Head and neck mycetoma: Clinical findings, investigations, and predictors for recurrence of the disease in Sudan: A retrospective study.

INTRODUCTION: Mycetoma is a unique neglected tropical disease which is found endemic in areas known as the "mycetoma belt". Head and neck mycetoma is a rarity and it has many devastating impacts on patients and communities. In this study, we assessed clinical findings, investigations, and predictors for recurrence of head and neck mycetoma in Sudan. METHODOLOGY: A retrospective study was conducted at Mycetoma Research Center in Khartoum between January 1999 and December 2020 for all patients with head and neck mycetoma. Data were analyzed using R software version 4.0.2. RESULTS: We included 107 patients with head and neck mycetoma. 65.4% were young adult males from mycetoma endemic areas in Sudan, and most of them were students (33.6%). Most of patients (64.4%) had actinomycetoma. Before presenting with head and neck mycetoma, majority (75.7%) had a long duration with mycetoma, and 30.8% had a history of trauma. The commonest invaded site was the parietal region (30.8%). The lesion started gradually in most of the patients (96.3%). 53.3% of the patients had large size lesions with no sweating, regional lymph nodes involvement, or distal vein involvement. CT scan was the most accurate diagnostic tool while 8.4% of patients were diagnosed by clinical examinations only. Laboratory investigations confirmed that 24/45 (44.4%) of actinomycetoma was caused by Streptomyces somaliensis while 13/28 (46.4%) of eumycetoma was caused by Madurella mycetomatis. All patients with recurrence of head and neck mycetoma underwent surgical excision of the lesion (n = 41/41 {100%}, p < 0.001). CONCLUSION: In head and neck mycetoma, the most common type was actinomycetes in Sudan. Majority had a long course of mycetoma and the commonest causative organism was Streptomyces somaliensis. The treatment outcome was poor and characterized by a low cure rate.

The proportion and determinants of COVID-19 infection among medical doctors in Sudan, 2020: A cross-sectional survey.

Globally, frontline health care providers are among the most affected population group by the COVID-19 pandemic. Knowing the factors contributing to the transmission of COVID-19 infection among frontline health care providers is essential for implementing tailored control measures and protecting this vital population group. This study aimed to estimate the proportion and to identify factors associated with COVID-19 infection among medical doctors in Sudan. A web-based survey was used to collect data from medical doctors who were working in Sudan during the study period. Data were analyzed using SPSS® version 25; Descriptive analysis in terms of means (SD) for continuous variables, frequencies, and percentages with 95% CI for the categorical variable was conducted. Chi-square test and binary logistic regression for associations between the outcome variables (risk of exposure to COVID-19 infection and ever tested positive for COVID-19 infection) and independent variables (socio-demographic and infection control standards) were also performed. Out of 352 valid responses, 13.6% had tested positive for COVID-19 infection at least once during the pandemic. More than one-third have identified colleagues as the main sources of infection compared to 21% of patients (p-value < 0.04). Doctors who received training on COVID-19 were 60% less likely to have positive tests for COVID-19 (p-value <0.03), while lack of PPE and hand hygiene utilities had no statistically significant associations with testing positive for COVID-19 infection. In conclusion, a significant proportion of doctors have contracted COVID-19 infection from their colleagues. This calls for restricting infection control practices at hospitals, doctor's doormats, and any other shared places that allow day-to-day interaction between doctors and their colleagues. Also, urgent need for training doctors on COVID-19 infection control practices as it has been identified as the key protective factor.

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

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

The basic reproduction number of COVID-19 across Africa.

The pandemic of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) took the world by surprise. Following the first outbreak of COVID-19 in December 2019, several models have been developed to study and understand its transmission dynamics. Although the spread of COVID-19 is being slowed down by vaccination and other interventions, there is still a need to have a clear understanding of the evolution of the pandemic across countries, states and communities. To this end, there is a need to have a clearer picture of the initial spread of the disease in different regions. In this project, we used a simple SEIR model and a Bayesian inference framework to estimate the basic reproduction number of COVID-19 across Africa. Our estimates vary between 1.98 (Sudan) and 9.66 (Mauritius), with a median of 3.67 (90% CrI: 3.31-4.12). The estimates provided in this paper will help to inform COVID-19 modeling in the respective countries/regions.

