Accessibility crisis of essential medicines at Sudanese primary healthcare facilities: a cross-sectional drugs' dispensaries assessment and patients' perspectives.

BACKGROUND: Access to essential medicines is a critical component of universal health coverage. However, the availability of essential medicines in Sudan isn't well studied. As well, most Sudanese people lack health insurance, making out-of-pocket spending the primary source of drug financing. Therefore, the affordability of medicines in Sudan is questionable, with only 30% of the total population being covered by a public health service or public health insurance. We undertook this study to assess the availability and prices of essential medicines in public-sector health facilities in Khartoum state. Moreover, this study aims at assessing patients' perceived affordability of essential medicines, and accommodation and acceptability of the public facility. METHODS: A cross-sectional study was carried out at 30 primary healthcare facilities' drug dispensaries across three districts in Khartoum state. Within each Centre's dispensary unit, a standardized checklist evaluated the availability and affordability of 21 essential medicines selected from Sudan's national essential medicines list and assessed their storage conditions. Furthermore, 630 patients were selected from all dispensary units for an exit interview that assessed their perceived accessibility, acceptability, accommodation, and affordability of essential medicines. Data were collected through the Kobo toolbox and analyzed using SPSS version 26. RESULTS: Participants' ratings of accessibility, affordability, accommodation, and acceptability were 3.7/5, 1.5/4, 5/6, and 5.4/6, respectively, with a 26.7% full access and weak correlation between some of the indices. The overall availability of adults and pediatric medicines was 36.8% 6.7%, respectively. Cost of a single course of treatment for 10 and 16 drugs out of the 19 drugs consumed exceeds the daily wage of insured and uninsured patients, with a median price ratio of 16.4 and 62.8, respectively. Moreover, the dispensary area conditions were found to be of good quality, yet the storerooms were not functioning in 40% of the outlets. CONCLUSION: Patients had limited access to their needed drugs due to high prices and physical unavailability, and primary healthcare capacities are not meeting the demands of citizens. The outcomes for the patients' access variables (accessibility, accommodation, acceptance, and affordability) are comparable to those in countries with low incomes. Ensuring access to free medicines is likely to improve patients' satisfaction with healthcare services and reduce private expenditure on medicines, which is a long-term, sustainable way towards universal health coverage in Sudan.

Efficacy and safety of inhaled nitric oxide administered during cardiopulmonary bypass for pediatric cardiac surgery: a systematic review and meta-analysis.

Cardiopulmonary bypass (CPB) utilized for cardiac surgeries has been associated with significant mortality and adverse outcomes. The benefits of incorporating nitric oxide (NO) into the CPB circuit have been reported in terms of reduced inflammation, enhanced dynamic circulation, oxygenation, and end-organ function. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of inhaled NO introduced to the CPB circuit among pediatric patients undergoing various cardiac surgeries. Methods: A systematic literature search was conducted on 26 July 2022, using the electronic databases of PubMed, Cochrane, Scopus, and Web of Science to include randomized controlled trials, with no restriction regarding the date of study conduction. The quality of studies was assessed using the Cochrane tool. RevMan 5.3 software was used to analyze data in the inverse variance method, with pooling data as mean difference (MD), risk ratio, and 95% CI. Results: Six trials were included comprising 1666 children who had undergone the interventions of interest. All studies amenable to assessment were of good quality. NO was significantly superior to the control treatments regarding ventilation time (MD=-8.34; 95% CI [-14.50 to -2.17], P=0.008), postoperative interleukin-6 (IL-6) levels (MD=-0.50; 95% CI [-0.54 to -0.46], P<0.001), 24-h IL-6 levels (MD=-0.30; 95% CI [-0.32 to -0.20], P<0.001), and 24-h tumor necrosis factor-alpha (TNF-α) levels (MD=-1.72; 95% CI [-3.44 to -1.00], P=0.05). The side effects of NO and the control treatments were comparable (P=0.9). Conclusion: NO administered as part of the CPB circuit during cardiac surgeries is efficacious in terms of reducing ventilation time, postoperative IL-6, and TNF-α levels compared to control, with a comparable safety profile.

Pattern of infectious diseases among Khalwa (Quran boarding school) students in Khartoum State, Sudan.

Khalawi are one of the most ancient non-governmental educational institutions that are commonly found all over Sudan playing a major role in the Sudanese society. The majority of Khalwa students are children. This study was part of a mixed methods project, conducted by Khartoum Medical Students' Association, aiming to investigate the health status of Khalwa students. It is a cross-sectional study carried out in Mustafa Alfadni Khalwa, Sharg Al-Neel suburb in Khartoum State. The participants were clinically assessed by a doctor and data were collected by using a data entry tool made specially to screen for major infectious diseases among students. The results showed a mean age of 13.7 years. Most of the students (47.7%) were originally from Darfur, and 27.5% of them had only Khalwa education. Respiratory clinic results revealed that 10% were complaining of cough, and 3.4% were diagnosed with pneumonia. Additionally, 44.6% of the students had tinea capitis and 21% had scabies. On examination, 2.3% and 1.1% had mild splenomegaly and hepatomegaly, respectively. Infectious conjunctivitis and trachoma were reported among 11.7% and 10.9%, respectively. Blood films for malaria were positive in 51.3%. Macroscopic and microscopic haematuria was evident among 13.4% and 10.8% of the participants, respectively. Stool examination results showed that 1.4% of the students had worms, 1.5% had ova and 18.8% had red blood cells in stools. Infectious diseases are very common among Khalwa students and their living environment is facilitating the transmission of these diseases. Agent control and sanitation improvement are crucial to decrease such infectious diseases.