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This article undertakes a comprehensive assessment of the African Union (AU)'s Agenda 2063 Aspiration 4: A peaceful and secure Africa and the progress made at continental level towards it. Aspiration 4 is informed by the AU's acknowledgment that the scourge of conflict on the continent plays a significant role in hampering socioeconomic development. Against this background, the article examines the role played by the AU and its regional economic communities (RECs) in response to armed conflict on the continent, as exemplified by the AU and Southern African Development Community (SADC) response to the Cabo Delgado conflict in northern Mozambique. The AU's response to the recent surge of military coups in Africa is also examined, with a focus on the coups in Sudan in 2019 and 2021. The article concludes that the Agenda 2063 blueprint is a useful tool for the continental body when dealing with the scourge of conflicts and unconstitutional changes of governments, which threatens to hamper the AU's developmental agenda.

Background:Hypertension is defined as blood pressure ≥140/90 mm Hg. It is emerging as one of the major healthcare challenges in low- and middle-income countries. Hypertension is considered as a silent killer and is the leading risk factor for cardiovascular mortality and accounts for a large proportion of premature deaths in developing countries. Most people with hypertension are asymptomatic and are undiagnosed for years. Objectives:This study aimed to find out the prevalence of undiagnosed hypertension and related risk factors among adults in Wad Medani Alkobra locality in Gezira State, Sudan. Methods:A community-based cross-sectional study involving 464 adults in different locations in Wad-Medani Alkobra locality, from June 2022 to August 2022 was performed in collaboration with the Sudanese Society of Hypertension within May Measure Month (MMM) 2022 study. WHO Stepwise Approach to Surveillance (STEPS) questionnaire was used to collect data, and was analyzed by SPSS version 20. Demographics, blood pressure, pulse, and socioeconomic status were measured. Diagnosis of hypertension was defined based on a systolic and diastolic blood pressure of ≥140 mmHg and ≥90 mmHg, respectively and three readings were obtained. Blood pressure was measured in all women and men aged 15 years and above. Results:Total number of study population was 464, males were 239 (52%), females were 225 (48%). Mean age was 45 years. 68 were known hypertensive (15%). Of those who are hypertensive, 27 (39%) had high blood pressure. Undiagnosed hypertension in the study population was found to be 10% (39 individual) which equals to 59.1% from the total number of the populations who had HTN (66). The prevalence of HTN (new and old cases) in this study group was 25%. There was positive relation between high blood pressure and old age, diabetes mellitus increased body weight and sex (more common in males}, P-value was (,0.00, 0.026, 0.014, 0.033) respectively. Conclusions:The prevalence of hypertension was high and associated with some modifiable risk factors which should be addressed. Frequent screening and proper treatment is required to prevent complications of this hidden epidemic.

Background: Dietary patterns and its associated factors and can play an essential role in development of preeclampsia and implication in pregnancy-induced hypertension (PIH). Objective: This study was performed to determine nutritional factors associated with PIH among pregnant women in Khartoum, Sudan. Methods: This study was a case-control involving 100 women with PIH and 200 normotensive pregnant women. Results: The mean current weight in the control and PIH groups was 70.25 ± 12.35 and 72.42 ± 12.33 kg; whereas the mean energy intake in the control and PIH groups was 1991.58 ±140.72 and 2154.37 ± 130.85 kcal, respectively. The study results indicated a significantly lower risk of PIH among women ingesting fruits and legumes (odds ratio, 8.44 and 4.07, respectively; 95% confidence interval; P < 0.05). Conclusion: PIH was positively associated with higher energy, fat, and protein intake. A lower risk of PIH was calculated for women whose dietary habits included fruits and legumes. Measures with which to ensure proper nutrition education are needed to obtain good health and pregnancy outcomes. PIH is a multifactorial disease with an unclear etiology, and the findings of this study will serve as a baseline for future studies in this field. Keywords: Nutrition; pregnancy-induced hypertension; health; Sudan.

Samples taken from the canopic jars of Djehutyhotep, chief of Tehkhet (Debeira), Lower Nubia, and local versions of Egyptian canopic jars from Sai, Upper Nubia, suggest that the materials used for mortuary ritual unguents in Nubia may have differed from those used in Egypt. Nubian samples consisted of plant gum and bitumen, whereas those from Egypt conformed to the standardizing black resinous liquid recipe used for mummification and other funerary rituals. However, there may be time frame issues to be considered as most samples analyzed from Egypt date to later periods. A standard black funerary liquid was used at Amara West, Upper Nubia, probably poured over a wrapped body, which might suggest that the gum and bitumen mixture was reserved for filling canopic jars, perhaps indicating that the use of canopic jars in Nubia differed from their use in Egypt. Evidence from the canopic jars of Djehutyhotep, local versions of canopic jars from Sai, and the sample from Amara West also indicate a source of bitumen that was not the Dead Sea, which was the main (although not only) source used in Egypt. The new results from the analysis of the Djehutyhotep canopic jars and previously published results from Sai point towards alternative ritual practices associated with local conceptions and uses of canopic jars in colonized Nubia. These samples and data from Amara West further reveal that the bitumen used in mortuary contexts in Nubia originated elsewhere than bitumen used in Egypt, which might have implications for our understanding of colonized Nubia as part of other trade networks independently from Egypt.

Background Lactating mothers are susceptible to anaemia. Little published data are available on lactational anaemia in Africa, including Sudan. This study was conducted to assess the prevalence of and associated factors for anaemia among lactating mothers in eastern Sudan. Methods A cross-sectional study was conducted and sociodemographic and clinical characteristics were gathered through a questionnaire. Results A total of 650 lactating mothers were included in the analysis. Their median age and parity were 28.0 y (interquartile range [IQR] 23.7‒32.0) and 3.0 (IQR 2.0‒4.0), respectively. Haemoglobin (Hb) levels ranged from 7.0 to 15.0 g/dL (median 11.2 [IQR 10.4‒12.0]). Of the 650 lactating mothers, 442 (68.0%) had anaemia (Hb Conclusions This study showed a high prevalence of anaemia among lactating mothers. Public health intervention activities designed towards education would be helpful to reduce anaemia.

The goal of this paper is to investigate the influence of oral dipping of Tombak Smokeless Tobacco (SLT) on prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio(INR) values, and platelet counts (PLTs), in Sudanese Tombak users. An analytical cross-sectional study was conducted at Kosti health insurance hospital, Sudan, in 2019. According to the inclusion and exclusion criteria, 100 adult users of oral Tombak for three or more years were chosen randomly as a study group. Another 100 matched healthy individuals who never used Tombak were randomly selected as a comparative group. Venous blood specimens were collected in ethylene diamine tetra-acetic acid (EDTA) containers for the PLT counts using the automated haematology analyser (Sysmex, Tokyo, Japan XK-21SYSMEX) and in trisodium citrate anti-coagulant containers for coagulation tests using a co-agulometer machine analyser. Our findings show a significant decrease in PLT count mean values in the Tombak users group (212.1 × 103/mm3 ± 74.3 × 103/mm3) compared with the non-taking Tombak group mean values (243.2 × 103/mm3 ± 83.0 × 103/mm3), (p < 0.006). Both PT and APTT were significantly prolonged in Tombak users (16.03 ± 1.22 s vs. 14.44 ± 0.557 s), p < 0.001 for PT, and (41.62 ± 7.28 s vs. 34.99 ± 4.02 s), (p < 0.001) for APTT. INR mean values were significantly longer in Tombak users (1.11 ± 0.096) vs. (1.07 ± 0.66; p < 0.001). Multiple linear regression analysis findings show a significant impact of the four investigated variables, including duration of taking Tombak, age, and frequency of taking Tombak per day (p < 0.001). In conclusion, using Tombak a Smokeless Tobacco (SLT) for a long period significantly affect Platelet counts and coagulation profile.

Background: Believing research prioritization can increase the research value and augment advances in the scientific base of any profession, this study aimed to identify research priorities relevant for medical education in Sudan.Methods: The study was designed to capture a qualitative exploration of multiple stakeholders’ opinions. Data were collected from two stakeholder groups: experts and students of medical education in Sudan. Semi-structured individual interviews and focus groups from 10 experts and 41 learners were incorporated. The categories and subcategories, derived from experts’ data inductively through constant comparison, enhanced the development of a coding framework. This framework was used deductively to analyze the beliefs and opinions of the learners leading to a list that exemplifies priorities for medical education research.Results: A set of seven principal and three minor themes were identified, the principal themes were: Curriculum Content, Design, and Delivery; Faculty Development; Assessment Methods; Research; Accreditation, Evaluation, and Quality; Professionalism; and Student Selection and Support. Four themes were identified to justify participants’ selections: Quality education and patient care; Accreditation of schools; Curricula contextualization; and Documentation of success stories.Conclusion: This instrumental research fulfilled its aim to mount a set of medical education research priorities grounded in collected perceptions with optimal stakeholder engagement. Importantly, there were many more similarities than differences between these findings and those from other countries which suggests that some topics are relevant across the international arena and one may propose the commencements of an international medical education agenda. Keywords: medical education, master students, research priorities, priority setting, Sudan

This article presents documents relating to the embassy sent by Sultan ʿAbd al-Raḥmān of Darfur to the Ottoman Sultan Selim III in 1791. These include an original Arabic letter which is an unusually early surviving example of sultanic correspondence from the Sahel. The documents permit a new interpretation of the purposes of the embassy, as well as an examination of chancery practice in Darfur, and offer an insight into Darfuri views of the outside world. To aid the analysis, the article compares this letter with a second surviving letter from ʿAbd al-Raḥmān addressed to Napoleon Bonaparte around 1800, of which the Arabic text has not previously been published.

Intellectual disability is a form of neurodevelopmental disorders that begin in childhood and is characterized by substantial intellectual difficulties as well as difficulties in conceptual, social, and practical areas of living. Several genetic and nongenetic factors contribute to its development; however, its most severe forms are generally attributed to single-gene defects. High-throughput technologies and data sharing contributed to the diagnosis of hundreds of single-gene intellectual disability subtypes.We applied exome sequencing to identify potential variants causing syndromic intellectual disability in six Sudanese patients from four unrelated families. Data sharing through the Varsome portal corroborated the diagnosis of one of these patients and a Tunisian patient investigated through exome sequencing. Sanger sequencing validated the identified variants and their segregation with the phenotypes in the five studied families.We identified three pathogenic/likely pathogenic variants in CCDC82, ADAT3, and HUWE1 and variants of uncertain significance in HERC2 and ATP2B3. The patients with the CCDC82 variants had microcephaly and spasticity, two signs absent in the two previously reported families with CCDC82-related intellectual disability.In conclusion, we report new patients with pathogenic mutations in the genes CCDC82, ADAT3, and HUWE1. We also highlight the possibility of extending the CCDC82-linked phenotype to include spastic paraplegia and microcephaly.

