Diagnostic accuracy of an automated microscope solution (miLab™) in detecting malaria parasites in symptomatic patients at point-of-care in Sudan: a case-control study.

BACKGROUND: Microscopic detection of malaria parasites is labour-intensive, time-consuming, and expertise-demanding. Moreover, the slide interpretation is highly dependent on the staining technique and the technician's expertise. Therefore, there is a growing interest in next-generation, fully- or semi-integrated microscopes that can improve slide preparation and examination. This study aimed to evaluate the clinical performance of miLab™ (Noul Inc., Republic of Korea), a fully-integrated automated microscopy device for the detection of malaria parasites in symptomatic patients at point-of-care in Sudan. METHODS: This was a prospective, case-control diagnostic accuracy study conducted in primary health care facilities in rural Khartoum, Sudan in 2020. According to the outcomes of routine on-site microscopy testing, 100 malaria-positive and 90 malaria-negative patients who presented at the health facility and were 5 years of age or older were enrolled consecutively. All consenting patients underwent miLab™ testing and received a negative or suspected result. For the primary analysis, the suspected results were regarded as positive (automated mode). For the secondary analysis, the operator reviewed the suspected results and categorized them as either negative or positive (corrected mode). Nested polymerase chain reaction (PCR) was used as the reference standard, and expert light microscopy as the comparator. RESULTS: Out of the 190 patients, malaria diagnosis was confirmed by PCR in 112 and excluded in 78. The sensitivity of miLab™ was 91.1% (95% confidence interval [CI] 84.2-95.6%) and the specificity was 66.7% (95% Cl 55.1-67.7%) in the automated mode. The specificity increased to 96.2% (95% Cl 89.6-99.2%), with operator intervention in the corrected mode. Concordance of miLab with expert microscopy was substantial (kappa 0.65 [95% CI 0.54-0.76]) in the automated mode, but almost perfect (kappa 0.97 [95% CI 0.95-0.99]) in the corrected mode. A mean difference of 0.359 was found in the Bland-Altman analysis of the agreement between expert microscopy and miLab™ for quantifying parasite counts. CONCLUSION: When used in a clinical context, miLab™ demonstrated high sensitivity but low specificity. Expert intervention was shown to be required to improve the device's specificity in its current version. miLab™ in the corrected mode performed similar to expert microscopy. Before clinical application, more refinement is needed to ensure full workflow automation and eliminate human intervention. Trial registration ClinicalTrials.gov: NCT04558515.

Nutritional Status of Adolescents in Eastern Sudan: A Cross-Sectional Community-Based Study.

BACKGROUND: Malnutrition among adolescents is a major public health issue. This problem is particularly pressing in Sudan, an African country where there is scarce published data on the nutritional status of adolescents. In this study, we aimed to assess the nutritional status of adolescents in eastern Sudan. METHODS: A community-based cross-sectional survey was carried out in Gadarif, eastern Sudan. A questionnaire was used to collect sociodemographic data, and the anthropometric measurements (weight and height) of adolescent participants were recorded. Height-for-age and body mass index-for-age Z-scores were calculated using the WHO anthropometric standards. Binary and multivariate multinomial regression analyses were performed. RESULTS: A total of 388 adolescents were included in this survey, 207 (53.4%) were female, and 181 (46.6%) were male. The median (interquartile) age was 13.9 (12.0-16.0) years. The results showed that a total of 29 (7.5%), 93 (24.0%), 33 (8.5%), and 16 (4.1%) adolescents were stunted, thin, overweight, and obese, respectively. None of the investigated factors (age, sex, parents' education levels, and occupation) were associated with stunting. In the multivariate multinomial analysis, the male sex was associated with thinness (OR = 2.41, 95.0% CI = 1.47-3.94). Moreover, adolescents whose mothers had an education lower than secondary level were at a lower risk of overweight/obesity (OR = 0. 0.35, 95.0% CI = 0. 0.35). CONCLUSIONS: While both undernutrition and overnutrition exist in eastern Sudan, undernutrition is more common. Male sex and mothers' education levels are associated with malnutrition.

