Examining the use, confidence, and barriers to follow Advanced Life Support in Obstetrics (ALSO) course guides in managing obstetric emergencies in Sudan.

BACKGROUND: The Advanced Life Support in Obstetrics (ALSO) course is a globally recognized interprofessional training program designed to assist healthcare professionals in acquiring and sustaining the necessary knowledge and skills to handle obstetric emergencies effectively. This survey aimed to assess the use, barriers, and confidence in using the ALSO course guidelines in managing obstetric emergencies in Sudan. METHODS: This descriptive cross-sectional study involved 103 physicians from the Sudan ALSO group in Sudan. A structured, close-ended questionnaire was distributed electronically to the participants. Data analysis was conducted using Statistical Package of Social Sciences Software version 26. RESULTS: More than half of the participants were specialists (54.4%). Although all respondents claimed to adhere to the ALSO guidelines for managing shoulder dystocia, a lower percentage followed them for neonatal resuscitation (75.0%) and maternal venous thrombosis management (68.9%). Only 62.1% of participants felt confident performing neonatal resuscitation. The main barriers to implementing the ALSO course guidelines were the respondents' preference for other guidelines and their belief that the guidelines were not applicable in their specific settings. CONCLUSION: The majority of participants displayed a high level of confidence, indicating a positive perception of the guide's effectiveness. However, there is room for improvement, particularly in areas such as neonatal resuscitation and forceps-assisted births, where confidence levels were lower. Addressing barriers, including the preference for other guidelines and the applicability of the guide in specific settings, is crucial to ensure widespread adoption. Refresher training programs, contextual adaptations, and the integration of guidelines may help overcome these barriers and enhance the overall implementation of the ALSO guide in managing obstetric emergencies in Sudan.

Progress and challenges in implementing non-communicable disease policies in Sudan.

Non-communicable diseases (NCD) pose a substantial global public health challenge, representing the leading cause of morbidity and mortality worldwide. This study investigates the progress and challenges in implementing NCD policies in Sudan. Document analysis following the ready your materials, extract data, analyse data and distil your findings (READ) approach, was utilized to review published literature and reports. Data from the NCD Progress Monitor showed that the percentage of NCD-related mortality had increased from 32% in 2015 to 54% in 2022. Sudan's progress in implementing NCD policies has been slow and challenging; eight of the 19 NCD target indicators had never been fully achieved, and only five targets were fully achieved in the year 2022. However, these figures may be underestimated due to the lack of robust NCD information systems. Like many countries, Sudan faces challenges in implementing NCD policies, particularly those targeting healthy diets, medications and data management systems. This may be linked to the prolonged history of conflict, shortage of trained health personnel, limited resources and lack of robust NCD surveillance systems in the country. The ongoing devastating war and destruction of the healthcare system infrastructure in Sudan further intensified these challenges. Prioritizing NCD policies and programmes during the anticipated post-conflict health system reforms is crucial for enhancing NCD prevention and outcomes in Sudan.

Physician experiences with teleconsultations amidst conflict in Sudan.

The current conflict in Sudan severely hinders the accessibility of health services across the country. To address this, several initiatives were proposed including offering services using teleconsultations. This study aimed to assess Sudanese doctors' teleconsultation experience, perception, and concerns during the recent conflict. This cross-sectional survey focused on Sudanese medical officers, residents, specialists, and consultants living inside or outside the country having a practice license from the Sudan Medical Council and conducting teleconsultations with Sudanese patients during the conflict period. The questionnaire was distributed to personal and professional contacts and via social media platforms in the English language among doctors who provided teleconsultation during the conflict. Data analysis was performed using the Statistical Package for Social Sciences software version 26. The study enrolled 2463 clinicians from 17 different specialties, and females represented more than half the sample (56.8%). Internal medicine was the most frequent specialty (36.1%) and the majority (68.7%) of clinicians had less than 5 years of work experience. Voice call was the most frequent platform (50.1%) used for teleconsultation during the conflict and had the highest convenience score (p < 0.01), whereas messaging platforms had the lowest score. Most clinicians (73.3%) agreed that teleconsultations created a trusted patient-physician relationship and provided good-quality care (61.8%). However, 85.1% highlighted the importance of physical touch in medical practice. Clinicians were concerned that incomplete information (81.4%), missed diagnosis (76.8%), medicolegal problems (71.0%), and prescription errors (68.4%) could arise with teleconsultations. Most respondents (70.7%) emphasized the importance of continuing to offer teleconsultation even after the war abated. In conclusion, physicians who participated in the current study agreed that teleconsultation provided quality care even in this dire crisis in Sudan. Based on our study findings, we recommend upscaling telemedicine interventions including teleconsultations at the national level. This would require unified coordination efforts of a wide mix of stakeholders to address concerns identified in the current study.

