of the four main elements of the worldwide polio eradication strategy is acute flaccid paralysis surveillance (AFP). This system is based on (acute flaccid paralysis (AFP) cases reported and tested at World Health Organization (WHO) accredited laboratories. To measure and monitor performance, indicators were created. The current study aims to evaluate the system components, performance, and efficiency in River Nile State, Northern Sudan, and their compliance with World Health Organization (WHO) requirements for it to be adopted as a good system; its results can be used to certify whether a country is polio-free or not. Material and methods: A facility-based retrospective descriptive study was conducted in the River Nile State, Northern Sudan, from Jan 2017 to Dec 2020. This study included all reporting sites/units, workers who reported acute flaccid paralysis (AFP) cases, and officers at the locality level. A total of 50 health institutions were visited for surveillance, and interviews with 59 health workers who were part of the AFP surveillance system were undertaken. The data were collected from participants using a pre-tested questionnaire designed and constructed by the World Health Organization (WHO) framework, and the data were analyzed using the SPSS version (22). Results: The River Nile State's AFP surveillance system was of high quality in terms of the infrastructure that had been put in place and the effectiveness of the system's operations, as evidenced by the following statistics: from 2017 to 2020, the reported non-polio acute flaccid paralysis (AFP) cases were at a mean rate of 4.02 per 100,000 children under the age of 15; the majority of AFP reported cases were under 10 years; and males made up 73.3% of reported cases; The completeness of reports and surveillance documents exceeded 80%, and active surveillance was applied in 80% of reporting sites. Conclusion: Despite the fact that the surveillance system is capable of detecting cases, Sudan continues to report cases of imported polio from other countries, highlighting the need to strengthen surveillance systems and eradication efforts in these countries. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is a common cancer in the world, Pap smear and human papilloma virus test are used for early detection and follow up of cervical cellular changes and cervical cancer, but here in Sudan they are still poorly used. Diabetes and cancer share some risk factors and they have both been found to happen in the same patients. The aim of this study is to evaluate abnormal pap smears from diabetics and non-diabetics. Methods: this is a case-control hospital base study, (109) cases and (109) controls, the patients who requested pap smear during study period and who matched the characteristics of the study. Controls are diabetes-free, but they have another complains because of which the pap smear is requested like genital infection complaints or gynecological complaints, cases have diabetes plus the infection or gynecological complaints because of which the pap smear is requested. Results:(74.3%) of the cases showed abnormal results (positive), (47.6%) of them Atypical Squamous Cells of Undetermined Significance and Atypical Glandular Cells of Undetermined Significance, (26.7%) of them inflammation and infection. (22.9%) of the controls showed positive results (4.6%) of them Atypical Squamous Cells of Undetermined Significance and Atypical Glandular cells of Undetermined Significance, (18.3%) of them signs of inflammation and infection signs. (25.7%) of the cases have had negative pap results for intraepithelial lesion, malignancy, or infections while (77.1%) of control. Conclusions: there is association between diabetes mellitus and abnormal finding of pap smear test and controlling of diabetes mellitus is important issue affecting pap smear findings. also, diabetes increases liability of diabetic women to get infections and cervical cellular changes. [ABSTRACT FROM AUTHOR]

