Nile Province Research Articles

The Ongoing Epidemic of West Nile Virus in Greece: The Contribution of Biological Vectors and Reservoirs and the Importance of Climate and Socioeconomic Factors Revisited.

Emerging infectious diseases have inflicted a significant health and socioeconomic burden upon the global population and governments worldwide. West Nile virus, a zoonotic, mosquito-borne flavivirus, was originally isolated in 1937 from a febrile patient in the West Nile Province of Uganda. It remained confined mainly to Africa, the Middle East, and parts of Europe and Australia until 1999, circulating in an enzootic mosquito-bird transmission cycle. Since the beginning of the 21st century, a new, neurotropic, more virulent strain was isolated from human outbreaks initially occurring in North America and later expanding to South and South-eastern Europe. Since 2010, when the first epidemic was recorded in Greece, annual incidence has fluctuated significantly. A variety of environmental, biological and socioeconomic factors have been globally addressed as potential regulators of the anticipated intensity of the annual incidence rate; circulation within the zoonotic reservoirs, recruitment and adaptation of new potent arthropod vectors, average winter and summer temperatures, precipitation during the early summer months, and socioeconomic factors, such as the emergence and progression of urbanization and the development of densely populated areas in association with insufficient health policy measures. This paper presents a review of the biological and socioenvironmental factors influencing the dynamics of the epidemics of West Nile virus (WNV) cases in Greece, one of the highest-ranked European countries in terms of annual incidence. To date, WNV remains an unpredictable opponent as is also the case with other emerging infectious diseases, forcing the National Health systems to develop response strategies, control the number of infections, and shorten the duration of the epidemics, thus minimizing the impact on human and material resources.

Association of environmental exposure to heavy met-als with chronic kidney disease (CKD) in patients from White Nile province, Sudan

This research was focused on assessment of chronic kidney disease (CKD), due to the contamination of water, in White Nile Province, Sudan with heavy metals, agrochemicals, hard water, ionicity, and climate changes. Nevertheless, the levels of any of the pollutants or conditions reported in this water are inconsistent not correlated with the prevalence of the disease and are too low to cause (CKD). The most common cause of chronic kidney disease (CKD) among all groups was diabetes mellitus (46.50%); followed by hypertension (46.50%); chronic glomerulonephritis (7.64), while other causes account for only (9.55%). The highest prevalence of CKD was recorded in Eld – Duiem, followed by Allahamed localities, with a percentage of (22.9% and 17.8%), respectively. The highest prevalence of the cases was recorded in patients of the range age of 31-50 years, followed by patients from the group 51-70 years old, and least in the group of 71-90 years old. Famers recorded a frequency of (20.38%) and sponsors recorded a frequency of (17.20%), while, among groups of other occupation a high frequency of (42%) was recorded. The level of education reflected a high frequency of CKD among the individuals of primary education, followed by individuals of secondary education, while the lowest frequency was recorded among illiterates. People living in red brick building, recorded the highest number of CKD patients (142 patients) while only (5 patients) who live in wool building were recorded. On the other hand, high prevalence of CKD (113 patients) was recorded in groups who do not take herbs, while the more patients (44) were recorded among individuals who take herbs. All results showed significance of (P ≤ 0. 05).

The Degree to which Islamic Education Teachers Employ the Strategy of Directed Discovery in Teaching to Develop Higher-Order Thinking Skills

The study aimed to know the degree to which Islamic education teachers employ the strategy of directed discovery in teaching to develop higher thinking skills (analysis, synthesis, and evaluation) among sixth-grade students at the basic stage in East Nile Province, Khartoum State - Sudan. The researcher used the descriptive-analytical method, and adopted a questionnaire that consisted of (15) indicators representing the skills of analysis, synthesis, and evaluation as a tool of the study. A random sample of (175) Islamic education teachers was selected, from the Department of Basic Education. The data were analyzed according to the Statistical Packages for Social Sciences (SPSS) program, and the results of the study have shown that the use of the directed discovery strategy by Islamic education teachers came (with a medium degree) in the axes of the indicators of the tool (analysis, synthesis, and evaluation), as well as in its calculation of their averages concerned with the three skills. This requires much more attention to be given to the employment of the directed discovery. As such a strategy help students to develop their skills and solve the problems they face. The researcher has recommended the necessity of creating applications and programs that help Islamic education teachers to develop their teaching capabilities using new and advanced methods of teaching, in order to raise their competencies and develop their students' higher thinking skills.