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.

Predictors of Tetanus Vaccine Uptake among Pregnant Women in Khartoum State, Sudan: A Hospital-Based Cross-Sectional Study.

Tetanus toxoid (TT) vaccination during pregnancy has been proven as an effective preventative measure to reduce the incidence of maternal and neonatal morbidity and mortality worldwide. This study aimed to assess the determinants of TT vaccine uptake among pregnant women at two public maternity specialized hospitals in Sudan. A hospital-based cross-sectional study was conducted at two public hospitals, Omdurman Maternity Hospital and Al Saudi Hospital in Omdurman, Khartoum State, in Sudan from February to April 2020. Logistic regression analysis was carried out to identify factors associated with receiving three or more doses of the TT vaccine among pregnant women, presented as odds ratios, with p-values < 0.05 considered significant (at a 95% confidence interval). The study recruited 350 pregnant women, with 313 participants included in the analysis. This study found that only 40% of the pregnant women had received three doses or more of the TT vaccine. Pregnant women who attended Al Saudi Hospital were less likely to be vaccinated with the recommended dose of the TT vaccine in districts at high risk (received ≥3 doses) compared to those who attended Omdurman Hospital [OR = 0.49 (95% C.I. 0.29-0.82), p-value < 0.05]. Furthermore, the number of children at home was a significant predictor of the mothers' immunization status as those with five children or more were ten times more likely to be vaccinated with three doses or more [OR = 10.54 (95% C.I. 4.30-25.86), p-value < 0.05]. We conclude that this low rate of TT vaccine uptake found in this study among pregnant women increases the number of newborn babies susceptible to contracting neonatal tetanus. The findings of this study should be considered in the development of communication strategies targeting and prioritizing at-risk groups to increase TT vaccine uptake among pregnant women in Sudan.

The Psychological Antecedents to COVID-19 Vaccination among Community Pharmacists in Khartoum State, Sudan.

Background and Objectives: Little is known regarding the 5C psychological antecedents to COVID-19 vaccination among pharmacists in low- and middle-income countries. This study aimed to assess the acceptance of COVID-19 vaccination and its psychological antecedents among community pharmacists in Khartoum State, Sudan. Materials and Methods: A cross-sectional study was conducted from July to September 2022. A self-administered questionnaire was used to collect data about sociodemographic and health status characteristics, vaccine acceptance, and the 5C psychological antecedents to vaccination. Stepwise logistic regression analysis was conducted, and results were presented using odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). Results: A total of 382 community pharmacists participated in the current study, with a mean age of 30.4 ± 5.6 years. Nearly two-thirds of the participants (65.4%) were females, and the majority (74.9%) have received or intended to receive the COVID-19 vaccination. Vaccine acceptance was significantly associated with the following psychological antecedents to vaccination: confidence, complacency, constraints, and calculation (p < 0.001). Results of the logistic regression showed that confidence in vaccines [OR = 6.82 (95% CI = 3.14-14.80)], conspiracy beliefs [OR = 0.44 (95% CI = 0.23-0.85)], and constraints to vaccination [OR = 0.18 (95% CI = 0.06-0.56)] were the significant determinants of vaccine acceptance. Conclusion: The study revealed important predictors of COVID-19 vaccine acceptance that can be used to guide policymakers in designing target-oriented interventions that can improve the vaccine acceptance rate among community pharmacists in Sudan. These findings suggest that interventions to promote vaccine acceptance among pharmacists should focus on building confidence in vaccines and providing accurate information about the safety and efficacy of the COVID-19 vaccine, and reducing constraints to vaccination.