The impact of the military conflict in Sudan on maternal health: a mixed qualitative and quantitative study.

Objectives: Ongoing military conflict in Sudan has had significant repercussions on the health and well-being of the population, particularly among women of reproductive age. This study aimed to investigate the impact of conflict on maternal health by employing a mixed qualitative and quantitative research approach. Methods: Through in-depth interviews and survey questionnaires (388 women), this study examined the experiences and challenges faced by pregnant women and new mothers and the availability and accessibility of maternal healthcare services in conflict-affected areas. Using a qualitative approach, in-depth interviews were conducted with 35 women who had recently given birth or were pregnant in regions affected by the Khartoum State-Sudan conflict. Thematic analysis was used to analyze the data collected from the interviews. Result: Most women did not have access to healthcare services (86.6%), and out of the total sample, 93 (24%) experienced adverse outcomes. The factors associated with adverse effects were parity (OR 1.78, CI [1.15-2.75], p-value 0.010), gestational age (OR 2.10, CI [1.36-3.25], p-value 0.002), access to healthcare (OR 2.35, CI [1.48-3.72], p-value 0.001), and delivery mode (OR 1.68, CI [1.05-2.69], p = 0.030). Factors significantly associated with accessibility to maternal healthcare services included age (OR, 1.28; = 0.042) and higher conflict levels (1.52 times higher odds, p = 0.021). The narratives and experiences shared by women exposed the multifaceted ways in which the conflict-affected maternal health outcomes. Conclusion: The significance of this study lies in its potential to contribute to the existing literature on maternal health in conflict-affected areas, especially in Sudan, and to help us understand how women can receive maternal health services.

Prevalence of and factors associated with placental malaria in the White Nile State: a cross-sectional study.

INTRODUCTION: Malaria during pregnancy can lead to maternal and perinatal adverse effects. Despite the preventive measures, recent research has shown that malaria during pregnancy is still a threatening health problem, especially in Sub-Saharan African countries. The current study was conducted to determine the prevalence of and factors associated with placental malaria in Rabak Hospital in central Sudan. METHODOLOGY: A cross-sectional study was conducted from September to October 2021. Pregnant women who delivered at the Rabak Maternity Hospital in Central Sudan were included. A questionnaire was used to gather both obstetric and socio-demographic information. Blood films for malaria were prepared using the maternal, placental, and cord blood, and a placental histology was performed. A logistic regression analysis was performed. RESULTS: For the 208 women, the medians (interquartile range) of their age and parity were 25 (21.0 ‒30.0) years and 2 (1‒4), respectively. Twenty-five (12.0%) of the women had used insecticide-treated nets. Active infection, active-chronic infection, and past-chronic infection were detected in four (1.9%), five (2.4%), and 35 (16.8%) placentas, respectively. One hundred and sixty-four (78.8%) placentas showed no signs of infection. Logistic regression analysis showed that none of the examined factors (age, parity, education, antenatal care level, use of insecticide-treated nets, and blood group) was associated with placental malaria. CONCLUSIONS: Malaria affects 20% of pregnant women, regardless of their age and parity. Preventative measures should therefore be encouraged in this area.

Intestinal Parasitic Infections and Associated Risk Factors Among Sudanese Psychiatric Patients.

BACKGROUND: Intestinal parasitic infections (IPIs) are considered to be a major health problem, particularly in the tropical countries, such as Sudan. Due to poor hygiene practices, the psychiatric patients may pick up parasitic infections. Until now, there exists no published data or available information regarding the prevalence rate of intestinal parasitic infections among Sudanese psychiatric patients. Therefore, our present study aimed to determine the prevalence of intestinal parasitic infections and the potential associated risk factors among Sudanese psychiatric patients. METHODS: A hospital based cross-sectional study was conducted from September 2021 to March 2022. A total of 422 stool samples were randomly collected from psychiatric patients attending the psychiatric section at Kosti Teaching Hospital in the White Nile State of Sudan. Socio-demographic data were gathered using structured questionnaires. All stool samples were examined using different parasitological techniques. RESULTS: The overall prevalence rate of intestinal parasitic infection among psychiatric patients was 120/211 (56.8%) and among non-psychiatric patients 66/211 (31.3%) The prevalence rate of intestinal parasites (IPs) among psychiatric patients were as follows: Entamoeba histolytica (29.9%), Giardia lamblia (19.4%), Entamoeba coli (5.2%), Ascaris lumbricoides (0.9%), Hymenolepis nana (0.9%), and Enterobius vermicularis (0.5%). There was no relationship between intestinal parasitic infection and age, sociodemographic features, sources of drinking water, contact with domestic animals, washing of hands, eating of raw vegetables/meats, or having psychiatric disorders (p > 0.05). CONCLUSIONS: Studying the prevalence rate of intestinal parasitic infections among psychiatric patients may help to assess their health condition or status, leading to better psychiatric healthcare services, diagnoses, and treatments.

