Sudan Experience Research Articles

The Role of Interventional Radiology in Patients Management during Sudan War 2023-2024: A Western Sudan Experience

Background: The purpose of this study is to evaluate the availability of interventional radiology services in Western Sudan from 2023 to 2024, during the Sudan War. This study aimed to evaluate the role of interventional radiology in the country's ongoing conflict. Methodology: This is a retrospective descriptive study with a prospective component that was conducted at El-Obeid International Hospital in North Kordofan State, Sudan, in August and September 2024. All information on patients who had interventional radiology operations between August 15th, 2023 and August 15th, 2024 was obtained from the hospital. Results: The findings revealed that 41% of the 131 patients received operations in the Interventional Radiology Clinic and 59% in the Catheterization Laboratory department. Among the 131 patients, 55% were men and 45% were women. The most common age group for undergoing IR treatments was 46-65 years, followed by ≥65 and 18-45 years, with incidence rates of 40%, 34%, and 25%, respectively. 41% of the procedures were performed in the interventional radiology clinic, with 59% performed in the catheterization laboratory. The most common technique was permacath implantation (36%). Conclusion: The ongoing conflict between 2023 and 2024 aggravated the situation. As a result, our study discovered that the only IR facility in Western Sudan during this difficult time is based in El-Obeid and serves seven states. This was exemplified by a severe breakdown in the healthcare system, the loss of basic needs, great poverty, and the plight of the refugees.

The Mycetoma Research Center, University of Khartoum, Sudan's experience in community engagement initiatives spans 3 decades.

Mycetoma profoundly affects marginalised communities, especially in impoverished and remote areas with limited access to healthcare. This chronic and debilitating inflammatory disease highlights the typical issues of neglected tropical diseases (NTDs), such as insufficient attention, funding, and resources, which perpetuate neglect and suffering. Patients often delay seeking medical help, leading to advanced disease stages, severe complications, and lasting disabilities. The lack of medical infrastructure and skilled healthcare professionals worsens the situation, causing delays in diagnosis and inadequate treatment. Engaging affected communities in tailored interventions is essential to tackle these challenges, promote collaboration, raise awareness, and mobilise resources to improve healthcare access and enhance diagnostic and treatment capabilities. Since 1991, the Mycetoma Research Center (MRC) at the University of Khartoum, Sudan, has led community engagement initiatives aimed at improving the quality of life for mycetoma-affected individuals through education, advocacy, and local collaboration. In this communication, the MRC shares its extensive experience in community engagement to benefit mycetoma-affected communities.

Chinese peace and its discontents: China's peacemaking and peacekeeping in South Sudan

Abstract China shows a growing commitment to peacemaking and peacekeeping overseas. Yet Chinese peace efforts have met considerable challenges across multiple conflict settings. This article seeks to understand the difficulties facing Chinese peacemaking and peacekeeping and asks how these experiences influence the future behaviour of Chinese actors towards peace and conflict issues. Previous scholarship has largely taken a state-centric perspective to explain China's engagement in peacemaking and peacekeeping. In contrast, this article harnesses an assemblage approach to reveal the diversity of Chinese actors and the significant role local actors and normative forms of power play in influencing China's broader peace efforts. In South Sudan, it finds that the political ideas advanced by warring factions and the legitimacy they placed on United Nations peacekeeping intervention, both undermined Chinese peacemaking and peacekeeping and held far-reaching effects for Chinese actors beyond the conflict. Consequently, these challenges in South Sudan pushed China's national oil company to adopt new risk management policies throughout its investments in conflict settings. The South Sudan experience also influenced China's foreign ministry by tempering its proactive approach to conflict resolution in other conflict-affected countries and to promote peacekeeper safety and support peacekeeping intelligence at the United Nations.

