Mortality In Sudan Research Articles

Contribution of water, sanitation, hygiene and basic education to reduce under-five mortality in Sudan

ABSTRACT Until 2015, the under-five mortality rate (U5MR) in Sudan was 65.9 per 1,000 livebirths, higher than the MDG4 target, and it has to be reduced by 5.04% per year from its 2020 level to achieve the SDG3.2 by 2030. This target cannot be achieved without improvements in access to safe drinking water (ASW), sanitation and hygiene (ISF) (WASH) and basic education. An estimated autoregressive distributed lag bounds test model confirms a long-run equilibrium relationship between U5MR, WASH, basic education, economic growth and health care. In the short run, U5MR decelerates itself with a coefficient of 0.56. Sanitation and basic education significantly reduce U5MR. Collectively, health care and economic growth affect U5MR adversely. In the long run, declines of U5MR are driven respectively by access to sanitation, hygiene and basic education (a factor of 1.79), economic growth (a factor of 0.21), and health care (a factor of 0.18). The study recommends promotion of access to safe drinking water with investments in sanitation and hygiene of 32 million $US annually between 2020 and 2030, in order to meet the SDG3.2 in Sudan. Skilled physicians and full vaccination of children can be more effective in reducing U5MR, dependent on progress in safe WASH.

Knowledge and Awareness of Sudanese Women toward Breast Cancer Detection

Background: The most frequent cancer in women is breast cancer (BC), which unfortunately has high mortality in Sudan whereas most of the patients are diagnosed at late stages of this disease sequence either due to a lack of awareness or unavailability of screening programs. objective: to asses of the knowledge and awareness of breast cancer detection among Sudanese women 2022 - 2023. Material and Methods: a community representative descriptive cross-sectional study of women aged 17 to 70 years in different Sudanese provinces was included using a semi-structural interview questionnaire. Results: out of 200 participants, the mean age was 39.8 (±12.13) years and the majority of them were aged between 41 and 50 years 54 (27%). 120 (60%) had no prior experience with breast cancer at all and 73 (36.5%) had never heard of breast self-examination for BC. The study resulted that the dominant of interviewed women 181 (90.5%) had a good awareness of breast cancer, and 161 (80.5%) believed that breast screening must require for the early detection of breast tumors. Breast changes, discharge, and lump pain were the most common prevalent reasons for breast screening in this study 95 (38.7%), 46 (18.7%), and 45 (18.3). It was clear that education level has a significant effect on the level of knowledge of breast cancer and its diagnostic screening tools among participants, with graduated women having adequate knowledge in comparison to those not graduated women 92 (50.5%) and 89 (49.2%) (p-value = 0.004 < 0.05). As well, the central resident participants had good knowledge about breast cancer 112 (70 %) in comparison with other residents. Conclusion: awareness and knowledge of BC detection increase with increasing educational levels and central urban living, there is an urgent need for intensive breast cancer awareness programs and the availability of screening centers authorities in Sudanese periphery areas.

Relapse-free survival in Sudanese women with non-metastatic breast cancer.

Breast cancer (BC) is the most frequently diagnosed cancer and a major cause of cancer mortality in Sudan. However, there is lack of data related to BC relapse. Therefore, this study was undertaken to estimate the 5-year relapse free survival (RFS) rate and factors related to BC relapse in Sudanese women with non-metastatic BC. Data of BC women with BC diagnosed and treated at the National Cancer Institute-University of Gezira during 2012 were retrieved from medical records. The cases were followed-up through hospital records and telephone contact. Survival functions were calculated using Kaplan-Meier method and compared by log-rank test. The prognostic factors were tested using univariate and multivariable Cox regression analyses. We included 168 women with median age of 45years (range, 22-83years). 53.5%of women had stage III at time of diagnosis, whereas 4.2% and 42.3% of women presented with stage I and stage II, respectively. At the end of 5years follow-up, with median follow-up period of 64months, 94 (56.0%) women were alive in remission, 11 (6.5%) were alive with BC relapse, 49 (29.2%) were dead, and survival status was unknown in 14 (8.3%) women. Most of the occurred relapses were distant relapses. The 5-year RFS was 59%. The independent predictors of relapse were: larger primary tumor size (HR:1.84, 95% CI: 1.54-5.48, p=0.018); involved axillary lymph nodes with tumour (HR: 2.91, 95% CI: 1.53-7.91, p=0.001); not receiving adjuvant radiotherapy (HR: 2.2, 95% CI: 1.22-3.95, p=0.009); and not receiving hormone therapy (HR: 1.67, 95% CI: 1.01-2.76, p= 0.046). We found a high risk of BC relapse in our resource-constrained settings. Advanced stages, not receiving adjuvant radiotherapy, and not receiving adjuvant hormone therapy were independent predictors associated with worse 5-year RFS. Therefore, enhancing the early diagnosis of BC and improving timely access to appropriate treatments represent key approaches to achieving better treatment outcomes.

