Factors associated with unfavorable treatment outcomes among multidrug-resistant tuberculosis patients, Sierra Leone: a cross-sectional secondary data analysis.

BACKGROUND: Globally, multidrug-resistant tuberculosis (MDR-TB) is a major public health problem. The tuberculosis rate in Sierra Leone is 298 per 100,000 people, and Sierra Leone is considered a country with a high burden of tuberculosis. In Sierra Leone, there are few studies on the outcomes of MDR-TB treatment, especially those exacerbated by COVID-19. We identified factors associated with unfavorable treatment outcomes among people with MDR-TB in Sierra Leone. METHODS: We conducted a cross-sectional study to analyze hospital-based MDR-TB data from 2017 to 2021. Demographic, clinical, and treatment outcome data were extracted from the main MDR-TB referral hospital database. We defined unfavorable outcomes as patients who died, were lost to follow-up, or defaulted. We calculated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to identify predictors of the outcomes of MDR-TB treatment. RESULTS: Between 2017 and 2021, 628 people with MDR-TB were reported at Lakka Hospital; 441 (71%) were male, with a median age of 25 years (interquartile ranges: 17-34). Clinically, 21% of the 628 MDR-TB patients were HIV positive, and 413 were underweight (66%). 70% (440) of MDR-TB patients received tuberculosis treatment. The majority of patients, 457 (73%), were treated with a short treatment regimen, and 126 (20%) experienced unfavorable outcomes. Age 45 years or younger (aOR = 5.08; CI:1.87-13.82), 21-45 years (aOR = 2.22; CI:140-3.54), tuberculosis retreatment (aOR = 3.23; CI:1.82-5.73), age group, HIV status (aOR = 2.16; CI:1.33-3.53), and malnourishment status (aOR = 1.79; CI:1.12-2.86) were significantly associated with unfavorable treatment outcomes for DR-TB patients. CONCLUSION: This analysis revealed a high proportion of unfavorable treatment outcomes among MDR-TB patients in Sierra Leone. Malnourishment, TB retreatment, HIV coinfection, and age 45 years or younger were associated with unfavorable outcomes of MDR-TB treatment. Increasing patients' awareness, mainly among young people, heightens treatment adherence and HIV monitoring by measuring the amount of HIV in patient blood, which can reduce adverse treatment outcomes in Sierra Leone and other sub-Saharan African countries.

Unique Outbreak of Rift Valley Fever in Sudan, 2019.

We report a unique outbreak of Rift Valley fever in the Eldamar area, Sudan, May-July 2019, that resulted in 1,129 case-patients and 19 (1.7%) deaths. Patients exhibited clinical signs including fever (100%), headache (79%), and bleeding (4%). Most (98%) patients also reported death and abortions among their livestock.

Dengue Fever in the Darfur Area, Western Sudan.

We report an outbreak of dengue in Darfur, western Sudan, during September 2014-April 2015. Dengue virus-specific PCR testing of 50 samples from nonmalaria febrile illness case-patients confirmed 35 dengue cases. We detected 7 cases of dengue shock syndrome and 24 cases of dengue hemorrhagic fever.

Digitalizing disease surveillance: experience from Sierra Leone.

The Integrated Disease Surveillance and Response (IDSR) system was adopted by the Sierra Leone Ministry of Health (MOH) in 2008, which was based on paper-based tools for health data recording and reporting from health facilities to the national level. The Sierra Leone MoH introduced the implementation of electronic case-based disease surveillance reporting of immediately notifiable diseases. This study aimed to document and describe the experience of Sierra Leone in transforming her paper-based disease surveillance system into an electronic disease surveillance system. Retrospective mixed methods of qualitative and quantitative data were reviewed. Qualitative data was collected by reviewing surveillance technical reports, epidemiological bulletins, COVID-19, IDSR technical guidelines, Digital Health strategy, and DHIS2 documentation. Content and thematic data analysis were performed for the qualitative data, while Microsoft Excel and DHIS2 platform were used for the quantitative data analysis to document the experience of Sierra Leone in digitalizing its disease surveillance system. In early 2017, a web-based electronic Case-Based Disease Surveillance (eCBDS) for real-time reporting of immediately notifiable diseases and health threats was piloted using the District Health Information System 2 (DHIS2) software. The eCBDS, integrates case profile, laboratory, and final outcome data. All captured data and information are immediately accessible to users with the required credentials. The system can be accessed via a browser or an Android DHIS2 application. By 2021, there was a significant increase in the proportion of immediately notifiable cases reported through the facility-level electronic platform, and more than 80% of the cases reported through the weekly surveillance platform had case-based data in eCBDS. Case-based data from the platform is analyzed and disseminated to stakeholders for public health decision-making. Several outbreaks of Lassa fever, Measles, vaccine-derived Polio, and Anthrax have been tracked in real-time through the eCBDS.