The impact of the exchange rate systems on macroeconomic indicators: an evaluation study on Sudan experience 1970–2019)

This study followed both descriptive and correlation approaches to evaluate the impact of the application of the exchange rate systems on Sudan’s macroeconomic indicators from 1970 to 2019. During the 1970s, Sudan adopted the system of fixing exchange rates, and the “managed exchange rate” with the successive devaluation of the local currency during 1980s. During 1990s, the floating and liberalization policy of the exchange rate had been adopted beside the system of the crawling peg between 1997 and 1999. During the first decade of the millennium (i.e., the period of the flow of the oil revenues), Sudan followed a managed exchange rate system and during the second decade (the period of the extreme scarcity of foreign exchange resources after the secession of the southern Sudan). This study concluded that the systems of the fixing exchange rate, the crawling peg and the systems managing exchange rate that are closer to fixing positively supported the macroeconomic indicators, while the systems of exchange rate that are closer to liberalization, floating and flexibility negatively affected the exports, imports gross domestic product (GDP), personal income, and increasing the inflation rate. One of the most important recommendations of this study is the need to adopt a system of the exchange rate that is closer to fixing to ensure the improvement of the macroeconomic indicators.

Integrated disease surveillance and response in humanitarian context: South Sudan experience.

Introductiondecades of instability continue to impact the implementation of the Integrated Disease Surveillance and Response (IDSR) strategy. The study reviewed the progress and outcomes of rolling out IDSR in South Sudan.Methodsthis descriptive cross-sectional study used epidemiological data for 2019, 2020, and other program data to assess indicators for the five surveillance components including surveillance priorities, core and support functions, and surveillance system structure and quality.ResultsSouth Sudan expanded the priority disease scope from 26 to 59 to align with national and regional epidemiological trends and the International Health Regulations (IHR) 2005. Completing the countrywide rollout of electronic Early Warning Alert and Response (EWARS) reporting has improved both the timeliness and completeness of weekly reporting to 78% and 90%, respectively, by week 39 of 2020 in comparison to a baseline of 54% on both timeliness and completeness of reporting in 2019. The National Public Health Laboratory confirmatory testing capacities have been expanded to include cholera, measles, HIV, tuberculosis (TB), influenza, Ebola, yellow fever, and Severe Acute Respiratory Syndrome 2 (SARS-COV-2). Rapid response teams have been established to respond to epidemics and pandemics.Conclusionsince 2006, South Sudan has registered progress towards using indicator and event-based surveillance and continues to strengthen IHR (2005) capacities. Following the adoption of third edition IDSR guidelines, the current emphasis entails maintaining earlier gains and strengthening community and event-based surveillance, formalizing cross-sectoral one-health engagement, optimal EWARS and District Health Information Systems (DHIS2) use, and strengthening cross-border surveillance. It is also critical that optimal government, and donors’ resources are dedicated to supporting health system strengthening and disease surveillance.

Social Cohesion From the Top‐Down or Bottom‐Up? The Cases of South Sudan and Burundi

Both Burundi and South Sudan experience intractable conflicts which national and international actors struggle to resolve. Efforts to consolidate the nation‐state and foster social cohesion seem to be unsuccessful. As has been well documented in the literature, top‐down efforts to facilitate social cohesion by international and national actors are not enough to foster sustainable peace. Yet the dynamics and actors involved in bottom‐up interventions for social cohesion are less well understood than elite interventions. This article contributes to a deeper understanding of the bottom‐up interventions and explores the vertical integration between top‐down and bottom‐up efforts at social cohesion that exist along the local, national, and international trajectory in the two cases. Particularly in contexts such as South Sudan and Burundi, which are characterized by societies that are held together through complex social and relational networks, and in which informal governance and conflict resolution mechanisms hold high levels of legitimacy, this under‐researched aspect of social cohesion may hold critical insights in terms of consolidating nation‐states. The article provides an argument for the consideration of bottom‐up approaches for more integration of social cohesion mechanisms.

A Role Model for Africa or Exceptional Engagement? Assessing China’s South Sudan Experience

ABSTRACT China’s engagement in South Sudan has been branded a crucial test case for the country’s foreign and security policy in Africa. Investment in the oil sector is significant, and Chinese political engagement in conflict mediation and peacekeeping are unparalleled. Will the experiences gathered provide China with reasons to extend its engagement, is South Sudan a model or exceptional case? In this context three sectors will be explored: the economic, political and security sphere. This article finds that there are few reasons to assume that South Sudan is a role model. Access to oil was never critically important, and oil revenue is fuelling the conflict. The Chinese model of developmental peace and conflict mediation preferring non-punitive diplomacy are problematic. The peacekeeping mission could not stop the fighting but succeeded in setting up civilian protection sites. In sum, the South Sudan engagement has not produced favorable outcomes and is unlikely to be replicated.

