Fragmented landscapes affect honey bee colony strength at diverse spatial scales in agroecological landscapes in Kenya.

Landscape fragmentation and habitat loss at multiple scales directly affect species abundance, diversity, and productivity. There is a paucity of information about the effect of the landscape structure and diversity on honey bee colony strength in Africa. Here, we present new insights into the relationship between landscape metrics such as patch size, shape, connectivity, composition, and configuration and honey bee (Apis mellifera) colony strength characteristics. Remote-sensing-based landscape variables were linked to honey bee colony strength variables in a typical highly fragmented smallholder agroecological region in Kenya. We examined colonies in six sites with varying degrees of land degradation during the period from 2017 to 2018. Landscape structure was first mapped using medium resolution bitemporal Sentinel-1 and Sentinel-2 satellite imagery with an optimized random forest model. The influence of the surrounding landscape matrix was then constrained to two buffer distances, i.e., 1 km representing the local foraging scale and 2.5 km representing the wider foraging scale around each investigated apiary and for each of the six sites. The results of zero-inflated negative binomial regression with mixed effects showed that lower complexity of patch geometries represented by fractal dimension and reduced proportions of croplands were most influential at local foraging scales (1 km) from the apiary. In addition, higher proportions of woody vegetation and hedges resulted in higher colony strength at longer distances from the apiary (2.5 km). Honey bees in moderately degraded landscapes demonstrated the most consistently strong colonies throughout the study period. Efforts towards improving beekeeper livelihoods, through higher hive productivity, should target moderately degraded and heterogeneous landscapes, which provide forage from diverse land covers.

Splenic haematoma and rupture, a rare complication of ventriculoperitoneal shunt.

Complications of ventriculoperitoneal (VP) shunts have been well described in the literature. To our knowledge, only two cases with splenic tear have been reported to date. We report here a case of splenic haematoma and rupture caused by the distal catheter looping around the spleen, requiring urgent splenectomy for spontaneous rupture and massive haemorrhage. This complication was noted six weeks following VP shunt insertion.

The possibilities of explicit Striga (Striga asiatica) risk monitoring using phenometric, edaphic, and climatic variables, demonstrated for Malawi and Zambia.

Food insecurity continues to affect more than two-thirds of the population in sub-Saharan Africa (SSA), particularly those depending on rain-fed agriculture. Striga, a parasitic weed, has caused yield losses of cereal crops, immensely affecting smallholder farmers in SSA. Although earlier studies have established that Striga is a constraint to crop production, there is little information on the spatial extent of spread and infestation severity of the weed in some SSA countries like Malawi and Zambia. This study aimed to use remotely sensed vegetation phenological (n = 11), climatic (n = 3), and soil (n = 4) variables to develop a data-driven ecological niche model to estimate Striga (Striga asiatica) spatial distribution patterns over Malawi and Zambia, respectively. Vegetation phenological variables were calculated from 250-m enhanced vegetation index (EVI) timeline data, spanning 2013 to 2016. A multicollinearity test was performed on all 18 predictor variables using the variance inflation factor (VIF) and Pearson's  correlation approach. From the initial 18 variables, 12 non-correlated predictor variables were selected to predict Striga risk zones over the two focus countries. The variable "start of the season" (start of the rainy season) showed the highest model relevance, contributing 26.8% and 37.9% to Striga risk models for Malawi and Zambia, respectively. This indicates that the crop planting date influences the occurrence and the level of Striga infestation. The resultant occurrence maps revealed interesting spatial patterns; while a very high Striga occurrence was predicted for central Malawi and eastern Zambia (mono-cultural maize growing areas), lower occurrence rates were found in the northern regions. Our study shows the possibilities of integrating various ecological factors with a better spatial and temporal resolution for operational and explicit monitoring of Striga-affected areas in SSA. The explicit identification of Striga "hotspot" areas is crucial for effectively informing intervention activities on the ground.

Assessment of Plasmodium falciparum drug resistance molecular markers from the Blue Nile State, Southeast Sudan.

