Delays in presentation, diagnosis, and treatment in Sudanese women with breast cancer: a cross-sectional study.

BACKGROUND: The poor prognosis of breast cancer in Sudan could be due to delayed treatment and diagnosis at an advanced stage. Our study aimed to assess the extent of delays from onset of symptoms to treatment in Sudanese women with breast cancer, as well as identify factors contributing to these delays. MATERIALS AND METHODS: We conducted a multi-center cross sectional study between March and April 2023. Data were collected from the medical records and interviews with women with breast cancer in the two main oncology centers in Sudan. Linear regression was used to identify the predictors of delayed presentation. RESULTS: We interviewed 601 women with breast cancer. The majority of women (50.1%) were diagnosed at locally advanced or metastatic disease. The median interval from the onset of symptoms to receiving oncologic treatment was 221 days (IQR = 92, 496). The longest delay was the presentation delay 61 (31 244) days. The median duration for diagnosis delay and treatment delay was 21 (10.57) days and 27 (10.64) days, respectively. Predictors of early presentation included, being young (ß = -5.3; 95% CI = 0.06 to 10), married (ß = -264; 95% CI = -427 to -101), divorced (ß = -306; 95% CI = -549 to -63), or widowed (ß = -320; 95% CI = --543 to -97), urban residence (ß = -107; 95% CI = -213 to -2.3), and seeking traditional healer (ß = -204; 95% CI = -383 to -26). CONCLUSION: Most Sudanese women with breast cancer experience significant patient delays, often presenting at advanced stages. Factors like being single, older, and living in rural areas contribute to these delays. Increasing breast cancer education, improving healthcare access and addressing sociodemographic barriers can potentially expedite diagnosis and improve outcomes.

Awareness towards urinary schistosomiasis and its relation with active infection among primary school pupils and students in North Kordofan state, Sudan 2022.

Objectives: This study intends to evaluate the prevalence of active Schistosomiasis in school children, as well as their awareness, attitude, and behavior towards the illness in El-Rahad province. Methods: This facility-based analytical cross-sectional study among 495 primary school children aged seven to 13 in five villages; Structured and pre-tested questionnaires were used to collect the data in face-to-face interviews, in addition, urine samples were collected from each pupil and then assessed microscopically for S. Haematobium eggs Presence. Data was analyzed using SPSS version 25.0. Results: A total of 424 primary school students participated in the study. Almost all the students (96%) had poor knowledge about urinary schistosomiasis. In general, 100% of the students had poor practices. Attitude revealed that females have lower chance of having the infection than their male counterparts. About 27% (n = 115) of them had active urinary schistosomiasis infection at the time of the study. Conclusion: The study revealed poor level of awareness and knowledge, positive attitude, and poor practices among primary school students. There was also high level of active infection among participants.

Undergraduate oncology education in Sudanese public medical schools; a national cross-sectional study.

BACKGROUND: Cancer was the fifth leading cause of death in Sudan general hospitals in 2020, and its incidence is increasing. Medical students' cancer education is key in cancer control. Evaluating the current education is the first step in optimizing it. The aim of this study was to assess undergraduate oncology education in Sudan public medical schools as reflected by the graduates of the year 2021-2022. METHOD: This was a cross-sectional institution-based study. A validated online questionnaire was sent between 8 September and 11 November 2022 to graduates who were selected using a stratified random sampling technique from 17 Sudan public medical schools. The data were collected using Google Forms and analyzed using R software version 4.2.2 and Microsoft Excel 2022. RESULTS: A total of 707 graduates completed the questionnaire. They reported generally poor exposure to oncology. Palliative and radiation oncology in addition to chemotherapy daycare units were never attended by 76.0%, 72.0%, and 72.0% of graduates, respectively. The massed oncology curriculum was associated with increased hours of lectures dictated to medical (p = 0.005), radiation (p < 0.001), and palliative oncology (0.035). It was associated with an increased likelihood of assessment in breaking bad news (p < 0.001), counseling cancer patients (p = 0.015), and oncology-related knowledge (p < 0.001). The massed curriculum was associated with a decrease in interest in pursuing an oncology career (p = 0.037). Students were generally confident in their oncology competencies, and no difference was observed in relation to the curriculum approach (p > 0.05). CONCLUSION: This study reflected poor exposure to oncology at the undergraduate level in Sudanese public medical schools. The massed oncology curriculum was associated with formal assessment of oncology-related competencies and better exposure to some disciplines, such as radiation and palliative oncology. Nonetheless, it was associated with decreased interest in an oncology career. In spite of the poor exposure, graduates were confident in their skills in oncology-related competencies. Further objective analysis of competence is needed.