First evaluation and detection of ivermectin resistance in gastrointestinal nematodes of sheep and goats in South Darfur, Sudan.

In Sudan, resistance to benzimidazoles has been reported recently in cattle and goats from South Darfur. Herein, ivermectin efficacy against gastrointestinal nematodes (GINs) was evaluated in sheep and goats in three study areas in South Darfur. The faecal egg count reduction test (FECRT) was used to evaluate the efficacy of ivermectin in sheep and goats naturally infected with GINs in the region of Bulbul (goats: n = 106), Kass (goats: n = 40) and Nyala (Domaia (sheep: n = 47, goats: n = 77) and the University farm (goats: n = 52)), using different treatment plans, and the efficacy was evaluated 12 days after treatment. Ivermectin efficacy was also evaluated in goats experimentally infected using local Haemonchus contortus isolates from Kass and Nyala. Nematodes surviving ivermectin treatment in goats in Bulbul and Nyala were harvested and larvae used to infect worm-free male sheep (n = 6, ≤6 months old). Infected sheep were dosed subcutaneously with ivermectin every eight days with increasing doses from 0.2 mg/kg to 1.6 mg/kg bodyweight (bw). Reduced ivermectin efficacy was identified in sheep and goats in the four study locations. Using a paired statistic, the efficacy of a therapeutic dose in sheep was 75.6% (90% upper credible limit (UCrL): 77.5%), while twice the recommended dose led to a reduction of 92.6% (90% UCrL: 93.3%). In goats, the FECRs of a therapeutic dose were 72.9-95.3% (90% UCrL range: 73.6-95.7%) in Bulbul, Nyala Domaia, Nyala University farm and Kass. Twice the dose recommended for goats in Bulbul revealed a 90% UCrL of 87.6%. All post-treatment faecal cultures contained only Haemonchus spp. larvae. The experimental infection trials in sheep and goats supported our findings from field trials and calculated upper 90% CrL of below 98.9%. For the first time highly ivermectin resistant H. contortus populations have been identified in sheep and goats in Sudan, and resistance was experimentally confirmed.

Maximum surgical blood ordering schedule for elective surgical procedures in Omdurman teaching hospital, Sudan.

BACKGROUND: The need for blood during a surgical procedure is greater than what blood banks are able to provide. There is an excessive amount of blood being ordered for elective surgeries, surpassing the actual requirements. Only 30% of the cross matched blood is actually used in these surgeries. The accuracy of estimating the transfusion needs before a surgical procedure can be determined by looking at the cross match to transfusion ratio and the transfusion index. "These indicators play a crucial role in developing the maximum surgical blood ordering schedule; in this study, these indicators were tested." AIM OF STUDY: Is to determine the efficiency of blood ordering and transfusion practices for patients undergoing elective surgeries. METHODS: This study is a prospective cross-sectional hospital-based study done at Omdurman Teaching Hospital-Sudan. Conducted for the duration of 6 months period from July to December 2019.The study participants were patients who underwent elective surgical procedures in general surgery and Urology departments as total coverage sample over a period of study duration. Ethical clearance obtained from ethical committee of Sudan Medical Specialization Board. RESULTS: Two hundreds seven patients included in this study, the amount of blood units requested were 443-unit, cross matching for 98.6% (n 437) of units were done. Only 100 unit were Transfused (22,8%). The calculated CT ratio was 4.4, transfusion index was 1.6 and transfusion probability was 29.9%. CONCLUSION: Transfusion probability and transfusion index of the present study were optimal but comparatively higher than the standard guidelines as most of the cross matched blood was not utilized.