Background: Event-based surveillance (EBS) is an essential component of Early Warning Alert and Response (EWAR) as per the International Health Regulations (IHR), 2005. EBS was established in Sudan in 2016 as a complementary system for Indicator-based surveillance (IBS). This review will provide an overview of the current EBS structure, functions and performance in Sudan and identify the gaps and ways forward.  METHODS: The review followed the WHO/EMRO guidelines and tools. Structured discussions, observation and review of records and guidelines were done at national and state levels. Community volunteers were interviewed through phone calls. Directors of Health Emergency and Epidemic Control, surveillance officers and focal persons for EBS at the state level were also interviewed. SPSS software was used to perform descriptive statistical analysis for quantitative data, while qualitative data was analysed manually using thematic analysis, paying particular attention to the health system level allowing for an exploration of how and why experiences differ across levels. Written and verbal consents were obtained from all participants as appropriate.Results: Sudan has a functioning EBS; however, there is an underestimation of its contribution and importance at the national and states levels. The link between the national level and states is ad hoc or is driven by the need for reports. While community event-based surveillance (CEBS) is functioning, EBS from health facilities and from non-health sectors is not currently active. The integration of EBS into overall surveillance was not addressed, and the pathway from detection to action is not clear. The use of electronic databases and platforms is generally limited. Factors that would improve performance include training, presence of a trained focal person at state level, and regular follow-up from the national level. Factors such as staff turnover, income in relation to expenses and not having a high academic qualification (Diploma or MSc) were noticed as inhibiting factors.Conclusion: The review recommended revisiting the surveillance structure at national and state levels to put EBS as an essential component and to update guidelines and standard operation procedures SOPs to foster the integration between EBS components and the overall surveillance system. The need for strengthening the link with states, capacity building and re-addressing the training modalities was highlighted. [ABSTRACT FROM AUTHOR]

Introduction: Mycetoma is a unique neglected tropical disease which is found endemic in areas known as the "mycetoma belt". Head and neck mycetoma is a rarity and it has many devastating impacts on patients and communities. In this study, we assessed clinical findings, investigations, and predictors for recurrence of head and neck mycetoma in Sudan. Methodology: A retrospective study was conducted at Mycetoma Research Center in Khartoum between January 1999 and December 2020 for all patients with head and neck mycetoma. Data were analyzed using R software version 4.0.2. Results: We included 107 patients with head and neck mycetoma. 65.4% were young adult males from mycetoma endemic areas in Sudan, and most of them were students (33.6%). Most of patients (64.4%) had actinomycetoma. Before presenting with head and neck mycetoma, majority (75.7%) had a long duration with mycetoma, and 30.8% had a history of trauma. The commonest invaded site was the parietal region (30.8%). The lesion started gradually in most of the patients (96.3%). 53.3% of the patients had large size lesions with no sweating, regional lymph nodes involvement, or distal vein involvement. CT scan was the most accurate diagnostic tool while 8.4% of patients were diagnosed by clinical examinations only. Laboratory investigations confirmed that 24/45 (44.4%) of actinomycetoma was caused by Streptomyces somaliensis while 13/28 (46.4%) of eumycetoma was caused by Madurella mycetomatis. All patients with recurrence of head and neck mycetoma underwent surgical excision of the lesion (n = 41/41 {100%}, p < 0.001). Conclusion: In head and neck mycetoma, the most common type was actinomycetes in Sudan. Majority had a long course of mycetoma and the commonest causative organism was Streptomyces somaliensis. The treatment outcome was poor and characterized by a low cure rate. Author summary: Head and neck mycetoma is the rarest form of mycetoma. It has devastating impacts on patients, communities, and the health system. The study concludes that: Head and neck Mycetoma -like all mycetoma- mainly affects young adult males in rural areas of Sudan. The disease is diagnosed using numerous radiological methods and investigations alongside clinical examination. Despite the CT scan being the most accurate tool, most patients are diagnosed by clinical tests only; due to the high cost of investigations and financial issues. In this study, all patients with the recurrence of head and neck mycetoma underwent surgical excision of the lesion. The worst thing about the head and neck Mycetoma is that the treatment outcome was poor and characterized by a low cure rate. More attention in is needed regarding mycetoma globally and in Sudan, especially in Gezira and Sinnar states. Therefore, screening by history and clinical examination of Mycetomata's lesions is mandatory for persons living in an endemic regions. [ABSTRACT FROM AUTHOR]