BACKGROUND: Plasmodium falciparum malaria is a public health problem worldwide. Malaria treatment policy has faced periodic changes due to emergence of drug resistant parasites. In Sudan chloroquine has been replaced by artesunate and sulfadoxine/pyrimethamine (AS/SP) in 2005 and to artemether-lumefantrine (AL) in 2017, due to the development of drug resistance. Different molecular markers have been used to monitor the status of drug resistant P. falciparum. This study aimed to determine the frequency of malaria drug resistance molecular markers in Southeast Sudan. METHODS: The samples of this study were day zero dried blood spot samples collected from efficacy studies in the Blue Nile State from November 2015 to January 2016. A total of 130 samples were amplified and sequenced using illumina Miseq platform. The molecular markers included were Pfcrt, Pfmdr1, Pfdhfr, Pfdhps, Pfk13, exonuclease and artemisinin resistant (ART-R) genetic background (Pfmdr2, ferroredoxine, Pfcrt and Pfarps10). RESULTS: Resistance markers for chloroquine were detected in 25.8% of the samples as mutant haplotype Pfcrt 72-76 CVIET and 21.7% Pfmdr1 86Y. Pfdhfr mutations were detected in codons 51, 59 and 108. The ICNI double-mutant haplotype was the most prevalent (69%). Pfdhps mutations were detected in codons 436, 437, 540, 581 and 613. The SGEGA triple-mutant haplotype was the most prevalent (43%). In Pfdhfr/Pfdhps combined mutation, quintuple mutation ICNI/SGEGA is the most frequent one (29%). Six of the seven treatment failure samples had quintuple mutation and the seventh was quadruple. This was significantly higher from the adequately responsive group (P < 0.01). Pfk13 novel mutations were found in 7 (8.8%) samples, which were not linked to artemisinin resistance. Mutations in ART-R genetic background genes ranged from zero to 7%. Exonuclease mutation was not detected. CONCLUSION: In this study, moderate resistance to chloroquine and high resistance to SP was observed. Novel mutations of Pfk13 gene not linked to treatment failure were described. There was no resistance to piperaquine the partner drug of dihydroartemisinin/piperaquine (DHA-PPQ).

Impact of insecticide resistance in Anopheles arabiensis on malaria incidence and prevalence in Sudan and the costs of mitigation.

Insecticide-based interventions have contributed to ∼78% of the reduction in the malaria burden in sub-Saharan Africa since 2000. Insecticide resistance in malaria vectors could presage a catastrophic rebound in disease incidence and mortality. A major impediment to the implementation of insecticide resistance management strategies is that evidence of the impact of resistance on malaria disease burden is limited. A cluster randomized trial was conducted in Sudan with pyrethroid-resistant and carbamate-susceptible malaria vectors. Clusters were randomly allocated to receive either long-lasting insecticidal nets (LLINs) alone or LLINs in combination with indoor residual spraying (IRS) with a pyrethroid (deltamethrin) insecticide in the first year and a carbamate (bendiocarb) insecticide in the two subsequent years. Malaria incidence was monitored for 3 y through active case detection in cohorts of children aged 1 to <10 y. When deltamethrin was used for IRS, incidence rates in the LLIN + IRS arm and the LLIN-only arm were similar, with the IRS providing no additional protection [incidence rate ratio (IRR) = 1.0 (95% confidence interval [CI]: 0.36-3.0; P = 0.96)]. When bendiocarb was used for IRS, there was some evidence of additional protection [interaction IRR = 0.55 (95% CI: 0.40-0.76; P < 0.001)]. In conclusion, pyrethroid resistance may have had an impact on pyrethroid-based IRS. The study was not designed to assess whether resistance had an impact on LLINs. These data alone should not be used as the basis for any policy change in vector control interventions.

Severe malaria management: current situation, challenges and lessons learned from Gezira State, Sudan.