Context Evidence is needed to inform expansion of hospital-based palliative care in low and middle-income countries. Objectives This study aimed to measure need for palliative care among adult inpatients at five hospitals in Sudan. Objectives were to 1) measure point prevalence of life-limiting and life-threatening illness (LL/LTI); 2) determine patient insight into diagnosis and prognosis; 3) assess palliative care-related symptoms and concerns. Methods In this two-day census, data were extracted from charts on documented LL/LTI for each occupied bed. For patients with LL/LTI, self-report data was collected on symptoms, concerns and understanding of diagnosis and prognosis using Integrated African Palliative Outcome Scale (IAPOS). Results 1) Prevalence of LL/LTI in general hospitals was 30.9%-70.5%. 2) n = 439 patients gave self-report data (response rate 89.8%). Mean age was 52.3 (SD 17.8), 59% of patients correctly knew their diagnosis, and 36% knew their illness was progressive. Those with a non-cancer diagnosis were significantly less likely to know their prognosis (28.4% vs 40.7% respectively, P = 0.012). 3) Family anxiety was most burdensome (56.7% scoring on the two most severe categories on a 6-point Likert), followed by pain (52.4%), poor mobility (40.5%), patient worry (39.9%), and fatigue (36.9%). Patients unaware of prognosis had higher total IAPOS scores than those aware their prognosis was progressive, 38.9 (SD = 15.6) (t = -3.297, P = 0.001, mean difference = -5.010, 95% CI: -7.997, -2.023). Conclusion Care for those with life-limiting and life-threatening illness places a significant occupancy burden on public hospitals. Communication skills are required to provide patients with insight, and core palliative care skills for acute hospital clinicians are needed to manage the high burden of symptoms and concerns.

Aim of the work To evaluate the demographic, clinical presentation, and laboratory findings of the juvenile idiopathic arthritis (JIA) subtypes in Sudanese patients attending the Pediatric Rheumatology Clinic. Patients and methods This single-center study was conducted at the Rheumatology Clinic of Ahmed Gasim Hospital, Khartoum North. A specially designed data collection form was used. Full medical history and physical examination of patients was done. The initial investigation was collected from the patients' records. Results Eighty-one patients were enrolled in the study. Females were 54 and 27 males (F: M was 2:1). The mean age of the patients was 10.8 ± 3.6 years, 58% were above 10 years; disease duration 5.8 ± 2.4 years and age at onset 9 ± 3.8 years, the commonest age at onset was between 5 and 10 years. Half of the patients were from rural areas. There was a positive family history in 7.4%. Morning stiffness was the commonest presenting symptom (98.8%) and uveitis was present in 8.6%. The knee was the most affected joint (82.7%). The polyarticular subtype was found in 51 (63%), systemic-onset in 18 (22.2%), oligo articular in 10 (12.3%) and spondyloarthritis in 2 (2.5%). Seven patients (8.6%) had uveitis. Rheumatoid factor (RF) and antinuclear antibody (ANA) were positive among 30.9% and 46.9% of the participants respectively. Conclusion Females predominate and half of the patients are from rural areas. Polyarticular is the commonest subtype. Morning stiffness is the presenting symptom. The knee joint was the most affected. Positive RF was found in one-third of patients, ANA in about half of them.

Un étrange dépôt découvert dans une tombe du cimetière Kadruka 1 (KDK1), voisine de la célèbre tombe 131, dite « du chef », laisse envisager que des populations néolithiques de Nubie utilisaient des pierres de pluie. Vu la place occupée par les « faiseurs de pluie » dans la théorie frazérienne, et la localisation de Kadruka au cœur du futur royaume de Kerma, une présence de pierres de pluie dans ce contexte particulier serait riche d’enseignement sur le processus de construction du pouvoir politique dans cette partie de l’Afrique. Mais peut-on croire que cet assortiment de pierres fut utilisé dans le cadre d’un rituel de pluie ? Pour tenter de répondre à cette question, nous convoquerons la littérature ethnographique, à la recherche de récurrences, qu’elles concernent les pierres de pluie où les rites et croyances s’y rapportant. Les lois de la magie sympathique expliquant ces récurrences, la question posée pourra être traitée. Au-delà de cette question, qui restera ouverte, l’étude montrera qu’en se fondant sur ces lois universelles, donc transculturelles, on peut utiliser les données ethnographiques pour pénétrer les systèmes de pensée de sociétés disparues depuis des millénaires. An unusual lithic deposit discovered in a grave in the Kadruka 1 (KDK1) cemetery, close to the famous “chief’s” grave 131, raises the possibility that certain Neolithic Nubian communities made use of rainmaking stones. Considering, on the one hand the place occupied by rainmakers in Frazer’s theories of religion, and on the other hand the location of Kadruka in the very heart of what would become the Kerma Kingdom nearly two millennia later, the presence of rainstones in this particular context could shed light on the process of power-building in this part of Africa. To what extent can we be confident that this assortment of stones was used as part of a rain ritual? To broach this question, we will draw upon ethnographic literature to establish recurrent patterns concerning rainstones and the rites and beliefs related to them. We will see that these patterns can be explained through reference to the universal laws of sympathetic magic. Nevertheless these patterns don’t provide definitive proof that these deposits are rainstones. Still, the study will show that, through these universal (and therefore cross-cultural) laws one can use ethnographic information to enter the systems of thought of societies that have disappeared for millennia.

Darfur in Western Sudan has the most volatile camps of internally displaced persons (IDPs) and has experienced several outbreaks of dengue, chikungunya and yellow fever.To determine the prevalence and Stegomyia indices of Aedes aquatic stages in El Geneina town, Western Darfur.Cross-sectional entomological surveys of immature stages of Aedes were carried out during August-November 2019 in 4 sites with IDP camps and a residential area with no camp.We searched 17 730 houses, IDP camps and buildings of governmental corporations for Aedes larvae, and 6809 (38.4%) were positive for Aedes aquatic stages. Both Aedes aegypti and Aedes vittatus larvae were found. However, Ae. aegypti constituted90% of the larvae. Six positive water containers were recorded: tyres, clay pots, barrels, plastic water tanks, flower vases and old cars: 26% of 92 tyres contained Aedes larvae compared to 23.8% of 21 old cars and 17.1% of 44 198 clay pots. This suggested that clay pots were the main source of Aedes. The results showed high infestation of El Geneina town with Aedes immature stages in all study sites including public buildings and residential areas with no IDP camps. Stegomyia indices varied among study sites, and were more elevated in sites with IDP camps. For all sites, House index = 38.40, Container Index = 11.40, Breateu index = 13.60 and Pupa Index = 27.Multisectoral response coupled with community participation are urgently needed to reduce the burden of Aedes-borne diseases in the unstable El Geneina town.مؤشرات السَّقْفاوات لمراحل الزاعجة المائية في بلدة الجنينة، غرب السودان.حامد حامد، هبة موسى، عادلة أحمد، تيسير عبد العزيز، أسماء آدم، مواهب عبد عبدالمالك، عزيزة الطاهر، حمودة كافي، رشا أزرق.يضم إقليم دارفور غرب السودان أحد أكثر مخيمات النازحين داخليًّا تأثرًا، وقد شهدت هذه المخيمات العديد من فاشيات حمى الضنك والشيكونجونيا والحمى الصفراء.هدفت هذه الدراسة إلى تحديد معدل انتشار مؤشرات ”السَّقْفاوات“ لمراحل ”الزاعجة“ المائية في بلدة الجنينة، غرب دارفور.أُجريت مسوحات حشرية مقطعية للمراحل غير الناضجة من ”الزاعجة“ خلال شهري أغسطس/ آب ونوفمبر/ تشرين الثاني 2019 في 4 مواقع بها مخيمات للنازحين داخليًّا ومنطقة سكنية ليس فيها مخيم.لقد قمنا بتفتيش 17730 موقعًا من المنازل ومخيمات النازحين داخليًّا وأبنية المؤسسات الحكومية بحثًا عن يرقات ”الزاعجة“، فوجدنا أن 6809 عينات (38.4٪) كانت إيجابية للمراحل المائية”للزاعجة“. وعُثر على يرقات كل من ”الزاعجة المصرية“ و”الزاعجة فيتاتوس“. إلا أن ”الزاعجة المصرية“ شكلت أكثر من 90٪ من اليرقات. وسُجِّلت ست حاويات مياه إيجابية، وهي إطارات السيارات، والأوعية الطينية، والبراميل، وخزانات المياه البلاستيكية، ومزهريات الزهور، والسيارات القديمة: واحتوى 26٪ من 92 إطارًا على يرقات ”الزاعجة“ مقارنة بنسبة 23.8٪ من 21 سيارة قديمة، و 17.1٪ من 44198 وعاء طينيًّا. ويشير ذلك إلى أن الأوعية الطينية كانت المصدر الرئيسي ”للزاعجة“. وأظهرت النتائج انتشارًا مرتفعًا للمراحل غير الناضحة من ”الزاعجة“ في بلدة الجنينة في جميع مواقع الدراسة، ومنها المباني العامة والمناطق السكنية التي ليس فيها مخيمات للنازحين داخليًّا. واختلفت مؤشرات ”السَّقْفاوات“ بين مواقع الدراسة، وكانت أعلى في المواقع التي فيها مخيمات للنازحين داخليًّا. وفي جميع المواقع، كان مؤشر المنازل = 38.40، ومؤشر الحاويات = 11.40، ومؤشر بريتو = 13.60، ومؤشر الخادرة = 27.توجد حاجة ماسة إلى استجابة متعددة القطاعات مقترنة بمشاركة مجتمعية من أجل تخفيف عبء الأمراض المنقولة عن طريق الزاعجة في بلدة الجنينة غير المستقرة.Indices Stegomyia parmi les moustiques Aedes aux stades aquatiques dans la ville d'El-Genena dans l'ouest du Soudan.Le Darfour, dans l'ouest du Soudan, compte les camps de personnes déplacées internes les plus instables et a connu plusieurs épidémies de dengue, de chikungunya et de fièvre jaune.Déterminer la prévalence des moustiques Aedes aux stades aquatiques et les indices Stegomyia parmi ces derniers dans la ville d'El-Genena, au Darfour occidental.Des enquêtes entomologiques transversales sur les stades immatures des moustiques Aedes ont été réalisées entre août et novembre 2019 dans quatre sites abritant des camps de personnes déplacées internes et dans une zone résidentielle sans camp.Nous avons recherché des larves d'Aedes dans 17 730 maisons, camps de personnes déplacées internes et bâtiments de sociétés gouvernementales, et 6809 (38, 4 %) étaient positifs pour les stades aquatiques du moustique Aedes. Des larves d'Aedes aegypti et d'Aedes vittatus ont été trouvées. Cependant, Ae. aegypti représentait plus de 90 % des larves. Six récipients d'eau positive ont été recensés : pneus, pots en argile, barils, réservoirs d'eau en plastique, vases à fleurs et anciennes voitures : 26 % des 92 pneus contenaient des larves d'Aedes contre 23,8 % des 21 anciennes voitures et 17, 1 % des 44 198 pots en argile. Cela laisse penser que les pots en argile étaient la principale source d'Aedes. Les résultats ont révélé une infestation élevée de la ville d'El-Genena par des moustiques Aedes aux stades immatures dans tous les sites examinés, notamment les bâtiments publics et les zones résidentielles sans camps de personnes déplacées internes. Les indices Stegomyia variaient selon les sites d'étude ; ils étaient plus élevés dans les sites abritant des camps de personnes déplacées internes. Pour tous les sites, l'indice habitation était de 38,40, l'indice récipient de 11,40, l'indice de Breateu de 13,60 et l'indice pupaire de 27.Une réponse multisectorielle et la participation de la communauté sont nécessaires de toute urgence pour réduire le fardeau des maladies transmises par les moustiques Aedes dans la ville d'El-Genena marquée par l'instabilité.