COVID-19 vaccine acceptance, hesitancy, and associated factors among medical students in Sudan.

BACKGROUND: The COVID-19 vaccination in Sudan launched in March 2021 but the extent of its acceptance has not been formally studied. This study aimed to determine the acceptance and hesitancy of the COVID-19 vaccine and associated factors among medical students in Sudan. METHODS: A descriptive cross-sectional study was conducted using an online self-administered questionnaire designed on Google Form and sent to randomly-selected medical students via their Telegram accounts from 30th June to 11th July 2021. Data were analyzed using Statistical Package for Social Sciences software. Chi-square or Fisher's exact test and logistic regression were used to assess the association between vaccine acceptance and demographic as well as non-demographic factors. RESULTS: Out of the 281 students who received the questionnaire, 220 (78%) responded, of whom 217 consented and completed the form. Males accounted for 46. 1%. Vaccine acceptance was 55. 8% (n = 121), and vaccine hesitancy was 44. 2% (n = 96). The commonly cited reasons for accepting the vaccine were to protect themselves and others from getting COVID-19. Concerns about vaccine safety and effectiveness were the main reasons reported by those who were hesitant. Factors associated with vaccine acceptance were history of COVID-19 infection (adjusted odds ratio (aOR) = 2. 2, 95% CI 1. 0-4.7, p = 0. 040), belief that vaccines are generally safe (aOR = 2.3, 95% CI 1. 2-4.5, p = 0.020), confidence that the vaccine can end the pandemic (aOR = 7.5, 95% CI 2. 5-22. 0, p<0.001), and receiving any vaccine in the past 5 years (aOR = 2.4, 95% CI 1.1-5.4, p = 0.031). No demographic association was found with the acceptance of the vaccine. CONCLUSIONS: This study has revealed a high level of COVID-19 vaccine hesitancy among medical students. Efforts to provide accurate information on COVID-19 vaccine safety and effectiveness are highly recommended.

SARS-CoV-2 Antibody Prevalence and Population-Based Death Rates, Greater Omdurman, Sudan.

In a cross-sectional survey in Omdurman, Sudan, during March-April 2021, we estimated that 54.6% of the population had detectable severe acute respiratory syndrome coronavirus 2 antibodies. Overall population death rates among those >50 years of age increased 74% over the first coronavirus disease pandemic year.

Oral health in Sudan: the current situation during COVID-19 pandemic.

The coronavirus pandemic (COVID-19) has affected the delivery of healthcare services and posed enormous challenges to medical and dental care across the world. This article sought to explore various challenges implicated in the provision, access, and utilization of oral healthcare services in Sudan and to describe the current situation amid COVID-19. The oral health sector in Sudan has been experiencing multiple challenges in the delivery of dental care, and the current pandemic of COVID-19 has aggravated and multiplied the existing challenges. Conflict, economic meltdown, and political instability have disrupted all medical and dental services in many parts of Sudan. Furthermore, the oral health sector in Sudan suffers a lack of essential instruments, materials, and supplies, a shortage of health workers, and poor infection control practices, which present major threats to dental care in the region. The COVID-19 pandemic has contributed to further scarcity of essential materials and supplies. Moreover, the frequent closure of dental hospitals and clinics either due to civil disobedience or COVID-19 lockdown has limited accessibility and utilization of oral services. There is an urgent need to address challenges identified to ensure adequate provision of oral healthcare in Sudan.

Extent of COVID-19 Healthcare Services of Isolation Center of Private Hospital across Khartoum State, Sudan.