BACKGROUND: The present study aimed to evaluate the management of severe malaria at Gezira State hospitals in Sudan by assessing hospital readiness, health care provider knowledge and the care received by severe malaria patients. METHODS: A cross-sectional descriptive study was performed to assess the severe malaria management practices at hospitals level in Gezira State. The study population included hospitals, health care providers and patients. Data was collected using checklists and structured questionnaires. RESULTS: A total of 20 hospitals, 158 health care providers and 370 patients were included in the study. Out of the total hospitals, 95% (19/20) were providing 24 h outpatient services, 65% (13/20) had ICU units, while triage system was found in only 35% (7/20) of hospitals. From all hospitals evaluated, 90% (18/20) were suffering from shortage of staff, especially doctors. About half of the health care providers (46.7%) did not receive severe malaria management training. The average knowledge score among health care providers was 55.4%. Microscopy was available in all hospitals (100%), while rapid diagnostic test, complete blood count and renal function test were available in 15 hospitals (75%). Fever was the most presenting symptom (97.8%) followed by repeated vomiting (51.4%), convulsion in children (24.3%) and prostration in adult (57.9%). Correctly diagnosed patients were 68.9%. Essential tests were done for only 11.1% of patients. Majority of patients (91.7%) were treated with quinine, 5.9% received artemether, while 2.4% were treated with artemether-lumefantrine. Those who received both the correct dose and dosing regimen were 53.8%. The overall compliance to guidelines was 2.2%. CONCLUSION: This study highlights the fact that management of severe malaria at hospital level was suboptimal with serious shortcomings in the different aspects of care particularly in specialized hospitals. Technical staff was inadequate, hospitals were anguish from defective emergency services, and most patients were not treated according to the national guidelines.

Efficacies of DHA-PPQ and AS/SP in patients with uncomplicated Plasmodium falciparum malaria in an area of an unstable seasonal transmission in Sudan.

BACKGROUND: Artemisinin-based combination therapy (ACT), together with other control measures, have reduced the burden of falciparum malaria in sub-Saharan countries, including Sudan. Sudan adopted ACT in 2004 with a remarkable reduction in mortality due to falciparum malaria. However, emergence of resistance to the first-line treatment artesunate and sulfadoxine/pyrimethamine (AS/SP) has created new challenges to the control of malaria in Sudan. A search for an alternative drug of choice for treating uncomplicated malaria has become inevitable. The objective of this study was to evaluate the therapeutic efficacies of dihydroartemisinin/piperaquine (DHA-PPQ) and AS/SP in an area of unstable transmission in Blue Nile State, Sudan in 2015-16. METHODS: A total of 148 patients with uncomplicated malaria were recruited in the study from November 2015 to end of January 2016. Seventy-five patients received DHA-PPQ while 73 received AS/SP. Patients were monitored for clinical and parasitological outcomes following the standard WHO protocol for a period of 42 days for DHA-PPQ and 28 days for AS/SP; nested PCR (nPCR) was performed to confirm parasite re-appearance from day 7 onwards. RESULTS: Fifty-five patients completed the DHA-PPQ arm protocol with success cure rate of 98.2% (95% CI 90.3-100%) and one late clinical failure 1.8% (95% CI 0.0-9.7%). The AS/SP showed adequate clinical and parasitological response (ACPR) of 83.6% (95% CI 71.9-91.8%), early treatment failure was 1.6% (95% CI 0.0-8.8%) and late parasitological failure (LPF) was 14.8% (95% CI 7-26.2%). The respective PCR uncorrected LPF was 20%. CONCLUSION: DHA-PPQ is an efficacious ACT and candidate for replacement of first-line treatment in Sudan while AS/SP showed high treatment failure rate and must be replaced.

Maize Cropping Systems Mapping Using RapidEye Observations in Agro-Ecological Landscapes in Kenya.

Cropping systems information on explicit scales is an important but rarely available variable in many crops modeling routines and of utmost importance for understanding pests and disease propagation mechanisms in agro-ecological landscapes. In this study, high spatial and temporal resolution RapidEye bio-temporal data were utilized within a novel 2-step hierarchical random forest (RF) classification approach to map areas of mono- and mixed maize cropping systems. A small-scale maize farming site in Machakos County, Kenya was used as a study site. Within the study site, field data was collected during the satellite acquisition period on general land use/land cover (LULC) and the two cropping systems. Firstly, non-cropland areas were masked out from other land use/land cover using the LULC mapping result. Subsequently an optimized RF model was applied to the cropland layer to map the two cropping systems (2nd classification step). An overall accuracy of 93% was attained for the LULC classification, while the class accuracies (PA: producer's accuracy and UA: user's accuracy) for the two cropping systems were consistently above 85%. We concluded that explicit mapping of different cropping systems is feasible in complex and highly fragmented agro-ecological landscapes if high resolution and multi-temporal satellite data such as 5 m RapidEye data is employed. Further research is needed on the feasibility of using freely available 10-20 m Sentinel-2 data for wide-area assessment of cropping systems as an important variable in numerous crop productivity models.

