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.

Epidemiology of strongyle nematode infections and first report of benzimidazole resistance in Haemonchus contortus in goats in South Darfur State, Sudan.

BACKGROUND: Since pastoralists in South Darfur, Sudan, had complained about lack of albendazole (ABZ) efficacy to control nematodes in goats, the frequency of infection with gastrointestinal helminths was studied before in vivo faecal egg count reduction tests (FECRT) were conducted using ABZ orally either at the dose recommended for sheep, 5 mg/kg body weight (bw) or at 10 mg/kg bw. Experiments included goats naturally infected with gastrointestinal nematodes or experimentally infected with local Haemonchus contortus isolates. Three study areas (Nyala, Beleil and Kass) were visited in autumn or winter. RESULTS: Out of 478 screened goats, 82.4% were infected with gastrointestinal helminths and 82% were shedding eggs of strongyle nematodes with 90% of the strongyle larvae representing Haemonchus spp. A FECRT using naturally infected goats (n = 225: 71 untreated, 104 and 50 treated with 5 and 10 mg ABZ/kg bw, respectively) detected reduced ABZ efficacy in Nyala and Kass. Paired and unpaired FECRT calculations detected reductions of 72-92% with samples taken at 8 days post treatment with 5 mg ABZ/kg bw and of 85-94% with 10 mg ABZ/kg bw. The FECRT based on day 14 post treatment samples showed reductions of 69-77% with 5 mg/kg and of 75-87% with 10 mg ABZ/kg bw. In Beleil, ABZ efficacy was 95%. In the egg hatch test EC50 values for Nyala and Kass ranged from 0.12-0.24 µg thiabendazole/ml, corresponding to benzimidazole resistant phenotypes. Only Haemonchus spp. larvae were present after treatments in coprocultures. When the efficacy was evaluated experimentally using isolates of H. contortus from Nyala and Kass, the 5 mg ABZ/kg dose revealed reductions of 76-78% on day 8 and of 62-70% on day 14 with the unpaired method. Using 10 mg ABZ/kg, the FECR was still only 77-82%. CONCLUSIONS: Both, in vivo and in vitro methods detected resistant H. contortus populations in goats from South Darfur State. The time point 14 days post treatment was more sensitive for detection of ABZ resistance than 8 days post treatment. This is the first report on the occurrence of anthelmintic resistance in Sudan confirming that anthelmintic resistance selection is occurring in African subsistence farming systems.

Complexity, continuity and change: livelihood resilience in the Darfur region of Sudan.

Darfur farming and pastoralist livelihoods are both adaptations to the environmental variability that characterises the region. This article describes this adaptation and the longer-term transformation of these specialised livelihoods from the perspective of local communities. Over several decades farmers and herders have experienced a continuous stream of climate, conflict and other shocks, which, combined with wider processes of change, have transformed livelihoods and undermined livelihood institutions. Their well-rehearsed specialist strategies are now combined with new strategies to cope. These responses help people get by in the short term but risk antagonising not only their specialist strategies but also those of others. A combination of factors has undermined the former integration between farming and pastoralism and their livelihood institutions. Efforts to build resilience in similar contexts must take a long-term view of livelihood adaptation as a specialisation, and consider the implications of new strategies for the continuity and integration of livelihood specialisations.

Participation, political economy and protection: food aid governance in Darfur, Sudan.

Humanitarian food assistance aims to meet short-term emergency needs, yet often it is sustained over many years and develops its own systems and infrastructure that interact with local governance and local communities. This paper explores the links between participation and local governance, as well as the implications for exclusion of certain groups, the dignity of those involved, and protection issues. The paper proposes a framework for reviewing the governance functions and capacities of local Food Relief Committees, based on the following criteria: accountability; gender equity; legitimacy and authority; representativeness; responsiveness; and transparency. A case study of the Darfur region reviews how local governance evolves as a result of both the wider conflict and of adapting to the international humanitarian system, itself a form of governance. The paper concludes by proposing three strategies for enhancing participation and applying lessons learned: improved analysis of participation; linking programming strategies and protection; and taking account of governance functions and capacities.

Trachoma Prevalence in Four Localities of Darfur Region, Sudan, following One Round of Antibiotic Mass Drug Administration.