To assess the knowledge and attitude toward epilepsy among the final and semi-final years medical students at University of Bahri.An observational cross-sectional study was carried out at College of Medicine, University of Bahri. Self-administered questionnaires were applied to 228 medical students in the final and semi-final years.Sixty-three percent of students showed a high level of knowledge. Despite that 10.1% of the students do not know that atonic seizure is a type of epilepsy, 62.7% attributed the causes of epilepsy to psychological factors only, and 9.6% considered epilepsy is an untreatable disease. The majority of students are not aware that screaming is a manifestation of certain types of epilepsy. More than half of the students considered inserting something into the patient's mouth during the seizure will prevent tongue biting. Interestingly, a total of 8.3% of students thought that it is a demonic attack, whereas 34.6% of students thought the Holy Quran as an appropriate treatment for epilepsy (P = .026). Up to 77% of the students showed a positive attitude toward patients with epilepsy. However, 42.1% of students agreed that there should be some restrictions in sport and leisure activities for people who suffer from epilepsy, and 13.6% of students admitted they will not get married to someone with epilepsy.Our study showed an overall relatively high level of knowledge toward epilepsy among medical students with a potentially positive attitude toward patients with the disease. However, there are still misconceptions of epilepsy in different aspects. This study showed some important facts for policymakers and key opinion leaders in curriculum preparation and training programs for medical schools which should be designed to increase knowledge and understanding of epilepsy among the medical students, not just the scientific knowledge but also discuss the social impact of epilepsy on a patient's life.

Purpose of the paper: The study aimed to evaluate the impact of the political change that occurred in Sudan on the practice of public relations. Methodology: The descriptive analytical approach was used to obtain the results, and it is defined as a method of analysis that focuses on sufficient and accurate information about a particular phenomenon or topic or a known period. The questionnaire was utilized as one of the tools that are used in the descriptive research to obtain the primary data and then analyze it. Findings: The study concluded that the practice of public relations in Sudan needs a more democratic environment, which helps the independence of public relations.The study also found that the intellectual and cultural shifts that accompanied the political change had a positive impact on the practice of public relations. This study indicates that the environment directly affects the practice of public relations, especially during political change. The study also emphasizes the importance of continuous training and education of public relations practitioners to deal with environmental change, especially political change. Therefore, public relations practitioners who work in public institutions should consider that successful public relations practice will be measured by its contribution to social advancement and the creation of harmony and consensus among the components of society. Originality/value of paper: This study contributes to providing a detailed assessment of the reality of public relations practice in Sudan before and after the political change.

Seit Jahrzehnten ist die Geschichte des Sudan, dem drittgrößten Land Afrikas mit rund 46 Millionen Einwohnern, von gewaltsamen Auseinandersetzungen zwischen den nördlichen, muslimischen und arabischen Militäreliten der Hauptstadt Khartum auf Kosten der Zivilbevölkerung geprägt. Seit der Unabhängigkeit Sudans im Jahr 1956 kam es zu 16 Putschversuchen, von denen sechs erfolgreich waren. Das war mehr als in jedem anderen Land auf einem Kontinent, der selbst mehr Staatsstreiche erlebt hat als jede andere Region der Welt. Zwei Bürgerkriege zwischen der Regierung in Khartum und den südlichen Regionen forderten rund 1,5 Millionen Opfer. Darüber hinaus hat der anhaltende Konflikt in der westlichen Darfur-Region mehr als 200.000 Menschen getötet und zwei Millionen Menschen vertrieben. In diesen Konflikten bedeuten Grenzen wenig. Die Kontrolle über Ressourcen und Untertanen ist das Hauptziel, und in den Grenzgebieten entstehende Kräfte streben nach Rache an den verachteten Eliten der Metropolen. Die geopolitische Bedeutung des Sudan in einer instabilen Region an der Grenze zum Roten Meer, der Sahelzone und dem Horn von Afrika sowie sein landwirtschaftlicher Wohlstand zogen regionale und globale Akteure an und behinderten den erfolgreichen Übergang zu einer zivil geführten Regierung und einer nachhaltigen Entwicklung. Neben Großbritannien, der ehemaligen Kolonialmacht, kämpften Russland, die USA, Saudi-Arabien, die Vereinigten Arabischen Emirate und weitere Nachbarländer um Einfluss im Sudan, darunter Äthiopien, Tschad und Süd-Sudan. Auch sie waren von politischen Unruhen und Konflikten betroffen und litten unter der Last der sudanesischen Flüchtlinge, die vor den Kämpfen in die Nachbarländer flohen. Bereits die britischen Kolonialherren nutzten bestehende Unterschiede, um die Bevölkerung nach ethnischen und regionalen Zugehörigkeiten aufzuteilen, eine Praxis, die bis heute Bestand hat. Der Aktivismus der Milizen vertiefte die Spaltungen unter den Rebellenanhängern. Diese "Teile-und-herrsche"-Politik entsprach einer bewährten Taktik afrikanischer Regierungen in ethnischen Bürgerkriegen, bei der die Milizen häufig ausgenutzt wurden, um ethnische Migration zu fördern und zu erleichtern, indem sie in die nationale Armee integriert wurden. Auch transnationale, fest verwurzelte kriminelle Netzwerke im Drogen-, Waffen- und Menschenhandel standen bereit, das Chaos auszunutzen. Dies machte den Sudan zu einem der fragilsten Länder der Welt. Der Zusammenbruch des Sudan würde nicht nur seine Nachbarn erschüttern, sondern könnte auch zahlreiche andere afrikanische Länder in Mitleidenschaft ziehen, darunter fragile Staaten in der Sahelzone sowie in Ost- und Nordafrika. Die Nebenwirkungen einer solch unkalkulierbaren Konfliktzone und das daraus resultierende Chaos würden auch Westeuropa treffen, das bereits unter dem Zustrom von Flüchtlingen aus Syrien und anderen Kriegsgebieten im Nahen Osten und in Afrika leidet. For decades, the history of Sudan, Africa's third largest country with around 46 million inhabitants, has been marked by violent clashes between the northern, Muslim and Arab military elites of the capital Khartoum at the expense of the civilian population. Since Sudan gained independence in 1956, there have been 16 attempted coups, six of which were successful. That was more than in any other country on a continent that has itself seen more coups than any other region in the world. Two civil wars between the government in Khartoum and the southern regions claimed around 1.5 million victims. In addition, the ongoing conflict in the western Darfur region has killed more than 200,000 people and displaced two million people. In these conflicts, borders mean little. Control of resources and subjects is the primary objective, and forces arising in the borderlands seek revenge on the despised metropolitan elites. Sudan's geopolitical importance in a volatile region bordering the Red Sea, the Sahel and the Horn of Africa, as well as its agricultural prosperity, attracted regional and global actors and hampered the successful transition to civilian-led government and sustainable development. In addition to Great Britain, the former colonial power, Russia, the USA, Saudi Arabia, the United Arab Emirates and other neighbouring countries were fighting for influence in Sudan, including Ethiopia, Chad and South Sudan. They, too, were affected by political unrest and conflict and suffered under the burden of Sudanese refugees fleeing the fighting to neighbouring countries. The British colonial rulers had already used existing differences to divide the population according to ethnic and regional affiliations, a practice that survives to this day. Militia activism deepened divisions among rebel supporters. This divide-and-conquer policy corresponded to a well-established tactic used by African governments in ethnic civil wars, often exploiting the militias to encourage and facilitate ethnic migration by integrating the militias into the national army. Transnational, well-entrenched criminal networks involved in drug-, arms- and human trafficking also stood ready to take advantage of the chaos. This made Sudan one of the most fragile countries in the world. Sudan's collapse would not only shake its neighbours, but could also upset several other African countries, including fragile states in the Sahel, and East and North Africa. The side effects of such an incalculable conflict zone and the resulting chaos would also affect Western Europe, which is already suffering from the influx of refugees from Syria and other war zones in the Middle East and Africa. Depuis des décennies, l'histoire du Soudan, troisième plus grand pays d'Afrique avec environ 46 millions d'habitants, est marquée par de violents affrontements entre les élites militaires du Nord, musulmanes et arabes de la capitale Khartoum aux dépens de la population civile. Depuis que le Soudan a obtenu son indépendance en 1956, il y a eu 16 tentatives de coup d'État, dont six ont réussi. C'était plus que dans tout autre pays sur un continent qui a lui-même connu plus de coups d'État que toute autre région du monde. Deux guerres civiles entre le gouvernement de Khartoum et les régions du sud ont fait environ 1,5 million de victimes. En outre, le conflit en cours dans la région occidentale du Darfour a tué plus de 200 000 personnes et déplacé deux millions de personnes. Dans ces conflits, les frontières ont peu d'importance. Le contrôle des ressources et des sujets est l'objectif principal, et les forces qui surgissent dans les régions frontalières cherchent à se venger des élites métropolitaines méprisées. L'importance géopolitique du Soudan dans une région instable, bordant la mer Rouge, le Sahel et la Corne de l'Afrique, ainsi que sa prospérité agricole, ont attiré des acteurs régionaux et mondiaux et ont entravé la réussite de la transition vers un gouvernement dirigé par des civils et le développement durable. Outre la Grande-Bretagne, l'ancienne puissance coloniale, la Russie, les États-Unis, l'Arabie Saoudite, les Émirats arabes unis et d'autres pays voisins se battaient pour l'influence au Soudan, notamment l'Éthiopie, le Tchad et le Soudan du Sud. Eux aussi ont été touchés par les troubles politiques et les conflits et ont souffert sous le fardeau des réfugiés soudanais fuyant les combats vers les pays voisins. Les dirigeants coloniaux britanniques avaient déjà utilisé les différences existantes pour diviser la population en fonction des affiliations ethniques et régionales, une pratique qui survit à ce jour. L'activisme des milices a approfondi les divisions entre les partisans des rebelles. Cette politique, de diviser pour régner correspondait à une tactique bien établie, utilisée par les gouvernements africains dans les guerres civiles ethniques, exploitant souvent les milices pour encourager et faciliter la migration ethnique en intégrant les milices dans l'armée nationale. Des réseaux criminels transnationaux bien établissent impliqués dans le trafic de drogue, d'armes et d'êtres humains étaient également prêts à profiter du chaos. Cela a fait du Soudan l'un des pays les plus fragiles au monde. L'effondrement du Soudan ébranlerait non seulement ses voisins, mais pourrait également bouleverser plusieurs autres pays africains, y compris des États fragiles du Sahel et d'Afrique de l'Est et du Nord. Les effets secondaires d'une zone de conflit aussi incalculable et le chaos qui en résulte affecteraient également l'Europe occidentale, qui souffre déjà de l'afflux de réfugiés de Syrie et d'autres zones de guerre au Moyen-Orient et en Afrique.