The Role and Experience of Sudan in Assisting To Develop and Implement National Drug Policies

The strategy of price liberalisation and privatisation had been implemented in Sudan over the last decade, and has had a positive result on government deficit. The investment law approved recently has good statements and rules on the above strategy in particular to pharmacy regulations. Under the pressure of the new privatisation policy, the government introduced radical changes in the pharmacy regulations. The 2001 Pharmacy and Poisons Act and its provisions established the Federal Pharmacy and Poison Board (FPPB). All the authorities of the implementation of Pharmacy and Poisons Act were given to this board. This article provides an overview of the impact of the pharmaceutical regulations on the quality of medicines on the Sudanese market from the perspective of the pharmacists working with drug importing companies. The information necessary to conduct the evaluation was collected from 30 pharmacists who are the owners or shareholders in medicines’ importing companies. The participants were selected randomly. 89% of respondents considered the medicines on the Sudanese market are generally of good quality. The design of the research itself may be considered inadequate with regard to selection process. However, the authors believe it provides enough evidence, and the current pharmaceutical regulations have some loopholes. The Pharmacy, Poisons, Cosmetics and Medical Devices Act-2001 and its regulation should be enforced. The overall set-up including the Act itself needs to be revised. The emerging crisis in pharmacy human resources requires significant additional effort to gather knowledge and dependable data that can inform reasonable, effective, and coordinated responses from government, industry, and professional associations. Furthermore research should be carried out to understand the scope, magnitude directions of the migratory flows, within and outside the country, as well as the characteristics and skills of the emigrated pharmacists.

The Health Status and Demographics of a Conflicting Country: The Sudan Experience

The Republic of Sudan is a country located in the Northeastern region of Africa. It has a very diverse culture with about 597 ethnic groups communicating in 400 different languages and dialects. Sudan is the third-largest country in Africa and the sixteenth largest in the world. This country is blessed with numerous mineral resources such as asbestos, chromite, copper, gold, iron, lead, mica, nickel, petroleum, silver, uranium, zinc and many more. However, Sudan is not a peaceful nation. The government of Sudan has been engaged in military warfare against the Sudan Revolutionary Front since 2011. There are widespread human rights violations and religious persecutions. There are allegations that Sudan is a safe haven for terrorist. This study therefore gives an overview of the health status and demographics of the populace inhabiting this conflicting nation. In discussing the health status of the Sudan population, the data on number of the different types of health care facilities and major equipment in Sudan were presented. Also data on maternal and child health, malaria, HIV/AIDS, yellow fever, nodding diseases, noncommunicable disease mental health and dental health were presented. The demographics section displayed the population, population distribution and statistics, religion distribution and many more of the Sudan populace. Author appeals that the statistics and data presented be used in attending to the health needs of the populace of Sudan.

Sugar-Coating Female Genital Mutilation in United Nations Documents in English and Arabic: A Diachronic Study of Lexical Variation

This study investigates the terminology used when addressing “Female genital mutilation” in English and Arabic and, the impact of each term. Large number of young girls in the Middle East, Asia and Africa go through female genital mutilation, which is known as ‘FGM’. According to a United Nations Children's Fund report (UNICEF 2005a), 91% of girls in Egypt and 88% of girls in Sudan experience this procedure annually. Arabic language practitioners’ lexes for FGM include the words (ﺧﺘﺎن) (khetan) which means “circumcision”, (طﮭﺎرة) (tahara), which means “purification”, (ﻗﻄﻊ) (Kat’e) which means “cutting”, (ﺗﺸﻮﯾﺔ) (tashweeh) which means “corruption - damaging” and the term (اﻟﺒﺘﺮ) (batr) which means “mutilation”. This study will focus on the translation of FGM from English to Arabic over twenty years from 1996 until 2016 in the United Nations documents.