INTRODUCTION: The prevalence of trachomatous inflammation-follicular (TF) in 1-9-year-olds and of trachomatous trichiasis (TT) in ≥15-year-olds in four endemic evaluation units (EUs) of Darfur region, Sudan, was measured more than a year after the required single round of antibiotic mass drug administration (MDA). METHODS: Surveys were conducted using highly standardised, World Health Organization-recommended methodologies. Individuals aged ≥1 year, resident in selected households, were chosen for the survey using a two-stage cluster sampling process. Consenting adults and children were examined for the signs TF and TT by graders trained to international standards. Prevalence of disease in key indicator groups was calculated and weighted to the underlying population structure. RESULTS: A mean of 1,415 (range: 1,253-1,611) children aged 1-9 years were examined in each EU. The age-adjusted prevalence of TF in 1-9-year-olds in each of the four surveyed EUs was <5%. A mean of 1,139 people aged ≥15 years (range: 1,080-1,201) were examined in each EU. The estimated age- and gender-adjusted prevalence of TT in ≥15-year-olds was <0.2% in all four EUs. In general, the proportion of households with access to improved WASH facilities was generally lower in this study than in corresponding baseline studies. CONCLUSIONS: No further MDA should be conducted in these four EUs for the next 2 years, at which point they should be re-surveyed to determine whether the prevalence of TF in 1-9-year-olds has remained <5%. Active TT case-finding is also not indicated. Environmental improvement and promotion of facial cleanliness measures should continue to be implemented to prevent disease recrudescence.

Echocardiographic surveillance of rheumatic heart disease in West and North Darfur compared with Kassala State: socioeconomic or genetic differences?

Rheumatic heart disease (RHD), a preventable complication of group A beta-haemolytic streptococcal infection, is highly prevalent in Sudan. Echocardiographic (echo) screening has an established role in disease surveillance. This study aims to measure the echo prevalence of RHD using handheld echo (HHE) in West and North Darfur and Kassala states and initiate control programs. School children 10-18 years of age were selected from the three states and HHE screening was performed by trained paediatric residents supervised by cardiologists using a pre-tested protocol. Health worker training and public awareness sessions were carried out. The study was conducted between November 2020 and December 2021. In West Darfur, 1,547 children were screened, echo prevalence was found to be 17.4/1,000, and 22% had moderate to severe disease. In North Darfur, 800 children were screened and echo prevalence was 16.2/1,000, 23% had moderate to severe disease while in Kasala 2,225 children were screened and the prevalence was 3.1/1,000 and all cases were mild. One hundred and fifty-eight health workers were trained and 20,150 people benefited from health education sessions. The prevalence of RHD in Darfur is 5 times more than in Kassala. This may reflect socioeconomic and genetic differences between the two regions. RHD control in Darfur needs to be consolidated, and echo surveillance is an important tool for early detection and the institution of secondary prophylaxis.

Molecular Characterization of Ticks and Tick-Borne Pathogens in Cattle from Khartoum State and East Darfur State, Sudan.

Ticks transmit many pathogens with public health and veterinary importance. Despite the wide distribution of tick-borne pathogens in Sudan, the information on the tick-pathogen relationship needs to be updated, particularly using modern molecular techniques. This cross-sectional study, conducted between September and November 2019, used morphology, PCR, and sequencing to confirm the identity of adult cattle ticks (male and female; n = 536) from Khartoum State (n = 417) and East Darfur State (n = 119). Moreover, the presence of Theileria annulata, Babesia bigemina, B. bovis, Anaplasma marginale, and Ehrlichia ruminantium was detected and confirmed in each tick using species-specific PCR or nested PCR and sequencing. The most economically important tick genera, Rhipicephalus, Hyalomma, and Amblyomma, were prevalent in the study area, and 13 different tick species were identified. The most prevalent tick species were Rhipicephalusevertsi evertsi (34.3%) and Hyalomma anatolicum (57.3%) in Khartoum State, and Rhipicephalus annulatus (27%), Rhipicephalus decoloratus (25%), and Hyalomma rufipes (29%) in East Darfur State. We detected all five pathogens in both states. To the best of our knowledge, this is the first study to report the presence of E. ruminantium, its vector Amblyomma variegatum, and B. bovis in Khartoum State. Further, this is the first report on most tick and pathogen species identified in East Darfur State. Our findings indicate the migration of some tick and pathogen species beyond their distribution areas in the country, and this consideration is necessary to develop future control strategies.

Addressing the Lack of Forensic Scientific Evidence and Expertise in the "Trigger Mechanisms" of Genocide Investigations.