Behavioral practices towards antibiotic use among health care workers - Sierra Leone, 2021: a facility-based cross-sectional study.

Introduction: globally, antimicrobial resistance (AMR) kills around 1.27 million 700,000 people each year. In Sierra Leone, there is limited information on antibiotic use among healthcare workers (HCWs). We assessed antibiotic prescribing practices and associated factors among HCWs in Sierra Leone. Methods: we conducted a cross-sectional survey among HCWs. We collected data using a questionnaire containing a Likert scale for antibiotic prescribing practices. We categorized prescribing practices into good and poor practices. We calculated adjusted odds ratios (aOR) to identify risk factors. Results: out of 337 (100%) HCWs, 45% scored good practice. Out of the total, 131 (39%) of HCWS considered fever as an indication of antibiotic resistance and 280 (83%) HCWs prescribed antibiotics without performing microbiological tests and 114 (34%) prescribed a shorter course of antibiotics. Factors associated with good practice were being a doctor (aOR=1.95; CI: 1.07, 3.56), the internet as a source of information (aOR=2.00; CI: 1.10, 3.66), having a high perception that AMR is a problem in the health-facility (aOR=1.80; CI: 1.01, 3.23) and there is a connection between one´s prescription and AMR (aOR=2.15; CI: 1.07, 4.32). Conclusion: this study identified a low level of good practice toward antibiotic prescription. We initiated health education campaigns and recommended continuous professional development programs on antibiotic use.

Prevalence of malaria and dengue co-infections among febrile patients during dengue transmission season in Kassala, eastern Sudan.

BACKGROUND: Malaria and dengue are common mosquito-borne diseases around the world that cause high mortality and morbidity. The number of cases of both diseases is currently rising in Sudan and is associated with climate and environmental changes. Limited information is available on malaria and dengue co-infections and the severity of the two diseases among febrile patients in eastern Sudan. Thus, this study aimed to estimate the prevalence of malaria and dengue co-infections among febrile patients in Kassala, eastern Sudan. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional hospital-based study was conducted among febrile patients from September to December 2019. A total of 395 patients were enrolled after consenting to participate in the study. Demographic and clinical data were collected by structured questionnaires. Blood samples were provided to diagnose malaria infections using microscopy and polymerase chain reaction (PCR) and for serology diagnosis of dengue using enzyme-linked immune sorbent assay (ELISA) IgM. Multiple logistic regression analysis was used to assess the association between demographic information, clinical symptoms and malaria and dengue co-infections. Out of 395 febrile patients examined 158 (40%) were malaria positive and 67 (17%) were dengue positive. The prevalence of malaria and dengue co-infections was 6.6% (26/395). Results of multiple logistic regression indicated that elder patients (41-60 years) had less rate of co-infections (OR = 0.3, 95% CI 0.11 to 0.81, p-value = 0.018), while patients of co-infections were eight times more likely to have fatigue, and two times more likely to suffer from joint and muscle pain and this difference was statistically significant with (OR = 8.3, 95% CI: 1.89 to 37.22, p-value = 0.005) and (OR = 2.4, 95% CI 1.10 to 5.39, p-value = 0.027), respectively. CONCLUSIONS/SIGNIFICANCE: This study confirmed the existence of malaria and dengue co-infections among febrile patients in Kassala, eastern Sudan for the first time. The severity of clinical symptoms of patients with malaria and dengue co-infections was observed, and the co-infections were found prevalent among young people.

The Targeted Maximum Likelihood estimation to estimate the causal effects of the previous tuberculosis treatment in Multidrug-resistant tuberculosis in Sudan.