High levels of burnout among health professionals treating COVID-19 patients in two Nile basin countries with limited resources.

Burnout syndrome is a real cause for concern in African health facilities. Healthcare professionals (HCPs) burnout is considered a great public health problem and especially during pandemics as several physical and emotional stressors on this population can lead to increased burnout. This study aimed to investigate the frequency and associated factors of occupational burnout among HCPs working at COVID-19 isolation facilities in Egypt and Sudan. This is important to summarize lessons learned and inform relevant interventions for future pandemic responses. A cross-sectional survey was conducted among frontline HCPs from May 2021 to July 2021. An online, anonymous, self-administered questionnaire was used for data collection. Occupational burnout was estimated using  the Oldenburg Burnout Inventory. A total of 362 HCPs participated in the study and were equally recruited from Egypt (181) and Sudan (181) with a mean age of (31.84 ± 8.32) years. More than half of HCPs were females (60%) and physicians (58.3%). Most HCPs included in the study had high levels of work disengagement (75.4%) and emotional exhaustion (98.6%). Burnout syndrome was present in 75% of the HCPs with 77% among Egyptian HCPs and 71% among Sudanese HCPs. Multivariate logistic regression was used to determine predictors of burnout, working hours per week were the parameters associated with burnout syndrome among Egyptian HCPs; while for Sudanese HCPs, these were age and number of days off. The study revealed a high level of burnout syndrome among HCPs working at COVID-19 isolation facilities in both Egypt and Sudan. Appropriate actions should be taken to preserve the mental health status of HCPs through the establishment of effective and efficient coping strategies.

Quality of life among health care workers in Arab countries 2 years after COVID-19 pandemic.

Background: Assessment of the quality of life (QoL) among healthcare workers (HCWs) is vital for better healthcare and is an essential indicator for competent health service delivery. Since the coronavirus disease 2019 (COVID-19) pandemic strike, the frontline position of HCWs subjected them to tremendous mental and psychological burden with a high risk of virus acquisition. Aim: This study evaluated the QoL and its influencing factors among HCWs residing in the Arab countries. Methods: This was a cross-sectional study using a self-administered online questionnaire based on the World Health Organization QoL-BREF instrument with additional questions related to COVID-19. The study was conducted in three different languages (Arabic, English, and French) across 19 Arab countries between February 22 and March 24, 2022. Results: A total of 3,170 HCWs were included in the survey. The majority were females (75.3%), aged 18-40 years (76.4%), urban residents (90.4%), married (54.5%), and were living in middle-income countries (72.0%). The mean scores of general health and general QoL were 3.7 ± 1.0 and 3.7 ± 0.9, respectively. Those who attained average physical, psychological, social, and environmental QoL were 40.8, 15.4, 26.2, and 22.3%, respectively. The income per capita and country income affected the mean scores of all QoL domains. Previous COVID-19 infection, having relatives who died of COVID-19, and being vaccinated against COVID-19 significantly affected the mean scores of different domains. Conclusion: A large proportion of the Arab HCWs evaluated in this study had an overall poor QoL. More attention should be directed to this vulnerable group to ensure their productivity and service provision.

Exploring enablers and barriers toward COVID-19 vaccine acceptance among Arabs: A qualitative study.