The impetus to begin a legal investigation or prosecution of the crime of genocide is a "trigger mechanism," which serves as the prima facie case against the accused state or actor. Unlike domestic cases of homicide, the trigger mechanisms for international genocide investigations to date have not included any forensic evidence nor have they sought input from forensic scientists. The jurists tasked with addressing the trigger mechanisms were fully capable of assessing forensic evidence but unable to generate it. This study reviews four recent large-scale investigations of genocide in Bosnia, Rwanda, Darfur and Myanmar to reveal pitfalls in the cases that could have been avoided by the earlier inclusion of scientific expertise, and identifies the potential contributions of forensic science in future investigations.

Unimproved water sources and open defecation are associated with active trachoma in children in internally displaced persons camps in the Darfur States of Sudan.

PURPOSE: To estimate the proportion of children with trachomatous inflammation-follicular (TF) and adults with trachomatous trichiasis (TT) in internally displaced persons (IDP) camps in the Darfur States of Sudan and to evaluate associated risk factors. METHODS: IDP camps were identified from government census data. We conducted a subanalysis of data collected in these camps during 2014-2015 as part of surveys covering 37 districts of the Darfur States within the Global Trachoma Mapping Project. A random-effects hierarchical model was used to evaluate factors associated with TF in children or TT in adults. RESULTS: Thirty-six IDP camps were represented in the survey data, in which 1926 children aged 1-9 y were examined, of whom 38 (8%) had TF. Poor sanitation, younger age and living in a household that purchased water from a vendor were associated with TF in children aged 1-9 y. Of 2139 individuals examined aged ≥15 y, 16 (0.7%) had TT. TT was strongly independently associated with being older and living alone. CONCLUSION: Trachoma is found at low levels in these camps, but still at levels where intervention is needed. Disease elimination in conflict-related settings presents a unique challenge for the trachoma community, and may require an innovative approach. Understanding how best to undertake trachoma elimination interventions in these areas should be prioritized.

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.

Rheumatic heart disease in North Darfur: an alarmingly high burden and control initiative.

Rheumatic heart disease (RHD) is the most common cause of cardiac morbidity in Sudanese young people and it is particularly prevalent in Darfur area. A retrospective review of clinical and echocardiography (echo) data for children with RHD seen in Al Fashir Hospital from 2010 to 2016 was conducted. Data from the hospital statistics, outpatient and echo clinic records were collected and analysed. A control program was started based on training modules and public awareness material. In the study period, 324 patients were admitted and 3,777 patients with RHD were seen in outpatient clinics. Complications occurred in 33% of inpatients with a case fatality of 12%. Echo revealed that 83% of patients have severe disease and 50% have a combination of more than two valves affected. Training of 50 medical assistants, 30 physicians and 10 health promoters was achieved. Public awareness programs were conducted. We found a significant burden of RHD in Al Fashir Hospital. A control program was initiated that needs substantial support from governmental and nongovernmental organizations.

Kala-azar in Darfur: Evidence for indigenous transmission in Al-Malha Locality, North Darfur, western Sudan.

BACKGROUND: Recent reports showed high numbers of visceral leishmaniasis cases in North Darfur, western Sudan. Due to a lack of previous studies, no information is available on local transmission of the disease in these areas. Therefore, a pilot entomological and epidemiological study was conducted in Al-Malha Locality during the year 2013, to investigate possibility of local transmission and places and times of the year where and when people contract the infection. METHODS: Kala-azar incidence data were obtained from records of Ministry of Health, North Darfur; Al-Malha rural hospital; and the Federal Ministry of Health, Division of Communicable and Non-communicable Diseases. Sand flies were collected using sticky paper and rodent burrow traps from five different microhabitats during three different phases of the year. Species identification was undertaken using appropriate taxonomic keys. Data were statistically analyzed to determine the distribution of kala-azar among different age groups and between sexes, and to compare the species richness and distribution of different sandfly species between the different microhabitats. RESULTS: The most affected age groups with kala-azar during the period 2013-2016 were children between one and five years old and those under one year. Females were found to be more affected than males. A total of 918 sand fly specimens were collected using sticky paper and rodent burrow traps from five microhabitats. Identified specimens belong to 13 species; 5 Phlebotomus and 8 Sergentomyia. Phlebotomus orientalis, the principal vector of visceral leishmaniasis (VL) in Sudan and other East African countries, was found for the first time in the area. No other known vector of VL was found in the collection. The highest number of sand flies was recorded during the summer season (63%), with S. antennata (48%) and S. schwetzi (24.1%) being the most abundant species. Among Phlebotomus species, P. orientalis showed relatively high density (8.6%). A dry seasonal water course (called "Khor") seems to be the most preferred habitat for most of the sand fly species since most of the collections (41.2%) were made from this site, followed by the rodent burrows. CONCLUSIONS: The presence of P. orientalis and the high prevalence of VL in infants in the Al-Malha area provide the first evidence for local transmission of the parasite causing kala-azar in Darfur. Transmission is probably occurring during summer near the woodland where a high density of the vector was recorded. As a pre-requisite for designing effective control of VL in North Darfur, large scale entomological and epidemiological studies are recommended.