The fruits of Balanites aegyptiaca, a wild savannah tree, constitute a promising source of steroidal sapogenins, chemicals in demand by the pharmaceutical industry, in addition to an untapped source of an edible fixed oil. Large guantity of the fruit (ca. 400 000 tons per annum) are traditionally collected and marketed in Sudan due to their edible mesocarp. This study is concerned with accumulation of the fixed oil as well as of steroidal sapogenins in 11 fruit developmental stages, from the young immature to the fully ripe, dry stages. The fruits were separated into "kernels" and combined "epicarp+ mesocarp" tissues. An infra-red spectrophotometric method was used for sapogenin quantification. Total sapogenin contents expressed per tissue was 0.5 mg in kernels and 2.5 mg in "epicarp=mesocarp" in the first stage (S1). Thereafter, these values rose sharply in later fruit developmental stages so that by stage S7 (a mature but still green stage), they contained maximum values of 22.0 and 60.0 mg/tissue, respectively. Similarly, balanites kernel oil (BKO) dramatically increased in amount with fruit development; from < 5.0% in the first two very young stages to over 45.0% of kernel dry weight by stages 7 and 8. Thus, harvesting fruits at the still green 7th stage would minimize losses of the dry, sapogenin-rich epicarp encountered during traditional harvesting and handling of dry fruits. "Epiarp+mesocarp" tissue contained both 25a and 25b sapogenins, the proportion of 25b increased with fruit maturation. On the other hand, kernel tissue contained only 25a (diosgenin type) sapogenin till the very late fruit stage, when plastid degradation occurred. Linoleic acid was the major fatty acid of balanites kernel oil in all fruit developmental stages. Linolenic and palmitoleic acids were present in the kernel oil of very young fruits but disappeared with the degradation of plastid-membrane lipids on further fruit maturation and desication. [ABSTRACT FROM AUTHOR]

In this study, a proposed Galat Sufar open pit mine, river Nile state, Sudan has been approved through mining design processes. However, the area situated within highly tectonic region with different rock masses. This study is aimed to assess surface and sub-surface conditions of the rock masses and identify the expected rock failures. In this study, Televiewer survey and core logging methods are performed for sub-surface investigation. The limited surface exposure of the rock masses lead to the big differences from those recorded from the oriented core samples. Two shear planes and three joint sets constitute the discontinuity properties of surface rock masses, while two foliation planes (S1: 86°/059° and S2: 78°/292°) and four joint sets (J1:89°/244°; J2:12°/076°; J3: 71°/287° and J4:74°/158°) were recognized from drilled boreholes. In order to determine appropriate bench face angle for the weathered and fresh rock masse kinematic analysis technique was adopted using dip software. The kinematic scenarios performed at 20° and 10°-slope direction intervals, while bench face angles is calculated for 50°, 55° and 60° at the pit border for the top weathered rock masses and 70°, 75° and 80° for the sub surface one. The results show that the southern part of the proposed mine represents the highest risk with toppling failure for the top weathered rock masses, while low planar and toppling failure risk values recorded for the sub-surface rock masses. Finally, this study recommended that during mine development inherent site investigation must be continued to examine the stability of rock masses for the expected slope failure especially the southern part of the proposed mine. [ABSTRACT FROM AUTHOR]

Background: Visceral leishmaniasis (also known as Kala-azar) is a systemic parasitic infection with many clinical presentations. The present study assesses the variation in presentations among patients who attended the Tropical Diseases Teaching Hospital (TDTH) in Khartoum, Sudan. Methods: This analytical cross-sectional, hospital-based study was conducted at the TDTH between November 2019 and September 2020. Medical records of patients who presented at the TDTH were reviewed using a structured data extraction checklist. The Chi-square test was used to determine the associations between sociodemographic and clinical presentations of patients. P-value < 0.05 was considered as statistically significant. Results: Out of 195 patients, 79.5% were male and 48.2% were <31 years old. Fever was the main clinical presentation (90.2%) while 53.3% presented with weight loss and 72.3% and 39% presented, respectively, with splenomegaly and hepatomegaly. HIV was detected in 4.6% of the patients. RK39 was the main diagnostic test. We found a significant association between the abdominal distention and the age of the patients (P < 0.05) – age groups 11–20 and 41–50 years were more likely to present with abdominal distention than other age groups. Conclusion: There is no exact clinical presentation or routine laboratory findings that are pathognomonic for visceral leishmaniasis; therefore, it should be considered in the differential diagnosis of any patient with fever, weight loss, and abdominal distention, and among patients with HIV. [ABSTRACT FROM AUTHOR]