Neonatal Mortality and Associated Factors in the Neonatal Intensive Care Unit of Gadarif Hospital, Eastern Sudan.

Neonatal mortality is a serious public-health issue, especially in Sub-Saharan African countries. There are limited studies on neonatal mortality in Sudan; particularly, there are none on eastern Sudan. Therefore, this study aimed to determine the incidence, causes and associated factors for mortality among neonates admitted to the neonatal intensive care unit (NICU) of Gadarif Hospital, eastern Sudan. This retrospective study included 543 neonates admitted to the NICU of Gadarif Hospital, eastern Sudan, between January and August 2019. Data were obtained from the hospital record using a questionnaire composed of sociodemographic data, neonatal and maternal information and neonatal outcomes. Logistic regression analyses were performed and the adjusted odds ratio (AOR) and 95% confidence interval (CI) were calculated. Of the 543 neonates, 50.8% were female, 46.4% were low birth weight (LBW), 43.5% were preterm babies and 27% were newborns admitted after caesarean delivery. The neonatal mortality before discharge was 21.9% (119/543) of live-born babies at the hospital. Preterm birth and its complications (48.7%), respiratory distress syndrome (33.6%), birth asphyxia (21.0%) and infection (9.0%) were the most common causes of neonatal mortality. In multivariable logistic regression analysis, preterm birth (AOR 2.10, 95% CI 1.17-3.74), LBW (AOR 2.47, 95% CI 1.38-4.41), low 5 min APGAR score (AOR 2.59, 95% CI 1.35-4.99) and length of hospital stay <3 days (AOR 5.49, 95% CI 3.44-8.77) were associated with neonatal mortality. There is an increased burden of neonatal mortality in the NICU of Gadarif Hospital, eastern Sudan, predominantly among preterm and LBW babies.

Spatial–temporal trends of COVID-19 infection and mortality in Sudan

Since its emergence, the coronavirus disease 2019 (COVID-19), is constantly affecting many parts of the globe and threatening millions of lives worldwide. Charting and aligning disease incidence to identify spatial clustering and patterns continue to be a substantial pathway to understanding disease epidemiology and is essential for implementing effective planning and prevention strategies. A national descriptive study was implemented to present the infection and mortality rates of the COVID-19 pandemic in all states of Sudan. Data were collected and summarized in monthly statistical reports of COVID-19 infection and mortality rates. The reports used were from May 2020 to March 2021. The highest COVID-19 incidence rate occurred in December 2020 with a total incidence of 4863 cases ranging from 0 cases in some of the states to 4164 cases in other states (mean = 270 ± 946, median = 21 cases). Followed by the incidence in May 2020 with a total of 4524 cases ranging from 4 to 3509 cases (mean = 251 ± 794, median = 31 cases). The western and southern states of the country had the lowest mortality rates. While, the middle states (Khartoum and El Gezira) had the highest mortalities. Northern and eastern states had lower mortalities than the middle states, yet, higher than the western states. A strong positive correlation between infection and mortality was found.

Overview of Cervical Cancer Prevention Services in Khartoum State – December 2018: A Case Study

Background: Although cervical cancer is largely preventable, it continues to be an important cause of morbidity and mortality in Sudan, due to the lack of national control programs. This study aimed to evaluate the availability of cervical cancer prevention services and assess the facility readiness in Khartoum state, as a base for future plans.
 Methods: This study was an observational, mixed-method, health service research. Purposive sampling method was used to select focal persons to explore the current situation and the available services qualitatively. Observation through standardized checklists of screening and colposcopy centers was conducted, and service providers were interviewed. Thematic analysis and descriptive statistics were used to analyze data.
 Results: Based on the qualitative interviews, Khartoum Oncology Hospital is the only specialized center providing chemotherapy and radiotherapy services for the state. Although six screening and nine diagnostic centers were surveyed, services were not available in most localities. Reasonable but unutilized resources in the secondary level exist at the time of the study, primary-level efforts to control cervical cancer are uncoordinated and ineffective, with no linked efforts at the community level. Since initiatives to reduce cervical cancer mortality need to adopt a holistic approach to the disease continuum, a comprehensive model was suggested and explained, the gaps and challenges were discussed.
 Conclusion: Cervical cancer prevention still remains a highly unaddressed need in Sudan. Sustainable financing of robust programs is necessary to achieve elimination. Contextually relevant devices must be selected to improve resource allocation. These results might be useful for the establishment of cervical cancer control in Sudan.
 Keywords: cervical cancer, screening, health system, developing countries, Sudan