Conflict and tuberculosis in Sudan: a 10-year review of the National Tuberculosis Programme, 2004-2014.

BACKGROUND: Sudan is a fragile developing country, with a low expenditure on health. It has been subjected to ongoing conflicts ever since 1956, with the Darfur crisis peaking in 2004. The conflict, in combination with the weak infrastructure, can lead to poor access to healthcare. Hence, this can cause an increased risk of infection, greater morbidity and mortality from tuberculosis (TB), especially amongst the poor, displaced and refugee populations. This study will be the first to describe TB case notifications, characteristics and outcomes over a ten-year period in Darfur in comparison with the non-conflict Eastern zones within Sudan. METHODS: A cross-sectional review of the National Tuberculosis Programme (NTP) data from 2004 to 2014 comparing the Darfur conflict zone with the non-conflict eastern zone. RESULTS: New case notifications were 52% lower in the conflict zone (21,131) compared to the non-conflict zone (43,826). Smear-positive pulmonary TB (PTB) in the conflict zone constituted 63% of all notified cases, compared to the non-conflict zone of 32% (p < 0.001). Extrapulmonary TB (EPTB) predominated the TB notified cases in the non-conflict zone, comprising 35% of the new cases versus 9% in the conflict zone (p < 0.001). The loss to follow up (LTFU) was high in both zones (7% conflict vs 10% non-conflict, p < 0.001) with a higher rate among re-treatment cases (12%) in the conflict zone. Average treatment success rates of smear-positive pulmonary TB (PTB), over ten years, were low (65-66%) in both zones. TB mortality among re-treatment cases was higher in the conflict zone (8%) compared to the non-conflict zone (6%) (p < 0.001). CONCLUSION: A low TB case notification was found in the conflict zone from 2004 to 2014. High loss to follow up and falling treatment success rates were found in both conflict and non-conflict zones, which represents a significant public health risk. Further analysis of the TB response and surveillance system in both zones is needed to confirm the factors associated with the poor outcomes. Using context-sensitive measures and simplified pathways with an emphasis on displaced persons may increase access and case notification in conflict zones, which can help avoid a loss to follow up in both zones.

Prevalence of Theileria annulata in dairy cattle in Nyala, South Darfur State, Sudan.

AIM: This study was conducted in dairy cattle in Nyala, South Darfur State, during the period from June to September 2015, to study the prevalence of bovine tropical theileriosis. MATERIALS AND METHODS: Apparently, healthy cattle of different age groups, different breeds, and from both sexes were randomly selected from seven locations. Three age groups of cattle were selected, group one <1 year old, group two 1-3 years old, and group three older than 3 years. These cattle were indigenous and cross (Friesian X zebu). A total of 150 blood samples were collected for blood smears, blood in EDTA tubes, and serum samples as well as ticks infesting cattle. Three diagnostic techniques were used such as blood smear, indirect fluorescent antibody test (IFAT), and polymerase chain reaction (PCR). RESULTS: Of 150 samples, 11 (7.3%, 95% confidence interval [CI]: 9.1-5.5) were positive for Theileria spp. piroplasms in the blood smears, 70 (46.7%, 95% CI: 35.7-57.7) were positive for Theileriaannulata antibodies in the IFAT, and of 100 samples, 39 (39%, 95% CI: 46.6-31.4) were positive for T. annulata using PCR. The prevalence of T. annulata was higher in indigenous breed than cross cattle by the three diagnostic techniques. The highest prevalence of T. annulata was recorded among cattle older than 3 years old. There were three genera and ten species of ticks found feeding on cattle. These were Rhipicephalus evertsi evertsi, Rhipicephalus decoloratus, Rhipicephalus annulatus, Hyalomma dromedrii, Hyalomma impeltatum, Hyalomma rufipes, Hyalomma anatolicum, Hyalomma truncatum, Amblyomma variegatum, and Amblyomma lepidum. CONCLUSION: The study concluded that tropical theileriosis is prevalent among dairy cattle in Nyala. H. anatolicum was found in very low numbers, suggesting other ticks may play a role in the transmission of the disease. Molecular characterization of T. annulata is recommended for accurate mapping of the disease and evaluates the magnitude problem of tropical theileriosis in South Darfur region.