Sudan's two main security forces are fighting each other. A swift military outcome is not to be expected in view of the relatively balanced power between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF). This strategic stalemate means that the chances for successful mediation are not hopeless. For this to happen, however, Sudan's international partners would have to abandon the approach that dominated negotiations for decades, namely giving violent actors a leading role in negotiations. Civilian actors formed a broad anti-war coalition that should set the tone for peace talks from the very beginning. This could well be in the interest of the parties to the conflict, as they will need a third actor to arbitrate their relationship in the future. The German government should strive for stronger coordination of the international mediation approaches under civilian leadership from Sudan, while the European Union (EU) should initiate constrains on the financial leeway of Sudan's violent actors.

Numerous studies have reported that sleep disorders are linked to poor health outcomes. However, studies on these associations in children and adolescents in an African context are limited. The aim of the present study was to analyze the relationship between sleep duration and the presence of metabolic syndrome among early adolescents in Sudan. Methods: A cross-sectional study was conducted on participants aged 10–15 years in Khartoum State, Sudan. Metabolic syndrome (MetS) was diagnosed by increased waist circumference and the presence of two or more metabolic abnormalities (triglycerides [TG], high-density lipoproteins [HDL-C], blood pressure [BP], and fasting plasma glucose [FBG]). Short sleep duration was defined based on National Sleep Foundation (NSF) classification. Data were collected by physical examinations, biochemical analyses, and self-developed standardized questionnaires. Data were analyzed with IBM SPSS Statistics Version 24. A generalized additive model (GAM) was used for the smoothing function between sleep duration and MetS. p < 0.05 was considered as significant. Results: The prevalence of MetS and short sleep among early adolescents aged 10–15 years in Sudan was 2.3% and 55.0%, respectively. A higher prevalence of short sleep was found among overweight and obese participants (p < 0.05). The prevalence of MetS among short sleepers was 2.8%. Binary logistic regression analysis showed that male short sleepers had higher odds of having MetS compared to female short sleepers. The relationship between short sleep and low HDL-C in boys and between short sleep and high TG in girls was statistically significant. The highest risk of MetS was observed at less than 6.5 h of sleep per night. Conclusions: Short sleep duration was significantly associated with overweight/obesity in the total population and with low HDL-C in boys and high triglycerides in girls. A nonlinear curve pattern was observed between sleep duration and prevalence of MetS. Longitudinal studies are needed to further determine the causal relationship between sleep habits and MetS and its components.

Seit Jahrzehnten ist die Geschichte des Sudan, dem drittgrößten Land Afrikas mit rund 46 Millionen Einwohnern, von gewaltsamen Auseinandersetzungen zwischen den nördlichen, muslimischen und arabischen Militäreliten der Hauptstadt Khartum auf Kosten der Zivilbevölkerung geprägt. Seit der Unabhängigkeit Sudans im Jahr 1956 kam es zu 16 Putschversuchen, von denen sechs erfolgreich waren. Das war mehr als in jedem anderen Land auf einem Kontinent, der selbst mehr Staatsstreiche erlebt hat als jede andere Region der Welt. Zwei Bürgerkriege zwischen der Regierung in Khartum und den südlichen Regionen forderten rund 1,5 Millionen Opfer. Darüber hinaus hat der anhaltende Konflikt in der westlichen Darfur-Region mehr als 200.000 Menschen getötet und zwei Millionen Menschen vertrieben. In diesen Konflikten bedeuten Grenzen wenig. Die Kontrolle über Ressourcen und Untertanen ist das Hauptziel, und in den Grenzgebieten entstehende Kräfte streben nach Rache an den verachteten Eliten der Metropolen. Die geopolitische Bedeutung des Sudan in einer instabilen Region an der Grenze zum Roten Meer, der Sahelzone und dem Horn von Afrika sowie sein landwirtschaftlicher Wohlstand zogen regionale und globale Akteure an und behinderten den erfolgreichen Übergang zu einer zivil geführten Regierung und einer nachhaltigen Entwicklung. Neben Großbritannien, der ehemaligen Kolonialmacht, kämpften Russland, die USA, Saudi-Arabien, die Vereinigten Arabischen Emirate und weitere Nachbarländer um Einfluss im Sudan, darunter Äthiopien, Tschad und Süd-Sudan. Auch sie waren von politischen Unruhen und Konflikten betroffen und litten unter der Last der sudanesischen Flüchtlinge, die vor den Kämpfen in die Nachbarländer flohen. Bereits die britischen Kolonialherren nutzten bestehende Unterschiede, um die Bevölkerung nach ethnischen und regionalen Zugehörigkeiten aufzuteilen, eine Praxis, die bis heute Bestand hat. Der Aktivismus der Milizen vertiefte die Spaltungen unter den Rebellenanhängern. Diese "Teile-und-herrsche"-Politik entsprach einer bewährten Taktik afrikanischer Regierungen in ethnischen Bürgerkriegen, bei der die Milizen häufig ausgenutzt wurden, um ethnische Migration zu fördern und zu erleichtern, indem sie in die nationale Armee integriert wurden. Auch transnationale, fest verwurzelte kriminelle Netzwerke im Drogen-, Waffen- und Menschenhandel standen bereit, das Chaos auszunutzen. Dies machte den Sudan zu einem der fragilsten Länder der Welt. Der Zusammenbruch des Sudan würde nicht nur seine Nachbarn erschüttern, sondern könnte auch zahlreiche andere afrikanische Länder in Mitleidenschaft ziehen, darunter fragile Staaten in der Sahelzone sowie in Ost- und Nordafrika. Die Nebenwirkungen einer solch unkalkulierbaren Konfliktzone und das daraus resultierende Chaos würden auch Westeuropa treffen, das bereits unter dem Zustrom von Flüchtlingen aus Syrien und anderen Kriegsgebieten im Nahen Osten und in Afrika leidet. For decades, the history of Sudan, Africa's third largest country with around 46 million inhabitants, has been marked by violent clashes between the northern, Muslim and Arab military elites of the capital Khartoum at the expense of the civilian population. Since Sudan gained independence in 1956, there have been 16 attempted coups, six of which were successful. That was more than in any other country on a continent that has itself seen more coups than any other region in the world. Two civil wars between the government in Khartoum and the southern regions claimed around 1.5 million victims. In addition, the ongoing conflict in the western Darfur region has killed more than 200,000 people and displaced two million people. In these conflicts, borders mean little. Control of resources and subjects is the primary objective, and forces arising in the borderlands seek revenge on the despised metropolitan elites. Sudan's geopolitical importance in a volatile region bordering the Red Sea, the Sahel and the Horn of Africa, as well as its agricultural prosperity, attracted regional and global actors and hampered the successful transition to civilian-led government and sustainable development. In addition to Great Britain, the former colonial power, Russia, the USA, Saudi Arabia, the United Arab Emirates and other neighbouring countries were fighting for influence in Sudan, including Ethiopia, Chad and South Sudan. They, too, were affected by political unrest and conflict and suffered under the burden of Sudanese refugees fleeing the fighting to neighbouring countries. The British colonial rulers had already used existing differences to divide the population according to ethnic and regional affiliations, a practice that survives to this day. Militia activism deepened divisions among rebel supporters. This divide-and-conquer policy corresponded to a well-established tactic used by African governments in ethnic civil wars, often exploiting the militias to encourage and facilitate ethnic migration by integrating the militias into the national army. Transnational, well-entrenched criminal networks involved in drug-, arms- and human trafficking also stood ready to take advantage of the chaos. This made Sudan one of the most fragile countries in the world. Sudan's collapse would not only shake its neighbours, but could also upset several other African countries, including fragile states in the Sahel, and East and North Africa. The side effects of such an incalculable conflict zone and the resulting chaos would also affect Western Europe, which is already suffering from the influx of refugees from Syria and other war zones in the Middle East and Africa. Depuis des décennies, l'histoire du Soudan, troisième plus grand pays d'Afrique avec environ 46 millions d'habitants, est marquée par de violents affrontements entre les élites militaires du Nord, musulmanes et arabes de la capitale Khartoum aux dépens de la population civile. Depuis que le Soudan a obtenu son indépendance en 1956, il y a eu 16 tentatives de coup d'État, dont six ont réussi. C'était plus que dans tout autre pays sur un continent qui a lui-même connu plus de coups d'État que toute autre région du monde. Deux guerres civiles entre le gouvernement de Khartoum et les régions du sud ont fait environ 1,5 million de victimes. En outre, le conflit en cours dans la région occidentale du Darfour a tué plus de 200 000 personnes et déplacé deux millions de personnes. Dans ces conflits, les frontières ont peu d'importance. Le contrôle des ressources et des sujets est l'objectif principal, et les forces qui surgissent dans les régions frontalières cherchent à se venger des élites métropolitaines méprisées. L'importance géopolitique du Soudan dans une région instable, bordant la mer Rouge, le Sahel et la Corne de l'Afrique, ainsi que sa prospérité agricole, ont attiré des acteurs régionaux et mondiaux et ont entravé la réussite de la transition vers un gouvernement dirigé par des civils et le développement durable. Outre la Grande-Bretagne, l'ancienne puissance coloniale, la Russie, les États-Unis, l'Arabie Saoudite, les Émirats arabes unis et d'autres pays voisins se battaient pour l'influence au Soudan, notamment l'Éthiopie, le Tchad et le Soudan du Sud. Eux aussi ont été touchés par les troubles politiques et les conflits et ont souffert sous le fardeau des réfugiés soudanais fuyant les combats vers les pays voisins. Les dirigeants coloniaux britanniques avaient déjà utilisé les différences existantes pour diviser la population en fonction des affiliations ethniques et régionales, une pratique qui survit à ce jour. L'activisme des milices a approfondi les divisions entre les partisans des rebelles. Cette politique, de diviser pour régner correspondait à une tactique bien établie, utilisée par les gouvernements africains dans les guerres civiles ethniques, exploitant souvent les milices pour encourager et faciliter la migration ethnique en intégrant les milices dans l'armée nationale. Des réseaux criminels transnationaux bien établissent impliqués dans le trafic de drogue, d'armes et d'êtres humains étaient également prêts à profiter du chaos. Cela a fait du Soudan l'un des pays les plus fragiles au monde. L'effondrement du Soudan ébranlerait non seulement ses voisins, mais pourrait également bouleverser plusieurs autres pays africains, y compris des États fragiles du Sahel et d'Afrique de l'Est et du Nord. Les effets secondaires d'une zone de conflit aussi incalculable et le chaos qui en résulte affecteraient également l'Europe occidentale, qui souffre déjà de l'afflux de réfugiés de Syrie et d'autres zones de guerre au Moyen-Orient et en Afrique.

