Prevalence and associated factors of stunting and thinness among adolescent Sudanese schoolchildren: a cross-sectional study.

BACKGROUND: Malnutrition among adolescents is a considerable health problem worldwide. There are scarce data on undernutrition among adolescents in Sudan. METHODS: A cross­sectional study was conducted to investigate the prevalence and associated factors of stunting and thinness among adolescent schoolchildren in northern Sudan. The questionnaires were used to collect information on sociodemographics. Weights and heights were measured and the height-for-age and body mass index-for-age cut-offs recommended by the WHO were applied, followed by logistic regression analysis. RESULTS: Of 384 enrolled adolescents, 202 (52.6%) were females and 182 (47.4%) were males. The median (IQR) age of these adolescents was 15.1 (14.0‒16.3) y. Seventy-six (19.8%) and 52 (15.4%) adolescents had stunting and thinness, respectively, and 15 (3.9%) had both stunting and thinness. Multivariate analysis showed that increased age (adjusted OR [AOR]=1.30, 95% CI 1.08 to 1.57) and male gender (AOR=5.82, 95% CI 3.11 to 10.91) were associated with stunting. Male gender (AOR=2.08, 95% CI 1.14 to 3.82) and smoking/tobacco snuff (AOR=2.61, 95% CI 1.07 to 6.36) were associated with thinness. CONCLUSIONS: The findings of the current study are that both stunting and thinness are important health problems, especially among boys, older participants and smokers.

Maternal Undernutrition and Low Birth Weight in a Tertiary Hospital in Sudan: A Cross-Sectional Study.

Background: The World Health Organization set a Global Nutrition Target of a 30% reduction in LBW by 2025. Maternal malnutrition/undernutrition is among the most important modifiable risk factors for impaired fetal growth. This study investigates the effect of maternal undernutrition on LBW in Sudan. Methods: A cross-sectional study was conducted at Saad Abuelela Hospital in Khartoum, Sudan, from May to October 2020. The sociodemographic and obstetric data of the women were gathered via questionnaire, and their mid-upper arm circumference (MUAC) was measured. Maternal undernutrition was defined as a MUAC of <23 cm. Results: In total, 1,505 pairs of pregnant women and their newborns were enrolled in the study. The medians [interquartile (IQR)] of the age, parity, and gestational age were 27.0 (9.0) years, 1.0 (3.0), and 38.0 (2.0) weeks, respectively. The median (IQR) of the birth weight was 3,028.0 (690.0) g. Of the 1,505 participants, 182 (12.1%) delivered LBW infants. Multivariate logistic regression showed that MUAC [adjusted odds ratio (AOR) = 0.91, 95% confidence interval (CI) = 0.87-0.96] and gestational age (AOR = 0.79, 95% CI = 0.73-0.85) were negatively associated with LBW. The level of antenatal care <2 visits (AOR = 2.10, 95% CI = 1.30-3.57) was associated with LBW. Women with undernutrition were at a higher risk of delivering LBW infants (AOR = 1.66, 95% CI = 1.09-2.53). Conclusion: LBW is a health problem in Sudan, and women with undernutrition were at a higher risk of delivering LBW infants.

Low and high birth weight in a hospital population in Sudan: An analysis of clinical cut-off values.

OBJECTIVE: To determine the cut-off values for low birth weight (LBW) and high birth weight (HBW) of Sudanese newborns. METHODS: Data (maternal age, parity, birth weight, and gender of the newborn) from women (n = 2818) who delivered at Saad Abualila Hospital in Khartoum were retrieved from the medical files. RESULTS: The cut-off for LBW (the 10th centile) was 2400 g and the 90th centile (HBW) was 3700 g. Out of 2818 newborns, 317 (11.2%) had birth weights below 2400 g. Using the WHO (traditional) cut-off of 2500 g, the prevalence of LBW was 14.3%. The difference between the two prevalences of LBW was statistically significant (P < 0.001). However, the agreement rate between the two was high (κ = 0.86). The cut-off to define HBW was 3700 g. In the study, 292 (10.4%) newborns had birth weights of at least 3700 g. Using the cut-off of 4000 g, the prevalence of HBW was 9.5%. The difference between the two prevalences of HBW was statistically significant (P < 0.001). However, the agreement rate between the two was low (κ = 0.06). CONCLUSION: The cut-off values for low and high birth weight were 2400 and 3700 g, respectively.