HIV/AIDS in South Sudan past, present, and future: a model of resilience in a challenging context

The Republic of South Sudan (RSS) is the newest state in the world which earned its independence on the 9th July 2011, following a peaceful secession from Sudan through a referendum in January 2011. In barely about 2.5 years after independence, the country ran into civil crisis starting on 15th December 2013, and refreshed in July 2016. The situation caused massive displacement and health systems disruption. The aim is to reflect on the HIV response in South Sudan despite the challenges of continued conflicts, displacement, and system disruption. Published data, as well as unpublished data available at the HIV Directorate in the Ministry of Health have been reviewed, including the HIV National Strategic plans, ANC sentinel Surveillance data, surveys and special studies, annual Health Management Information System cumulative reports from routine programmatic data (HTS, PMTCT, ART, TB/HIV, retention on care) and the UNAIDS spectrum data. The HIV epidemic in South Sudan is categorized as low and generalized (2.7%), with pockets of HIV concentration among key and vulnerable populations; who have a prevalence of 5% or more. The epidemic is thought to be widely variable across the country and geographically concentrated in the southern states of the greater Equatorial region formerly known as Western Equatoria with HIV prevalence of 6.8%, Central Equatoria 3.1%, and Eastern Equatoria 4.0%. The primary mode of infection is heterosexual exposure followed by mother-to-child transmission during pregnancy, at birth, and through breastfeeding. About 42% of the new HIV infections occurred mainly in clients of sex workers, while men and women involved in casual sexual relationships accounted for 14.5% of new infections. Female sex workers (FSWs) themselves only contributed to 11.2% of new HIV infections. Children born by HIV infected mothers accounted for 15.7%. In post conflict era in South Sudan, there is an urgent need for global initiative to conduct epidemiological studies about HIV. This will not only help peoples of South Sudan but will also increase our knowledge about how conflict and war can contribute in the spread of infectious diseases. Importantly, there are valuable lessons to learn from the South Sudan experience in terms of persistence and resilience during war and peace as HIV interventions continued to be implemented in a challenging context. Unless a strong health system is developed and sustained, building a sustainable HIV response will continue to be a challenge, and a lot more will be required.

Factors associated with common mental health problems of humanitarian workers in South Sudan.

BackgroundThe latest data on major attacks against civilian aid operations have identified South Sudan as the most dangerous country for aid workers globally. Exposure to other traumatic events and chronic stress is also common in this population. No research exists on the mental health of humanitarian workers in South Sudan.ObjectivesThis study examined symptom burden and predictors of posttraumatic stress disorder (PTSD), depression, anxiety, hazardous alcohol consumption, and burnout among humanitarian workers in South Sudan.MethodWe conducted a cross-sectional online survey with humanitarian workers (national and international staff, consultants, United Nations volunteers). We applied validated measures useful for this setting. We applied Least Absolute Shrinkage and Selection Operator (LASSO) regression to fit models with high prediction accuracy for each outcome and used ordinary least squares (OLS) regression to obtain final coefficients and perform inference.ResultsA total of 277 humanitarian workers employed by 45 organizations completed the survey (a response rate in the order of 10%). We estimated prevalence of PTSD (24%), depression (39%), anxiety disorder (38%), hazardous alcohol consumption in men (35%) and women (36%), and the burnout components emotional exhaustion (24%) and depersonalization (19%). Chronic stress exposure was positively associated with PTSD (p < .001), depression (p < .001), anxiety (p < .001), emotional exhaustion (p < .01), and depersonalization (p < .001). We found no significant association between emotion focused and problem focused coping and mental health outcomes. Associations between dysfunctional coping and depression (p < .001) and anxiety (p < .01) were positive. Higher levels of spirituality were associated with lower risk of hazardous alcohol consumption (p < .001). Contrary to expectations, working directly with humanitarian aid beneficiaries was significantly associated with lower risk for emotional exhaustion (p < .01).ConclusionOur results suggest that humanitarian workers in South Sudan experience substantial levels of mental ill-health. This study points to the need for staff support strategies that effectively mitigate humanitarian workers’ chronic stress exposure. The dynamics between coping and mental health among humanitarian workers require further study.