Background: The plasma serine protease inhibitor alpha 2-antiplasmin (α2-AP, otherwise known as α2-plasmin inhibitor) is a rapid-acting plasmin inhibitor recently found in human plasma, which seems to have a significant role in the regulation of in vivo fibrinolysis. Congenital deficiency of α2-AP is extremely uncommon.Case Presentation: We report here a case of absolute deficiency of α2-AP in an 11-year-old Sudanese boy, who had a lifelong intermittent hemorrhagic tendency (gum bleeding, epistaxis, and exaggerated bleeding after trauma). Coagulation tests including prothrombin time, partial thromboplastin time, thrombin time, bleeding time, platelet count, clot retraction test, antithrombin, and factor VIII levels were within normal limits. Hepatic function tests and complete blood count were also normal. The main interesting finding in this patient was that the whole blood clot lysis was extremely fast, completed within 5-8 hours. The second abnormal finding is that the euglobulin clot lysis time was short. Nevertheless, the concentration of α2-AP in the patient's plasma was 0.2 IU/ml (reference range is 0.80-1.20 IU/ml). The addition of pooled plasma (with normal α2-AP) to the patient's whole blood corrected the accelerated fibrinolysis.Conclusion: The study showed that α2-AP deficiency resulted in uninhibited fibrinolysis that caused the hemorrhagic tendency in this patient. Thus, this report demonstrates the significant role of α2-AP in coagulation. [ABSTRACT FROM AUTHOR]

Food contains several microorganisms that may cause illnesses and food poisoning in humans. Small numbers of microorganism contamination could result in rapid spoilage of food. The Centres for Disease Control and Prevention (CDC), USA estimates that 76 million people are affected by foodborne illnesses each year in the USA. Salmonella infections alone account for one billion dollars yearly in direct and indirect medical costs and more than 5,000 deaths. In Sudan, diarrhoeal disease was reported as the second major disease during the years from 2003 to 2007 (Annual health statistical report of the Federal Ministry of Health, Sudan). We aimed to develop a rapid molecular procedure for the detection of Escherichia coli, Shigella dysentery, and salmonella Typhiin food so as to minimize the public health hazard of food contamination. We used the Multiplex PCR method as rapid methods were tested for identification of Enterobacteriaceae species Escherichia coli as an indicator organism for food contamination and two strains of Enterobacteriaceae that causes food borne illness (namely Shigella dysentery and salmonella Typhi). The Multiplex PCR was performed to detect E. coli using Mdh primer pair, Salmonella Typhi using IpaB primer pair, and Shigella dysentery using IpaH1 primer pair. The sensitivity to detect E. coli, Salmonella Typhi, and Shigella dysentery in contaminated food in the concentration of the infective and the over infective doses were 100%, 96.3%, and 88.9% respectively for the three bacteria strains. There was no significant difference in the detection of the bacteria after incubation for 8 hours, 24 hours, or even without incubation period. There were no differences in the result of the samples that were contaminated artificially in laboratory and those obtained from the market. The Multiplex PCR method for identification of E. coli, Salmonella Typhi and Shigella dysentery was developed as a model for detection and risk assessment of the three bacteria in one program, and it is suitable for routine analysis. [ABSTRACT FROM AUTHOR]

Concentrated solar power plants can play a significant role in alleviating Sudan's energy crisis. These plants can be established and implemented in Sudan, as their potential is considerably high due to the climate conditions in Sudan. This study investigates the design of a parabolic trough concentrated solar power plant in Sudan and analyzes its technical and economic feasibility. The simulation of the plant's model used System Advisor Model (SAM) software. To determine the best location for the construction of the plant, data from 15 cities in Sudan were compared with each other based on their solar radiation and land properties. Wadi Halfa, a city in the northern region of Sudan, was chosen as the location due to its good topographical properties and climate conditions. The results show that the proposed plant can generate 281.145 GWh of electricity annually with a capacity factor of 40.1% and an overall efficiency of 15%. Additionally, a simple cost analysis of the plant indicates a levelized cost of electricity of 0.155 $/kWh. As the study results are consistent with the characteristics of similar plants, the proposed plant is considered technically and economically feasible under the conditions at its location. [ABSTRACT FROM AUTHOR]