Metabolic syndrome and its association with physical activity in Sudanese early adolescents - Khartoum state, Sudan: An observational study.

The growing prevalence of overweight/obesity in adolescents highlights the significance of studying metabolic syndrome (MetS) in increasingly sedentary adolescents. To date, no study in Sudan has examined the association between MetS and physical activity (PA) among adolescents. This study aimed to assess the association between MetS and its components and PA among Sudanese early adolescents. A cross-sectional assessment was conducted from to 2018 to 2019 on a sample of 921 primary school students from Khartoum State, Republic of Sudan. MetS was defined according to the International Diabetes Federation criteria and a standardized questionnaire was used to assess PA. Metabolic equivalents of task were calculated, and levels of different intensities of PA (tertiles) were identified accordingly. The association between PA and MetS and its components was assessed using a logistic regression model. The participants comprised 388 boys and 533 girls with a mean age of 12.59 ±â€…1.21 years. The prevalence of MetS was significantly higher in subjects in the 1st PA tertile (least active) than in the 2nd and 3rd (most active) tertiles of PA, and this difference was observed in both boys and girls. After adjusting for other study factors, the odds of MetS among adolescents in the 1st PA tertile were 7 times higher than those in the highest PA tertile (adjusted odds ratio = 7.01, 95% confidence interval: 1.48, 32.99). A physically inactive lifestyle was associated with higher odds of MetS and its components, especially waist circumference and triglyceride levels, in Sudanese early adolescents. This study highlights the importance of promoting PA in this age group.

Factors influencing health-seeking behavior among Sudanese immigrants in Saudi Arabia.

BACKGROUND: Health-seeking behavior (HSB) involves any action or inaction taken by individuals who perceive themselves to have a health problem or illness aimed at finding appropriate medical treatments. Studies suggest a positive relationship between the availability and quality of health services and their utilization. This study aimed to identify the factors influencing health-seeking behavior among Sudanese immigrants in Saudi Arabia, to improve healthcare access and health outcomes. METHOD: A cross-sectional study was conducted targeting Sudanese residents of the Kingdom of Saudi Arabia (KSA). Participants were recruited using convenient sampling. A self-administered questionnaire was distributed electronically. A total of 494 participants were recruited for the study. RESULTS: This study showed that the majority of the participants (66.6%) visited a primary healthcare center when faced with a medical problem. However, the prevalence of self-medication in the past three months was 45.7%. Significant factors influencing health-seeking behavior included age (OR [95% CI]: 1.032 [1.000-1.066]) and lack of health insurance (OR = 1.01, 95% CI [1.00-1.02], p = 0.019). CONCLUSIONS: This study emphasizes the importance of understanding healthcare-seeking behavior among immigrant groups, particularly Sudanese immigrants in Saudi Arabia. It highlights the significance of insurance as a determinant of healthcare-seeking behavior and calls for reforming current policies to reduce disparities in accessing healthcare services.

Knowledge, Attidue and Practice of Advanced Trauma Life Suppoort (ATLS) Protocol among House-Officers in Khartoum State Hospitals, Sudan, 2023.

BACKGROUND: Advanced Trauma Life Support was originated mainly to train doctors who don't manage trauma on a regular basis, including junior doctors as it prepares them more efficiently and effectively for treating and managing trauma patients. This study was conducted to study knowledge, attitude and practice of advanced trauma life support protocol among house-officers in Khartoum state hospitals, Sudan 2023. METHODS: This is a cross-sectional descriptive health facility based study conducted in Bahri Teaching Hospital, Omdurman Teaching Hospital and Ibrahim Malik teaching hospital, Khartoum state, Sudan. Data of 151 House-officers of all nationality working in Khartoum state hospitals was collected using a simple random technique, filling questionnaire that was designed especially for this study. Comparison between different variables by Chi-square test and statistical significance difference at P value < 0.05 was done. RESULT: A total of 151 house officers were included in the study. 49% aged between 20 and 25 years, females were the majority 56.3%. About 41.1% have took ATLS course before. 55.21% of the study participants didn't take the course because it was not available, while 35.42% because it was expensive and 29.17% referred it to their busy lifestyle. 91% of the study population think that ATLS course should be compulsory and 85% think that the ATLS protocol should be recommended to both junior and senior doctors. 77% of the study participants stated that their seniors teaching skills affect how they apply ATLS. CONCLUSION: Overall junior doctors at Khartoum state hospitals demonstrated a positive attitude towards ATLS, but they showed poor knowledge regarding the topic. It's advised that an earlier training program is introduced by incorporating ATLS course to be part of all final year medical school's curriculum.