Background: With the emergence of the coronavirus disease 2019 (COVID-19) and rapid vaccine development, research interest in vaccine hesitancy (VH) has increased. Research usually focuses on quantitative estimates which largely neglected the qualitative underpinnings of this phenomenon. This study aimed to explore the beliefs and views towards COVID-19 vaccination among Arabs in different countries. Furthermore, we explored the effect of confidence in the healthcare system, misinformation, and scientific approaches adopted to mitigate COVID-19 on how individuals are following the recommended preventative actions including vaccination. Methods: This study was based on the Strategic Advisory Group of Experts (SAGE)-VH Model: A qualitative design that utilized in-depth, online interviews. The study was conducted in seven Arab countries (Egypt, Qatar, Kingdom of Saudi Arabia, Libya, Sudan, United Arab Emirates and Jordan) from June 2020 to December 2021. Transcripts were analyzed using NVivo 12 Software. Results: A total of 100 participants, 44 males and 56 females, of different age groups (37.1 ± 11.56 years) were interviewed. Findings revealed six themes as enablers and barriers to COVID-19 vaccination. Many participants indicated trusting the vaccines, the healthcare systems, and the vaccination policies were the main driver to get the vaccine. Participants showed concerns towards potential long-term vaccine effects. A consistent inclination towards collective responsibility, which is the willingness to protect others by own vaccination, was also reported. Conclusion: Enablers and barriers of COVID-19 vaccination acceptance in the Arab region, from sociocultural and political perspectives, are critical to guide policymakers in designing target-oriented interventions that can improve vaccine acceptance.

Perceived Vaccine Availability and the Uptake of Measles Vaccine in Sudan: The Mediating Role of Vaccination Hesitancy.

This study aimed to evaluate whether measles vaccine uptake can be predicted directly or indirectly by parental perceptions about the availability of measles vaccine services with parental hesitancy towards the measles vaccine as a potential mediator. This was a community-based cross-sectional study conducted at Omdurman locality in Khartoum state, Sudan in February 2019. The study population included parents/guardians having at least one child aged 2-3 years old. Mediation analysis was conducted using two models, the ordinary least squares path analysis and multiple logistic regression. These models considered perceived vaccine accessibility and availability as independent factors, vaccine uptake as dependent factors, and vaccine hesitancy (PACV scores) as a mediator. A total of 495 responded and the mean age of the mothers who participated in the study was 31.1 (SD = 5.73). Half of the respondents (50.1%) completed university education and nearly three-quarters of the respondents (74.7%) were housewives. After controlling for the other factors, including the mother's age and the number of children, parental perception about the accessibility and availability of the measles vaccine influences the uptake of the measles vaccine indirectly through the mediation effect of measles vaccine hesitancy. We suggest that intervening in measles vaccine hesitancy in addition to measles vaccination access issues will have a positive impact on the uptake and coverage of the measles vaccine in Sudan.

Self-reported adherence to preventive practices during the third wave of COVID-19 in Afghanistan.