Global emergence of West Nile virus: Threat & preparedness in special perspective to India.

West Nile virus (WNV) is a mosquito-borne single-stranded RNA neurotropic virus within the family Flaviviridae. The virus was first reported in the West Nile province of Uganda in 1937. Since then, sporadic cases have been reported until the last two decades when it has emerged as a threat to public health. The emergence of WNV with more severity in recent times is intriguing. Considering this phenomenon, the WNV-affected areas of the world were distinguished as old versus new in a depicted world map. The present review showcases the historical and epidemiological perspectives of the virus, genetic diversity of prevailing lineages and clinical spectrum associated with its infection. Emergence of the virus has been discussed in special context to India because of co-circulation of different WNV lineages/strains along with other flaviviruses. Recent laboratory diagnostics, vaccine development and clinical management associated with WNV infection have also been discussed. Further, the research gaps, especially in context to India have been highlighted that may have a pivotal role in combating the spread of WNV.

Prevalence of Ear Disorders at Rabak City, White Nile Province, Sudan, 2017

Background: Residence to industrial areas was associated with increased risk of health problems. Lacks of epidemiological data of ear disorders were noticed among Sudanese. Objectives: This study was set out to determine the prevalence of preventable ear disorders in Rabak city, White Nile province in Sudan. Methods: A well-structured open-ended (pro forma) questionnaire was used to screen 300 participants who suffered of ear, nose and throat (ENT) complaints in the industrial area of Rabak city. Ear examinations for participants complaining of ear disorders were conducted using illuminated and pneumatic otoscope, tuning fork and pure tone audiometry. Diagnosis, risk factors and therapeutic outcomes were evaluated. Data were analyzed statistically and manipulated in a suitable manner. Results: Of total (n = 300), only (n = 186) fit the study criteria. About 85 (28.6%) of participants aged 20 - 40 years old, whilst most 99 (33%) lived at urban-industrial part of the city. The participants who were not working 131 (43.6%) and those with basic level of education were 134 (44.6%). Otitis externa was prevalent in 50 (26.9%) of our participants. Around 44 (23.6%) were suffering of chronic otitis media and 40 (21.4%) were suffering of otitis media with effusion. Acute otitis media was detected in 27 (14.3%). Ear wax was detected in 13 (7.1%), and foreign bodies were found in 12 (6.6%) of the study population. Smoking was commonest amongst participants with otitis externa. Our results revealed that the preferred treatment modality was medical treatment and follow-up the participants which resulted in good outcome. Conclusion: Preventable ear diseases represent a significant health problem among participants of Rabak city. Amongst the ear problems, the incidence of otitis media and otitis externa due to industrial pollution was reported to be high. Creating comprehensive health education about the common ear disorders in this community can help reduce the prevalence of these conditions and is highly recommended.

Toxicological effects of a herbicide – Pendinmethalin: a case study of Kenana Sugar Industry, White Nile Province, Sudan

The aim of this experiment is to know the toxicity of high uses of pendimethalin as herbicide used in Kenana Sugar Industry, period of experiment is 30 days. The results were reveal that there was significantly effect of high doses of pendimethalin on the liver of Wistar rats, because increase in the dose of the pendimethalin reflected by increasing the alkaline phosphatase enzyme during increase the period of time. In addition there were histopathological medical in cells of the liver of Wistar rats, which lead to impaired function of the liver, so it is very clear observed in water collected from Kenana Sugar Industry plate two, and 375 and 750 (plate three and four) compared with plate one( free from pendimethalin treatment. This experiment indicated that high dose of pendimethalin causes toxicity. DOI: http://dx.doi.org/10.3126/ije.v3i2.10638 International Journal of the Environment Vol.3(2) 2014: 258-262

Visceral Leishmaniasis Outbreak in South Sudan 2009–2012: Epidemiological Assessment and Impact of a Multisectoral Response