Clinical and genetic characteristics of disorders of sex development in Sudanese patients

Given the scarce data on DSD in Sudan, we aimed to characterize DSD's clinical and genetic profile in Sudanese patients. We studied 60 patients with DSD using clinical data, cytogenetics, and PCR for the SRY gene. The results showed that 65% grew up as females and 35% as males. There was a high percentage of consanguineous parents (85%). Female genital mutilation (FGM) was performed in 75% of females. Patients who presented after pubertal age were 63%, with ambiguous genitalia in 61.7%, followed by primary amenorrhea (PA) in 30%. The SRY gene was positive in 3.3% of patients with 46,XX karyotype and negative in 6.7% of patients with 46,XY karyotype. 5αR2D-DSD was seen in 43.3%, gonadal dysgenesis in 21.7%, Ovotesticular syndrome in 6.7%, Swyer and Turner syndrome in 5% each, and Androgen Insensitivity Syndrome (AIS) in 3.3%. In conclusion, DSD in Sudan has a distinct profile with late presentation, dominated by 5αR2D-DSD due to the increased consanguineous marriage, and FGM represents a significant risk for DSD patients.

Compte tenu du peu de données sur le DSD au Soudan, nous avons cherché à caractériser le profil clinique et génétique du DSD chez les patients soudanais. Nous avons étudié 60 patients atteints de DSD en utilisant des données cliniques, cytogénétiques et PCR pour le gène SRY. Les résultats ont montré que 65 % ont grandi en tant que femmes et 35 % en tant qu'hommes. Il y avait un pourcentage élevé de parents consanguins (85 %). Des mutilations génitales féminines (MGF) ont été pratiquées chez 75 % des femmes. Les patientes qui se sont présentées après l'âge pubertaire étaient 63 %, avec des organes génitaux ambigus dans 61,7 %, suivis d'une aménorrhée primaire (AP) dans 30 %. Le gène SRY était positif chez 3,3 % des patients de caryotype 46,XX et négatif chez 6,7 % des patients de caryotype 46,XY. Le 5αR2D-DSD a été observé dans 43,3 %, la dysgénésie gonadique dans 21,7 %, le syndrome ovotesticulaire dans 6,7 %, le syndrome de Swyer et Turner dans 5 % chacun et le syndrome d'insensibilité aux androgènes (AIS) dans 3,3 %. En conclusion, le DSD au Soudan présente un profil distinct avec une présentation tardive, dominé par le 5αR2D-DSD en raison de l'augmentation des mariages consanguins, et les MGF représentent un risque important pour les patients DSD.

Health workers' adherence to malaria case management protocols in Northern Sudan: a qualitative study.