Objective: The study objectives were aimed to highlight the areas where public awareness is needed to enhance preventive practices among the public. Hence, to avoid the spread of virus in public settings. In addition, the study has provided compelling data and evidence on the coronavirus disease-2019 trend for health policymakers to make strategic decisions. Introduction: The coronavirus disease-2019 is a highly contagious respiratory disease caused by severe acute respiratory syndrome coronavirus type-2. The disease has spread across the globe. In Afghanistan, thousands of confirmed cases with hundreds of deaths have been reported. In addition, due to insufficient healthcare workforce, insecurity, fragile healthcare infrastructure, low coronavirus disease-2019 vaccination and low testing capacity, the true nature of the pandemic is unlcear. Method: An online survey of the general population in Afghanistan was conducted from April-May 2021. Convenience sampling technique was used to recruit the respondents. Social media platforms were used (WhatsApp, Twitter and Facebook Messenger) to disseminate the electronic survey instrument. Written informed consent was taken from the participants before the filling questionnaires. Data collection was guided through a self-administered questionnaire developed by the researchers according to the World Health Organization guidelines. The sample size was calculated using EPI software. The inclusion criteria were being 18 years or older and having access to the Internet to fill out the online questionnaire. IBM SPSS Statistics version 25.0 was used for analysis. Descriptive statistics (frequencies, percentages) and bi-variable (chi-square) analyses were done. A p value of <0.05 was considered significant at a 95% confidence interval. Results: From 1094 respondents, 78% were male. The majority of respondents were aged ⩽30 years and had an undergraduate education. Nearly 1 in 3 participants were healthcare workers, and 70% lived in households with five or more family members. Overall, 70% of the respondents reported good preventive practices. The majority of the participants reported covering their mouth and nose while coughing and sneezing and cleaning their hands regularly and using alcohol. Meanwhile, 80% of the participants wore a mask when going outside. Moreover, people with post-graduate education had a higher level of preventive practices than those with an undergraduate education.The results of logistic regression revealed participants residence in Kabul, healthcare workers, family size less than 5, avoid meeting people outside, gender, and avoiding 3Cs, were the significant determinants of adhering to good preventive practices. Conclusion: Generally, the public in Afghanistan followed infection prevention rules. However, certain areas require further improvement, such as observing social distance and avoiding shaking hands when meeting others. Negligence of these prevention practices can lead to an increase in infection transmission among people. Public awareness should be continued to keep the people supportive of the government policies.

COVID-19 Vaccine Acceptance among Social Media Users: A Content Analysis, Multi-Continent Study.

Vaccine hesitancy (VH) is defined as a delayed in acceptance or refusal of vaccines despite availability of vaccination services. This multinational study examined user interaction with social media about COVID-19 vaccination. The study analyzed social media comments in 24 countries from five continents. In total, 5856 responses were analyzed; 83.5% of comments were from Facebook, while 16.5% were from Twitter. In Facebook, the overall vaccine acceptance was 40.3%; the lowest acceptance rates were evident in Jordan (8.5%), Oman (15.0%), Senegal (20.0%) and Morocco (20.7%) and the continental acceptance rate was the lowest in North America 22.6%. In Twitter, the overall acceptance rate was (41.5%); the lowest acceptance rate was found in Oman (14.3%), followed by USA (20.5%), and UK (23.3%) and the continental acceptance rate was the lowest in North America (20.5%), and Europe (29.7%). The differences in vaccine acceptance across countries and continents in Facebook and Twitter were statistically significant. Regarding the tone of the comments, in Facebook, countries that had the highest number of serious tone comments were Sweden (90.9%), USA (61.3%), and Thailand (58.8%). At continent level, serious comments were the highest in Asia (58.4%), followed by Africa (46.2%) and South America (46.2%). In Twitter, the highest serious tone was reported in Egypt (72.2%) while at continental level, the highest proportion of serious comments was observed in Asia (59.7%), followed by Europe (46.5%). The differences in tone across countries and continents in Facebook and Twitter and were statistically significant. There was a significant association between the tone and the position of comments. We concluded that the overall vaccine acceptance in social media was relatively low and varied across the studied countries and continents. Consequently, more in-depth studies are required to address causes of such VH and combat infodemics.

Healthcare Utilization with Drug Acquisition and Expenses at the National Health Insurance Fund in Sudan.

Background: Understanding the pattern of care use can provide valuable information for reform interventions. This study investigates the pattern of healthcare utilization and its association with drug acquisition patterns and expenses in the National Health Insurance Fund (NHIF) of Al Jazira State in Sudan. Methods: A cross-sectional survey was conducted at NHIF primary healthcare centers of Al Jazirah state in Sudan. Results: A total of 768 beneficiaries were interviewed, of which 63.2% reported using out-of-network physician care, while 36.8% receive care from the NHIF physician network only. More than half (60.8%) of NHIF-interviewed clients reported a heavy burden of medication costs. The pattern of physician utilization was significantly associated with the number and source of regular drugs, the burden of out-of-pocket payment, and monthly out-of-pocket expenditures on medications, (p < 0.001). The regression analysis revealed that gender, marital status, number of chronic diseases, and number of regular drugs were the significant predictors of the pattern of physician care utilization; these factors explained nearly 36% of the variance in respondents' pattern of physician care utilization. Conclusions: An impressive proportion of out-of-network care was found in Al Jazirah State in Sudan. The NHIF stakeholders should consider medication subsidy as a potential strategy for decreasing patient leakage to out-of-network services.

