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This paper discusses the long-term history underpinning the tension between the "national" army and provincial "militias" that led to the outbreak of conflict in Sudan in April 2023. Sudan's British colonizers created the distinction between what would later become a professional military in the northern region of the country, and what were deemed as "tribal", irregular and ethnically defined forces elsewhere. The aspiring revolutionaries of the post-independence era hoped they could use the military as a short-cut to social change and modernization that would sweep away the neo-tribal system of "Native Administration" imposed by the British, but by aligning themselves to an unreformed colonial army and economic system, found that they forced violent reactions in marginalized regions. The reactions included Western Sudanese involvement in attempts to change the regime in Khartoum by force in 1971, 1975, 1976, and 2008, which this paper documents. These crises exposed the broader tensions within Sudanese nationalism, based as it was on the ideal of synergy between military and people. The paper draws on a wide range of Arabic and English sources, including newspapers and archival content. [ABSTRACT FROM AUTHOR]

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In Khartoum/Sudan the consumption of water per capita in urban areas far below the real need and WHO standard and huge volume of untreated municipal wastes water and industrial waste is discharged directly to an upstream from the town's sewage water and treatment plants. Only 5% of resident received waste water treatment services, and 95% of waste discharge in unregulated dumps and injected into ground, these leading to pollution of the atmosphere, surface and ground waters, and poses a serious environmental hazard downstream. The main objective of this paper to Simulate pollutant produce from water sector demands being prime indicators of water and environment challenge, using WEAP model, and GIS software.The methodology used in this study to identified appropriate indicators and creates a model that represents water resource status, and pollution generator sectors for a specific system boundary.Khartoum satellite Landsat Mosaic Image (copy write), and Digital elevation model, (DEM) for Sudan, from Global ESRI map, and Land cover map, acquired from Sudanese remote sensing and seismology authority are used in this study to create maps.The Basin Catchment model WEAP21 system scenarios with Remote Sensing, and GIS predicted response and evaluated water deterioration risk quantity and quality related to river Nile catchment area in Khartoum. The model software selected provides decision makers with watershed environmental response factors, with allocation for sustainable water concern lower River Nile catchments.The model approach across user was taken into consideration to ensure withdrawals, assumed improvement in consumption, researcher assumed building a reservoir to improve quality, and reduces people suffering from water shortage, building expansion to reform waste, with reference time from 2015 and projected year by 2030.To fulfill objectives the models was used for pollutant transport from upstream to watershed, to evaluate the effect of applying alternative management practices by development of different Scenarios.Water quality data are collected from Ground water central laboratories, also from Khartoum state data base center. While Waste water data collected from waste water treatment plants in the towns, and from constructional and environmental laboratories, centre. Also, field samples were collected from discharge point in lagoons near river shore and from the cross point of discharge into the river. The study result show how satellite technology combined with local monitoring, GIS, and advanced modeling system can be used to investigate the improved accuracy of the model results, and to improve operations and performance of service providers downstream. The result indicated that scenarios can be developed to explore options for the future and sustainability, and implication of various policies can evaluated. For environmental carrying capacities, the model results indicated that, 90% of water consuming by sector demands end at the receptors as waste water need to be treated. The pollutant load produced by those waste water treatment plants were measured and simulated including pollutant (BOD, COD, TSS, Phosphate, Nitrate, Total organic carbon, heavy metals (Pb, Cr, Zn, Cu), which in turn affects the quality of water resources available for direct use. The improvements in water collection systems affect water supply and wastewater treatment, while the improvement in waste water treatment plants after built new environmental expansion and technology may reduce the flow of waste water to receptors 50% by 2030. In order to ensure a long term development of water resources, and to avoid water becoming a limiting factor in the development of dependent activities, we recommend that country should develop environmental pollution reform and management policy based on an integrated management which associates management of surface and underground waters, qualitative and quantitative measures and management of use by various water sector. [ABSTRACT FROM AUTHOR]