Background Sub-Saharan African women are often treated as a single group in epidemiological studies of immigrant birth outcomes, potentially masking variations across countries. Methods Cross-sectional population-based study of 432,567 singleton births in Victoria, Australia comparing mothers born in one of four East African countries (453 Eritreans, 1094 Ethiopians, 1,861 Somali and 1,404 Sudanese) relative to 427,755 Australian-born women was conducted using the Victorian Perinatal Data Collection. Pearson’s chi-square test and logistic regression analyses were performed to investigate disparities and estimate risks of perinatal mortality and other adverse perinatal outcomes after adjustment for confounders selected a priori. Results Compared with mothers born in Australia, East African immigrants as a group had elevated odds of perinatal mortality (ORadj1.83, 95 % CI 1.47, 2.28), small for gestational age births (SGA) (ORadj1.59 95 % CI 1.46, 1.74), very low birthweight (ORadj1.33, 95 % CI 1.11, 1.58) and very preterm birth (ORadj1.55, 95 % CI 1.27, 1.90). However, they had lower odds of preterm birth (ORadj0.86 95 % CI 0.76, 0.98) and macrosomia (ORadj0.65 95 % CI 0.51, 0.83). Individual country of birth analyses indicated significant variations, with Eritrean women having higher odds of very low birthweight (ORadj1.80, 95 % CI 1.09, 2.98), very preterm birth (ORadj 1.96, 95 % CI 1.08, 3.58), small for gestational age births (ORadj 1.52, 95 % CI 1.14, 2.03) and perinatal mortality (ORadj 2.69, 95 % CI 1.47, 4.91). Sudanese women had higher odds of low birthweight (ORadj 1.36, 95 % CI 1.10, 1.68), very low birthweight (ORadj 1.53, 95 % CI 1.13, 2.07), very preterm birth (ORadj 1.78, 95 % CI 1.26, 2.53), small for gestational age births (ORadj 2.13, 95 % CI 1.84, 2.47) and perinatal mortality (ORadj 2.10, 95 % CI 1.44, 3.07)]. Ethiopian women differed from Australian-born women only in relation to higher odds of very preterm birth, (ORadj1.70 95 % CI 1.16, 2.50), and only Somali-women had significantly lower odds of preterm birth (ORadj0.70 95 % CI 0.56, 0.88). Conclusions Overall, East African countries of birth were associated with increased perinatal death and some adverse perinatal outcomes; suggesting the need for strategies to enhance surveillance and health care delivery for these women. Analysis by individual country of birth groups has shown women from Eritrea and Sudan are particularly at increased risk of adverse outcomes, demonstrating the importance of antenatal identification of maternal country of birth. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0886-z) contains supplementary material, which is available to authorized users.

One of the main implications of reducing biodiversity is the loss or decline of ecosystem function. We have previously seen in the Rashad location that agricultural practices have a lower effect on ant biodiversity. However, how they affect the environmental services, they provide is unclear. The main objective of this study was to evaluate whether the conversion of native areas into agricultural systems affects the removal of biomass carried out by ants, an important ecosystem function linked to decomposition and predation. We sampled three transects from (the Rashad district). Each sampling plot consisted of a grid of 12 pitfall traps filled with sardine baits (simulating animal organisms) and bananas (as attractive vegetable resources). In addition, grass seeds (Sorghum bicolor) were applied in both natural (Campo, Kubos, and forest) and agricultural settings (soy monoculture, pastures, and organic agriculture). The Results showed that ant’s removal was highest in sardine with an average of 87.3g (σ ± 23.8), followed by banana (average of 70.5g, σ ± 31.5) and lowest in the seed (mean of 7.8g, σ ± 7.3) (highest p = 0.017). Only the soy monoculture regions showed the lowest levels of sardine removed, indicating an effect associated with the kind of land use. Because little biomass is eliminated in both natural and agricultural settings, no effect of the seeds bait has been observed. As for the banana bait, the data suggested a redundancy effect with another group of macro-fauna). Our results suggest that there is a redundancy effect with another group of macrofauna. However, macrofauna biomass (excluding ants) does not explain this biomass removal. In addition, it detected no impact of ant species composition on removed biomass. The reduction of sardine and banana biomass was correlated with ant richness, indicating that the effects on ecosystem function depend on the particularities of each evaluated role (such as resource type), the type of land use, and the ant richness in the study area.

Background The past two decades were associated with innovation and strengthening of malaria control interventions, which have been increasingly adopted at large scale. Impact evaluations of these interventions were mostly performed in moderate or high malaria transmission areas. This study aimed to evaluate the use and performance of malaria interventions in low transmission areas on malaria infections and anaemia. Methods Data from the 2016 Sudan malaria indicator survey was used. Multi-level logistic regression analysis was used to assess the strength of association between real-life community-level utilization of malaria interventions [diagnosis, artemisinin-based combination therapies (ACTs) and long-lasting insecticidal nets (LLINs)] and the study outcomes: malaria infections and anaemia (both overall and moderate-to-severe anaemia). Results The study analysis involved 26,469 individuals over 242 clusters. Malaria infection rate was 7.6%, overall anaemia prevalence was 47.5% and moderate-to-severe anaemia prevalence was 4.5%. The average community-level utilization was 31.5% for malaria diagnosis, 29.9% for ACTs and 35.7% for LLINs. The odds of malaria infection was significantly reduced by 14% for each 10% increase in the utilization of malaria diagnosis (adjusted odds ratio (aOR) per 10% utilization 0.86, 95% CI 0.78–0.95, p = 0.004). However, the odds of infection was positively associated with the utilization of LLINs at community-level (aOR per 10% utilization 1.20, 95% CI 1.11–1.29, p Conclusion There was strong evidence that utilization of malaria diagnosis at the community level was highly protective against malaria infection. No protective effect was seen for community utilization of ACTs or LLINs. No association was established between any of the interventions and overall anaemia or moderate-to-severe anaemia. This lack of effectiveness could be due to the low utilization of interventions or the low level of malaria transmission in the study area. Identification and response to barriers of access and low utilization of malaria interventions are crucial. It is crucial to ensure that every suspected malaria case is tested in a timely way, notably in low transmission settings.

Petrous bones and teeth are the skeletal elements most often targeted by researchers for ancient DNA (aDNA) extraction, and the sources of the majority of previously published ancient African genomes. However, the high temperature environments that characterise much of Africa often lead to poor preservation of skeletal remains. Here, we successfully reconstruct and analyse genome-wide data from the naturally mummified hair of a 4000-year-old individual from Sudan in northeastern Africa, after failed attempts at DNA extraction from teeth, petrous, and cranium of this and other individuals from the Kadruka cemeteries. We find that hair DNA extracted with an established single-stranded library protocol is unusually enriched in ultra-short DNA molecules and exhibits substantial interior molecular damage. The aDNA was nonetheless amenable to genetic analyses, which revealed that the genome is genetically indistinguishable from that of early Neolithic eastern African pastoralists located 2500 kms away. Our findings are consistent with established models for the southward dispersal of Middle Nile Valley pastoral populations to the Rift Valley of eastern Africa, and provide a possible genetic source population for this dispersal. Our study highlights the value of mummified hair as an alternate source of aDNA from regions with poor bone preservation. Results - Archaeological context of Kadruka 1 SK68. - Ancient DNA authentification and sequencing strategy. - Characteristics of the aDNA fragments from hair. - Genetic affinity to early eastern African pastoralists. Discussion Methods