Introduction: Spatial presentation is considered a useful tool for analyzing and mapping the frequencies of incidences of different pathogens. Khartoum State accounted for 78% of the overall cases of COVID-19 in Sudan. The aim of this study was to present the spatial extent of healthcare services of a private isolation center during the pandemic at the locality level. Materials and Methods: A spatial descriptive study was conducted using ArcGIS to present the locations of all COVID-19 patients who attended Imperial Hospital isolation center on November-December 2020 in Khartoum, Sudan. Results: Patients diagnosed with COVID-19 during the study period were 188; they had attended Imperial Hospital from 9 states. Patients from Khartoum State were 167 patients. Of those 167 patients, 75 were from the Khartoum locality; it is the locality in which Imperial Hospital is located, followed by Khartoum Bahri (34 patients), Omdurman (19 patients), and South Khartoum (14 patients), while 10 patients each were from the Sharg En Nile and Karary localities. Conclusion: Patients from 8 different states of Sudan had travelled to reach Khartoum State to get health services. At the state level, Khartoum State was the most benefited state from the healthcare services of Imperial Hospital. At a locality level, Khartoum locality was the most benefited one.

Obstacles faced by healthcare providers during COVID-19 pandemic in Sudan.

The impacts of COVID -19 pandemic have been quite significant on healthcare providers. I was particularly challenging for those in Low and Middle-Income Countries including Sudan . Unfortunately, the pandemic has hit Sudan on extremely difficult time for the country and its people. The country was coming out of long-brutal and devastating dictatorship and transitioning to new democracy with civilian leadership. In addition to the pandemic related issues, trying to rebuild the health system during socioeconomic crisis, healthcare providers  in the country were challenged personally and professionally. These challenges include the stress of working in under-resourced settings with limited access to personal-protection equipment and testing kits raised the fear of contracting the virus and spreading it to their families. The professional, social, and personal life of healthcare providers have been dramatically changed by the ongoing pandemic, however, they are heroically accepting this change in a hope that, this will save the life of many more people. Nevertheless, their fights and sacrifices should at least be rewarded by governments and communities altogether strictly enforce the implementation of other preventive measures including vaccination, face masking, and social distancing and get all protected. We should all understand that, unless we are all protected no one is protected, so all must adapt to the new norm of life and collaborate not only on ending this pandemic but to prevent similar ones in the future.

Impact of the COVID-19 pandemic on intimate partner violence in Sudan, Malawi and Kenya.

The COVID-19 infection control and prevention measures have contributed to the increase in incidence of intimate partner violence (IPV) and negatively impacted access to health and legal systems. The purpose of this commentary is to highlight the legal context in relation to IPV, and impact of COVID-19 on IPV survivors and IPV prevention and response services in Kenya, Malawi, and Sudan. Whereas Kenya and Malawi have ratified the Convention on Elimination of all forms of Discrimination against Women (CEDAW) and have laws against IPV, Sudan has yet to ratify the convention and lacks laws against IPV. Survivors of IPV in Kenya, Malawi and Sudan have limited access to quality health care, legal and psychosocial support services due to COVID-19 infection control and prevention measures. The existence of laws in Kenya and Malawi, which have culminated into establishment of IPV services, allows a sizable portion of the population to access IPV services in the pandemic period albeit sub-optimal. The lack of laws in Sudan means that IPV services are hardly available and as such, a minimal proportion of the population can access services. Civil society's push in Kenya has led to prioritisation of IPV services. Thus, a vibrant civil society, committed governments and favourable IPV laws, can lead to better IPV services during the COVID-19 pandemic period.

Coronavirus 2019-like illness and public adherence to preventive measures, Sudan 2020.

INTRODUCTION: In December 2019, a novel corona virus disease was identified and was responsible for the new cases of respiratory tract infections in Wuhan, China. This virus was responsible for the pandemic with more than 84 million cases and 1.82 million deaths worldwide. In Sudan till now the reported cases exceed 23,000 with 1.400 deaths. This study aims to determine the prevalence of COVID-19 suspected cases, health seeking behavior and public adherence to protective measures. METHODS: Descriptive community based cross-sectional study using nonprobability snowball sampling technique, conducted in Khartoum state 2020. 3499 respondents with diverse socio-demographic backgrounds were finally enrolled in the study. Data was collected through Manitoba Coronavirus 2019 screening form which distributed through online anonymous Google forms. Data was entered and analyzed by Statistical Package of Social Sciences version 23. RESULTS: The study revealed that 26.5% of the respondents were clinically suspected with headache or fatigability being the most common symptom followed by pharyngitis and then dry cough. Asthma and chronic respiratory disease as the commonest comorbidities. Wearing facial masks and regular hand washing were found to be the most used protective measures with only 39.4% implicates social distancing in their daily life. Health seeking behavior was significantly different among suspected respondents the majority tend to use antibiotics than to isolate themselves or undergo testing. CONCLUSION: COVID-19 suspected cases were prevalent among Sudanese population; screening capacity has to be increased with more strong policies for implications of personal protective measures in the daily life.