The Role of Islam in the Political Life of Sudan

The aim of the study is to show the historical development of the influence of Islam on the formation of political forces in Sudan in the post-colonial period. The region’s role in the struggle for power in independent Sudan is analyzed. The reaction of the world to the introduction of Sharia norms in the southern provinces of Sudan explored. The author elaborates possible ways of development similar to Sudan in other countries of the region. The study shows that conniving at the radical Islamism the authorities is prone of unforeseen consequences. The author has collected the data on the new socio-political organization “National Congress”. In contrast to the existing clerical parties and the suffiist brotherhoods, the NK adheres to the principle of broad participation of the masses in the religious and political processes of Sudanese society. A new model of Islamic parties, has emerged which differentiates the experience of Sudan from other African countries.

Abstract 771: Cervical cancer: Our experience in Sudan

Abstract Introduction: Cervical cancer is the second most prevalent cancer in Sudanese Women; breast cancer forms between 29 - 35% of female cancers while Ca Cervix forms 12 - 16%. There are limited screening activities in the country using VIA, and Pap smears in Obs. and Gyn. clinics. With the main emphasis on health education programs, teaching women the early symptoms of ca cervix and early detection. Due to lack of awareness the majority of women don’t know anything about screening, so there is limited demand. Method: This is a retrospective study of 405 Cases of Ca Cervix treated during the period between 2000—2013 at the Radiation and Isotopes Center of Khartoum, RICK. Data was collected from patients records. Results: Age distribution showed,&amp;lt;40 years =8 = 2 %,41 -50 = 94 =23.2%,51—60 = 187 = 46.2%,61—70 = 102 = 25.2%,&amp;gt;70 14= =3.5%. Age range =28—79,mean age =47 years. Residence distribution was as follows, western Sudan = 48 %,central Sudan = 41.%,North = 7%,East = 4%. Length of duration of symptoms, range between 1—10 months, mean of 5 months. FIGO Stage distribution: Stage 1= 6%, Stage 2 A =13%.Stage 2 B =23%,Stage 3 A=18%,Stage 3B =34%,Stage 4 A,B =7%,. Pathology: poorly dif. Squamous ca 38%, moderately dif. Squamous 26%,well dif 25%,Adenocarcinoma 9%,others 2%. Treatment: external Radiotherapy,45-50 Gy in 20—25 fractions, by 2 or 4 fields, using Co 60 or lineacs 6,9 Mv, concurrent chemo radiotherapy was given to patients with stage 2B, 3A, 3B, and 4A. Using weekly Cisplatinum, this was given to 32% of patients. 60 %% of the patients had Brach therapy, 34% with Low Dose Rate, LDR, Manual Brachy therapy, 35Gy to point A,and 66% had High Dose Rate Brachy, HDR, 9 Gy x 2 sessions, using a cobalt source. Results: 175 patients (43.3%) survived for 5 years and more, mostly patients with stage one and two 158 = 39% survived for 3-4 years after treatment,39 patents = 9.6 %, mostly patients with stage four, died during follow up due to the disease and 33 patients = 8.2% disappeared after treatment. The poor outcome is attributed to the advanced stages at presentation, lack of screening and awareness about cervical cancer, poverty, illiteracy, the large size of the country and the poor distribution of the limited medical resources. The patients treated with LDR or HDR have equal outcome and morbidity. Conclusion: Most of Ca Cervix Patients present with advanced disease, hence the poor prognosis, due to lack of awareness and screening, illiteracy and poverty, the majority are poorly differentiated squamous cancers. There is a need for increasing public awareness about ca cervix and its early symptoms, and provision of a pap smear and VIA services in the primary health care facilities. Citation Format: Kamal Eldein H. Mohamed, Dr Ammar Ashmeig Ahmed Ashmeig. Cervical cancer: Our experience in Sudan [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 771. doi:10.1158/1538-7445.AM2017-771