Bu çalışma, literatürdeki genel tanımlamaya göre 1821-1885 yılları arasındaki zaman dilimini kapsayan Türk hâkimiyeti döneminde, Afrikalılık ve Araplığı sentezleyerek bu coğrafyaya özgü bir Afro-Arap kültürü oluşturmayı başarmış Sudan’da bu kültürün en önemli öğelerinden biri olan Sudan Arap şiirinin incelenmesini konu edinmektedir. Konuyu temellendirmek ve meseleye bütüncül bir bakış açısı sağlamak amacıyla çalışmada, Sudan şiirinin başlangıç evresi olarak bilinen Func döneminden önceki erken dönemden itibaren Arap şiirinin gelişim aşamalarından söz edilmiştir. Bu dönemde Sudan’da Arap şiirinin durumunu ortaya koymak adına Arap edebiyat tarihi kaynaklarında yer alan bilgilerden yararlanılmıştır. Söz konusu dönemin meşhur şairlerine nispet edilen gerek edebiyat tarihi kaynakları gerekse şairlerin divanlarında yer alan şiirler tema analizine tâbi tutularak dönemin önemli şiir türlerinin tespiti için çaba gösterilmiştir. Tespit edilen şiirlerin içerikleri üzerine yapılan incelemeler, şairlerin yoğun bir şekilde üzerinde durdukları konuların belirlenmesine imkân tanımıştır. Bu bağlamda methiye ve mersiye şiirlerinin, Türk hâkimiyeti döneminde şairlerin en çok örnek verdikleri iki şiir türü olduğu tespit edilmiştir. Çalışmanın odağında yer alan dönemde Sudanlı şairlerin ortaya koydukları eserler ile Câhiliye, Emevî ve Abbâsî dönemi şairlerinin şiirleri arasındaki bağın güçlü olduğu görülmüştür. Sudan şiirinin önceki dönemlerinde halk dili olan âmmiceyle söylenen şiirlerin fasîh Arapçayla nazmedilmesi, Fasîh Klasik Şiir Akımı adında bir akımı başlatmıştır. Türk hâkimiyeti döneminde Sudanlı şairlerin özellikle Mısır ve Hicâz gibi bölgelerde dinî eğitim almaları, dinî-tasavvufî akımların etkisiyle muhafazakâr bir kişiliğe sahip olmaları, söyledikleri şiirlerde dinî anlamların yoğunlaşmasına yol açmıştır. Bu şiirler sadece dinî anlamlar içermekle yetinmemiş, eserlerin ritim, name ve melodik yönlerini ön planda tutan tasavvuf şiirinin aksine sağlam yapı, etkileyici üslup, güzel anlam ve hatasız dil gibi şiirin kalitesini artıracak hususlara odaklanmıştır. Sudan’da Türk hâkimiyeti döneminde pek çok şair yetişmiştir. Bu şairlerin büyük bir kısmı şair kişiliklerinin yanında din âlimi vasfına sahiptir. Şeyh el-Emîn ed-Darîr, eş-Şeyh İbrâhîm Abduddâfi‘, Ahmed el-Ezherî, Hüseyin ez-Zehrâ, Muhammed Osmân el-Mîrğanî, el-Medâvî Abdurrahmân, Muhammed Ahmed Hâşim, Ömer el-Ezherî, Muhammed Ömer el-Bennâ, Abdulğanî es-Sillâvî, Yahyâ es-Sillâvî ve Muhammed Tâhir el-Meczûb gibi şairler, dönemin Arap şiirinin önemli isimlerindendir. Bu dönemde pek çok şair yetişmiş olsa da günümüze ulaşan şiir miktarı oldukça sınırlıdır. Bu şiirler büyük ölçüde methiye ve mersiyelerden ibaret olmakla birlikte, bu iki tür kadar çok olmasa da fahr ve hamaset şiirleri de bizlere seçkin örnekler sunmaktadır. İçerdiği anlam itibarıyla ele alındığında methiyelerin genellikle; Hz. Peygamber’e (sas), devlet yöneticileri ve tasavvuf ehli din adamlarına tahsis edildiği anlaşılmaktadır. Mersiyelerin ise Sudan toplumuna siyasî, askerî, dinî-tasavvufî alanlarda önderlik yapan şahsiyetlerin vefatlarından duyulan hüznün dile getirilmesinde kamuoyunun duygularına tercüman olduğu görülmektedir. Fahr ve hamaset şiirlerinin olumlu veya olumsuz bir şekilde Sudan’daki Türk yönetimini konu edinmekten uzak durması, dikkatleri çeken bir husus olarak ön plana çıkmaktadır. Türklerden bahseden methiye ve mersiyelerin aksine fahr ve hamaset şiirlerinin Sudan’ın coğrafî sınırlarını aşarak Mısır’daki ʻUrâbî isyanı gibi Arap milliyetçiliği temelli hareketleri destekleyici bir karakter sergilediği görülmektedir. Sudan’daki Türk-Mısır hükümetine karşı savaşmış, Mehdîlik iddiasında bulunmuş ve kendi adıyla kurduğu harekete dinî ve siyasî liderlik yapmış Muhammed Ahmed el-Mehdî’nin, dönemde görülen tüm şiir türlerine konu olan önemli bir karakter olduğu anlaşılmaktadır. Şiirlerin dua, rahmet, şefaat, bağışlanma temennisinin yanında ebced harfleriyle tarih düşürerek sona ermesi, Kur’ân ayetlerinden iktibâsı önemsemesi, muhtelif bedî sanatları içermesi, fasîh Arapçayla âmmicenin bir arada kullanılması gibi hususlar, dönem şiirinin karakteristik özellikleri arasında yer almaktadır., This study is based on the examination of Sudanese Arabic poetry, which is one of the most important elements of the Afro-Arabic culture successfully formed in Sudan in a manner that is unique to this geography by synthesizing Africanness and Arabicness during the Turkish rule encompassing the time period between the years 1821 and 1885 according to the general definition in the literature. With the aim of grounding the subject and providing a holistic perspective to the matter, this study discusses the developmental phases of Arabic poetry starting from the early period prior to the Funj era, which is known as the starting phase of Sudanese poetry. In order to reveal the state of Arabic poetry in Sudan during this period, information obtained from Arabic literary history sources was used. It was aimed to determine the important genres of poetry in the corresponding period by subjecting the literary history sources attributed to the well-known poets of the era as well as the poems included in the collections of these poets to a theme analysis. The examinations made on the content of detected poems allowed for the determination of the subjects that were intensively used by the poets. In this context, it was determined that eulogy and elegy were the two genres of poetry that the poets in the period of Turkish rule exemplified the most. It was observed that the connection between the poems produced by Sudanese poets during the period in the focus of the study and those of the poets of the Jahiliyyah, Umayyad and Abbasid periods was reinforced. The versing of poems that had previously been recited in ammiya, which was the public language in the former periods of Sudanese poetry, in Modern Arabic initiated a movement called the Modern Classical Poetry Movement. The fact that Sudanese poets during the period of Turkish rule received religious education particularly in regions such as Egypt and Hejaz and possessed a conservative personality with the influence of religious-sufi movements caused religious meanings to be intensified in the poems they recited. These poems not only included religious meanings, but also focused on matters increasing the quality of poetry such as a solid structure, striking tone, pleasant meaning and faultless language, in contrast with Sufi poetry, which emphasizes rhythm, harmony and melodic aspects of works. The period of Turkish rule in Sudan produced many poets. Most of these poets functioned as religious scholars in addition to their literary persona. Poets such as Sheikh al-Amin ed-Darîr, Sheikh İbrahim Abdul Dafi, Ahmad al-Azhari, Husayn al-Zahra, Mohammad Uthman al-Mirghani, al-Madawi Abdul Rahmân, Mohammad Ahmad Hashem, Omar al-Azhari, Mohammad Omar al-Banna, Abdul Ghani al-Sillawi, Yahia al-Sillawi and Mohammad Taher al-Majdhub are among the important figures of the Arabic poetry of the time. Although many poets emerged during this period, the number of poems that reached today is very limited. These poems mostly consist of those in the genres of eulogy and elegy while poems in the genres of self-praise and heroism (although not as many as the aforementioned genres) present select examples, as well. In terms of their meaning, it is understood that eulogy poem generally refer to the Holy Prophet (PBUH), state administrators and religious scholars specializing in sufism. It is observed that elegy poems, on the other hand, reflect the emotions of the public in the expression of the sorrow felt by the passing of figures that led the Sudanese society in political, military and religious-sufistic fields. The fact that self-praise and heroism poems refrained from mentioning the Turkish administration in Sudan in a positive or negative light stands out as a striking point. In contrast with the eulogy and elegy poems that mention the Turks, it is observed that self-praise and heroism poems exceeded the geographical boundaries of Sudan and exhibited a characteristic in support of the movements based on Arabic nationalism, such as the ʻUrabi revolt in Egypt. It is understood that Mohammad Ahmad al-Mahdi, who fought against the Turkish-Egyptian government in Sudan, claimed to be the Mahdi and served as a religious and political leader in the movement he established under his own name, is an important character who was subject to all types of poetry found in the period. The fact that the poems ended by providing the date with abjad letters, placed importance on citing the verses of the Qur'an, included various unique arts and used Modern Arabic in conjunction with ammiya in addition to their petition for forgiveness, prayer, mercy and intercession are among the characteristic features of the poetry of the period.

Several studies suggested a significant role of epigenetic changes, including alterations in miRNA, histone modifications, and DNA methylation of α-synuclein (SNCA) in Parkinson's disease (PD) pathogenicity. As of yet, only very few studies have been carried out in this field in Africa and none in Sudan.We collected DNA from 172 Sudanese individuals (90 cases, 82 controls) who donated saliva for DNA extraction (mean age of onset: 40.6 ± 22.4 years). A family history of PD was evident in 64 patients. DNA preparation and bisulfite sequencing of SNCAintron1 was performed as described earlier.Of the fourteen analyzed CpGs of SNCAintron1, CpGs 16-23 were hypomethylated in PD (P-value ranged from 0.023 to 0.003). P-values improved, when sporadic cases were excluded from the analysis.We identified the presence of a specific pattern of DNA methylation in a young Sudanese cohort of familial PD, which confirms the importance of the methylation of SNCAintron1 for PD. This phenomenon appears to be independent of ethnicity, the impact of environmental factors, drug history, or familial clustering.

Cystic lymphangioma is a benign congenital malformation of the lymphatic vessels. At the National Center for Pediatric Surgery, Gezira State, Sudan; 2021; a female baby of 15 months old age presented complaining of abdominal distention of 10 days duration. Patient Looks unwell, not febrile, and not pale or jaundice; abdomen was distended with full flanks, there was a palpable mass in the epigastric region, no area of tenderness and no palpable organs. Abdomino-pelvic U/S showed very huge abdomino –pelvic cystic mass with multiple thick septa. CT abdomen showed huge abdomino-pelvic mass with multiple cysts that having variable sizes measuring up to 6*7 cm. An elective explorative laparotomy was done. Intra operative findings: Multiple cystic masses arise from the root of the small bowel mesentery matted together with multiple enlarged mesenteric lymph nodes involving segment of distal jejunum with multiple adhesions. Release of adhesion, resection of the masses along with 57 cm of the involving jejunum, anastomosis was done, and homeostasis was secured. Histopathology result showed dilated cystic spaces; lined by flat endothelial cells and multiple reactive lymph nodes, no evidence of malignancy. Features are in line with lymphangioma and associated mesenteric lymphadenitis. Discussion and Conclusion: Our case was 15 months old which is the age of presentation as mentioned internationally. Mesenteric cystic Lymphangiomas are more common among male unlike our case. Ultrasonography and CT abdomen were highly recommended to achieve early diagnosis and treatment of such cases.

lt;bgt;Background and Objective:lt;/bgt; Angiogenesis is a mechanism by which new blood vessels are developed in healing and tumour tissues, where it is necessary for regeneration growth, tumour cells survival and metastasis. This study aimed to assess the angiogenesis mechanism among Sudanese females with breast cancer using anti-CD34 and anti-CD105 markers.lt;bgt;Materials and Methods:lt;/bgt; Three hundred female representative Formalin-Fixed Paraffin-Embedded (FFPE) breast tissue blocks were included in this study. Of the 300 representative tissue blocks, 200 were breast cancer patient's tissues (confirmed cases) and 100 were normal breast tissues (controls). Their ages mean±SD, 47.3±12.9 years.lt;bgt;Results:lt;/bgt; The results showed the MVD of CD34 significantly increased in malignant lesions as compared to normal breast tissues. The mean of MVD CD34 and MVD CD105 showed statistical differences among different histologic types of breast cancer. Also, a strong positive correlation was detected between the manual and automated MVD counting methods. Also, the current study revealed no significant differences were observed in mean MVD counting for both markers and menopausal status or the age groups of the study population.lt;bgt;Conclusion:lt;/bgt; The MVD is a good tool for assessing prognostic markers. The CD105 marker has a high specificity to the new evolving tumour vessels and is a useful predictor for angiogenesis and breast cancer metastasis.

This study discusses the methodological component of a research project with Sudanese musicians and their associated activist groups. The methodology included song-writing and, as such, is an example of collaborative creative research practice. Proponents of collaborative creative practice argue that the combination of aesthetic methods with ethnographic and participatory research methods brings both epistemological and ethical dividends. This paper considers whether these alleged epistemological and ethical advantages bore out in this research project. While confirming some benefits, my study also shows evidence of underlying tensions between aesthetic ‘micro-methods’ and ethnographic and participatory traditions of knowledge production. In relation to the alleged epistemological dividends, I argue that autoethnographic embedding in collaborative creative practice is alone insufficient. It requires a theoretical framework which theorises the relationship between one player’s musical experience and another’s. Only with this, can the sensory experiences of the researcher be used to inform analysis of participant observations and interviews. The autoethnographic experiences of the researcher are not findings in themselves. In relation to the ethical dividends, unlike other arts-based research, I found that the aesthetic micro-methods in this study did not naturally lend themselves to participant empowerment. The pursuit of aesthetic goals has its own division of labour which can lead to the deprioritisation of self-expression and co-learning which constitute the primary aims of classical participatory research. Overall, collaborative creative practice did enhance this research project but there are important caveats. To reflect these, I aruge that creative collaboration should not be considered as a simple sub-set of either ethnographic or participatory research but as a method in its own right.