The humanitarian situation in South Sudan is dire, with over two million returnees since 2005 and another 300,000 expected to return by the end of 2013. In 2012, 170,000 refugees settled in five camps in Unity and Upper Nile states, endemic areas of visceral leishmaniasis (VL) (Office for the Coordination of Humanitarian Affairs Sudan Humanitarian Update 1st Quarter 2012). VL in South Sudan is endemic in four states, namely Upper Nile, Unity, Jonglei, and Eastern Equatoria, where 2.7 million people in 28 counties are considered to be at risk. It is an anthroponosis caused by Leishmania donovani, and the vectors are Phlebotomus orientalis and P. martini. South Sudan is suffering from recurrent epidemics in areas previously considered to be nonendemic [1]. VL in South Sudan was first described in a child from Bahr-el-Ghazal in 1904 [2]. Since then, outbreaks have been reported in several different areas, namely Jonglei state in the 1930s and 60s [3], [4], the former Blue Nile province in the 50s [5], and Unity state (formerly Western Upper Nile) in the 80s, until by the 90s it was claimed that almost one-third of the population had been affected between 1984 and 1994 [6]–[8]. In 1994 and in 2002 there were two further outbreaks in northern Jonglei and Eastern Upper Nile states, resulting in 17,000 cases reported. Since 2002, the number of cases reported has progressively decreased to reach 582 in 2008. From 2004 to 2008, an average of 1,756 cases were reported annually, although the actual number of cases was estimated to be between 7,400 and 14,200 cases [9]. Until 2004, VL treatment services were provided almost exclusively by Medecins Sans Frontieres-Holland (MSF-H), after which time part of the VL-treatment activities were handed over to the Southern Sudan Secretariat of Health. In addition to this, the World Health Organization (WHO) supported eight health facilities run by nongovernmental organizations (NGOs), and in 2009, that network was expanded to 12. Another VL outbreak was declared in 2009 and it is still ongoing. This publication provides a detailed report on the epidemiology of and the response to this outbreak.

Visceral leishmaniasis: Clinical and demographic features in an African population

To describe the clinical and demographic features of patients with visceral leishmaniasis (VL), from Sudan, Africa. A descriptive study was conducted during 5 years period on confirmed VL patients. These patients are, originally, from White Nile Province (WNP) region, a previously non-endemic VL focus which is located in southern part of Sudan. They were referred during the period 2006-2010 for management at Tropical Diseases Hospital (TDH) in the capital Khartoum. The patients data were retrieved from the hospital electronic software system, and were studied. A total of 71 patients with VL were reviewed. The main clinical features were: fever 68 (95.8%), splenomegaly 66 (93%), weight loss 61 (85.9%), pallor 59 (83.1%), hepatomegaly 52 (73.2%). The most notable haematology finding was the mean Hb value (7.6 g/dL) on admission to hospital. Gender showed males at higher risk for VL as compared to females with a ratio of 3:1 (53 vs 18). VL was largely a disease of children with 42 (59.1%) aged < 15 year, and around quarter (23.9%) under 5 years. The clinical features of Sudanese VL in WNP region is, generally, similar to the pattern seen globally in endemic foci. The majority of the study population are paediatric indigenous VL patients, suggesting that adults were immune, and indicating change of disease pattern from previous sporadic to present endemic. This finding emphasizes the need for research to better understand VL in non-endemic areas with the objective of developing effective and sustainable control strategies.

Insights to Substrate Binding and Processing by West Nile Virus NS3 Protease through Combined Modeling, Protease Mutagenesis, and Kinetic Studies

West Nile Virus is becoming a widespread pathogen, infecting people on at least four continents with no effective treatment for these infections or many of their associated pathologies. A key enzyme that is essential for viral replication is the viral protease NS2B-NS3, which is highly conserved among all flaviviruses. Using a combination of molecular fitting of substrates to the active site of the crystal structure of NS3, site-directed enzyme and cofactor mutagenesis, and kinetic studies on proteolytic processing of panels of short peptide substrates, we have identified important enzyme-substrate interactions that define substrate specificity for NS3 protease. In addition to better understanding the involvement of S2, S3, and S4 enzyme residues in substrate binding, a residue within cofactor NS2B has been found to strongly influence the preference of flavivirus proteases for lysine or arginine at P2 in substrates. Optimization of tetrapeptide substrates for enhanced protease affinity and processing efficiency has also provided important clues for developing inhibitors of West Nile Virus infection.