Global prevalence of congenital malaria: A systematic review and meta-analysis.

OBJECTIVE: The aim of this systematic review and meta-analysis is to pool the prevalence of congenital malaria. STUDY DESIGN: The guideline of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was strictly followed. The published studies were searched in international and national databases. Quality assessment for studied was performed using the modified Newcastle - Ottawa scale. Pooled Meta logistic regression was computed using OpenMeta Analyst software. The heterogeneity was explored by the subgroup and meta-regression method. RESULTS: Twenty-four studies enrolling 8148 newborns were conducted. All the studies were high-quality studies. The prevalence of congenital malaria ranged from 0.0 % in Colombia to 46.7 % in Nigeria. The overall prevalence of congenital malaria was 6.9 % (95 % CI: 4.8-7.9 %) (562/8148). There was large heterogeneity in prevalence of congenital malaria estimates among the different settings (I2 = 96.1 %). Hence the random effect model was used. In subgroup analyses, with respect to the type of malaria transmission, the prevalence of congenital malaria was significantly higher in areas characterized by unstable malaria transmission vs. the rate in areas with stable malaria transmission [16.8 % (95 % CI: 8.0-25.6 %) vs. 3.5 % (95 % CI: 2.3-4.6 %), Coefficient = 0.111; P = 0.035]. The results of additional sub- group (meta-regression) analyses showed a non-significant difference in prevalence of congenital malaria in study-sample sizes (Coefficient = -0.001, 95 % CI: -0.001 to 0.001), P-value = 0.534) and year of publication (C = -0.005; 95 % CI: -0.016 to 0.006), P-value = 0.369). CONCLUSION: This meta-analysis showed a varied prevalence of congenital malaria across endemic areas and it was higher in areas with unstable malaria transmissions.

Poor adherence to the World Health Organisation guidelines of management of severe acute malnutrition in children 6 to 59 months of age at Kalakla Turkish Hospital in Khartoum, Sudan.

Severe acute malnutrition (SAM) constitutes about a third of the estimated 8 million deaths in under 5-year-old children, and the World Health Organisation (WHO) protocol of management is used in hospital management. The present study aims to assess adherence to the WHO guidelines of management of SAM in children aged 6-59 months at Kalakla Turkish Hospital in Khartoum, Sudan. Medical records/files of 169 children, mean (standard deviation) age was 18.5 (10.4) months with a range of 6-54 months, admitted to the hospital were reviewed. The male/female ratio was 1.5:1. No records of history and the proportion of missing examination information were >5%. Weight-for-height Z-score was not calculated for 61% of children and other anthropometric measurements were inadequately recorded. Seven classifications of acute malnutrition were recorded instead of two. Oedema, mid-upper arm circumference and Z-score were neglected as tools of classification. Blood sugar, haemoglobin concentration and malaria film/rapid diagnostic tests were the only requested tests in 122 (72.2%), 14 (8.3%) and 49 (29%), respectively. Appropriate treatment was documented in 68 (40.2%) children for intravenous (IV) dextrose for hypoglycaemia, 25 (14.8%) for kangaroo technique, 32 (18.9%) covering with blanket for hypothermia, 106 (62.7%) for F75 milk formula and 115 (68%) for F100 milk formula feeding; and there were no records of receiving oral/IV rehydration. The case fatality rate was 5.9%. Quality of care can be improved by training. Improvement of hospital infrastructure with attention to specifying rooms for management of acute malnutrition will be of benefit to the application of the guidelines.

Malaria Parasite Density Estimation using Actual and Assumed White Blood Cells Count in Children in Eastern Sudan.