ALS in Africa: current knowledge and exciting opportunities for future study - short communication.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that can present with motor and extra-motor manifestations. Its global prevalence is 4.42 per 1 000 000, and it has a high mortality rate. In sub-Saharan Africa alone, 15 per 100 000 develop ALS mainly between their 40s and 60s and only one-fourth of them have access to treatment. ALS was found to be not only affected by genetic variation but also by the patient's mood and lifestyle. In Africa, males and younger people tend to be affected with ALS and rarely present with bulbar onset. ALS diagnosis is very challenging due to the lack of ALS-specific biomarkers and the sharing of some clinical features with other syndromes. ALS treatment is mainly riluzole and supportive treatment via nasogastric tube and ventilatory support. The access to treatment in Africa is very limited, thus a very bad prognosis with a median survival time of 14 months post-diagnosis. Further research is needed to assess the real situation in Africa and to try to closely monitor patients suffering from ALS.

Knowledge, attitude, and ethical concepts of Sudanese medical students regarding stem cells and its application.

One of the major challenges that stem cell transplantation faces is a lack of donors due to a lack of knowledge and awareness of the importance of stem cell transplantation, this implies that health care providers should arm themselves with sufficient knowledge to contribute positively to raising awareness. This is an analytical cross-sectional study of 1040 medical students from 10 universities from various Sudanese states, through an online self-administered pre-tested and structured questionnaire formulated by the authors with a particular focus and/or reflection on the knowledge and attitudes of medical students. The median knowledge score among all students was 8.0 (6-9) with the majority of students confirming that stem cells are capable of dividing and can self-renew for a long period (88.6%). Regarding attitude, the median score among the participants was 23 (17-27) with (47.9%) agreeing that competency in stem cell knowledge is important for them as future health care providers. In terms of ethical attitude; the majority of the students (59, 2%) think there's a need to obtain ethical approval before conducting research. Moreover, (45.9%) of students believe that health practitioners have the right to use stem cells in treatments if those treatments have been scientifically proven to be effective on animals and on human cells in the laboratory. It is important to promote educational programs that inform medical students about the full range of possibilities offered by stem cell research. Furthermore, more studies is required to determine how society and religion affect medical students' attitudes toward stem cells.

Prevalence and reasons to seek traditional healing methods among residents of two localities in North Kordofan State, Sudan 2022: A cross-sectional study.

Background and Aims: Traditional medicines are one of Africa's primary response mechanisms to medical emergencies, while, in other communities, all healthcare decisions are based on indigenous traditions and beliefs. For millions of individuals who reside in rural areas throughout low- and middle-income nations, those healers serve as their only primary healthcare practitioners. This study intends to examine the availability, preferences, and practices of traditional medicine seeking among the Sudanese of North Kordofan state. Method: A descriptive cross-sectional study was carried out in two conveniently chosen localities in North Kordofan state, namely Barrah, and Shaikan. A structured questionnaire with three sections-sociodemographic, attitudes, and forms of traditional medical practices-was used for face-to-face interviews with the residents. The frequency (n) and percentage (%) of categorical data are presented. The Chi-square and Fischer exact tests were performed to determine characteristics related to traditional medicine practice and the preferred type of medicine among participants; a p value of.05 was considered significant. Results: A total of 302 residents took part in the study, with the 15-30 age group constituting the majority. The majority of participants (89.1%) used traditional medicine, and the majority of them (92.4%) learned about it from their families. The major type of traditional medicine (60.3%) used was a medical herbs-herb practitioner. Cultural influences (57%) and the effectiveness of traditional medicines (48.3%) were the most common reasons for seeking those medicines. Conclusion: Most participants seek traditional medicine, with traditional herbs and holy recitation commonly used. Affordability, therapeutic effectiveness, and cultural and religious influence were reasons for preferring traditional medicine.

Consanguinity and willingness to perform premarital genetic screening in Sudan.