The Epidemiology of Trachoma in Darfur States and Khartoum State, Sudan: Results of 32 Population-Based Prevalence Surveys.

PURPOSE: To complete the baseline trachoma map of Sudan by estimating the prevalence of trachoma and associated risk factors in the five Darfur States and Khartoum State. METHODS: Using a standardized methodology developed for the Global Trachoma Mapping Project, we undertook a cross sectional, community-based survey in each of 32 evaluation units (EUs) covering all accessible districts. RESULTS: We enumerated a total of 84,568 individuals, with 73,489 people (86.9%) examined from 20,242 households in 908 villages. The highest prevalence of trachomatous inflammation - follicular (TF) in children was found in El Fashir district (18.7%), and the lowest in El Malha district (0.0%). Five districts (El Fashir, Zalinji, Azoom, Maleet, and El Koma) were in the three EUs that had TF prevalences above the 10% threshold at which the World Health Organization recommends mass treatment with azithromycin, together with facial clean3liness and environmental improvement interventions, for at least 3 years. The highest trachomatous trichiasis prevalence in adults was found in the EU composed of Forbranga and Habillah (1.2%), and the lowest in the EU composed of As-salam and Belale districts in South Darfur (0.0%). TF in children was independently associated with younger age, unimproved sanitation in the household, having ≥5 children in the household, outside annual maximum temperatures <40°C, and living in an internally displaced persons camp. CONCLUSION: We found a high prevalence of trachoma in some areas of Darfur, but in general the prevalence throughout Darfur and Khartoum was low.

Evidence from cluster surveys on the association between home-based counseling and use of family planning in conflict-affected Darfur.

OBJECTIVE: To examine the association between home counseling and awareness and use of modern family planning (FP) methods among women in internally displaced person (IDP) camps in conflict-affected West Darfur, Sudan. METHODS: In a community-based cross-sectional study, two questionnaire-based surveys were performed in three camps. Home-based counseling had been introduced in March 2006. An initial survey (February 2007) and a follow-up survey (April 2009) targeted women of child-bearing age. A sample of 640 randomly selected women aged 15-49 years who had experienced pregnancy after joining the camp were interviewed for each survey. RESULTS: Overall, modern FP use increased from 10.9% (70/640) in 2007 to 21.6% (138/640) in 2009 (P<0.001). As compared with the initial survey, women in the follow-up survey were more likely to be aware of and to use any modern FP method (adjusted odds ratio [aOR] 5.4, 95% confidence interval [CI] 3.9-7.4; and aOR 2.8, 95% CI 2.0-4.1, respectively). Contraceptive pills were the most common modern method used. Home counseling and loss of a child under 5years were the most significant predictors of awareness and use of modern FP methods. CONCLUSION: After the introduction of home-based FP counseling for couples and FP services in clinics, women's awareness and use of modern FP methods increased in a conflict-affected setting.

The role of non-governmental organizations in providing curative health services in North Darfur State, Sudan.

BACKGROUND: Conflict in North Darfur state, Western Sudan started in 2003, and the delivering of curative health services was becoming a greater challenge for the country's limited resources. NGOs have played an important role in providing curative health services. OBJECTIVES: To examine the role that Non-Governmental Organizations (NGOs) have played in providing curative health services, as well as to identify the difficulties and challenges that affect NGOs in delivering curative health services. METHODS: Secondary data was collected from different sources, including government offices and medical organizations in Sudan and in North Darfur state. Primary data was obtained through interviews with government and NGOs representatives. The interviews were conducted with (1) expatriates working for international NGOs (N=15) (2) health professionals and administrators working in health sector (N= 45) in the period from November 2010 to January 2011. RESULTS: The government in North Darfur state spent 70% of its financial budget on security, while it spent it less than 1% on providing health services. The international NGOs have been providing 70% of curative health services to the State's population by contributing 52.9% of the health budget and 1 390 health personnel. Since 2003 NGOs have provided technical assistance to the health staff. As a result, more than fifty nurses have been trained to provide care and treatment, more than twenty-three doctors have been trained in laboratory equipment operation, and approximately six senior doctors and hospital directors have received management training. NGOs have been managing and supporting 89 public health facilities, and established 24 health centres in IDP camps, and 20 health centres across all the districts in North Darfur state. CONCLUSION: The NGOs have played an important role in providing curative health services and in establishing good health facilities, but a future problem is how the government will run these health facilities after a peaceful settlement has been reached which might cause NGOs to leave the region.