Poor adherence to the malaria management protocol among health workers attending under-five year old febrile children at Omdurman Hospital, Sudan.

BACKGROUND: In spite of the World Health Organization recommendations for the treatment of malaria, febrile patients are still infrequently tested and erroneously treated for malaria. This study aimed to investigate the adherence to malaria national protocol for the management of malaria among under five years old children. METHODS: A cross sectional hospital-based study was conducted during the period from September through December 2013 among febrile children below the age of five years attending the outpatient department of Omdurman Children Hospital, Sudan. Demographic, clinical and laboratory data [blood film, rapid diagnostic test (RDTs), haemoglobin, WBCs and chest X ray] and anti-malarials and/or antibiotics prescription were recorded. RESULTS: A total of 749 febrile children were enrolled. The mean (SD) age was 37.51 (41.6) months. Less than a half, (327, 43.7%) of children were investigated for malaria using microscopy (271, 82.9%), RDT (4, 1.2%) or both (52, 15.9%). Malaria was not investigated for more than a half, (422, 56.3%) however investigations targeting other causes of fever were requested for them. Malaria was positive in 72 (22%) of the 327 investigated children. Five (1.6%) out of 255 with negative malaria tests were treated by an anti-malarials. Quinine was the most frequently prescribed anti-malarials (65, 72.2%) then artemisinin-based combination therapy (ACT) (2, 27.8%). The majority of the 749 children (655, 87.4%) were prescribed an antibiotic. CONCLUSION: There is a poor adherence to malaria management protocol in Sudan among physicians treating children below five years of age. There was a high rate of antibiotic prescription needs.

Do frontline health care providers know enough about artemisinin-based combination therapy to rationally treat malaria? A cross-sectional survey in Gezira State, Sudan.

BACKGROUND: In 2004, artemisinin-based combination therapy (ACT) was introduced in Sudan for the treatment of malaria. The role of health care providers working in first-level health care facilities is central for the effective implementation of this revised malaria treatment policy. However, information about their level of ACT knowledge is inadequate. This study sought to describe frontline health care providers' knowledge about the formulations and dose regimens of nationally recommended ACT in Sudan. METHODS: This cross-sectional study took place in Gezira State, Sudan. Data were gathered from five localities comprising forty primary health care facilities. A total of 119 health care providers participated in the study (72 prescribers and 47 dispensers). The primary outcome was the proportion of health care providers who were ACT knowledgeable, a composite indicator of health care providers' ability to (1) define what combination therapy is; (2) identify the recommended first- and second-line treatments; and (3) correctly state the dose regimens for each. RESULTS: All prescribers and 95.7% (46/47) of dispensers were aware of the new national malaria treatment policy. However, 93.1% (67/72) of prescribers compared to 87.2% (41/47) of dispensers recognized artesunate-sulphadoxine/pyrimethamine as the recommended first-line treatment in Sudan. Only a small number of prescribers and dispensers (9.4% and 13.6%, respectively) were able to correctly define the meaning of a combination therapy. Overall, only 22% (26/119, 95% CI 14.6-29.4) of health care providers were found to be ACT knowledgeable with no statistically significant difference between prescribers and dispensers. CONCLUSION: Overall, ACT knowledge among frontline health care providers is very poor. This finding suggests that efforts are needed to improve knowledge of prescribers and dispensers working in first-level health care facilities, perhaps through implementing focused, provider-oriented training programmes. Additionally, a system for regularly monitoring and evaluating the quality of in-service training may be beneficial to ensure its responsiveness to the needs of the target health care providers.

Design of a study to determine the impact of insecticide resistance on malaria vector control: a multi-country investigation.

