Intimate partner violence is an important health concern and a human rights violation in South Sudan. It is a major form of gender-based violence with serious consequences such as physical injuries, psychological distress, and loss of employability. This study identified personal determinants that perpetuate intimate partner violence in South Sudan. The study focused on the individual factors in the context of Haise’s Social Ecological Model. Literature from South Sudan and relevant contexts was used to provide factual bases for the study. The personal factors identified that influence intimate partner violence include alcohol abuse, young age, witnessing violence in childhood, and having been a victim of child abuse. Intimate partner violence is an important health problem to address to achieve equal gender relations. This is only possible when the root causes or violence determinants are identified, understood, and addressed using evidence-based strategies.

Introduction: Iron deficiency (ID) is common in patients with chronic heart failure (CHF). The convergence of CHF, ID, anaemia, and chronic kidney disease (CKD), termed Cardiorenal Anaemia Iron Deficiency Syndrome (CRAIDS), is associated with high morbidity and mortality according to published data from high-income countries. Despite the increasing occurrence of CHF in low- and middle-income countries, such as Tanzania, there is a paucity of published data. This study aims to unmask CRAIDS among CHF patients attending a tertiary hospital in Dodoma, Tanzania. Method: This descriptive post hoc secondary analysis utilized data from a previous prospective observational study at Benjamin Mkapa Hospital in Dodoma, Tanzania. A total of 268 adult patients with CHF and varying degrees of CKD were included. ID was defined using serum ferritin and transferrin saturation (TSAT) levels. Data were analysed and presented using descriptive and inferential statistical methods. A 2-sided p-value of ≤ 0.05 indicated statistical significance. Results: The 268 patients had a mean age of 56.25±14.83 years. There were 154 (57.5%) females. The prevalence of CRAIDS was 32.5% (87/268). Patients with CRAIDS were more likely to have diabetes mellitus (67.8%, p = 0.011), hypertension (62.1%, p = 0.048), New York Association Functional Classification (NYHA) class III/IV (77%, p < 0.001), significant proteinuria (63.2%, p = 0.012), and advanced CKD stages 4/5 (37.9%, p < 0.001). Clinical associations with CRAIDS included diabetes mellitus (AOR 2.10), NYHA III/IV (AOR 2.67), proteinuria (AOR 3.42), and advanced CKD (AOR 5.34). Conclusion: There is a high burden of CRAIDS among CHF patients in Dodoma, and it is strongly associated with diabetes mellitus, advanced CKD with proteinuria, and poor cardiac function. Early targeted screening and management of ID could improve outcomes in this vulnerable population.

Introduction: Intestinal anastomosis can be done in various ways, including the use of staples and hand-sewn methods. The hand-sewn method includes a one-layer technique and a two-layer technique. The safety and efficacy of one-layer or two-layer are controversial. This study aimed to compare the outcomes of these techniques. Method: Fifty patients were included in the study: 30 males and 20 females. The patients were categorized into two groups: 33 underwent elective surgery, and 17 underwent emergency surgery. Outcome measures included the mean time to anastomosis, mean operative time, anastomotic leak rate, mortality rate, and hospital stay duration. Statistical analysis used the Chi-square test, Fisher’s exact or Monte Carlo correction, Student’s t-test, and Mann-Whitney U test. Results: 32 patients were managed with the classical two-layer technique, and 18 with the one-layer extra-mucosal technique. The total operation time ranged from 1.0 to 5.0 hours for single-layer extra-mucosa anastomosis and 0.83 to 4.17 hours for classical two-layer anastomosis. Most wound infections and deaths occurred with the two-layer techniques, accounting for 8 (16%) and 5 (10%), respectively. The most common complications were wound infections, 11 (22%), and anastomotic leaks, 10 (20%), which mainly occurred under emergency conditions with the two-layer technique. Conclusion: The one-layer technique requires less time to perform compared to the two-layer technique, with no significant differences in the rate of anastomotic leaks. In terms of safety, the one-layer method may be superior to the classical two-layer technique.