Cholecystectomy is a commonly performed abdominal procedure, the gold standard currently is the laparoscopic approach and, however, the facilities and expertise for laparoscopy are not available widely, especially in developing countries. A Mini-laparotomy cholecystectomy is an additional approach that is performed through an incision that is less than 5cms thus minimizing the complications of the traditional open cholecystectomy and the postoperative hospital stay. The study aims to evaluate the outcome of mini-laparotomy cholecystectomy in terms of operative duration, complications, and hospital stay in a rural hospital. This is a retrospective study conducted in El-Dwaim Teaching Hospital, Sudan. All cases of mini-laparotomy cholecystectomy conducted from March 2009 to December 2020 were included and retrospectively studied. Descriptive statistics were applied using SPSS version 25. A total of 512 mini-laparotomy cases were involved in the study, of those 442 aged more than 40 years. The operation lasted less than 60 minutes for 486 of the participants, and the most frequent cholecystitis complication observed intraoperatively was mucocele, occurring in 70 (13.6%) participants. Intraoperative complications due to mini-laparotomy occurred in 4 (0.8%) cases, in the form of bleeding and none of the observed cases converted into open cholecystectomy. Postoperative complications occurred in the form of wound infection in 7 participants, biliary leak in 1 participant, and fistula formation in 1 participant. Post-operative hospital stay was 24 hours for 458 participants. Mini-laparotomy cholecystectomy is a safe minimally invasive approach with low rates of complications and short postoperative hospital stay, making it an optimum approach in facility-deprived countries. [ABSTRACT FROM AUTHOR]

Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic arboviral disease that poses a great threat to global health in the Old World, and it is endemic in Europe, Asia, and Africa, including Sudan. In this retrospective study, we reviewed previous epidemiological reports about the major epidemics of CCHF throughout Sudan between 2010 and 2020. During these epidemics, the infection of humans with Crimean-Congo hemorrhagic fever virus (CCHFV), the causative agent of CCHF, was diagnosed using qRT-PCR. We have identified 88 cases of CCHF, including 13 fatalities reported during five epidemics that occurred in 2010, 2011, 2015, 2019, and 2020. The two epidemics in 2010 and 2011 were by far the largest, with 51 and 27 cases reported, respectively. The majority of cases (78%) were reported in the endemic region of Kordofan. Here, we document that the first emergence of CCHFV in the Darfur region, West Sudan, occurred in 2010. We were not able to investigate outbreak dynamics through phylogenetic analysis due to the limited diagnostic capacity and the lack of sequencing services in the country. These findings call for establishing a genomic-based integrated One Health surveillance and response system for the early preparedness, prevention, and control of CCHF in the country. [ABSTRACT FROM AUTHOR]

Background: Five-medication regimen is recommended for patients after acute coronary syndrome (ACS) as a secondary prevention strategy at discharge to reduce recurrence and improve mortality. Objective: This study aimed to assess prescribing of optimal medical therapy (OMT) as five-medication regimens for secondary prevention at discharge after ACS in Sudan. Methods: A retrospective cohort study was performed at a tertiary hospital located in Wad Medani, Sudan, in the period between January and December 2019. Data were collected from patients' files. OMT was defined as a combination of five medications; aspirin and P2Y12 inhibitors, statins, beta-blockers (BBs), and angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) or if a valid contraindication was documented. Results: Of the 619 patients throughout the study period, 591 were selected based on inclusion and exclusion criteria. The median age of patients was 60 years, and 58.9% of patients were male. Diabetes (44.5%) and hypertension (42%) were the most common risk factors. Most patients (58.4%) were diagnosed with ST-segment elevation myocardial infarction. About 99.7% of patients were on aspirin, 99.5% on statins, 97% on clopidogrel, 96.8% on dual antiplatelet therapy, 70.4% on BBs, and 57.9% on ACEIs/ARBs. OMT for secondary prevention was prescribed to 267 (45.2%) patients with ACS at discharge. Conclusion: Although prescriptions for all five guideline-recommended medications after ACS were suboptimal, the study showed a positive trend in prescribing most individual medications. [ABSTRACT FROM AUTHOR]