Mansour Adam Mahmoud,1 Md Ashraful Islam,2 Malaz Ahmed,3 Randa Bashir,3 Romisa Ibrahim,3 Shahd Al-Nemiri,3 Ethar Babiker,3 Neven Mutasim,3 Sultan Othman Alolayan,1 Sultan Al Thagfan,1 Samrein BM Ahmed,4 Ibrahim Sales,5 Mohamed Azmi Hassali6 ,†Yaser Alahmadi,1 Mirghani A Yousif3 1Department of Clinical & Hospital Pharmacy, College of Pharmacy, Taibah University, Al-Madinah Al-Munawarah, Saudi Arabia; 2Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, University of Gezira, Wad Madani, Sudan; 4College of Medicine, University of Sharjah, Sharjah, United Arab Emirates; 5Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 6Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia†Mohamed Azmi Hassali passed away on July 16, 2021Correspondence: Mansour Adam MahmoudDepartment of Clinical and Hospital Pharmacy, College of Pharmacy, Al-Madinah Al-Munawarrah, Saudi ArabiaEmail Mammm.99@gmail.comObjective: The aim of this study was to validate the Arabic version of General Medication Adherence Scale (GMAS) in Sudanese patients with type 2 diabetes mellitus (T2DM).Methods: A 3-month cross-sectional study was conducted among patients with T2DM at Al-Daraja Health Center, located in Wad Medani, Sudan. A convenient sample of patients was selected, and the study sample size was calculated using the item response ratio. Factorial, known group, and construct validities were determined. Internal consistency and reliability were also determined.Results: Responses were provided by 500 patients. The average medication adherence score was 30 (median 31). The normed fit index (NFI) was 0.950, the comparative fit index (CFI) was 0.963, the incremental fit index (IFI) was 0.963, and the root-mean-square error of approximation (RMSEA) was 0.071. The results from these fit indices indicated a good model. Factorial, known group and construct validities were all established. A significant association was found between adherence score and age (P = 0.03) since a larger proportion of older patients were found to have high adherence compared to patients in other age groups. The reliability (α) of the questionnaire was 0.834.Conclusion: The Arabic version of GMAS was validated in Sudanese patients with T2DM making it a suitable scale to be used in this population.Keywords: medication adherence, patient compliance, medication persistence, chronic illness, Sudan

Establishment of diagnostic reference levels (DRLs) is an essential radiation optimization tool used to indicate optimum practice and radiation protection. This study aimed to report the current computed tomography (CT) of the chest–abdomen–pelvis radiation practice in Sudan as a part of the DRL establishment effort and dose optimization. CT radiation doses were collected from 530 patients of age ranging between 28 and 85 y and body weight ranging between 65 and 120 kg. DRLs were calculated based on the 75th percentile of dose length product (DLP) and CT dose index volume (CTDIvol). Effective and organ doses were calculated using the National Cancer Institute dosimetry system for the CT programme. The proposed DRLs are CTDIvol, 6 mGy, and DLP, 970 mGy.cm, and an effective dose of 9.9 mSv. Organ dose estimation showed that the thyroid received the highest dose during the scan.

lt;bgt;Background and Objective:lt;/bgt; Medicinal plants have been known to cure many diseases due to the presence of active bio constituents, the goal of this study to detect and evaluate the effectiveness of antimicrobial activity of some Sudanese medicinal plants.lt;bgt;Materials and Methods:lt;/bgt; Methanolic extracts of the following types of local medicinal plantslt;igt;Artemisia herba-albalt;/igt;,lt;igt; Cyperus rotunduslt;/igt;,lt;igt; Cymbopogon schoenanthuslt;/igt;sblt;igt;lt;/igt;sp.lt;igt; Proximuslt;/igt;,lt;igt; Trigonella foenum-graecumlt;/igt;,lt;igt; Nigella sativalt;/igt;,lt;igt; Hyphaene thebaicalt;/igt;,lt;igt; Nauclea latifolialt;/igt; andlt;igt;Ziziphus spina-christilt;/igt; were tested against eight types of bacteria that were isolated from the same plants as their pollutants. Cup-plate method was used and then the inhibition zone of each plant was measured and compared with the inhibitory zone of some antibiotics used for the same isolates.lt;bgt;Results:lt;/bgt; Methanol extracts of some plant species showed antibacterial activity against most of the studied bacterial species.lt;igt;Cymbopogon schoenanthuslt;/igt;ssp.lt;igt; Proximuslt;/igt;showed antibacterial activity against most isolated bacterial species in comparison with commercial antibiotics used.lt;bgt;Conclusion:lt;/bgt; According to the findings of this research, severalmedicinal plants have efficacy and effect on certain types of bacteria and are superior or comparable to certain types of antibiotics. When compared to the other medicinal plants used in this studylt;igt;, Cymbopogon schoenanthuslt;/igt;sbsp.lt;igt;proximuslt;/igt;has the highest activity on most types of Gram-positive and Gram-negative bacteria, as well as the superiority of some antibiotics.

Source: Sudan Meteorological Authority.

Various international guidelines have been developed regardingA cross-sectional study was conducted among medical doctors currently working in Khartoum, Sudan. Participants were enrolled from platforms of medical associations through an online questionnaire. The questionnaire was scored out of 25 points, and scoring 13 or above considered a good approach. Data analysis was carried out using Statistical Package for Social Sciences (SPSS).A total of 358 medical doctors participated in the study. The mean (±SD) score was 12.9(±4.5). Those who were using textbooks, campaigns, symposiums or general medical information to their primary Source of knowledge significantly scored higher. The most selected indication for both diagnosis (76.8%) and treatment (67.6%) was an active peptic ulcer. Stool antigen test (SAT) was the most preferred test (70.7%). The majority of respondents selected triple therapy (82.1%) as a first-line regimen. Only 37.7% confirmed the eradication after four weeks of stopping the treatment. They ensure eradication mainly through SAT (29%).A suboptimal approach was noted among medical doctors of Khartoum, Sudan, regarding

Background Hepatitis C virus (HCV) is a global public health problem, with ~ 11 million people in Africa infected. There is incomplete information on HCV in Sudan, particularly in haemodialysis patients, who have a higher prevalence compared to the general population. Thus, our objectives were to genotype and molecularly characterize HCV isolated from end-stage renal disease haemodialysis patients. Methods A total of 541 patients were recruited from eight haemodialysis centres in Khartoum and screened for anti-HCV. Viral loads were determined using in-house real-time PCR in seropositive patients. HCV was genotyped and subtyped using sequencing of amplicons of 5′ untranslated (UTR) and non-structural protein 5B (NS5B) regions, followed by phylogenetic analysis of corresponding sequences. Results The HCV seroprevalence in the study was 17% (93/541), with HCV RNA-positive viremic rate of 7% (40/541). A low HCV load, with a mean of 2.85 × 104 IU/ml and a range of 2.95 × 103 to 4.78 × 106 IU/ml, was detected. Phylogenetic analyses showed the presence of genotypes 1, 3, 4, and 5 with subtypes 1a, 1b, 1 g, 3a, 4a, 4 l, 4 m, 4 s, and 4t. Sequences of HCV from the same haemodialysis units, clustered in similar genotypes and subtypes intimating nosocomial infection. Conclusion HCV infection is highly prevalent in haemodialysis patients from Sudan, with phylogenetic analysis intimating nosocomial infection. HCV genotyping is useful to locate potential transmission chains and to enable individualized treatment using highly effective direct-acting antivirals (DAAs).

Background Body mass index (BMI) remains the most used indicator of nutritional status despite the presence of a potentially credible alternative. Mid-upper arm circumference (MUAC) is an anthropometric measure that requires simple equipment and minimal training. The aim of this study was to compare MUAC with BMI and propose a MUAC cut-off point corresponding to a BMI of < 18.5 kg/m2 (underweight) and ≥ 30.0 kg/m2 (obesity) among Sudanese adults. Methods A cross-sectional study using multistage cluster sampling was conducted in New-Halfa, eastern Sudan. Participants’ age and sex were recorded and their MUAC, weight and height were measured using the standard procedures. The MUAC (cm) cut-offs corresponding to < 18.5 kg/m2 and ≥ 30.0 kg/m2 were calculated and determined using receiver operating characteristic (ROC) curve analysis Results Five hundreds and fifty-two adults were enrolled in the study. The median (interquartile range, IQR) of the participants age was 31.0 (24.0 ̶ 40.0) years and 331 (60.0%) of them were females. The medians (IQR) of BMI and MUAC were 22.4 (19.1 ̶ 26.3) kg/m2 and 25.0 (23.0 ̶ 28.0) cm, respectively. There was a significant positive correlation between MUAC and BMI (r = 0.673, p < 0.001). Of the 552 enrolled participants, 104 (18.8%), 282 (51.1%), 89 (16.1%) and 77 (13.9%) were normal weight, underweight, overweight and obese, respectively. Best statistically derived MUAC cut-off corresponding to a BMI < 18.5 kg/m2 (underweight) was ≤ 25.5 cm in both males and females (Youden’s Index, YI = 0.51; sensitivity = 96.0%; specificity = 54.0%), with a good predictive value (AUROCC = 0.82). Best statistically derived MUAC cut-off corresponding to a BMI ≥ 30.0 kg/m2 (obesity) was ≥ 29.5 cm in both males and females (YI = 0.62, sensitivity = 70.3%, specificity = 92.0%), with a good predictive value (AUROCC = 0.86, 95.0% CI = 0.76 – 0.95). Conclusion The results suggest that the cut-offs based on MUAC can be used for community-based screening of underweight and obesity

Introduction: Repatriation is a fundamental and often preferred solution to the refugee crisis around the world. This study explored the process of repatriation of the South Sudanese refugees from the West Nile districts in Uganda. Methods: This was a retrospective analysis of the process of repatriation of refugees in three west Nile refugee districts of Adjumani, Arua, and Moyo, Uganda. Both qualitative and qualitative data were collected. Results: The findings showed that several stakeholders were involved in the repatriation exercise including the government at central and district levels, United Nations agencies and non-governmental organizations, and refugee communities. The key steps undertaken during repatriation include information and education campaigns to promote returns focussing on security and socio-economic conditions in South Sudan and the facilitation of confidence-building visits in the areas of origin. During the repatriation exercise, key interventions provided included health care screening and treatment, and the provision of reintegrationsupport services including the provision of food security items and cash allowances. Conclusions: The findings highlight the fundamental steps followed during a well-planned, structured, and effective repatriation of South Sudanese refugees from Uganda. Understanding repatriation requires an appreciation of how it is implemented to support offering an effective, durable, and lasting solution to refugees to promote their health and welfare. Keywords: Refugee; repatriation; process of repatriation; South Sudan; West Nile; Uganda.

Head and neck cancers (HNCs) are prevalent in Sudan, but the reasons for this and the incidence of different types of HNCs are not well understood. A cross-sectional retrospective study was conducted to provide baseline data on the epidemiology of HNCs among patients treated at the National Cancer Institute (NCI) in central Sudan. All cancer cases from 2016 to 2020 were retrieved from the NCI records. Of the 9475 new cancer patients who were registered at the NCI during the study period, 1033 (11%) had HNCs, of whom 767 (74.2%) were adults. The mean age of the adult patients was 54.5 years (standard deviation 15.8) and 449 (58.5%) patients were male. The annual incidence in adults was 4/105 population. The most common HNC sites were the nasopharynx (25.3%), hypopharynx (22.8%), and oral cavity (22.2%). Carcinoma was the most common diagnosis (87.6%), followed by lymphoma (5.6%). Most patients’ tumors were at a locally advanced (22%) or metastatic stage (47%) of HNCs at the time of presentation. Further studies to identify risk factors for HNCs, particularly for the most prevalent types in central Sudan, are needed. In addition, Sudan requires capacity building for cancer, including a national cancer registry.