The role of Islamic Sukuk in Achieving Economic Development - The Sudan's experience as a model

The aim of this study is to highlight the role of Islamic instrument, as financial tool to achieve economic development andmobilize financial resources. Instead of the traditional funding which depends on the interest rate; we have highlighted theexperience of Sudan by reviewing the most important sukuk issued by the government of Sudan. This study has concluded that thesukuk have contributed to the coverage of many financial needs of the State of Sudan. Like the budget deficit. And infrastructureprojects financing and revitalize Khartoum Stock Exchange

Learning in Africa: China’s Overseas Oil Investments in Sudan and South Sudan

In the past two decades, China’s national oil companies have become new players in the international oil industry. When they first entered the global scene in the 1990s, Chinese NOCs held few competitive advantages over international oil companies. They lacked the organizational capabilities and expertise to manage large projects overseas and had little experience with political and security risk. This article argues that political, social and security dynamics in the host countries of Chinese NOCs can play a transformative role in shaping their competitiveness and global strategy. It demonstrates how experiences in Sudan and South Sudan were instrumental in leveraging the competitiveness of the China National Petroleum Corporation, China’s largest oil company, particularly through developing its risk management capabilities, and steering its global strategy towards a more diverse and balanced investment portfolio.

Sowing date determinants for Sahelian rainfed agriculture in the context of agricultural policies and water management

Inappropriate sowing date constitutes a major reason for crop failure and low yields in the African Sahel region. Deriving from experience in Sudan, this study endeavors to: (1) identify the drivers of farmers’ choice of sowing date for rainfed agriculture, (2) suggest a best-suited guide for farmers in their decision making concerning sowing dates and (3) recommend integrated coping strategies that consider technical and socioeconomic dimensions and regional scales. In this study, sorghum is considered as a strategic crop for food security in the country. The result of data processing based on two climatic methods over the period 1971–2010 has determined the onset of rainfall between the last week of June and the first week of July. An early but safe sowing date in terms of less subsequent dry spells is 08 July. Accordingly, the probability for the establishment of the rainy season is high and the probability of occurrence of following dry spells is lowest. However, this date appears to be earlier than the sowing date commonly practiced by farmers which is usually in the end of July, but sometimes even in the beginning of August. The field survey analysis highlights several non-climatic factors that have significant influence on sorghum cultivation in general and sowing date definition specifically. These include limited agricultural extension service, weeds, basic machinery and low input of fertilizers, herbicides and pesticides. Weed presence and slow and long soil preparation procedures often cause farmers to delay sowing operations, consequently leading to yield reduction. Current coping strategies can serve as a base to advance long-term agricultural policies that guarantee sufficient institutional support and create an enabling environment for knowledge transfer and technical solutions. The results of this research constitute part of an integrated long-term adaptation strategy that has to be developed to improve agricultural activities under climate risk.

Commitment of Islamic banks to long-term economic development and society welfare: the Sudan experience

This paper attempts to evaluate the overall commitment of Islamic banks in Sudan to the economic development and social welfare, by analysing the pattern of financing provided by these institutions to the interested parties. The study developed three hypotheses with respect to the issue at hand and used annual data to test these hypotheses. The results indicated that the stated hypotheses of the study: commitment to long-term economic development, community development and social welfare, and risky investments could not be supported. The results revealed that there have been steady decline in the proportion of banks funds which were allotted to the long-term economic development, community development and social welfare, and risky investments in Sudan. The study helps in directing attention to the search for new ways of bringing Islamic banks to true spirit, and not artificial Islamic finance. Microfinance, new sub-institutions, entrepreneurship activities and private equity-like investments are only a few in that regard.

Mycetoma in the Sudan: an update from the Mycetoma Research Centre, University of Khartoum, Sudan.