INTRODUCTION: This study used Targeted Maximum Likelihood Estimation (TMLE) as a double robust method to estimate the causal effect of previous tuberculosis treatment history on the occurrence of multidrug-resistant tuberculosis (MDR-TB). TMLE is a method to estimate the marginal statistical parameters in case-control study design. The aim of this study was to estimate the causal effect of the previous tuberculosis treatment on the occurrence of MDR-TB using TMLE in Sudan. METHOD: A case-control study design combined with TMLE was used to estimate parameters. Cases were MDR-TB patients and controls were and patients who cured from tuberculosis. The history of previous TB treatment was considered the main exposure, and MDR-TB as an outcome. A designed questionnaire was used to collect a set of covariates including age, time to reach a health facility, number of times stopping treatment, gender, education level, and contact with MDR-TB cases. TMLE method was used to estimate the causal association of parameters. Statistical analysis was carried out with ltmle package in R-software. Result presented in graph and tables. RESULTS: A total number of 430 cases and 860 controls were included in this study. The estimated risk difference of the previous tuberculosis treatment was (0.189, 95% CI; 0.161, 0.218) with SE 0.014, and p-value (<0.001). In addition, the estimated risk ratio was (16.1, 95% CI; 12.932, 20.001) with SE = 0.014 and p-value (<0.001). CONCLUSION: Our findings indicated that previous tuberculosis treatment history was determine as a risk factor for MDR-TB in Sudan. Also, TMLE method can be used to estimate the risk difference and the risk ratio in a case-control study design.

Late diagnosis of Lassa fever outbreak in endemic areas lead to high mortality, Kenema District, Sierra Leone, February - March 2019.

Introduction: the Kenema District Surveillance team in Sierra Leone received notifications of patients with suspected Lassa fever on February 20th and March 2nd, 2019. On that day, an investigation started to confirm the diagnosis and search for additional cases. Methods: we used the Lassa fever surveillance case definition and collected demographic and exposure information from suspected cases through interviews and clinical records. Blood samples were collected from the cases to confirm the diagnosis. Active case finding was conducted in the community and health facility. Results: on February 10, 2019, an eight-year-old male developed a fever (>39.5°C) and a sore throat. On February 18, 2019, he was admitted to a hospital and treated for malaria and pneumonia. On February 20, 2019, Lassa fever was suspected because the patient was bleeding from orifices and testing. On February 15, a 5-year-old female developed fever and headache and was treated with anti-malarial drugs. On February 26th the high fever re-emerged with severe bleeding from the orifices. She was admitted and treated with antibiotics, confirmed for Lassa fever, and died on March 2, 2019. Conclusion: the two children had Lassa fever, and no additional cases were identified. We sensitized clinicians on suspicion of Lassa fever to improve early detection and treatment.

Assessment of Water, Sanitation and Hygiene Practices Among Households, 2019 - Sierra Leone: A Community-based Cluster Survey.

Introduction: In Sierra Leone, diseases related to water, sanitation, and hygiene remain among the leading cause of morbidity and account for 20% of all death. This study assessed the water, sanitation, and hygiene services and practices at household level in Sierra Leone. Methods: A cluster survey was conducted among 1002 households in 4 districts of Sierra Leone. Data was collected on water, sanitation, and hygiene indicators, occurrence of diarrhoeal diseases at household level within 14-day prior to the survey. Chi-square test at 95% significant level was computed to compare the difference in accessing improved water sources, sanitation, and hygiene in urban and rural areas. Result: Of the 1002 households surveyed, 650 (65%) had access to improved drinking water sources. In the urban areas, 432 (88%) out of 486 households had improved drinking water source, which is higher as compared to rural areas. Only 218 (42%) out of 516 households had improved drinking water (P < .001). Of the total households surveyed, 167 (17%) had improved sanitation with 45 (5%) having a handwashing facility. There were 173 households reporting diarrhoeal disease within 2 weeks prior to the survey, with prevalence of 17%. Conclusion: Majority of households in rural areas do not have access to improved water sources, sanitation, and handwashing facilities. This study found a high prevalence of diarrhoeal disease at the household level. It is recommended that The Ministry of Health and Sanitation work with relevant sectors to increase access to improved drinking water, sanitation, and handwashing facilities in rural areas.

Prevalence and risk factors of diarrheal diseases in Sierra Leone, 2019: a cross-sectional study.