Psychological effects of the COVID-19 pandemic: Perceived stress, anxiety, work-family imbalance, and coping strategies among healthcare professionals in Khartoum state hospitals, Sudan, 2021.

BACKGROUND: The 2019 novel coronavirus (COVID-19) is highly contagious and can spread a pandemic, so it is related to serious health issues and major public concerns, and is considered by the medical community to be the greatest concern because it is the greatest risk of infection. OBJECTIVE: To identify and assess the psychological effects of the COVID-19 pandemic on healthcare professionals in Khartoum state hospitals 2021. MATERIALS AND METHODS: Generalized Anxiety Scale (GAD-7), Perceived Stress Scale (PSS-10), and Work-Family Balance Measure Scale were used to assess the psychological impact of doctors and nurses working in four big hospitals in Sudan, by an online questionnaire, analyzed by the statistical package for social science (SPSS) during February. RESULTS: Most of the participants had minimal to mild anxiety according to GAD-7 score, 121 (35.2%) and 103 (29.9%), respectively. Using PSS-10, the cutoff point was determined as 19 as the mean for total score was 19.2 ± 6.2, accordingly, more than half had high levels of stress (scored 19 and above) 189 (54.9%). For the Work-Family Balance Scale, 10 was regarded as the cutoff point. There was a significant association between specialty and stress level p-value .032. No significant correlations were found between age and stress level, neither between age and anxiety level (r -.100, p-value .064 and r = -.022, p-value .683, respectively). CONCLUSION: More than half of healthcare professionals (54.9%) showed high levels of stress. Most of the healthcare professionals had poor work-family balance (60.2%).

Medical students' perception towards E-learning during COVID 19 pandemic in a high burden developing country.

BACKGROUND: In High-income countries, many academic institutions are using E-learning during COVID 19 Pandemic. However, in limited-resource countries, like Sudan, shifting towards E-learning requires many adjustments to be made to make sure the E-learning is held in a proper manner, as best as possible. This study was undertaken to assess medical students' perception towards implementing E-learning during COVID 19 Pandemic and to highlight for E-learning implementation in Sudan as an example of a limited-resource setting. METHODS: A cross-sectional survey was conducted between 10 and 25 of May 2020 among the undergraduate medical students at the Faculty of Medicine, University of Gezira, Sudan. The study used self-administered online-based questionnaire. E-mail and social media platforms such as Facebook and WhatsApp were utilized to disseminate the questionnaire. RESULTS: The total numbers of 358 undergraduate medical students responded to the online survey questionnaire. The majority (87.7 %) of students agreed that the closure of the university is an essential decision to control the spread of the COVID-19 infection. Approximately two-thirds (64 %) of students perceived that E-learning is the best solution during COVID 19 lockdown. The level of medical students (Pre-clerkship and Clerkship) and place of residence had significant correlation (p-value < 0.05) with medical students opinion regards starting the E-learning. Internet bandwidth and connectivity limitation, unfamiliarity with E-learning system, technical support limitation and time flexibility in case of technical problems during online exams, and lack of face-to-face interaction were the factors considered by medical students to be against the E-learning implementation. CONCLUSIONS: Most medical students had a positive perception of E-learning. However, there are many challenges considered as an inhibitory factor for utilizing electronic technologies for medical education. We recommend that challenges of E-learning in our limited-resource setting should be systematically evaluated and that effective strategies should be developed to overcome their inhibitory effects.

Acceptability and feasibility of strategies to shield the vulnerable during the COVID-19 outbreak: a qualitative study in six Sudanese communities.