BACKGROUND: Progress in reducing the malaria disease burden through the substantial scale up of insecticide-based vector control in recent years could be reversed by the widespread emergence of insecticide resistance. The impact of insecticide resistance on the protective effectiveness of insecticide-treated nets (ITN) and indoor residual spraying (IRS) is not known. A multi-country study was undertaken in Sudan, Kenya, India, Cameroon and Benin to quantify the potential loss of epidemiological effectiveness of ITNs and IRS due to decreased susceptibility of malaria vectors to insecticides. The design of the study is described in this paper. METHODS: Malaria disease incidence rates by active case detection in cohorts of children, and indicators of insecticide resistance in local vectors were monitored in each of approximately 300 separate locations (clusters) with high coverage of malaria vector control over multiple malaria seasons. Phenotypic and genotypic resistance was assessed annually. In two countries, Sudan and India, clusters were randomly assigned to receive universal coverage of ITNs only, or universal coverage of ITNs combined with high coverage of IRS. Association between malaria incidence and insecticide resistance, and protective effectiveness of vector control methods and insecticide resistance were estimated, respectively. RESULTS: Cohorts have been set up in all five countries, and phenotypic resistance data have been collected in all clusters. In Sudan, Kenya, Cameroon and Benin data collection is due to be completed in 2015. In India data collection will be completed in 2016. DISCUSSION: The paper discusses challenges faced in the design and execution of the study, the analysis plan, the strengths and weaknesses, and the possible alternatives to the chosen study design.

Scaling up family medicine training in Gezira, Sudan - a 2-year in-service master programme using modern information and communication technology: a survey study.

BACKGROUND: In 2010 the Gezira Family Medicine Project (GFMP) was initiated in Gezira state, Sudan, designed as an in-service training model. The project is a collaboration project between the University of Gezira, which aims to provide a 2-year master's programme in family medicine for practicing doctors, and the Ministry of Health, which facilitates service provision and funds the training programme. This paper presents the programme, the teaching environment, and the first batch of candidates enrolled. METHODS: In this study a self-administered questionnaire was used to collect baseline data at the start of the project from doctors who joined the programme. A checklist was also used to assess the health centres where they work. A total of 188 out of 207 doctors responded (91%), while data were gathered from all 158 health centres (100%) staffed by the programme candidates. RESULTS: The Gezira model of in-service family medicine training has succeeded in recruiting 207 candidates in its first batch, providing health services in 158 centres, of which 84 had never been served by a doctor before. The curriculum is community oriented. The mean age of doctors was 32.5 years, 57% were males, and 32% were graduates from the University of Gezira. Respondents stated high confidence in practicing some skills such as asthma management and post-abortion uterine evacuation. They were least confident in other skills such as managing depression or inserting an intrauterine device. The majority of health centres was poorly equipped for management of noncommunicable diseases, as only 10% had an electrocardiography machine (ECG), 5% had spirometer, and 1% had a defibrillator. CONCLUSIONS: The Gezira model has responded to local health system needs. Use of modern information and communication technology is used to facilitate both health service provision and training. The GFMP represents an example of a large-volume scaling-up programme of family medicine in Africa.

Correction: Synergies of integrated pest and pollinator management in avocado farming in East Africa: An ex-ante economic analysis.

[This corrects the article DOI: 10.1371/journal.pone.0271241.].

Studying the accessibility of healthcare services for cancer patients in Khartoum state amid the COVID-19 pandemic.

Objectives: This study aims to assess cancer patients' accessibility to healthcare services and perceived barriers during the COVID-19 pandemic in Khartoum state, aiming to explore the consequent impact on cancer patients. It also aims to determine the coping strategies used by patients to overcome these barriers. Study design: This is a retrospective analytical cross-sectional study. Methods: Data were collected from August 2020 to March 2021, with a sample size of 316 cancer patients. Systemic random sampling and SPSS version 25 were utilized for data collection and analysis. Results: The study found that 55.7 % of the surveyed cancer patients had experienced disruptions in accessing essential cancer healthcare services during the lockdown. The study identified the most common cancers as breast (19.7 %), gastrointestinal (19 %), and ovarian (11 %). Notable barriers included governmental travel restrictions (51.6 %), outpatient service closures (41.8 %), and high costs (27.8 %). Additionally, delayed treatment was directly associated with a 33.3 % fatality rate among the participants. Conclusions: This study highlights the considerable negative impact of the COVID-19 lockdown on cancer care in Sudan. Recommendations include a focus on telemedicine as an alternative form of patient consultation, the expansion of health insurance schemes to encompass cancer treatments, and strengthening healthcare infrastructure to facilitate cancer care during crises.