INTRODUCTION: many studies have shown that unimproved water sources, inadequate sanitation facilities and poor hygiene are the main causes of diarrheal diseases, especially in developing countries. The aim of this study was to determine the prevalence and risk factors associated with diarrheal diseases in Sierra Leone. METHODS: a cross-sectional study was conducted in March 2019. We used a questionnaire to collect data from study participants. Descriptive statistical analysis was followed to determine frequencies and percentages. Univariate analysis was used to find any association between dependent variable and independent variables. Independent variables that had an association in univariate were included in the multivariate model. RESULTS: we surveyed 1,002 households (516 in rural and 486 in urban), and 2,311 respondents in four districts. The main source of income was farming 437 (43.6%). A total of 49 (54.2%) households earned below the national minimum wage per month. Females represented 61.9% of respondents. A total of 242 (32.2%) households had one to five household members and 229 (30.5%) households had more than ten members. Around 88.9% of households in urban, and 42.2% rural areas use improved water sources. The prevalence of diarrheal diseases was 12.3%. Multivariate analysis showed that using of unimproved water sources (aOR=1.9; 95% CI, 1.01 to 3.63, p=0.045), and large family size (aOR= 2.5; 95% CI, 1.18 to 5.35, p=0.017) were associated with diarrheal disease. CONCLUSION: we concluded that the risk factors associated with diarrheal diseases included unimproved water sources and large family size. More efforts required to improve water resources, adequate sanitation, and hygiene, particularly in rural areas.

First report of epidemic dengue fever and malaria co-infections among internally displaced persons in humanitarian camps of North Darfur, Sudan.

OBJECTIVES: This study aimed to investigate an outbreak of a non-malaria, undifferentiated febrile illness, among internally displaced persons (IDPs) living in humanitarian camps in North Darfur, Sudan, in 2019. METHODS: An investigation team was deployed to North Darfur to identify suspected cases and collect blood samples, and clinical and demographical data. Blood samples were examined microscopically for Plasmodium spp and tested for dengue (DENV) and yellow fever viruses by reverse transcriptase-quantitative polymerase chain reaction. RESULTS: Between September 7 and December 18, 2019, we clinically identified 18 (24%), 41 (54%), and 17 (22%) cases of dengue fever, dengue with warning signs, and severe dengue, respectively. Blood samples were collected from 22% of patients, and 47% of these tested positive for DENV-1 RNA. We confirmed 32 malaria cases with 5 co-infections with DENV. This outbreak of dengue was the first among IDPs in the humanitarian camps. CONCLUSIONS: Our findings indicate that dengue has become endemic or that there has been a new introduction. Further epidemiological, entomological, and phylogenetic studies are needed to understand disease transmission in the area. An early warning and response system and an effective health policy are crucial for preventing and controlling arboviruses in Sudan.

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

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

High Seroprevalence of Dengue Virus Infection in Sudan: Systematic Review and Meta-Analysis.

The goal of this study was to systematically review the published data on dengue virus (DENV) seroprevalence in Sudan and to estimate disease burden through meta-analysis. We searched, reviewed, and extracted online available reports on DENV in Sudan. Among 168 identified records, 19 were selected. Dengue infections were documented in 11/18 states. The overall seroprevalence of DENV in Sudan was estimated to be 27%, while the prevalence of dengue IgM was 22% and IgG was 38%. The prevalence of dengue estimated from community and hospital-based cross-sectional studies were 26% and 30% respectively. Additionally, one cohort study and a single PCR-based study reported a prevalence of 1% and 4%, respectively. Regional analysis revealed that the variation in seroprevalence in East, North, West, and Central Sudan was 23%, 24%, 36% and 43%, respectively. Interestingly, we found that DENV is circulating countrywide with a significant spatiotemporal variation in the disease seroprevalence. Furthermore, publications on dengue prevalence are temporally and geographically fragmented, perhaps due to limited resources. However, this gap in data and knowledge highlights the urgent need for a country-wide surveillance system and continued study of dengue burden in Sudan to accurately estimate the disease prevalence and determine the associated risk factors.

Equality Analysis of Main Health Indicators among Children under 5 Years in Uganda.