BACKGROUND: Nonadherence to national standards for malaria diagnosis and treatment has been reported in Sudan. In this study, qualitative research examined the clinical domains of nonadherence, factors influencing nonadherent practices and health workers' views on how to improve adherence. METHODS: In September 2023, five Focus Group Discussions (FGDs) were undertaken with 104 health workers from 42 health facilities in Sudan's Northern State. The participants included medical assistants, doctors, nurses, laboratory personnel, pharmacists and public health officers. The FGDs followed a semi-structured guide reflecting the national malaria case management protocol. Qualitative thematic analysis was performed. RESULTS: Nonadherent practices included disregarding parasitological test results, suboptimal paediatric artemether-lumefantrine (AL) dosing, lack of counselling, use of prohibited artemether injections for uncomplicated and severe malaria, artesunate dose approximations and suboptimal preparations, lack of AL follow on treatment for severe malaria; and rare use of primaquine for radical Plasmodium vivax treatment and dihydroartemisinin-piperaquine as the second-line treatment for uncomplicated malaria. Factors influencing nonadherence included stock-outs of anti-malarials and RDTs; staff shortages; lack of training, job aids and supervision; malpractice by specialists; distrust of malaria microscopy and RDTs; and patient pressure for diagnosis and treatment. Health workers recommended strengthening the supply chain; hiring personnel; providing in-service protocol training including specialists; establishing external quality assurance for malaria diagnosis; and providing onsite supportive supervision and public health campaigns. CONCLUSIONS: This study revealed a broad spectrum of behavioural and systemic challenges in malaria management among frontline health workers in Northern Sudan, including nonadherence to protocols due to resource shortages, training gaps, a lack of supportive supervision and patient pressure. These insights, including health workers' views about improvements, will inform evidence-based interventions by Sudan's National Malaria Control Programme to improve health systems readiness and the quality of malaria case management.

Intra- and interspecies variation and population dynamics of Fasciola gigantica among ruminants in Sudan.

Fasciola gigantica is a widespread parasite that causes neglected disease in livestock worldwide. Its high transmissibility and dispersion are attributed to its ability to infect intermediate snail hosts and adapt to various mammalian definitive hosts. This study investigated the variation and population dynamics of F. gigantica in cattle, sheep, and goats from three states in Sudan. Mitochondrial cytochrome c oxidase subunit I (COI) and NADH dehydrogenase subunit 1 (ND1) genes were sequenced successfully to examine intra and interspecific differences. ND1 exhibited higher diversity than COI, with 15 haplotypes and 10 haplotypes, respectively. Both genes had high haplotype diversity but low nucleotide diversity, with 21 and 11 polymorphic sites for ND1 and COI, respectively. Mismatch distribution analysis and neutrality tests revealed that F. gigantica from different host species was in a state of population expansion. Maximum likelihood phylogenetic trees and median networks revealed that F. gigantica in Sudan and other African countries had host-specific and country-specific lineages for both genes. The study also indicated that F. gigantica-infected small ruminants were evolutionarily distant, suggesting deep and historical interspecies adaptation.

Stroke awareness and knowledge in Sudan: a cross-sectional analysis of public perceptions and understanding.

Introduction: Stroke, a leading cause of morbidity and mortality globally, demands heightened awareness and knowledge for effective preventive strategies and tailored response. Sudan is classified as a low income country with a low rate of literacy, lack of knowledge, and awareness about diseases. Thus, this study aimed to assess stroke awareness and knowledge among Sudanese population, and identify the associated factors influencing awareness. Methods: A cross-sectional study conducted between October and November 2022 through a self-administered online survey distributed via various social media platforms. The study involved adults aged 18 years and above through snow-ball sampling technique. The survey covered general awareness and knowledge concerning stroke risk factors, consequences, and the appropriate responses taken during acute stroke attacks. Results: A total of 410 participants were enrolled in the study, majority (93.4%) were from urban area and had university degree (92.4%). Furthermore, 92.2% were aware about stroke and 74.9% were able to recognize the symptoms of stroke. Only 40.2% identified all correct answers, 96.3, 92.3, and 95.1% recognized at least one risk factor, early symptom, and consequences, respectively. Females were significantly more than males able to identify at least one risk factor. Almost all participants (99.5%) perceived stroke as a serious disease (99.5%). Notably, 86.3% would promptly transport a suspected stroke patient to the hospital. The multivariable analysis showed that females versus males and patients with depression versus without depression had significantly higher odds to identify at least one risk factor (OR of 14.716 [95% CI 1.901; 113.908] and 0.241 [95% CI 0.059; 0.984], respectively). Conclusion: The study concluded that stroke knowledge and awareness among Sudanese population is suboptimal. Furthermore, early stroke recognition and intake of the appropriate management strategies are lacking which highlights the need for targeted education and awareness campaigns.