COVID-19 surveillance report for Sudan, 2020 to 2021.

Background: Following the World Health Organization declaration, COVID-19 was first appearance in Sudan was in March 2020. Cases were reported to the Sudan Federal Ministry of Heath through the surveillance system from different sources. This study used surveillance data from 2020 to 2021 to describe the epidemiologic patterns of COVID-19 occurrence in Sudan and provide insight for better preparedness and response. Methods: Through a retrospective descriptive study, COVID19 cases records obtained from the national surveillance line-list in Surveillance and Information Directorate in Federal Ministry of Health. The analysis of data was done with SPSS version 21. Descriptive analysis done by frequencies and percentages, and further analysis through performing multivariate logistic regression. Results: Out of 48,545 suspected cases tested for COVID-19 using RT-PCR, 27,453 (56.5%) tested positive with case fatality ratio of 6.5%. Higher death rate among elderly (78% > 60-year-old) and males (70.1%). From the reported cases, 53.8% showed no symptoms, while the common symptoms among symptomatic patients were; fever (26.4%), cough (19.1%), shortness of breath (16.8%) with small proportion (4.5%) reported loss of smell and taste. Specific states, Khartoum, Gezira and Red Sea showed highest prevalence. The disease peaked four times during 2020-2021, with a proposed alert threshold of 200-250 cases per week acting as an explosion point nationwide. Conclusions: The high case fatality rate in the country requires further analysis, as well as the high proportion of asymptomatic infection. This will be ensured by improving the quality and completeness of surveillance data. A proposed threshold of 200-250 cases per week should be an alert to augment the measures of controlling the pandemic over the country, including providing enough supplies to decrease mortality.

Investigating the association between household exposure to Anopheles stephensi and malaria in Sudan and Ethiopia: A case-control study protocol.

BACKGROUND: Endemic African malaria vectors are poorly adapted to typical urban ecologies. However, Anopheles stephensi, an urban malaria vector formerly confined to South Asia and the Persian Gulf, was recently detected in Africa and may change the epidemiology of malaria across the continent. Little is known about the public health implications of An. stephensi in Africa. This study is designed to assess the relative importance of household exposure to An. stephensi and endemic malaria vectors for malaria risk in urban Sudan and Ethiopia. METHODS: Case-control studies will be conducted in 3 urban settings (2 in Sudan, 1 in Ethiopia) to assess the association between presence of An. stephensi in and around households and malaria. Cases, defined as individuals positive for Plasmodium falciparum and/or P. vivax by microscopy/rapid diagnostic test (RDT), and controls, defined as age-matched individuals negative for P. falciparum and/or P. vivax by microscopy/RDT, will be recruited from public health facilities. Both household surveys and entomological surveillance for adult and immature mosquitoes will be conducted at participant homes within 48 hours of enrolment. Adult and immature mosquitoes will be identified by polymerase chain reaction (PCR). Conditional logistic regression will be used to estimate the association between presence of An. stephensi and malaria status, adjusted for co-occurrence of other malaria vectors and participant gender. CONCLUSIONS: Findings from this study will provide evidence of the relative importance of An. stephensi for malaria burden in urban African settings, shedding light on the need for future intervention planning and policy development.

Assessment of risk factors associated with surgical site infection following abdominal surgery: a systematic review.