Malaria infection and associated risk factors in pregnant women attending antenatal care clinics in Al Jabalian Locality, White Nile state, Sudan.

Pregnant women are more susceptible to malaria which is associated with adverse effects on pregnancy. It is one of the leading causes of maternal mortality in Sudan. The main aim of this study was to determine the prevalence rate of malaria in pregnant women. This cross sectional descriptive study was carried out in Al Jabalian and Kenana hospitals, White Nile State, Sudan. The data of the present study has been collected from 400 Sudanese pregnant women, during a period extending from 16th July 2018 to 25th October 2018. The overall the prevalence of malaria was 38.5% (154), Plasmodium falciparum was only malaria parasite observed in all samples. From 154 pregnant women infected with malaria, the third trimester had higher prevalence 53.9% (83), followed by the second trimester 31.8% (49) and the first trimester was 14.3% (22), P<0.0001. The multigravida had high infection with prevalence of 54.5% (84), secondgravida was 24.7% (38) and primigravida was 20.8% (32), P<0.0001. Significant association was noticed between the malaria parasite infection and occupation, ANC attendance and utility of mosquito net, P-value 0.05, 0.0024, 0.0010, respectively. However, no significant association was observed with education level and malaria infection. The study was recommended to promote diagnosis during pregnancy, take anti-malarial medicine as routine care to pregnant women and improve environmental sanitation.

Understanding the Correlates of Under-five Mortality in Sudan Using Survey Survival Models

Under-five mortality is among the major public health problems in developing countries, the rate of which is an important factor for a country’s development. For this reason, under-five mortality status is an important outcome to measure for children’s health. This study uses the Cox proportional-hazards model to identify risk factors associated with under-five mortality in Sudan. This study uses the 2014 Sudan Multiple Indicator Cluster Survey (MICS) conducted by the Central Bureau of Statistics in collaboration with several national institutions. The survival Cox proportional-hazards model was used to identify factors that affect under-five child mortality in Sudan. The results show that the weight of a child at birth is positively associated with the under-five child mortality rate. Under-five children who have both small and large weights at birth are at a higher risk of dying before reaching five years. Based on demographic factors associated with under-five mortality, our analysis showed that mothers who were married at the time of the survey are most likely to have higher under-five child mortality as compared to formerly married mothers. In addition to this, that mother’s age at the time of the birth is significantly associated with under-five mortality. Based on the result, the lack of important policies targeting the reduction of socioeconomic inequalities between rural and urban areas is the major problem of public health interventions to improve child health and survival in Sudan.

Survival status and determinants of under-five mortality in Sudan: Evidence from the Multiple Indicator Cluster Survey 2014

Survival status and determinants of under-five mortality in Sudan: Evidence from the Multiple Indicator Cluster Survey 2014

Infant mortality in Sudan: Health equity, territorial disparity and social determinants of health.

Recognition of, and acting on, Social Determinants of Health is crucial for reducing health inequalities and territorial disparities and hence improving health of the whole population. Although Sudan was among the first countries which adopted a roadmap for Health in All Policies, health inequity remains an important challenge for health makers in this country. This paper illustrates the urgent need to reduce health inequalities in Sudan by acting on Social Determinants of Health. Descriptive statistics and Principal Components Analysis were used to get summarized multidimensional data information. Statistical significance of differences was tested by Pearson’s chi-squared. A large territorial disparity was found between the 18 states. Infant mortality rate is more than three times higher in East Darfur (88.5) than in River Nile (28.1). Ratios of 1.9 and 1.6 were indicated for income and mother education respectively. A lower gap was seen for milieu (1.2) and gender (1.34). The difference was statistically significant for states (p-value <0.0001), income (p-value <0.001) and education (p-value <0.005). Urgent strategies are needed by acting sufficiently on social determinants of health like milieu, gender, education, income and territoriality in order to reduce avoidable heath inequalities and unacceptable territorial disparities in Sudan.