BACKGROUND: Inequality in the access to health services is a major cause of health problemsamong children under five old. The aim of this analysis is to measure the inequality among children under-5 years in relation to main health indicators in Uganda. METHODS: Main child health indicators data in Uganda were obtained from WHO inequity data set for the years 1995, 2000, 2001 and 2011. Indicators such as under-5 years mortality rate, underweight prevalence and full vaccination converge and child with infection access to health facilities were included in the analysis. For simple indicators, inequality difference was calculated, and relative concentration index for complex order indicators was used. Four different inequality dimensions were used to work as stratifies for these indicators. RESULTS: Inequality regarding child health indicators was observed in different dimensions. It was clear that inequality among people living in rural areas were more than urban areas. Femaleshad high inequality than males. Poor and uneducated people are more likely to have inequality than rich and educated people. CONCLUSION: Great effort should be made to decrease inequality among children less than five years through access to health services for all groups in different areas.

The First Outbreak of Dengue Fever in Greater Darfur, Western Sudan.

Dengue virus (DENV) is an arthropod-borne virus (arbovirus) transmitted by the Aedes mosquitoes, mainly Aedes aegypti. Dengue fever is a rapidly growing disease with expanding geographical distribution worldwide. We investigated a high number of non-malaria febrile cases reported to health clinics in refugee camps in the five states of Darfur between August 2015 and March 2016. The clinical presentation of cases and case definition criteria suggested involvement of one or more arboviral hemorrhagic fevers. Out of 560 suspected cases, we collected and analyzed 204 blood samples and serologically positive samples were confirmed by PCR. We identified 32 (15.7%) dengue viral infections, six West Nile virus infections, and three Crimean⁻Congo viral infections. Dengue infections were found in four out of the five Darfur states. We reported the first dengue fever outbreak in the Darfur region. Our results highlight the need for public health education and further molecular, phylogenetic, and entomological investigations for a better understanding of the disease transmission and the associated risk factors in the region.

Assessment of the risk factors associated with multidrug-resistant tuberculosis in Sudan: a case-control study.

OBJECTIVES: The emergence of multidrug-resistant tuberculosis (MDR-TB) is a major challenge for the global control of tuberculosis (TB). The aim of this study was to determine the risk factors associated with MDR-TB in Sudan. METHODS: This case-control study was conducted from May 2017 to February 2019. Patients newly diagnosed with MDR-TB were selected as cases, and controls were selected from TB patients who responded to first-line anti-TB drugs. A questionnaire was designed and used to collect data from study participants. Logistic regression was used to evaluate associations between risk factors and MDR-TB infection. The best multivariate model was selected based on the likelihood ratio test. RESULTS: A total of 430 cases and 860 controls were selected for this study. A history of previous TB treatment (adjusted odds ratio [aOR], 54.85; 95% confidence interval [CI], 30.48 to 98.69) was strongly associated with MDR-TB infection. We identified interruption of TB treatment (aOR, 7.62; 95% CI, 3.16 to 18.34), contact with MDR-TB patients (aOR, 5.40; 95% CI, 2.69 to 10.74), lower body weight (aOR, 0.89; 95% CI, 0.87 to 0.91), and water pipe smoking (aOR, 3.23; 95% CI, 1.73 to 6.04) as factors associated with MDR-TB infection. CONCLUSIONS: Previous TB treatment and interruption of TB treatment were found to be the main predictors of MDR-TB. Additionally, this study found that contact with MDR-TB patients and water pipe smoking were associated with MDR-TB infection in Sudan. More efforts are required to decrease the rate of treatment interruption, to strengthen patients' adherence to treatment, and to reduce contact with MDR-TB patients.

Female Genital Mutilation in Sudan.

BACKGROUND: Female genital mutilation or female circumcision (FGM) is a serious health problem in Sudan. This procedure is harmful to women and causes many complications during pregnancy and childbirth. OBJECTIVE: This study aims to determine the female genital mutilation (FGM) and its associated factors in Sudan. SUBJECTS AND METHODS: Data from Sudan Multiple Indicator Cluster Survey (MICS - UNICEF) was used in this research. The survey was carried out in 2014 and included women aged between 14 - 49 years. A logistic regression model was used to find an association between dependent and independent variables. RESULT: Total numbers of 21947 women were included in the survey and out of the 6249 (28.5 %) from urban and 15698 (71.5%) from rural areas. The prevalence of female circumcision was 89%. Women who had circumcised daughters were 32.1 %. The highest prevalence of FGM was reported from South Kordofan state with 7.8%, and lowest was in Red Sea state (7.6%). A significant association was observed between circumcised women and their marital status, daughter circumcision, and the level of education. CONCLUSION: The practice of female genital mutilation is spread all over the country. Poor women with low level of education are at high risk for this phenomenon. More efforts have to be provided to end this dangerous practice.