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.

A Meta-Analysis on the Safety and Immunogenicity of Covid-19 Vaccines.

OBJECTIVE: The presented meta-analysis (MA) aims at identifying the vaccine safety and immunogenicity in published trials about SARS-CoV-2 vaccines. METHODS: All relevant publications were systematically searched and collected from different databases (Embase, Scopus, EBSCO, MEDLINE central/PubMed, Science Direct, Cochrane Central Register for Clinical Trials (CENTRAL), Clinical Trials.gov, WHO International Clinical Trials Registry Platform (ICTRP), COVID Trial, COVID Inato, Web of Science, ProQuest Thesis, ProQuest Coronavirus Database, SAGE Thesis, Google Scholar, Research Square, and Medxriv) up to January 10, 2021. The pooled vaccine safety and immunogenicity following vaccination in phase 1 and 2 vaccine clinical trials, as well as their 95% confidence intervals (CI), were estimated using the random-effects model. RESULTS: The predefined inclusion criteria were met in 22 out of 8592 articles. The proportion of anti-severe acute respiratory distress coronavirus 2 (SARS-CoV-2) antibody responses after 7 days among 72 vaccinated persons included in 1 study was 81% (95% CI: 70-89), after 14 days among 888 vaccinated persons included in 6 studies was 80% (95% CI: 58-92), after 28 days among 1589 vaccinated persons included in 6 studies was 63% (95% CI: 59-67), after 42 days among 478 vaccinated persons included in 5 studies was 93% (95% CI: 80-98), and after 56 days among 432 vaccinated persons included in 2 studies was 93% (95% CI: 83-97). Meta regression explains more than 80% of this heterogeneity, where the main predictors were; the inactivated vaccine type (ß = 2.027, P = 0.0007), measurement of antibodies at week 1 (ß = -4.327, P < 0.0001) and at week 3 of the first dose (ß = -2.02, P = 0.0025). Furthermore, the pooled proportion adverse effects 7 days after vaccination was 0.01 (0.08-0.14) for fever, headache 0.23 (0.19-0.27), fatigue 0.10 (0.07-0.13), and 0.18 (0.14-0.23) for muscle pain. CONCLUSION: Immunogenicity following vaccination ranged from 63% to 93% depending on the time at which the antibody levels were measured.

Determinants of Out-of-Network Utilization of Care Among Insured Clients Under the National Health Insurance Fund of Sudan.

Purpose: Knowledge of insured clients' utilization behavior is essential for developing evidence-based interventions for reform activities. This study explored the magnitude and determinants of voluntary out-of-network physician visit utilization among an insured population under the National Health Insurance Fund (NHIF) of Sudan. Methods: This study was a cross-sectional survey conducted at the primary healthcare centers of NHIF in Al Jazirah state in Sudan. A structured interview questionnaire was used to collect data related to socio-economic and health insurance characteristics of NHIF clients and to assess their utilization behavior. Data were collected from September to October 2021. Results: Of 768 NHIF clients who were interviewed (mean age 46 years, 55.1% females), 63.2% reported using out-of-network physician visits during the last six months prior to the interview. The median out-of-pocket payment for the last out-of-network physician visit was 5000 Sudanese pounds. The regression analysis revealed that clients' gender, marital status, self-reported health, overall rating of the quality of care, rating of the general practitioner care, and ease of referral to a specialist were the significant determinants for seeking out-of-network physician care. Conclusion: A high magnitude of out-of-network physician visit utilization was found among the insured NHIF clients of Al Jazirah state in Sudan. Policymakers should address issues identified in the current study to reduce patients' leakage to out-of-network services.