Soybean is a good source of protein and calories and therefore important for food security. Soybean yields in small scale farmers field stand at less than 1.0 t ha-1 against a potential of 3 to 3.6 t ha-1. This has been attributed to low soil fertility. Although a lot of work has been carried out on Soybean nitrogen (N) and phosphorus (P) nutrition, but research findings indicate that yields are still low, raising suspicion that other nutrients could also be limiting. To investigate this, a nutrient omission trial was used in the greenhouse to find out the nutrients that limit soybean production in four distinct soil textures - clay loam, sandy clay loam, sandy clay and sandy loam following the recommended rate of 20:40:20:5:20 Kg/ha for N,P,K,Zn, and S respectively. Similarly we applied 1 ton/ha of poultry manure with thirty six treatments combinations arranged in a completely randomized design. The results revealed that soybean performance and nutrient uptake varied significantly (p<0.05) between the soil texture and nutrients application. Sandy clay loam and sandy loam textures respond significantly to nitrogen, phosphorus, potassium and manure application whereas zinc and NPK nutrients limits soybean performance and uptake in sandy clay and clay loam soils. In conclusion, to increase soybean production in sandy loam and clay loam of Sudan savanna of Nigeria, fertilizer formulations containing N, P, K and Zn should be used. Manure may be used to improve soybean production in sandy clay and sandy clay loam together with application of NPK fertilizer. [ABSTRACT FROM AUTHOR]

Western Baggara cattle breed (WBCB) is an East African zebu inhabiting Sudan, well‐known as beef‐producing cattle. We investigated herein two phenotypically and geographically distinct populations of this breed, namely Nyalawi and Daeinawi, which are renowned for their unique meat production capabilities and adaptation attributes, with the aim to contribute to our understanding of their maternal genetic diversity and demography dynamics. Genetic polymorphism analysis of the full‐length D‐loop mtDNA region revealed 44 and 35 polymorphic sites defining 28 and 24 distinct haplotypes in the Nyalawi and the Daeinawi, respectively. Observed genetic diversity is high within the population with a low level of genetic differentiation between populations. Approximate Bayesian computation via the calculation of Bayesian skyline plots and neutrality tests support past expansion with a higher maternal effective population size (Ne) in Nyalawi compared with the Daeinawi population and a population expansion beginning around 4,500 YBP and 3,500 YBP, respectively, before the arrival of zebu into the continent. [ABSTRACT FROM AUTHOR]

Increases in arbovirus outbreaks in Sudan are vectored by Aedes aegypti, raising the medical importance of this mosquito. We genotyped 12 microsatellite loci in four populations of Ae. aegypti from Sudan, two from the East and two from the West, and analyzed them together with a previously published database of 31 worldwide populations to infer population structure and investigate the demographic history of this species in Sudan. Our results revealed the presence of two genetically distinct subspecies of Ae. aegypti in Sudan. These are Ae. aegypti aegypti in Eastern Sudan and Ae. aegypti formosus in Western Sudan. Clustering analysis showed that mosquitoes from East Sudan are genetically homogeneous, while we found population substructure in West Sudan. In the global context our results indicate that Eastern Sudan populations are genetically closer to Asian and American populations, while Western Sudan populations are related to East and West African populations. Approximate Bayesian Computation Analysis supports a scenario in which Ae. aegypti entered Sudan in at least two independent occasions nearly 70–80 years ago. This study provides a baseline database that can be used to determine the likely origin of new introductions for this invasive species into Sudan. The presence of the two subspecies in the country should be consider when designing interventions, since they display different behaviors regarding epidemiologically relevant parameters, such as blood feeding preferences and ability to transmit disease. [ABSTRACT FROM AUTHOR]