Short-term aid or long-term gains? Harnessing Sudan's humanitarian response for the resilience of its health system.

The Sudan 2023 Humanitarian Response Plan was revised in May, 2023, due to the escalating violence in the country. This revision increased the scale of assistance and protection activities and suspended the funding allocated for access to livelihood, access to basic services, and for the implementation of resilience solutions. We call to rethink Sudan's current humanitarian response through a pro-resilience and people-centred approach. A pro-resilience approach prioritises investments in national systems and institutions capable of delivering aid and anticipates, prevents, mitigates, and manages imminent and simultaneous shocks. A people-centred humanitarian response involves meaningful engagement of communities and collaborations with civil society organisations, which continue to be the key responders to the ongoing conflict in Sudan. Finally, we propose approaches to effectively operationalise health system resilience to enhance immediate and long-term health outcomes.

Assessment of the impact of COVID-19 and political instability on mental health of university students in Sudan.

Background: The mental health of students plays a crucial role in their learning and performance. The COVID-19 pandemic, the political turmoil and a coup in Sudan has exacerbated stress and anxiety among university students in Sudan due to uncertainty about their academic activities. Aim: To assess post-traumatic stress disorder (PTSD) occurrence and coping strategies adopted by university students in Sudan. Methods: This cross-sectional survey was conducted from March to June 2022. It used the Coping Orientation to Problems Experienced (Brief-COPE) and Impact of Event Scale-Revised (IES-R) questionnaires to assess the occurrence of PTSD and coping strategies among 596 university students in Sudan. Descriptive statistics were used to determine the frequency and percentage, Student's t test was used to compare the means of 2 groups and one-way analysis of variance to compare the means of ≥ 3 groups. Results: There was a high prevalence of PTSD among the students, with a score of 31.2 (SD 16.4). The total score of PTSD was higher among female students. Around 36% of the students had a PTSD score > 37, which is considered high enough to suppress immune function. The most widely adopted coping strategies were religion and acceptance of the situation, while substance use was the least. Students who had COVID-19 infection during the pandemic differed significantly from uninfected students in the application of coping strategies. In contrast, students whose family members or friends had COVID-19 were not significantly different from students with uninfected family members or friends in the application of the coping strategies, such as self-blame, denial, substance use, and behavioural disengagement. Conclusion: We recommend the initiation and implementation of psychological counselling programmes for university students in Sudan onsite or remotely. Further research should be carried out to assess the long-term effects of the pandemic and the political conflicts so as to design and implement appropriate and efficient interventions.

Assessment of the environmental impacts of conflict-driven Internally Displaced Persons: A sentinel-2 satellite based analysis of land use/cover changes in the Kas locality, Darfur, Sudan.

Internal displacement of populations due to armed conflicts can substantially impact a region's Land Use and Land Cover (LULC) and the efforts towards the achievement of Sustainable Development Goals (SDGs). The objective of this study was to determine the effects of conflict-driven Internally Displaced Persons (IDPs) on vegetation cover and environmental sustainability in the Kas locality of Darfur, Sudan. Supervised classification and change analysis were performed on Sentinel-2 satellite images for the years 2016 and 2022 using QGIS software. The Sentinel-2 Level 2A data were analysed using the Random Forest (RF) Machine Learning (ML) classifier. Five land cover types were successfully classified (agricultural land, vegetation cover, built-up area, sand, and bareland) with overall accuracies of more than 86% and Kappa coefficients greater than 0.74. The results revealed a 35.33% (-10.20 km2) decline in vegetation cover area over the six-year study period, equivalent to an average annual loss rate of -5.89% (-1.70 km2) of vegetation cover. In contrast, agricultural land and built-up areas increased by 17.53% (98.12 km2) and 60.53% (5.29 km2) respectively between the two study years. The trends of the changes among different LULC classes suggest potential influences of human activities especially the IDPs, natural processes, and a combination of both in the study area. This study highlights the impacts of IDPs on natural resources and land cover patterns in a conflict-affected region. It also offers pertinent data that can support decision-makers in restoring the affected areas and preventing further environmental degradation for sustainability.