Under 5 Children Mortality in Sudan: Situation Analysis

Sudan like other developing countries suffers a high mortality rate among under 5 children. Although there is an steady minimal reduction of this rate among Sudanese children but it is still high even after implementing many policies and interventions by the federal government.&#x0D; The aim of this work is to analyze the situation of under 5children mortality in Sudan in term of trend, causes of death, policies and interventions under taken to reduce this risk. Methods :the Sudan annual statistical report of 2015 was reviewed, it revealed that : the trend of under 5children mortality in Sudan is 70.10 as of 2015 and this is the lowest value while the highest one is 178.40 in the year 1960.There are a lot of policies under taken by the government to reduce this risk like : diarrhea community treatment , antenatal corticosteroids , postnatal care and IMCI implementation and the essential interventions which are implemented include :exclusive breastfeeding, skilled birth attendance, postnatal care, early initiation of breastfeeding , access to improved drinking- water sources, pneumonia care-seeking and pneumonia antibiotics.

Communication for behavioural impact in enhancing utilization of insecticide-treated bed nets among mothers of under-five children in rural North Sudan: an experimental study.

BackgroundMalaria is the leading cause of morbidity and mortality in Sudan. The entire population is at risk of contracting malaria to different levels. This study aimed to assess the effectiveness of communication for behavioural impact (COMBI) strategy in enhancing the utilization of long-lasting insecticidal nets (LLINs) among mothers of under-five children in rural areas.MethodsA randomized community trial was conducted in rural area of Kosti locality, White Nile State, Sudan, among mothers of under-five children, from January 2013 to February 2014. A total of 761 mothers from 12 villages were randomly selected, 412 mothers from intervention villages and 349 were from comparison villages.ResultsThe knowledge of mothers, in intervention villages, about malaria vector, personal protective measures (PPM) against malaria, and efficacy of LLINs was significantly increased from 86.9 to 97.3 %; 45.9 to 92 % and 77.7 to 96.1 % respectively. Knowledge about usefulness of PPM, types of mosquito nets and efficacy of LLINs was significantly higher in intervention villages compared to comparison villages (p < 0.05), (η2 = 0.64). Mothers in intervention villages increasingly perceived, post-intervention, that malaria was a serious disease (99.3 %), a preventable disease (98.8 %) and also LLINs as an effective intervention in malaria prevention (92.2 %). This resulted in an increase in the utilization rate of LLINs from 19.2 to 82.8 % in intervention villages compared to comparison villages (p < 0.05) [OR = 4.6, 95 %, CI = (3.72–5.72)], (η2 = 0.64). The average of mothers’ knowledge about malaria was increased by 64 % (η2 = 0.64), the use of LLINs was increased by 79 % (η2 = 0.79) and a positive attitude towards malaria was 2.25 times higher in intervention villages than among mothers in the comparison villages.ConclusionsThese results established the usefulness of COMBI strategy for increasing awareness about malaria, developing a positive perception towards malaria prevention and, increasing the utilization of LLINs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1551-8) contains supplementary material, which is available to authorized users.

Neonatal mortality in Sudan: analysis of the Sudan household survey, 2010.

BackgroundSudan is classified as having insufficient progress in achieving the Millennium Development Goal (MDG-4), where the levels of child and infant mortality are among the highest in the region and the world. This study investigated factors associated with neonatal mortality in Sudan. Neonatal death is defined as death within the first 28 days of life.MethodsThis study analysed data from the Sudan Household Health Survey 2nd round, which was carried out in 2010. Total of 6,198 live-born infants delivered within the two years preceding the survey were included as the study population. Multivariate logistic regression was used to model neonatal mortality as a function of maternal health parameters, socioeconomic indicators and the sex of the child.ResultsThere were 189 neonatal deaths out of 6,198 live births (3.0%). In the multiple logistic regression, the factors associated with neonatal mortality were advanced maternal age (≥ 40 years; OR = 2.4; 95% CI: 1.21, 4.78, p = 0.012), poor household wealth index (OR = 1.6; 95% CI: 1.18, 2.47, p = 0.005), male child (OR = 1.8; 95% CI: 1.31, 2.42, p < 0.001), delivery of baby by Caesarean section (OR = 1.6; 95% CI: 1.78, 2.42, p = 0.013) and delivery complications (OR = 1.4; 95% CI: 1.18, 2.15, p = 0.002).ConclusionPublic health interventions which target neonatal mortality reduction should adopt a risk-factor-based approach to detect pregnancy complications early and once identified, the health system should be strengthened so that these complications can be dealt with adequately.