Purpose: To assess the impact of the COVID-19 pandemic on the psyche of uninfected people with chronic diseases in the Elduim community, White Nile State, Sudan, during the COVID -19 pandemic. Methods: We used a generalized anxiety disorder scale (GAD -7) and a patient health questionnaire (PHQ-9) for psychological assessment. The study included two hundred thirty-four participants; all participants with a chronic disease but not infected with COVID -19 were between 24 and 65 years of age. Residents of the study area were randomly selected. Descriptive statistics and a t-test were used for associations with a p-value of 0.05 or less. Results: This study found that anxiety rated by GAD 7 was either mild (18, 7.7%), moderate (98, 41.9%), or severe (41, 17.5%) among participants. PHQ 9-rated depression showed 22 (9.4%) mild depression, most of them in participants aged 36– 44 years. Participants with kidney disease showed major depression 11 (42.31%). Factors that significantly affected anxiety scores were age 24– 35 years (P =0.002), university graduates (P < 0.000), married (P < 0.000), those with diabetes and hypertension (P =0.041), and urban residents (P < 0.023). Those who had secondary education were married and smoked were significantly more likely to have major depression than those with another educational status (p < 0.05). Conclusion: COVID 19 pandemic had a significant impact on the psyche of uninfected people with chronic diseases in Sudan, and significant associated factors were identified. Unique interventions are strongly recommended to reduce the psychological impact of the COVID 19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Medications known to improve outcomes in heart failure (HF) are either not prescribed or prescribed at sub-therapeutic doses. The addition of clinical pharmacists to the HF team positively impacts optimizing prognostic medications for a patient with HF with reduced ejection fraction (HFrEF). Objective: To assess the intervention of the clinical pharmacist as part of the multidisciplinary (MD) team in up-titration to achieve target doses of key therapeutic agents for HFrEF. Methods: This was a prospective one group pretest-posttest interventional study; a comparison of the target dose achievement of key therapeutic agents for HFrEF was performed before and after clinical pharmacist interventions. Results: Out of 110 HFrEF patients, 57.3% were males, and the mean age of patients was 55.8 years (SD 12.6). Cardiomyopathy was the leading cause of HF. At baseline, 86% were on angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors (ACEIs/ARBs/ARNi) and 93.6% on beta blockers (BBs). At the end of study, the proportion of patients achieved the target dose was significantly increased (0 vs 77.4%, 6.8 vs 85.4%, and 0 vs 55.6%) for ACEIs, ARBs and ARNi, respectively, and (8.6% vs 66.1%; P = 0.001) for BBs. Moreover, the up-titration process was associated with significant improvement in most clinical as ejection fraction and New York Heart Association (NYHA) scale and laboratory characteristics. Conclusion: As a part of the MD team in the outpatient HF clinic, the clinical pharmacists increased the percentage of HFrEF patients achieving the target or maximal doses of key therapeutic agents and improving clinical and laboratory parameters. [ABSTRACT FROM AUTHOR]

The emergence of the Asian invasive malaria vector, Anopheles stephensi, has been identified in Khartoum, the capital city of Sudan. This is the first report that confirms the geographical expansion of this urban mosquito into Central Sudan. We urgently recommend the launch of a national entomological survey to determine the distribution of this invasive disease vector and to generate essential information about its bionomics and susceptibility to available malaria control measures. [ABSTRACT FROM AUTHOR]

The novel coronavirus disease (COVID-19) was first reported in Sudan on 13 March 2020. Since then, Sudan has experienced one of the highest rates of COVID-19 spread and fatalities in Africa. One year later, as per 22 March 2021, Sudan had registered 29,661 confirmed cases and 2,028 deaths with a case fatality rate (CFR) of 6.8 %. By 12 December 2020, of the 18 states in Sudan, South Kordofan had the fifth highest CFR of 17.4 %, only surpassed by the other conflict affected North (57.5 %), Central (50.0 %) and East (31.8 %) Darfur States. By late March 2021, just three months from December 2020, the number of cases in South Kordofan increased by 100 %, but with a significant decline in the CFR from 17.4 to 8.5 %. South Kordofan is home to over 200,000 poor and displaced people from years of destructive civil unrests. To date, several localities such as the Nubba mountains region remain under rebel control and are not accessible. South Kordofan State Ministry of Health in collaboration with the federal government and non-governmental organizations set up four isolation centres with 40 total bed capacity, but with only two mechanical ventilators and no testing centre. There is still need for further multi-sectoral coalition and equitable allocation of resources to strengthen the health systems of rural and conflict affected regions. This article aims at providing insight into the current state of COVID-19 in South Kordofan amidst the second wave to address the dearth of COVID-19 information in rural and conflict affected regions. [ABSTRACT FROM AUTHOR]