Objective: Surgical site infections (SSIs) are among the most common healthcare-associated infections occurring following 1%-3% of all surgical procedures. Their rates are the highest following abdominal surgery. They are still associated with increased morbidity and healthcare costs despite the advancement in the medical field. Many risk factors for SSIs following abdominal surgery have been identified. The aim of this study is to comprehensively assess these risk factors as published in peer-reviewed journals. Design: A systematic review was conducted with accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Setting: The databases for search were PubMed and Cochrane Library, in addition to reference lists. Studies were retrieved and assessed for their quality. Data were extracted in a designed form, and a stratified synthesis of data was conducted to report the significant risk factors. Participants: Patients undergoing general abdominal surgery. Intervention: The intervention of general abdominal surgery. Main outcome measures: To identify and assess the risk factors for SSI following abdominal surgery. Results: Literature search yielded 813 articles, and the final screening process identified 11 eligible studies. The total number of patients is 11 996. The rates of SSI ranged from 4.09% to 26.7%. Nine studies were assessed to be of high quality, the remaining two studies have moderate quality. Stratified synthesis of data was performed for risk factors using summary measures (OR/risk ratio, 95% CI, and p value). Male sex and increased body mass index (BMI) were identified as significant demographic risk factors, and long operative time was among the major significant procedure-related risk factors. Conclusions: Male sex, increased BMI, diabetes, smoking, American Society of Anesthesiologists classification of >2, low albumin level, low haemoglobin level, preoperative hospital stay, long operative time, emergency procedure, open surgical approach, increased wound class, intraoperative blood loss, perioperative infection, perioperative blood transfusion, and use of drains are potential independent risk factors for SSI following abdominal surgery.

Epidemiology of COVID-19 among Children and Adolescents in Sudan 2020-2021.

Children and adolescents account for a small proportion of confirmed COVID-19 cases, with mild and self-limiting clinical manifestations. The distribution and determinants of COVID-19 among this group in Sudan are unclear. This study used national COVID-19 surveillance data to study the epidemiology of COVID-19 among children and adolescents in Sudan during 2020-2021. A cross-sectional study was performed to estimate the reported incidence of children and adolescents with COVID-19; the clinical features; and the mortality among those who tested positive for COVID-19. A total of 3150 suspected cases of COVID-19 infection fulfilled the study criteria. The majority of cases were above 10 years of age, 52% (1635) were males, and 56% (1765) were asymptomatic. The reported incidence rates of COVID-19 among children and adolescents in Sudan was 1.3 per 10,000 in 2021. Fever, cough, and headache were the most frequent symptoms reported among the suspected cases. The case fatality rate was 0.2%. Binary logistic regression revealed that loss of smell was the most significantly associated symptom with a positive test. We recommend further study to identify risk factors. Additionally, we recommend including these age groups in the vaccination strategy in Sudan.

Computational biogeographic distribution of the fall armyworm (Spodoptera frugiperda J.E. Smith) moth in eastern Africa.

The fall armyworm (FAW), Spodoptera frugiperda J.E. Smith, has caused massive maize losses since its attack on the African continent in 2016, particularly in east Africa. In this study, we predicted the spatial distribution (established habitat) of FAW in five east African countries viz., Kenya, Tanzania, Rwanda, Uganda, and Ethiopia. We used FAW occurrence observations for three years i.e., 2018, 2019, and 2020, the maximum entropy (MaxEnt) model, and bioclimatic, land surface temperature (LST), solar radiation, wind speed, elevation, and landscape structure data (i.e., land use and land cover and maize harvested area) as explanatory variables. The explanatory variables were used as inputs into a variable selection experiment to select the least correlated ones that were then used to predict FAW establishment, i.e., suitability areas (very low suitability - very high suitability). The shared socio-economic pathways, SSP2-4.5 and SSP5-8.5 for the years 2030 and 2050 were used to predict the effect of future climate scenarios on FAW establishment. The results demonstrated that FAW establishment areas in eastern Africa were based on the model strength and true performance (area under the curve: AUC = 0.87), but not randomly. Moreover, ∼27% of eastern Africa is currently at risk of FAW establishment. Predicted FAW risk areas are expected to increase to ∼29% (using each of the SSP2-4.5 and SSP5-8.5 scenarios) in the year 2030, and to ∼38% (using SSP2-4.5) and ∼35% (using SSP5-8.5) in the year 2050 climate scenarios. The LULC, particularly croplands and maize harvested area, together with temperature and precipitation bioclimatic variables provided the highest permutation importance in determining the occurrence and establishment of the pest in eastern Africa. Specifically, the study revealed that FAW was sensitive to isothermality (Bio3) rather than being sensitive to a single temperature value in the year. FAW preference ranges of temperature, precipitation, elevation, and maize harvested area were observed, implying the establishment of a once exotic pest in critical maize production regions in eastern Africa. It is recommended that future studies should thus embed the present study's modeling results into a dynamic platform that provides near-real-time predictions of FAW spatial occurrence and risk at the farm scale.