BACKGROUND: Estimating malaria parasite count is needed for estimating the severity of the disease and during the follow-up. OBJECTIVE: This study was conducted to determine the malaria parasite density among children using actual white blood cell (WBC) and the assumed WBC counts (8.0 × 10(9)/l). METHODS: A cross-sectional study was conducted at New Halfa Hospital, Sudan. WBC count and count of asexual malaria parasite were performed on blood films. RESULTS: One hundred and three children were enrolled. The mean (SD) WBCs was 6.2 (2.9) cells × 10(9)/l. The geometric mean (SD) of the parasite count using the assumed WBCs (8.0 × 10(9)/l cells/µl) was significantly higher than that estimated using the actual WBC count [7345.76 (31,038.56) vs. 5965 (28,061.57) rings/µl,p = 0.042]. CONCLUSION: Malaria parasitemia based on assumed (8.0 × 10(9)/) WBCs is higher than parasitemia based on actual WBCs.

Clinical characteristics and needle aspiration management of Bacillus Calmette-Guérin lymphadenitis in children.

OBJECTIVES: To describe characteristics of children developing Bacillus Calmette-Guérin (BCG) lymphadenitis, and to evaluate needle aspiration treatment. METHODS: Children developing BCG lymphadenitis following BCG vaccination in Al-Rass General Hospital, Al-Rass, Saudi Arabia were prospectively studied from October 2008 to September 2013. Non-suppurative BCG lymphadenitis was conservatively managed, while suppurative lymphadenitis was treated by needle aspiration. RESULTS: The mean (SD) age of children (n=23) was 4.1 (1.4) months, and symptoms duration was 2.08 (1.38) months. Fifteen (65.2%) children had suppurative, whereas 8 (34.8%) had non-suppurative lymphadenitis. Age, gender, birth weight, and duration of symptoms were not significantly different between children with suppurative and non-suppurative lymphadenitis (p>0.05). Children with suppurative adenitis had higher weight, and larger size of the involved lymph nodes compared with those with non-suppurative nodes (p=0.001). Most (91.3%) had axillary lesions; with a mean lymph node size of 3.2 cm. Abscesses were detected by ultrasound in 8 (80%). Non-suppurative lymphadenitis was conservatively managed, while suppurative was aspirated. The mean duration for resolution was 3.25 months. Lymph nodes aspirate were positive for acid and alcohol fast bacilli in 10 patients (66.6%), and 3 of them grew Staphylococcus aureus. CONCLUSION: Bacillus Calmette-Guérin adenitis occurs in young children, mainly as unilocular suppurative left axillary group with a mean size of 3.2 cm. Needle aspiration is safe in treatment of suppurative lymphadenitis. Mycobacteria stained positive in most of the suppurative lesions. Excision is not needed.

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.

Poor adherence to the World Health Organization guidelines of treatment of severe pneumonia in children at Khartoum, Sudan.

BACKGROUND: Community-acquired pneumonia (CAP) is as a major cause for childhood morbidity and mortality worldwide. This study was conducted to investigate the adherence and response of the WHO guidelines for treatment of severe pneumonia. METHOD: A cross-sectional study was conducted in the period of June 2009 to July 2010 at Khartoum Hospital, Sudan. Children admitted and treated for severe pneumonia were enrolled. RESULTS: Only 39 (18.8%) out of 208 enrolled children received prescriptions that were adherent to the WHO guidelines of treatment of severe pneumonia. In logistic regression none of the investigated variable (age, gender, and clinical presentations) was associated with the adherence to the WHO guidelines. There was no significant difference in the response between adherent and non-adherent prescriptions. There was no association between the demographic, clinical data, treatment-adherence to the guidelines and the patients' response. CONCLUSION: There is a poor (18.8%) adherence to the WHO guidelines of the treatment of severe pneumonia in the region regardless to the age, gender and clinical presentation.

Acute Toxoplasma gondii infection in children with reactive hyperplasia of the cervical lymph nodes.