The state of heart disease in Sudan.

Cardiovascular disease (CVD) is the leading cause of mortality worldwide and an important cause of disability. In Africa, the burden of CVD is increasing rapidly and it is now a public health concern. Epidemiological data on diseases is scarce and fragmented on the continent. To review available data on the epidemiology and pattern of heart disease in Sudan. Data were obtained from the Sudan Household Survey (SHHS) 2006, annual health statistical reports of the Sudan Federal Ministry of Health, the STEPS survey of chronic disease risk factors in Sudan/Khartoum, and journal publications. The SHHS reported a prevalence of 2.5% for heart disease. Hypertensive heart disease (HHD), rheumatic heart disease (RHD), ischaemic heart disease (IHD) and cardiomyopathy constitute more than 80% of CVD in Sudan. Hypertension (HTN) had a prevalence of 20.1 and 20.4% in the SHHS and STEPS survey, respectively. There were poor control rates and a high prevalence of target-organ damage in the local studies. RHD prevalence data were available only for Khartoum state and the incidence has dropped from 3/1 000 people in the 1980s to 0.3% in 2003. There were no data on any other states. The coronary event rates in 1989 were 112/100 000 people, with a total mortality of 36/100 000. Prevalence rates of low physical activity, obesity, HTN, hypercholesterolaemia, diabetes and smoking were 86.8, 53.9, 23.6, 19.8, 19.2 and 12%, respectively, in the STEPS survey. Peripartum cardiomyopathy occurs at a rate of 1.5% of all deliveries. Congenital heart disease is prevalent in 0.2% of children. Heart diseases are an important cause of morbidity and mortality in Sudan. The tetrad of hypertension, RHD, IHD and cardiomyopathy constitute the bulk of CVD. Hypertension is prevalent, with poor control rates. A decline in rheumatic heart disease was seen in the capital state and no data were available on other parts of the country. No recent data on IHD were available. Peripartum cardiomyopathy and congenital heart disease occur at similar rates to those in other African countries.

Morbidity and Mortality Pattern of Neonates Admitted into Nursery Unit in Wad Medani Hospital, Sudan

Background: Neonatal outcome is an important indicator of obstetrics and health care. Few or no published data are available concerning neonatal morbidity and mortality in Sudan. Objectives: To study morbidity and mortality pattern amongst inborn neonates admitted into nursery unit in Wad Medani Hospital, Sudan during the period Jan-June, 2009.Results: A total of 1211 (29.5%) out of 4098 in-born neonates were admitted during study period. The major indications for neonatal admission were; infections 300 (24.8%), low birth weight (LBW) 307(25.4%) and asphyxia 130(10.7). There were 133(11%) neonatal deaths; preterm delivery, LBW and birth asphyxia were the major causes of death among these neonates.Conclusion: neonatal infection, preterm birth and LBW were the common causes of neonatal morbidity and mortality. There is an urgent need for more research throughout the country concerning these common causes of morbidity and mortality.Key words: pregnancy, preterm delivery, low birth weight, asphyxia

Education, prenatal care, and poor perinatal outcome in Khartoum, Sudan

Perinatal outcome is an important indicator of obstetric care and health status. Reducing the incidence of low birth weight neonates by at least one third between 2000 and 2010 is one of the major goals of the United Nations resolution A World Fit for Children and is an important contribution toward Millennium Development Goal (MDG) 4 which is to reduce child mortality by two thirds by 2015. Local surveillance and basic epidemiology can more accurately assess perinatal outcome and identify areas to which interventions should be targeted. The aims of the present study were to identify and quantify the risk factors for low birth weight neonates and perinatal mortality in Sudan and to assess the role of sociodemographic factors.

Ebola virus and hemorrhagic fever: Andromeda strain or localized pathogen?

Excerpt The nearly simultaneous occurrence of major epidemics of acute hemorrhagic fever with high mortality in Sudan (1) and Zaire (2) during late 1976 serves as a poignant reminder that infectiou...