This communication reports on the Mycetoma Research Centre of the University of Khartoum, Sudan experience on 6,792 patients seen during the period 1991–2014.The patients were predominately young (64% under 30 years old) males (76%). The majority (68%) were from the Sudan mycetoma belt and 28% were students. Madurella mycetomatis eumycetoma was the most common type (70%). In 66% of the patients the duration of the disease was less than five years, and 81% gave a history of sinuses discharging mostly black grains (78%). History of trauma at the mycetoma site was reported in 20%. Local pain was reported in 27% of the patients, and only 12% had a family history of mycetoma. The study showed that 57% of the patients had previous surgical excisions and recurrence, and only 4% received previous medical treatment for mycetoma. Other concomitant medical diseases were reported in 4% of the patients. The foot (76%) and hand (8%) were the most commonly affected sites. Less frequently affected sites were the leg and knee (7%), thigh (2%), buttock (2%) and arm and forearm (1%). Rare sites included the chest wall, head and neck, back, abdominal wall, perineum, oral cavity, tongue and eye. Multiple sites mycetoma was recorded in 135 (2%) of cases. At presentation, 37% of patients had massive lesions, 79% had sinuses, 8% had local hyper-hydrosis at the mycetoma lesion, 11% had regional lymphadenopathy, while 6% had dilated tortuous veins proximal to the mycetoma lesions. The diagnosis of mycetoma was established by combined imaging techniques and cytological, histopathological, serological tests and grain culture. Patients with actinomycetoma received a combination of antimicrobial agents, while eumycetoma patients received antifungal agents combined with various surgical excisions. Surgical excisions in the form of wide local excision, debridement or amputation were done in 807 patients, and of them 248 patients (30.7%) had postoperative recurrence. Different types of amputations were done in 120 patients (1.7%).

Coming to know about teaching, its development and researcher practice through collaborative action research with adult education teachers in Sudan

This study re-presents an open-ended process of coming to know through designing, conducting and analysing an action research project with youth and adult education teachers in Khartoum, Sudan. The inquiry responds to the overarching question: What knowledge can I generate about teaching, its development and my researcher practice through collaborative action research with teachers in Sudanese youth and adult education schools? This multifaceted focus encompasses reconnaissance into teaching practices and adult education, the processes of action research and teacher development and reflexive analysis of epistemological positioning and knowledge construction through our collaborative investigation. The action research forms the substantive basis of this thesis, constituting diverse processes of coming to know by the participating teachers and myself. Our interactions as practitioners and researchers interrogated the teachers’ contextualised, practical knowledge through academic mechanisms of data collection and analysis. The teachers reflected upon their taken-for-granted understandings of education, their school contexts and their practice, and re-cast them as more complex. Participation in the study resulted in the teachers becoming ‘learners-focused’ by developing greater focus on their practice, by being mufetih (observant and analytical), by being close to learners and by increased experimentalism. These dispositions were combined with a shift in the teachers’ epistemological positions towards ‘authoritative uncertainty’, in which partial, contextualised and contingent knowledge was recognised as legitimate, facilitating re-construction of their knowledge to develop their practice. In this narrative account, the field research is framed by my evolving theoretical understandings which informed the design, analysis and re-presentation of the study. An autobiographical introduction to my experience in Sudan outlines my nascent professional stance towards education development. I then explore my increasingly critical understanding of research on teachers and pedagogy in Africa and discourse on education quality in low-income countries. I discuss the formation of my specific researcher identity through postcolonial theorisation of my ethical stance towards making a difference in the field of practice, namely Sudanese schools. In this thesis, layered re-viewing, which derives from an epistemological stance of the partiality and contingency of knowledge, facilitates re-presentation of moments in which understanding is challenged and re-formed by theorisation and experience. Re-viewing literature and theoretical analyses brings new epistemological, ontological and ethical understandings, as my focus on ‘the practical’ in field research has been supplemented in the post-fieldwork period by ‘the practical’ in the academy, a contested domain of knowledge production. To conclude this thesis, the position of ‘authoritative uncertainty’ is applied in the reflexive deconstruction of the study, as the action research process and outcomes are re-viewed through postcolonial and feminist theories to unpick the situated complexities of cross-cultural practitioner research and its representation. While coming to know is a continuous process, its representation in this thesis reaches an arbitrary conclusion by proposing how coming to know teaching practices, action research processes and reflexive researcher analysis might bring new perspectives to academic and policy initiatives for teacher development.