Sudanese university students are at high risk of contracting HIV despite the prevailing religious values and social norms prohibiting premarital sex. This thesis investigated the psychosocial determinants of two important behaviors (abstinence and consistent condom use) among this population. Using a behavioral change model and adopting a mixed research methodology, this thesis explored the students’ sexual behaviors and identified their most salient psychosocial determinants. It was concluded that a more comprehensive approach that respects the religious values and social norms favoring abstinence from sex until marriage, but also options for those unwilling to comply with these values and norms, is urgently needed. By contextualizing these behaviors and their determinants, the thesis informed the cultural adaptation of such an intervention to increase its effectiveness and facilitate its adoption and implementation. Besides, the thesis highlighted the need for tailoring the intervention to meet the different needs of male and female university students in Sudan.

Background Medically unjustifiable caesarean section (CS) deliveries have been rising rapidly in many developed countries over the last three decades. While many developing countries show rates beyond optimal levels, few poorer countries appear to have sub-optimal obstetric care in relation to essential surgeries. The objective of this study is to document the rates of CS delivery, its time trend, and geographic and sociodemographic variability in Sudan. Methods We utilized a number of Multiple Indicator Cluster Surveys (MICS) conducted in 2014, 2010, and 2006 to quantify CS rates per 1000 live births. We also documented absolute changes in rates over three-time points and variation in CS rates across geographic regions and areas of residence. Results Over a decade, CS rates in Sudan increased steadily from 4.3% in 2006 to 6.7% in 2010 and 9.1% in 2014. During this period, CS rates varied considerably across regions showing higher rates in the Northern region (7–25%) and lower rates in Darfur (2–3%). Urban areas experienced rapidly increasing rates (6–14%), while rural areas showed negligible changes to absolute CS rates over time (5–7%). We also found geographic regions, maternal age, maternal education, receiving antenatal care, and birth order of the child were important determinants of CS in Sudan. Conclusion Sudan may be facing a double burden of problems associated with surgical interventions for childbirth. While the wealthier parts of Sudan are experiencing a rapid surge in CS, some poor parts of rural Sudan may not be getting the essential surgical intervention for birth when mandated. Urgent improvement to obstetric care and the development of appropriate public health interventions that focus on regional disparities are warranted.

Background: Neonatal mortality is a serious public-health issue, especially in Sub-Saharan African countries. There are limited studies on neonatal mortality in Sudan; particularly, there are none on eastern Sudan. Therefore, this study aimed to determine the incidence, causes and associated factors for mortality among neonates admitted to the neonatal intensive care unit (NICU) of Gadarif Hospital, eastern Sudan. Methods: This retrospective study included 543 neonates admitted to the NICU of Gadarif Hospital, eastern Sudan, between January and August 2019. Data were obtained from the hospital record using a questionnaire composed of sociodemographic data, neonatal and maternal information and neonatal outcomes. Logistic regression analyses were performed and the adjusted odds ratio (AOR) and 95% confidence interval (CI) were calculated. Results: Of the 543 neonates, 50.8% were female, 46.4% were low birth weight (LBW), 43.5% were preterm babies and 27% were newborns admitted after caesarean delivery. The neonatal mortality before discharge was 21.9% (119/543) of live-born babies at the hospital. Preterm birth and its complications (48.7%), respiratory distress syndrome (33.6%), birth asphyxia (21.0%) and infection (9.0%) were the most common causes of neonatal mortality. In multivariable logistic regression analysis, preterm birth (AOR 2.10, 95% CI 1.17–3.74), LBW (AOR 2.47, 95% CI 1.38–4.41), low 5 min APGAR score (AOR 2.59, 95% CI 1.35–4.99) and length of hospital stay

Toxoplasma gondii and Neospora caninum are closely related intracellular protozoan parasites of medical and veterinary concern by causing abortions and systemic illness. Limited or ambiguous data on the prevalence of T. gondii and N. caninum in camels triggered us to conduct this study.Camels (n = 460) recently imported from Sudan and destined mainly for human consumption, were tested for specific antibodies against these protozoans using commercially available ELISAs. From the two only quarantine stations for camels from Sudan, 368 camels were sampled between November 2015 and March 2016 in Shalateen, Red Sea governorate, and 92 samples were collected between September 2018 and March 2021 from Abu Simbel, Aswan governorate.Overall, seropositive rates in camels were 25.7%, 3.9% and 0.8% for T. gondii, N. caninum and mixed infection, respectively. However, marked differences were found between the two study sites and/or the two sampling periods: For T. gondii, a higher rate of infection was recorded in the Red Sea samples (31.5%, 116/368; odds ratio 20.7, 5.0-85.6; P0.0001) than in those collected in Aswan (2.2%, 2/92). The opposite was found for N. caninum with a lower rate of infection in the Red Sea samples (0.82%, 3/368; odds ratio 23.7, 6.7-83.9; P0.0001) than in the samples from Aswan (16.3%, 15/92). Additionally, our systematic review revealed that the overall published seroprevalence of T. gondii and N. caninum was 28.6% and 14.3% in camels worldwide, respectively. To the best of our knowledge, this study provides the first record of seroprevalence of both T. gondii and N. caninum in recently imported camels kept under quarantine conditions before delivery to other Egyptian cities and regions. In addition, our review provides inclusive data on the prevalence of T. gondii and N. caninum in camel globally. This knowledge provides basic data for the implementation of strategies and control measures against neosporosis and toxoplasmosis.

Radiation doses were determined to propose national diagnostic reference levels (NDRLs) and achievable doses (ADs) for computed tomography (CT) examinations in Sudan. Doses were estimated from retrospectively collected scan parameters for 1336 CT examinations of adult patients from 14 Sudanese hospitals using CT Expo 2.5 software. ADs and NDRLs were set at the 50th and 75th percentile of the hospital median dose distribution, respectively. The proposed CTDIvol (mGy) ADs ranged from: 10 (chest) to 64 (head), and that of the dose-length product (DLP; mGy.cm) ranged from 366 (chest) to 1225 (head). The proposed CTDIvol (mGy) NDRLs ranged from 15 kidney–ureter–bladder (KUB) to 79 (head), whereas that of the DLP (mGy.cm) ranged from 690 (chest) to 1490 (head). Current doses fell within the upper range of the doses presented in the literature emphasizing the need for implementation of the current ADs and NDRLs for CT to enhance patient protection and dose optimization in Sudan.

Fertility experts have advocated addressing preventable causes of infertility and early intervention. However, awareness of risk factors is low, especially in low- and middle-income countries where the prevalence of infertility is high. To address this lack of awareness, the Fertility Awareness Tool (FertiSTAT) was adapted for use in Sudan and other low-resource countries. The aims of this study were to ascertain the need for fertility education in Sudan (Aim 1), and to gauge the acceptability and feasibility of implementing the FertiSTAT in Sudan (Aim 2), both from the patients’ perspective. Convenience sampling was used to recruit participants for semi-structured-in-depth interviews from a fertility clinic in Sudan. We collected sociodemographic information, medical and reproductive history, asked about fertility knowledge, administered the FertiSTAT and asked about the acceptability of the FertiSTAT. Thematic analysis was conducted for qualitative data. Twenty participants were included; of these, 17 were female, 13 were educated beyond secondary school, the mean age was 32.8 years, and the mean duration of infertility was 4.1 years. Ten themes emerged: of these, three themes addressed Aim 1: ‘desire for fertility information’, ‘state of fertility knowledge’ and ‘benefits of fertility education’; and seven themes addressed Aim 2: ‘specific suggestions for the tool’, ‘factors influencing the acceptability and feasibility of implementing the tool’, ‘challenges and barriers to implementation’, ‘self-disclosure’, ‘understanding of being at risk’, ‘compatibility with worldview’ and ‘cultural tailoring’. Fertility education was viewed as necessary and beneficial; however, participants thought that lack of acceptability of sensitive topics would hinder the implementation of the FertiSTAT. Acceptability and feasibility would be enhanced if challenges were addressed in a culturally sensitive manner using cultural tailoring of materials to increase compatibility with individual worldviews.

This study focuses on the involvement of China in the above two African states, arguing that the development of the education sector, therefore the development via education is crucial for any of the states of the continent. It gives an overview of education as a significant aspect of human development in the context of opposing policies of the international financial institutions (IFIs) and the Chinese government. In the light of the FOCAC process, China’s involvement in the development of human resources on African soil will be looked at closely, also questioning whether or not China may present an ‘alternative’ to the IFIs in the field.

Background Snakebite statistics are lacking in Sudan despite the high estimated burden. In this study we aimed to describe the incidence of snakebite envenomation and death in Sudan and to show the state-wise distribution of snakebite episode. Methods We retrospectively analyzed hospital-based data on snakebite for 2014–2018. Data were obtained from the annual health statistical reports of the Ministry of Health. Descriptive statistics were used to illustrate the results. Results A total of 63 160 people were envenomed during 2014–2018 with an average of 12 632 cases/year. The death rate between inpatient cases was 2.5%. The annual incidence was 18– 47 cases/100 000 population. Gadarif state recorded the highest incidence (132/100 000 population) of snakebite envenomation in Sudan whereas Northern state had the least incidence (5/100 000 population). The 15–24 y age group experienced the highest risk of snakebite and males were more exposed to snakebites than females. Conclusions Although hospital-based records underestimate the burden of snakebite, they can still provide an insight regarding the actual numbers. Here, we highlight the at-risk states in Sudan to be targeted for further questionnaire-based epidemiological studies and to guide health authorities to reduce the burden of snakebite envenomation by insuring proper antivenom distribution to the highly affected areas.

PINK1 is the second most predominant gene associated with autosomal recessive Parkinson's disease. Homozygous mutations in this gene are associated with an early onset of symptoms. Bradykinesia, tremors, and rigidity are common features, while dystonia, motor fluctuation, and non-motor symptoms occur in a lower percentage of cases and usually respond well to levodopa. We investigated 14 individuals with parkinsonism and eleven symptom-free siblings from three consanguineous Sudanese families, two of them multigenerational, using a custom gene panel screening 34 genes, 27 risk variants, and 8 candidate genes associated with parkinsonism. We found a known pathogenic nonsense PINK1 variant (NM_032409.3:c.1366C>T; p.(Gln456*)), a novel pathogenic single base duplication (NM_032409.3:c.1597dup; p.(Gln533Profs*29)), and another novel pathogenic insertion (NM_032409.3:c.1448_1449ins[1429_1443; TTGAG]; p.(Arg483Serfs*7)). All variants were homozygous and co-segregated in all affected family members. We also identified intrafamilial and interfamilial phenotypic heterogeneity associated with PINK1 mutations in these Sudanese cases, possibly reflecting the nature of the Sudanese population that has a large effective population size, which suggests a higher possibility of novel findings in monogenic and polygenic diseases in Sudan.