BACKGROUND: Shielding of high-risk groups from coronavirus disease (COVID-19) has been suggested as a realistic alternative to severe movement restrictions during the COVID-19 epidemic in low-income countries. The intervention entails the establishment of 'green zones' for high-risk persons to live in, either within their homes or in communal structures, in a safe and dignified manner, for extended periods of time during the epidemic. To our knowledge, this concept has not been tested or evaluated in resource-poor settings. This study aimed to explore the acceptability and feasibility of strategies to shield persons at higher risk of severe COVID-19 outcomes, during the COVID-19 epidemic in six communities in Sudan. METHODS: We purposively sampled participants from six communities, illustrative of urban, rural and forcibly-displaced settings. In-depth telephone interviews were held with 59 members of households with one or more members at higher risk of severe COVID-19 outcomes. Follow-up interviews were held with 30 community members after movement restrictions were eased across the country. All interviews were audio-recorded, transcribed verbatim, and analysed using a two-stage deductive and inductive thematic analysis. RESULTS: Most participants were aware that some people are at higher risk of severe COVID-19 outcomes but were unaware of the concept of shielding. Most participants found shielding acceptable and consistent with cultural inclinations to respect elders and protect the vulnerable. However, extra-household shielding arrangements were mostly seen as socially unacceptable. Participants reported feasibility concerns related to the reduced socialisation of shielded persons and loss of income for shielding families. The acceptability and feasibility of shielding strategies were reduced after movement restrictions were eased, as participants reported lower perception of risk in their communities and increased pressure to comply with social commitments outside the house. CONCLUSION: Shielding is generally acceptable in the study communities. Acceptability is influenced by feasibility, and by contextual changes in the epidemic and associated policy response. The promotion of shielding should capitalise on the cultural and moral sense of duty towards elders and vulnerable groups. Communities and households should be provided with practical guidance to implement feasible shielding options. Households must be socially, psychologically and financially supported to adopt and sustain shielding effectively.

COVID-19 in Sudan.

The steadily growing COVID-19 pandemic is challenging health systems worldwide including Sudan. In Sudan, the first COVID-19 case was reported on 13th March 2020, and up to 11 November 2020 there were 14,401 confirmed cases of which 9,535 cases recovered and the rest 3,750 cases were under treatment. Additionally, 1,116 deaths were reported, indicating a relatively high case fatality rate of 7.7%. Several preventive and control measures were implemented by the government of Sudan and health partners, including the partial lockdown of the country, promoting social distancing, and suspending mass gathering such as festivals and performing religious practices in groups. However, new cases still emerging every day and this could be attributed to the noncompliance of the individuals to the advocated preventive measurements.

The first laboratory-confirmed imported infections of SARS-CoV-2 in Sudan.

BACKGROUND: The rapidly growing pandemic of coronavirus disease 2019 (COVID-19) has challenged health systems globally. Here we report the first identified infections of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; aetiology of COVID-19) among recent international arrivals to Sudan and their contacts. METHODS: Suspected cases were identified clinically and/or epidemiologically. Samples from suspected cases and their contacts were tested in the National Influenza Centre following World Health Organization protocols. Two real-time reverse transcription quantitative polymerase chain reaction assays were used to detect and confirm SARS-CoV-2 infection. RESULTS: Seven cases of COVID-19, including two deaths, were confirmed in Sudan between 27 February and 30 March 2020. Suspected cases were identified and tested. As of 30 March, no local transmission was yet reported in the country. Fifty-nine percent of the suspected cases were international travellers coming from areas with current COVID-19 epidemics. Cough and fever were the major symptoms, presented by 65% and 60% of the suspected cases, respectively. By early April, an additional seven cases were confirmed through limited contact tracing that identified the first locally acquired infections in recent contact with imported cases. CONCLUSIONS: The high mortality rate of COVID-19 cases in Sudan might be due to limitations in test and trace and case management services. Unfortunately, infections have spread further into other states and the country has no capacity for mass community screening to better estimate disease prevalence. Therefore external support is urgently needed to improve the healthcare and surveillance systems.