Epilepsy in Sudan accounts for 1.6 annual mortality rates and 238.7 disability adjusted life years per 100 000. These figures are higher among females; children and young adults. It is associated with notable stigma and social burdens. Patients of epilepsy are subjected to various forms of social discrimination that affect their quality of life. They are isolated, neglected and deprived of their education and employments rights and not able to achieve normal social and family life. Aiming at highlighting social implications of epilepsy among Sudanese patients, this study found that social encumbrances due to epilepsy in Sudan are more prevalent among highly vulnerable groups like women, children and poor populations living in remote areas. Lack of trained medical personnel in neurology and the medical equipment's required for proper diagnosis and treatment of epilepsy in Sudan are key reasons aggravating social and health burden of epilepsy both among patients and their caregivers. [ABSTRACT FROM AUTHOR]

Introduction: Epilepsy is one of the most prevalent neurological conditions for people of different age group, race, gender and socio-economic status in various nations, affecting 50 million people around the world; 80% of them living in developing countries. In Sudan, literature has well documented epilepsy stigma and it related elements of labelling, negative typecasting, isolation, devaluing and discrimination that are significantly affecting patients living standards and social life. This study focuses on understanding the prevailing, different types of stigma among people living with epilepsy (PWE) in Sudan and to determine its frequency in connection with demographic factors and patients coping ability of PWE. Methods: A health facility-based cross-sectional descriptive study was conducted on 270 people between the ages of 16-70years who are affected by epilepsy in an outpatient clinic. Standardized questionnaires were used to interview the patients with assistance gotten from their relative where necessary. The data is analyzed using SPSS version 20. The study was conducted in the outpatient clinic of The National Center for Neurological Sciences (NCNS), Ibrahim-Malik Teaching Hospital Sudan. Results: The study realized that 16.6% of the patient had a positive self-stigma score, half of them having coaching stigma and 25% courtesy stigma. One third of people with epilepsy had poor coping score that was strongly determined by self-stigma and courtesy stigma score. Conclusion: Parents and relatives related sigma is a major problem facing people of epilepsy in Sudan; thus, raising such group awareness and education about the disease can markedly improve the quality of life of people with epilepsy in Sudan. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori (H. pylori) infects nearly half of the world's population with a variation in incidence among different geographic regions. Genetic variants in the promoter regions of the IL1B gene can affect cytokine expression and creates a condition of hypoacidity which favors the survival and colonization of H. pylori. Therefore, the aim of this study was to characterize the polymorphic sites in the 5′- region [−687_ + 297] of IL1B in H. pylori infection using in silico tools. Results: A total of five nucleotide variations were detected in the 5′-regulatory region [−687_ + 297] of IL1B which led to the addition or alteration of transcription factor binding sites (TFBSs) or composite regulatory elements (CEs). Genotyping of IL1B − 31 C > T revealed a significant association between -31 T and susceptibility to H. pylori infection in the studied population (P = 0.0363). Comparative analysis showed conservation rates of IL1B upstream [−368_ + 10] region above 70% in chimpanzee, rhesus monkey, a domesticated dog, cow and rat. Conclusions: In H. pylori-infected patients, three detected SNPs (− 338, − 155 and − 31) located in the IL1B promoter were predicted to alter TFBSs and CE, which might affect the gene expression. These in silico predictions provide insight for further experimental in vitro and in vivo studies of the regulation of IL1B expression and its relationship to H. pylori infection. However, the recognition of regulatory motifs by computer algorithms is fundamental for understanding gene expression patterns. [ABSTRACT FROM AUTHOR]