Consanguineous marriage is prevalent in certain world regions due to cultural, economic, and social reasons. However, it can lead to negative consequences including an increased risk of genetic disorders in offspring. Premarital genetic screening (PMGS) is an important tool to identify and manage these risks before marriage. This study aimed to assess the magnitude of consanguineous marriage, knowledge of genetic diseases and PMGS, and attitudes and willingness to perform PMGS in Sudan. A national household survey was conducted using a multistage sampling technique, with a sample size of 2272 participants. Data were collected from December 2022 to March 2023 using an interviewer-administered questionnaire. A significant proportion of respondents (364/850, 42.8%) were married to consanguineal partners, with various types of relatedness. Moreover, 32.1% (242/755) of single respondents were planning to marry a close relative, signifying the likely persistence of consanguineous marriages in Sudan. The level of knowledge regarding genetic diseases and PMGS was relatively low in many states of Sudan, indicating the need for increased awareness interventions. A significant number of participants (85.2%) agreed that premarital screening is effective in reducing genetic diseases, whereas 71.2% supported the introduction of a mandatory PMGS program. Excluding married participants, 82.3% (1265/1537) of respondents were willing to perform PMGS, if implemented. These findings reflect the public positive attitude towards introducing the PMGS program and policies in Sudan and underscore the importance of addressing the knowledge gap of PMGS before such a potential implementation.

Burnout and its associated factors among healthcare workers in COVID-19 isolation centres in Khartoum, Sudan: A cross-sectional study.

BACKGROUND: Burnout prevalence and its consequences on healthcare workers during the Omicron wave are not well investigated in Sudan. This study aims to assess the prevalence of burnout and its associated factors among doctors and nurses during the omicron wave in COVID-19 isolation centres in Khartoum, Sudan. METHOD: This cross-sectional survey study was conducted at multiple COVID-19 isolation centres in Khartoum state during the omicron wave of Coronavirus Disease 2019 between 20th February 2022 and 10th April 2022. A total of 306 doctors and nurses filled out the questionnaire, with a response rate of 64.8℅. They were recruited from 5 isolation centers scattered in the three cities of Khartoum Metropolis. The level of burnout was assessed using an online semi-structured questionnaire based on the Oldenburg Burnout Inventory questionnaire. Descriptive statistics were used for continuous variables and frequencies with percentages for categorical variables. The Chi-square test and Fisher exact test were used to identify variables associated with burnout. Logistic regression was used to determine the factors associated with burnout, and the p-value of ≤ .05 is considered statistically significant. RESULTS: The prevalence of burnout was 45.7%. Doctors were more likely to have burnout than nurses (OR: 2.01, CI 95% 1.24-3.27; p = 0.005). Also, married healthcare workers were more likely to suffer burnout than single healthcare workers (OR: 3.89, CI 95% 1.41-12.5; P = 0.013). The number of household members (p = 0.035) was associated with burnout among participants. CONCLUSION: There is a high prevalence of burnout among healthcare workers in Khartoum Isolation Centers, which is more apparent among doctors.

Clinical phenotyping and genetic diagnosis of a large cohort of Sudanese families with hereditary spinocerebellar degenerations.

Hereditary spinocerebellar degenerations (SCDs) is an umbrella term that covers a group of monogenic conditions that share common pathogenic mechanisms and include hereditary spastic paraplegia (HSP), cerebellar ataxia, and spinocerebellar ataxia. They are often complicated with axonal neuropathy and/or intellectual impairment and overlap with many neurological conditions, including neurodevelopmental disorders. More than 200 genes and loci inherited through all modes of Mendelian inheritance are known. Autosomal recessive inheritance predominates in consanguineous communities; however, autosomal dominant and X-linked inheritance can also occur. Sudan is inhabited by genetically diverse populations, yet it has high consanguinity rates. We used next-generation sequencing, genotyping, bioinformatics analysis, and candidate gene approaches to study 90 affected patients from 38 unrelated Sudanese families segregating multiple forms of SCDs. The age-at-onset in our cohort ranged from birth to 35 years; however, most patients manifested childhood-onset diseases (the mean and median ages at onset were 7.5 and 3 years, respectively). We reached the genetic diagnosis in 63% and possibly up to 73% of the studied families when considering variants of unknown significance. Combining the present data with our previous analysis of 25 Sudanese HSP families, the success rate reached 52-59% (31-35/59 families). In this article we report candidate variants in genes previously known to be associated with SCDs or other phenotypically related monogenic disorders. We also highlight the genetic and clinical heterogeneity of SCDs in Sudan, as we did not identify a major causative gene in our cohort, and the potential for discovering novel SCD genes in this population.