Some observations on ticks (Acari : Ixodidae) infesting sheep in River Nile Province of Northern Sudan

Five species of ixodid ticks were found in a cross-sectional survey in which 200 sheep were examined for ticks in River Nile Province, Sudan. Hyalomma anatolicum anatolicum was the predominant species (73.6%), whereas ticks belonging to the Rhipicephalus sanguineus group (14.7%), Rhipicephalus evertsi evertsi (9.1%), Rhipicephalus simus (2%) and Hyalomma dromedarii (0.5%) were also found. The mean tick load was 11.2 per animal. In a subsequent longitudinal survey ticks were collected on a monthly basis from eight sentinel sheep that were introduced into the area. It was found that H. a. anatolicum almost disappeared during the hot period between April and August, whereas it's highest numbers were present in winter between November and February. It is concluded that there is only one generation of H. a. anatolicum per year, which may explain the year-round appearance of clinical cases of malignant ovine theileriosis indicating endemic instability of this disease in River Nile Province.

British Colonial Military Recruitment Policy in the Southern Kordofan Region of Sudan, 1900–1945

British Colonial Military Recruitment Policy in the Southern Kordofan Region of Sudan, 1900–1945

Site-directed Mutagenesis and Kinetic Studies of the West Nile Virus NS3 Protease Identify Key Enzyme-Substrate Interactions

The flavivirus West Nile virus (WNV) has spread rapidly throughout the world in recent years causing fever, meningitis, encephalitis, and fatalities. Because the viral protease NS2B/NS3 is essential for replication, it is attracting attention as a potential therapeutic target, although there are currently no antiviral inhibitors for any flavivirus. This paper focuses on elucidating interactions between a hexapeptide substrate (Ac-KPGLKR-p-nitroanilide) and residues at S1 and S2 in the active site of WNV protease by comparing the catalytic activities of selected mutant recombinant proteases in vitro. Homology modeling enabled the predictions of key mutations in WNV NS3 protease at S1 (V115A/F, D129A/E/N, S135A, Y150A/F, S160A, and S163A) and S2 (N152A) that might influence substrate recognition and catalytic efficiency. Key conclusions are that the substrate P1 Arg strongly interacts with S1 residues Asp-129, Tyr-150, and Ser-163 and, to a lesser extent, Ser-160, and P2 Lys makes an essential interaction with Asn-152 at S2. The inferred substrate-enzyme interactions provide a basis for rational protease inhibitor design and optimization. High sequence conservation within flavivirus proteases means that this study may also be relevant to design of protease inhibitors for other flavivirus proteases.

A Curse from God? Religious and political dimensions of the post-1991 rise of ethnic violence in South Sudan

Southern Sudanese civilian populations have been trapped in a rising tide of ethnicised, South-on-South, military violence ever since leadership struggles within the main southern opposition movement – the Sudan People's Liberation Army (SPLA) – split into two warring factions in August 1991. This paper traces the devastating impact of this violence on a particularly volatile and fractured region of contemporary South Sudan: the oil rich heartlands of the Western Upper Nile Province. Foregrounding the historical experiences and grassroots perspectives of Nuer civilian populations in this region, the paper shows how elite competition within the southern military has combined with the political machinations of the national Islamic government in Khartoum to create a wave of inter- and intra-ethnic factional fighting so intense and intractable that many Nuer civilians have come to define it as ‘a curse from God’. Dividing Sudan's seventeen-year-long civil war (1983–present) into four distinct phases, the paper shows how successive forms and patterns of political violence in this region have provoked radical reassessments of the precipitating agents and ultimate meaning of this war on the part of an increasingly demoralised and impoverished Nuer civilian population.