Introduction: Anaemia is a condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal, leading to insufficient oxygen being delivered to organs and tissues. It mainly affects women and children and is a public health concern affecting particularly people in low- and middle-income countries (LMICs). The most common causes of anaemia in pregnancy are iron deficiency and haemoglobinopathy. In 2019, the WHO estimated the prevalence of anaemia in pregnant women in South Sudan to be 40%. The objectives of this study were to determine the prevalence of anaemia among pregnant women attending the antenatal clinic (ANC) at Bor State Hospital and the associated risks for anaemia. Method: A cross-sectional hospital-based study was conducted in the ANC between August 17 and September 23, 2022. The haemoglobin level of each participant was measured by the researcher using the HemoCue Hb 301 device. A structured questionnaire was used to collect demographic details, clinical characteristics, and data related to risk factors. Results: A total of 384 pregnant women attending the ANC were enrolled. The prevalence of anaemia using the WHO definition was 45.3% (95% Confidence Interval 40.3% - 50.3%). 25% with anaemia had severe or very severe anaemia, 43% had moderate anaemia, and 33% had mild anaemia, based on the WHO/CDC classification. The clinical characteristics associated with anaemia in pregnancy were teenage pregnancy, grand-multigravidity, and being underweight (BMI). The risk factors found to be significantly associated were ‘diet containing meat less than three times in one week’, bleeding related to obstetric complications within the previous two years, malaria within one year, and birth interval less than three years. Conclusion: Anaemia is a significant problem found in 45.3% of pregnant women in Bor, which is very high compared to data available from other East African countries. The study identified risk factors and patient characteristics associated with anaemia, which require validation in further research. All stakeholders should be involved in preventing, identifying, and managing anaemia in pregnancy.

Introduction: Paediatric mortality is a pressing public health concern in South Sudan, particularly in tertiary care settings where systemic challenges constrain access to timely and quality healthcare. In response to this, the Momentum Integrated Health Resilience (MIHR), in collaboration with the Association of Gynaecologists and Obstetricians of South Sudan, undertook a paediatric death audit (PDA) at Al-Sabbah Children’s Hospital in Juba. This study aimed to describe the experience and the status of PDA implementations and provide recommendations for improvement. Method: This was a cross-sectional, descriptive study conducted in September 2024. Data were collected using a standardised tool adapted from the United States Agency for International Development Maternal and Child Survival Programme. To obtain the information, focal group discussions were conducted with 13 members from the PDA hospital committee and officials from the Ministry of Health of Central Equatoria State. Another group obtained retrospective data from the available PDA review forms and guidelines. Results: Based on this assessment, the PDA committee at Al-Sabbah Children’s Hospital is functional. The hospital has verifiable PDA guidelines, mainly from the World Health Organisation, standardised death notification and death review forms that capture paediatric death information, and job aids like the International Classification of Diseases-Perinatal Mortality and the International Classification of Diseases-Paediatric Death to support cause-of-death classification. However, it lacked standardised death certificates with a designated section to record the cause of death. The assessment revealed that only a few deaths were reviewed as sampled by the committee chair. Conclusion: PDA is well implemented in Al-Sabbah Children’s Hospital. The assessment recommends replicating the PDA in other national and state hospitals, as well as forming and training PDA committees on the standardised classification of causes of neonatal and paediatric deaths.

Introduction: Diabetic foot ulcers (DFUs) are a major complication of diabetes mellitus and are influenced by various factors, including dietary behavior. Proper diet adherence is essential for glycemic control and tissue regeneration, yet its role in ulcer healing remains underexplored. Method: This cross-sectional study involved 100 type 2 diabetes mellitus patients with DFUs receiving home-based care in a community setting. Dietary compliance was measured using a structured questionnaire based on the 3J principle (meal timing, type, and portion). Ulcer healing was evaluated using the Wagner grading system. Data were analyzed using chi-square and logistic regression tests with SPSS 25.0. Results: Among patients with high dietary compliance, 73.3% showed significant ulcer healing, compared with 42.5% in the low-compliance group (p = 0.008). Dietary compliance was a significant predictor of ulcer healing (OR = 3.18; 95% CI = 1.41–7.15). Conclusion: Higher dietary compliance was associated with better short-term healing of diabetic ulcers. While integrating nutrition education into home care services may be a valuable component of DFU management, our findings cannot confirm its independent effect, and further prospective research is warranted to determine causality and underlying mechanisms.

Systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are distinct autoimmune disorders that rarely coexist. Their co-occurrence, known as SLE/AAV overlap syndrome, represents a clinically significant entity characterized by combined serological and histopathological features of both conditions. It is most commonly reported in females, with limited data on male patients. We describe a case of SLE/AAV overlap syndrome in a 38-year-old male with albinism who presented with progressive polyarthritis, generalized oedema, oliguria, and constitutional symptoms. Laboratory findings included elevated serum creatinine (170 µmol/L), nephrotic-range proteinuria (2.0 g/day), positive antinuclear antibodies (ANA: 4000 IU/mL), anti-dsDNA (800 IU/mL), P-ANCA (50.74 IU/mL), and low complement levels (C3 and C4). Urinalysis revealed RBC casts and dysmorphic red blood cells. Renal biopsy confirmed a dual diagnosis of lupus nephritis (class III + V) and crescentic glomerulonephritis with full-house immunofluorescence and ANCA positivity. The patient was treated with intravenous methylprednisolone pulses followed by low-dose cyclophosphamide (Euro-Lupus protocol). Upon clinical improvement, he was transitioned to oral mycophenolate mofetil, hydroxychloroquine, and enalapril. Within two months, he showed significant clinical and laboratory improvement with normalization of renal function (serum creatinine 73 µmol/L), reduction in proteinuria (to 298 mg/day), and a decrease in disease activity (SLEDAI-2K score of 2). This case emphasises the need for a high clinical suspicion in atypical autoimmune presentations. Early renal biopsy and prompt immunosuppressive therapy are crucial for favourable outcomes.