Climate change, conflict and health.

Future climate change is predicted to diminish essential natural resource availability in many regions and perhaps globally. The resulting scarcity of water, food and livelihoods could lead to increasingly desperate populations that challenge governments, enhancing the risk of intra- and interstate conflict. Defence establishments and some political scientists view climate change as a potential threat to peace. While the medical literature increasingly recognises climate change as a fundamental health risk, the dimension of climate change-associated conflict has so far received little attention, despite its profound health implications. Many analysts link climate change with a heightened risk of conflict via causal pathways which involve diminishing or changing resource availability. Plausible consequences include: increased frequency of civil conflict in developing countries; terrorism, asymmetric warfare, state failure; and major regional conflicts. The medical understanding of these threats is inadequate, given the scale of health implications. The medical and public health communities have often been reluctant to interpret conflict as a health issue. However, at times, medical workers have proven powerful and effective peace advocates, most notably with regard to nuclear disarmament. The public is more motivated to mitigate climate change when it is framed as a health issue. Improved medical understanding of the association between climate change and conflict could strengthen mitigation efforts and increase cooperation to cope with the climate change that is now inevitable.

The influence of maternal health education on the place of delivery in conflict settings of Darfur, Sudan.

BACKGROUND: Armed conflict and socio-demographic characteristics of internally displaced persons (IDPs) are very important factors that influence the provision of reproductive health (RH) in humanitarian settings. Maternal health education plays a crucial role to overcome the barriers of RH care, reduce home births conducted by traditional birth attendants (TBAs), and improve increasing births in a health facility. The objectives of this study were to (1) determine the association between the place of delivery and home visits for maternal health education and (2) describe the socio-demographic characteristics of women who gave birth during the last two years. METHODS: A cross-sectional study among married women aged (15-49 years old) in IDP camps. All women were subjected to intensive maternal health education at their homes for 3 years prior to the survey. A sample of 640 women who gave birth during the last two years was randomly selected. RESULTS: Among all women investigated, 36.9 % (95 % CI: 33.1, 40.8) reported a home-based delivery, while 63.1 % (95 % CI: 59.2, 66.9) reported a facility-based delivery. Receiving visits for maternal health education at home was associated with an estimated 43.0 % reduction in odds of giving birth at home, compared to not receiving home visits (adjusted odds ratio [ aOR] 0.57; 95 % CI: 0.35, 0.93). The level of women's education and camp of residence were important predictors for home birth. CONCLUSION: Maternal health education at home was associated with a reduction in home-based delivery performed by TBAs in the conflict-affected setting of Darfur. Our study proposes that when facility-based delivery is made available in camp's clinics, and the targeted women educated at home to refrain from home-based delivery, they will choose to undergo facility-based delivery.

Psychiatric disorders among a sample of internally displaced persons in South Darfur.

BACKGROUND: The violent armed conflict in Darfur has been ongoing for years getting the attention of human rights activists and mental health professionals. AIM: The aim of this study was to assess psychiatric disorders in a sample of internally displaced persons (IDPs) in South Darfur. METHOD: A cross-sectional observational study, as a part of the 'Darfur Campaign' organized by Arab Federation of Psychiatrists, assessing psychiatric disorders in a sample of internally displaced women using the Structured Clinical Interview for DSM-IV (SCID-I) (clinical version). RESULTS: Up to 25.7% of participants had lost a close family member or more in the violent clashes. Psychiatric diagnoses were found in 62.2% of the participants. The most frequently reported was post-traumatic stress disorder (PTSD) reaching 14.9%, followed by depression 13.5% (among which 2.7% with psychotic features), while comorbid PTSD and depression reached 8.1% of participants. Patients with psychiatric diagnoses had an older age (36.6 years) (p = .024). Suffering from a psychiatric disorder was found to be associated with losing a family member in the conflict (p = .015), being 35.6% in patients with psychiatric diagnoses compared to 10.3% in those without losing a family member in the conflict (odds ratio (OR) = .7, 95% confidence interval (CI) = 1.25-18.28). CONCLUSIONS: This study used a standardized tool for diagnosing psychiatric morbidity among refugees in Darfur to give as much as possible an actual description of the problems and psychiatric morbidity caused by human-made disasters. This study can help to lead to a more detailed and specific mental health service program much needed by this population.