3. Visceral leishmaniasis

From the early 1900s, visceral leishmaniasis (VL; kala-azar) has been among the most important health problems in Sudan, particularly in the main endemic area in the eastern and central regions. Several major epidemics have occurred, the most recent—in Western Upper Nile province in southern Sudan, detected in 1988 — claiming over 100000 lives. The disease spread to other areas that were previously not known to be endemic for VL. A major upsurge in the number of cases was noted in the endemic area. These events triggered renewed interest in the disease. Epidemiological and entomological studies confirmed Phlebotomus orientalis as the vector in several parts of the country, typically associated with Acacia seyal and Balanites aegyptiaca vegetation. Infection rates with Leishmania were high, but subject to seasonal variation, as were the numbers of sand flies. Parasites isolated from humans and sand flies belonged to three zymodemes (MON-18, MON-30 and MON-82), which all belong to the L. donovani sensu lato cluster. Transmission dynamics have not been elucidated fully; heavy transmission in relatively scarcely populated areas such as Dinder national park suggested zoonotic transmission whereas the large numbers of patients with post kala-azar dermal leishmaniasis (PKDL) in heavily affected villages may indicate a human reservoir and anthroponotic transmission. Clinical presentation in adults and in children did not differ significantly, except that children were more anaemic. Fever, weight loss, hepato-splenomegaly and lymphadenopathy were the most common findings. PKDL was much more common than expected (56% of patients with VL developed PKDL), but other post-VL manifestations were also found affecting the eyes (uveitis, conjunctivitis, blepharitis), nasal and/or oral mucosa. Evaluation of diagnostic methods showed that parasitological diagnosis should still be the mainstay in diagnosis, with sensitivities for lymph node, bone marrow and spleen aspirates of 58%, 70% and 96%, respectively. Simple, cheap serological tests are needed. The direct agglutination test (DAT) had a sensitivity of 72%, specificity of 94%, positive predictive value of 78% and negative predictive value of 92%. As with other serological tests, the DAT cannot distinguish between active disease, subclinical infection or past infection. The introduction of freeze-dried antigen and control sera greatly improved the practicality and accuracy of the DAT in the field. An enzyme-linked immunosorbent assay using recombinant K39 antigen had higher sensitivity than DAT (93%). The polymerase chain reaction using peripheral blood gave a sensitivity of 70–93% and was more sensitive than microscopy of lymph node or bone marrow aspirates in patients with suspected VL. The leishmanin skin test (LST) was typically negative during active VL and converted to positive in c. 80% of patients 6 months after treatment. Immunological studies showed that both Th1 and Th2 cell responses could be demonstrated in lymph nodes from VL patients as evidenced by the presence of messenger ribonucleic acid for interleukin (IL)-10, interferon γ and IL-2. Treatment of peripheral blood mononuclear cells from VL patients with IL-12 was found to drive the immune response toward a Th1 type response with the production of interferon γ, indicating a potential therapeutic role for IL-12. VL responded well to treatment with sodium stibogluconate, which is still the first line drug at a dose of 20 mg/kg intravenously or intramuscularly per day for 15–30 d. Side effects and resistance were rare. Liposomal amphotericin B was effective, with few side effects. Control measures have not been implemented. Based on observations that VL does not occur in individuals who have a positive LST, probably because of previous cutaneous leishmaniasis, a vaccine containing heat-killed L. major promastigotes is currently undergoing a phase III trial.

The Upper Nile Province Handbook: A report of peoples and government in the Southern Sudan, 1931, compiled by C. A. Willis

The Upper Nile Province Handbook: A report of peoples and government in the Southern Sudan, 1931, compiled by C. A. Willis

C. A. Willis: The Upper Nile Province Handbook: a report on peoples and government in the Southern Sudan, 1931. Edited by Douglas H. Johnson. (Oriental and African Archives, 3.) xx, 476 pp., 8 plates. Oxford: Oxford University Press, 1995. £50.

C. A. Willis: The Upper Nile Province Handbook: a report on peoples and government in the Southern Sudan, 1931. Edited by Douglas H. Johnson. (Oriental and African Archives, 3.) xx, 476 pp., 8 plates. Oxford: Oxford University Press, 1995. £50. - Volume 60 Issue 2

Neonatal tetanus in rural and displaced communities in the East Nile Province.