Introduction: Rural communities near mining areas face serious environmental health risks due to water contamination and inadequate healthcare infrastructure. Penda Siron Village in Central Kalimantan, Indonesia, exemplifies these challenges, where mining pollution has compromised water quality, while limited access to healthcare exacerbates the community’s disease burden. This study examines the intricate relationship between environmental degradation and the health of the community in this mining region. Method: We used a qualitative study design to collect data through public discussions with village leaders and residents, a review of local health records from 2021 to 2023, and field observations of water sources and sanitation conditions. Thematic analysis identified possible health-environment linkages, patterns of health problems based on healthcare utilisation, and community adaptations. Results: The study revealed that 85% of villagers were heavily dependent on contaminated water from the river for their daily needs. This resulted in recurring outbreaks of diarrhoea (15 paediatric cases in 2017 - ~27% of the children) and chronic skin infections. The healthcare system combines traditional healing practices with under-resourced modern health services. 30% of the residents initially self-medicate due to financial constraints. Despite some recent corporate health initiatives, systemic gaps persist in the local health system, including a lack of neonatal equipment in community health posts and minimal health insurance coverage for the mine workers and their families. The study found that the presence of Mining-derived heavy metals (Pb, Hg, Cd) in water supply systems which were associated with acute and chronic diseases. Conclusion: This research highlights the urgent need for comprehensive interventions that address both environmental pollution and healthcare deficiencies in mining regions. Effective solutions must include water quality management, strengthening local health infrastructure, and developing appropriate culturally sensitive policies through multi-stakeholder consultation.

Pseudomonas mendocina is a rare, Gram‑negative, environmental organism that infrequently causes human infections, usually acting as an opportunistic pathogen in immunocompromised hosts. We present the case of a 47‑year‑old man with type 2 diabetes mellitus who developed a postoperative wound infection following surgical fixation of a distal tibial and fibular fracture. After an initially uneventful recovery, he presented on the eighth postoperative day with signs of localized infection. Microbiological examination of the purulent discharge identified P. mendocina using the VITEK2 automated system and confirmed the result with MALDI-TOF MS. The isolate was susceptible to a range of antibiotics, including cefepime, gentamicin, and ciprofloxacin. Targeted antimicrobial therapy combined with surgical debridement and musculocutaneous flap coverage resulted in complete clinical resolution. This case highlights the clinical significance of P. mendocina as an opportunistic pathogen in orthopaedic surgical site infections, especially in immunocompromised patients. Timely and accurate microbiological identification, along with appropriate targeted therapy, is crucial for favourable outcomes. Increased clinical awareness of rare environmental pathogens is vital when dealing with persistent postoperative infections, particularly in diabetic patients with open or contaminated wounds.

Introduction: Innovation enables firms to thrive under constraints or transform their sectors. This has been little studied in South Sudan’s pharmaceutical sector, where it could promote sustainable access to medicines. Methods: The World Bank’s Enterprise Survey 2014 was applied to private pharmaceutical firms between July and September 2021. There were 21 respondents (58% of the registered firms, n = 36). Firm characteristics, major constraints, and firm-level innovation were considered, and productivity was mapped. Percentage comparisons were drawn for firms in South Sudan and sub-Saharan Africa. Results: Nineteen firms were included in the analysis. The average pharmaceutical firm was 14 years old and had 10 employees. Only 16.7% of pharmaceutical firms offered training to their employees, while political and financial conditions constrained all. Additionally, only 11.1% invested in research and development, and the skilled workforce comprised 53.3% of the workforce. However, pharmaceutical firms innovated to address these constraints: 73.7% had introduced new products or services, 63.2% had partaken in process improvements, and 61.1% recognized products or services as new for their market. 89.5% of pharmaceutical firms increased revenue per worker by US$600-1200, with labour cost accounting for 5% of sales among 88.9% of firms and up to 10% of sales among 5.6% of firms. 40% of pharmaceutical firms reported growth of less than 2%. Conclusions: Innovation is a key factor in the survival of firms in South Sudan’s private pharmaceutical sector. Better sector governance and financial support would enable and help improve the availability of medicines.