OBJECTIVE: To determine the seroprevalence of Toxoplasma gondii (T. gondii) in children with reactive hyperplasia of the cervical lymph nodes. METHODS: This cross-sectional prospective study was conducted in Khartoum Children Emergency Hospital, Khartoum, Sudan between January 2010 and April 2011. Eighty children with cervical lymphadenopathy were selected using random sampling. Their lymph nodes were aspirated for cytology, and a blood sample was collected from all patients for routine laboratory analysis and T. gondii IgG and IgM antibodies. RESULTS: Among 80 children with cervical lymphadenopathy, 60 (75%) had non-specific reactive hyperplasia. The seroprevalence of T. gondii among children with cervical lymphadenopathy was 27.5% (n=22), and the seropositivity of acute T. gondii among those with reactive hyperplasia was 36.7% (n=22/60). Lymph nodes in the T. gondii positive group were mobile and warm (p<0.05). The clinical features and laboratory tests were insignificant predictors of acute T. gondii infection with reactive hyperplasia of the cervical lymph nodes. CONCLUSION: The prevalence of acute T. gondii infection is high among children with non-specific reactive hyperplasia of the cervical lymph nodes. Routine laboratory studies are not helpful in the diagnosis of T. gondii infection with reactive hyperplasia of the lymph nodes however, serological studies may be requested prior to invasive procedures.

Low neonatal blood glucose levels in cesarean-delivered term newborns at Khartoum Hospital, Sudan.

BACKGROUND: Glucose is the main source of energy for organ function in neonates. There are few published recent data on neonatal glucose levels during cesarean delivery. METHODS: A case (cesarean delivery) -control (vaginal delivery) study was conducted at Khartoum Hospital Sudan to compare blood glucose levels of term newborns born after elective cesarean delivery with those born vaginally. RESULTS: Cord blood glucose levels at delivery were significantly lower in women who had a cesarean delivery compared with those who delivered vaginally (99.8 ± 20.6 vs. 106.8 ± 11.1 mg/dl, P=0.026), but there was no significant difference (97.8 ± 16.7 vs. 102.1 ± 9.6, P=0.110) in newborn glucose levels at 2 hours after delivery between the groups. In linear regression, cesarean delivery (-6.475 mg/dl, P=0.013) and maternal blood glucose levels at the time of delivery (+0.619 mg, P<0.001) were significantly associated with mean cord glucose levels. CONCLUSION: This study shows that cord blood glucose levels are significantly lower in cesarean-delivered neonates than vaginally-delivered neonates. In addition, cord blood glucose levels are significantly associated with cesarean delivery and maternal blood glucose levels at delivery. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2011479878124993.

Documentation of vancomycin-resistant Staphylococcus aureus (VRSA) among children with atopic dermatitis in the Qassim region, Saudi Arabia.

INTRODUCTION: Staphylococcus aureus is known as a common pathogen in atopic dermatitis. A methicillin-resistant S. aureus strain with reduced susceptibility to vancomycin (VISA/VRSA) is increasing worldwide. The aims of this study were to evaluate the antibiotic-susceptibility pattern of S. aureus isolated from children with atopic dermatitis and to identify the occurrence of resistance to glycopeptide antibiotics. METHODS: Swabs were collected from atopic dermatitis skin lesions of 80 children being treated at dermatology clinics whose ages ranged from 6 months to 15 years in the period from March 2009 to February 2010. Isolates were studied with an antibiogram for an antibiotic-susceptibility test. The selected antibiotics were the usually administered antimicrobials at dermatological clinics in Buraydah (Qassim, Saudi Arabia). Results were determined as minimal inhibitory concentration (MIC) using the Vitek system. RESULTS: Thirty S. aureus isolates showed resistance to streptomycin (100%), benzylpenicillin and ampicillin (96.7%), and oxacillin (90%). S. aureus resistance to trimethoprim/sulfamethoxazole, tigecycline, and vancomycin was 63.3%, 83.3%, and 53.3%, respectively. Resistance to linezolid was less, at 5.7%. CONCLUSIONS: Strains of MRSA with decreasing susceptibility to vancomycin were documented in the Qassim region of Saudi Arabia. Other studies will be required on VISA/VRSA strains concerning phenotypic and genotypic characterization.