A retrospective neonatal tetanus survey was conducted among rural and displaced communities in the East Nile Province in the Sudan. The results showed that neonatal tetanus was a major cause of neonatal mortality. The incidence in the displaced community was more than double that in the stable rural community, 7.1 and 3.2 per 1000 live births, respectively. Coverage with two doses of tetanus toxoid was about 58 per cent in both areas, with a drop-off rate of 15 per cent. Making use of missed opportunities to vaccinate regular attendants of antenatal care services would have increased coverage in both areas. Wrong beliefs and attitudes towards tetanus toxoid were detected among schoolgirls and teachers in the two areas.

Guinea worm disease in Ayod, Upper Nile Province, southern Sudan: a cross-sectional study.

Upper Nile Province is one of the four main endemic areas for Guinea worm disease in the Sudan. In December 1994, a survey was conducted in the village of Ayod where the disease is endemic, to investigate morbidity and local knowledge of transmission and prevention. Interviews were conducted in households selected by standard cluster sampling procedures and of the 759 people examined, 156 (20.6%) had Guinea worm lesions. Adjusted odds ratios were used to estimate the relative risk for people with different personal or household characteristics in a multivariate analysis. After controlling for the possible confounding effects of other study variables, having a filter in the household, gender, and lack of knowledge about transmission and about prevention, were not associated with lesions. Only two variables were significantly associated with Guinea worm disease: getting water from a source other than a well increased the risk by a factor of 2.3, and being aged 5 years or more increased the risk by a factor of 31.1. This study demonstrates the clear association between the source of water for drinking and Guinea worm disease found elsewhere. We suggest the provision of reliable sources of pure drinking water and health education are the most suitable long-term preventive measures. The Sudan now represents the greatest challenge to the goal of global eradication of Guinea worm disease, following the reduction in cases in Nigeria. The continuing civil war and insecurity in southern Sudan hinder the implementation of an effective water programme and other control measures, but the potential benefits through reduced incapacity and improved agricultural productivity are considerable.

Patterns of infection and transmission of human schistosomiasis mansoni and schistosomiasis haematobium in White Nile Province, Sudan.

The overall prevalences of infection with Schistosoma mansoni, S. haematobium or both species among 6122 children from 27 schools in the former White Nile Province of Sudan (now divided into the Kosti, El Getaina, El Gebelein and El Duem Provinces) were 10.1%, 21.4% and 4.5%, respectively. Geometric mean egg counts in the pure S. mansoni and pure S. haematobium infections were 97.7 eggs/g faeces and 12.9 eggs/10 ml urine, respectively. There were marked differences in levels of endemicity between provinces and also between schools within each province. School-specific prevalences and intensities of infection were positively correlated, both for S. mansoni and for S. haematobium. Prevalences and intensities of infection were generally similar in male and female subjects and in the different age groups into which they were split (i.e. 5-9, 10-14 and 15-19 years). Community-based surveys of all age groups in two villages showed typical patterns of infections with S. mansoni and S. haematobium, with indices peaking in those aged 10-19 years, both in males and females. Observations on snail-related aspects of transmission revealed that transmission of both S. mansoni and S. haematobium was highly focal and also seasonal, taking place during the hot, dry and post-rainy seasons.

Socioeconomic determinants of long-term cropland fallowing: smallholders in north-western Uganda

SUMMARY Long-term cropland fallowing decisions of farmers in the West Nile Province of Uganda were studied. Tabular and regression methods are used to examine the relationship between farm and household factors and seasons of net fallowing. The results show that farmers plan to decrease the rate of fallowing in the immediate future. Serious (but undocumented) problems in maintaining cropland productivity could result. Population density had a large and negative effect on net fallowing (seasons of fallowing less seasons of crops), decreasing from the current average of −0.6 seasons to −2.21 seasons for a doubling of population. This 268% decrease in the use of fallowing could occur in as few as 13.5 years, assuming a 3% annual population growth rate. Farms larger in size, but with no increase in per capita cropland availability, had a higher rate of net fallowing. Cashcrop production was negatively associated with net fallowing, whilst farmer age had a positive association. The results have implications fo...