Efficacy and Effectiveness of SARS-CoV-2 Vaccines: A Systematic Review and Meta-Analysis.

The coronavirus disease 2019 (COVID-19) pandemic has threatened global health and prompted the need for mass vaccination. We aimed to assess the efficacy and effectiveness of COVID-19 vaccines to prevent mortality and reduce the risk of developing severe disease after the 1st and 2nd doses. From conception to 28 June 2021, we searched PubMed, Cochrane, EBSCO, Scopus, ProQuest, Web of Science, WHO-ICTRP, and Google Scholar. We included both observational and randomized controlled trials. The pooled vaccine efficacy and effectiveness following vaccination, as well as their 95 percent confidence intervals (CI), were estimated using the random-effects model. In total, 22 of the 21,567 screened articles were eligible for quantitative analysis. Mortality 7 and 14 days after full vaccination decreased significantly among the vaccinated group compared to the unvaccinated group (OR = 0.10, ([95% CI, 0.04-0.27], I2 = 54%) and (OR = 0.46, [95% CI, 0.35-0.61], I2 = 0%), respectively. The probability of having severe disease one or two weeks after 2nd dose decreased significantly (OR = 0.29 [95% CI, 0.19-0.46], I2 = 25%) and (OR = 0.08 [95% CI, 0.03-0.25], I2 = 74%), respectively. The incidence of infection any time after the 1st and 2nd doses diminished significantly (OR = 0.14 [95% CI, 0.07-0.4], I2 = 100%) and (OR = 0.179 [95% CI, 0.15-0.19], I2 = 98%), respectively. Also, incidence of infection one week after 2nd dose decreased significantly, (OR = 0.04, [95% CI (0.01-0.2], I2 = 100%). After meta-regression, the type of vaccine and country were the main predictors of outcome [non-mRNA type, ß = 2.99, p = 0.0001; country UK, ß = -0.75, p = 0.038; country USA, ß = 0.8, p = 0.02]. This study showed that most vaccines have comparable effectiveness, and it is purported that mass vaccination may help to end this pandemic.

A cross-sectional survey of burnout in a sample of resident physicians in Sudan.

BACKGROUND: Resident physicians in Sudan face a variety of physical and psychological stressors. Nevertheless, the prevalence of burnout syndrome among this critical population remains unknown. The purpose of this study was to estimate the prevalence rate of burnout and its associated factors in a sample of resident physicians in Sudan. METHODS: A cross-sectional design was used to assess the burnout syndrome among resident physicians at the teaching hospitals of Wad-Medani in Gezira state, east-central Sudan. Three hundred resident physicians at the dermatology, general surgery, pediatrics, obstetrics and gynecology, psychiatry, ear, nose and throat (ENT), oncology, urology, and internal medicine departments, were approached and invited to participate in the study. The Arabic version of the Maslach Burnout Inventory was distributed to respondents from July to October 2021. RESULTS: From the 300 resident physicians, 208 (69.3%) responded. The average age of the study population was 29.99 ± 3.01 years, with more than half were females (56.7%), single (59.6%), and with more than three years of residency experience (50.5%). In total, 86.1% met the criteria for burnout in at least one dimension and 13.9% in all three dimensions. On the dimension of emotional exhaustion (EE), 70.7% reported high levels of burnout. While, 44.2% reported high levels of depersonalization (DP), and 73.1% experienced a sense of decreased professional accomplishment (PA). There were significant differences in burnout, EE, and DP levels among different specialties, with the pediatrics-specialty trainees reported higher levels. Burnout syndrome was associated with the working hours per single duty; participants who reported working for more than 24 hours had experienced higher levels of burnout, EE, and DP. CONCLUSION: Large-scale studies are required to assess the determinants of burnout syndrome among resident physicians in Sudan. In addition, Stakeholders should urgently implement effective remedies to protect the mental health of resident physicians.