A Single Lineage of Hepatitis E Virus Causes Both Outbreaks and Sporadic Hepatitis in Sudan.

Few studies have reported sporadic hepatitis E virus (HEV) infections during non-outbreak periods in Africa. In this study, the prevalence of HEV infection in Sudan was investigated in 432 patients with acute hepatitis from 12 localities in North Kordofan, and from 152 patients involved in smaller outbreaks of hepatitis in the neighbouring Darfur. HEV infection was diagnosed in 147 (25%) patients: 98 from Kordofan and 49 from Darfur. The mortality was 10%; six of the patients who died from the infection were pregnant women. HEV RNA was detected by quantitative real-time polymerase chain reaction (RT-qPCR) in 38 (26%) patients: 22 from Kordofan and 16 from Darfur. Partial open reading frame (ORF) 1 and ORF2 were sequenced from HEV from nine and three patients, respectively. Phylogenetic analysis showed that the Sudanese strains belonged to genotype 1 (HEV1), and confirmed the segregation of African HEV1 strains into one branch divergent from Asian HEV1. It also revealed that the Sudanese strains from this study and from an outbreak in 2004 formed a separate clade with a common ancestor, distinct from strains from the neighbouring Chad and Egypt. This HEV strain has thus spread in a large area of Sudan, where it has caused both sporadic hepatitis E and outbreaks from at least 2004 and onwards. These data demonstrate that hepatitis E is a constant, on-going public health problem in Sudan and that there is a need for hepatitis E surveillance, outbreak preparedness, and general improvements of the sanitation in these remote areas of the country.

Assessing the Knowledge, Attitudes, and Practices of Students Regarding Ebola Virus Disease Outbreak.

BACKGROUND: The emergence and spread of Ebola outbreak is a growing problem worldwide, which represents a significant threat to public health. Evidence has shown that the level of knowledge, attitude, and practice of people in the society play major roles in controlling the spread of Ebola virus disease. This study was designed to determine knowledge, attitude and practice of students at School of Public Health, Tehran University of Medical Sciences towards Ebola. METHODS: A cross-sectional survey was performed in Tehran, Iran in 2014 using a pretested self-administered questionnaire on a stratified sample of 400 students. Descriptive and multivariate analyses were used for statistical analysis. RESULTS: All-in-all, 385 students returned the completed questionnaires making a response rate of 96.3%., 239 (62.2%) were females and 145 (37.8%) were males. The mean age of female and males were 28.44 and 30.3 years respectively. Of the 385 students, 83 (21.7%) were studying at PhD level, 210 (55.0%) at Masters Level (including MPH) and 89 (23.3%) at Bachelors level. knowledge of the students regarding EVD transmission was lowest among students of Department of Occupational Health (50.0%), followed by Health Education and Promotion Department (33.3%). Virology Department recorded the highest percentage of students who had selected correct answers regarding EVD prevention (100.0%). CONCLUSION: These findings will aid in the assessment of the adequacy of current students' educational curriculum. Also, it will provide further insight in designing future multifaceted interventions to promote specific messages to change attitude and improve practice.

Dengue and hepatitis E virus infection in pregnant women in Eastern Sudan, a challenge for diagnosis in an endemic area.

Dengue fever and hepatitis E virus infection are both a public health problem in developing countries due to poor sanitation. Infection with viral hepatitis and dengue fever can present with similar clinical such and fever, headache and abortion. This study was conducted in Port-Sudan city in the eastern part of the country. ELISA and Real Time PCR tests were used to detect the infection. A total number of 39 pregnant women with a mean age 26 ±7.8 were included in the study. All of them had fever, 32 (92.3%) admitted with headache, 11 (28.2%) of them had vomiting, and abortion was reported in two cases (5.1%). The study showed that 4 (10.3%) of pregnant women were positive for the Hepatitis E virus, 5 (12.8%) positive for Dengue virus IgG, and only one sample (2.6%) was positive for IgM capture ELISA and real time PCR. Death due to hepatitis E infection was reported in one case with 7(th) month of pregnancy. Most of hepatitis cases were reported in the central sector of the Portsudan city. The diagnosis of hepatitis E virus and dengue virus in an endemic area is a great challenge for health care staff working in these areas. Both Dengue virus and Hepatitis E virus infection should be considered in pregnant women especially in similar settings.