There are different feminist perspectives of education which focus on women’s empowerment. Some of these perspectives address instrumental and intrinsic circumstances influencing motivations and choices for schooling, whilst others look into the role of schooling in shaping and constraining perceptions of empowerment and self-esteem among women. There are also studies which look into the role of the school system in reproducing gender divisions and oppression. As a result, many educational researchers and feminists are concerned about the influence of the family and school systems on women’s/girl’s roles, self- esteem and aspirations. This paper is based on a qualitative case study which analyzes the impact of the schooling process on girls’ educational aspirations and gender inequality in the disadvantaged communities in Sudan. The data was collected by means of in-depth interviews, life history journals and focused group discussions. The sample comprised 30 teenage girls between the ages of 12 – 20 years at two disadvantaged communities’ basic schools in Juba and Khartoum, Sudan. This paper looks at the effects of structure and socio-cultural practices of mixed schools on girls’ educational aspirations, perceptions and inequalities and their implications for the conceptualization of gender within an empowerment framework. In this paper it is argued that whilst education is perceived as a means of women’s liberation and empowerment, it can also have negative effects on girls’ educational aspirations and expectations. The paper concludes that schooling perpetuates gender inequalities through schooling system as well it shapes girls’ educational aspirations among disadvantaged communities in Sudan. This study concludes that girls’ educational aspirations and perceptions are constructed and shaped within the gender role socialization and the traditional and patriarchal social system in Sudan. The home and the school environments in disadvantaged communities of Sudan appear to reinforce gender inequality in the manner in which parents and teachers treat children. The entrenched socio-cultural practices and pressures seem to impact negatively on the school girls’ educational aspirations, expectations and self-esteem. [ABSTRACT FROM AUTHOR]

This letter comments on the article "Emergence of the invasive malaria vector Anopheles stephensi in Khartoum State, Central Sudan" published in Parasites and Vectors 2021, 14:511. Here we aim of provide a response to this paper in the broader context of the invasion and spread of An. stephensi in the Horn of Africa, and the required response to it. We agree with the authors that the arrival of this invasive vector in Khartoum State is of high public health concern. Equally concerning, however, we found that the detection of the vector by the authors in 2018 seemingly took 3 years to communicate to the Ministry of Health and World Health Organization (WHO), and was reliant on an academic journal. We consider that this short report sets a poor example of how public health threats should be reported. Suitable communication alternatives to alert public health authorities to such threats have been put in place by the WHO and its Member States, and are well known to at least some of the authors of the short report. We would like to encourage all readers not to follow the example of Ahmed et al. but instead act as responsible public health professionals by drawing on the established reporting mechanisms and escalate potential threats as soon as they are identified. [ABSTRACT FROM AUTHOR]

Background: Mental health during armed conflicts is of paramount importance, as such situations often lead to increased risks of anxiety and depression symptoms among civilians. The military conflict between the Sudanese army and Rapid Support Forces, which began on April 15, 2023, is currently ongoing mainly in Khartoum State. Despite the significant impact of the conflict on the region, there is a lack of data regarding the mental health status of the residents. The aim of this study is to assess anxiety and depression symptoms among residents of Khartoum State during the first months of the 2023 military conflict. Method: We conducted a cross-sectional study among residents of Khartoum State between May 27 and June 19 using an online questionnaire. We used standardized screening questionnaires, namely the Generalized Anxiety Disorder (GAD-7) for anxiety and the Patient Health Questionnaire (PHQ-9) for depression. Multiple logistic regression was used to identify sociodemographic factors that are associated with anxiety and depression symptoms. Results: Out of the 393 participants in the study, 70% had symptoms suggestive of depression and 57.3% suffered from anxiety symptoms. Both anxiety and depression were associated with being female (p < 0.001). Being married was a predictor of anxiety (p = 0.028) but not depression (p = 0.3). Other predictors were not significant (p > 0.05). Conclusion: High levels of anxiety and depression symptoms were prevalent among Khartoum residents during the conflict, with females and married individuals at higher risk. Immediate medical assessment is essential for identifying cases and providing support. Mental health services should be integrated into emergency response efforts, particularly focusing on vulnerable groups. Future research should address study limitations and explore coping strategies for anxiety and depression in Sudanese adults. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is an immune-mediated, neurodegenerative disease with devastating, disabling, and negative impacts on the patients' quality of life (QoL). Although MS was not known in Sudan, it seems to be rising in recent years. This is a cross-sectional, hospital-based study aimed at assessing the impact of MS medications on patients' QoL in neurology clinics in Khartoum City. Sixty-four patients diagnosed with MS were recruited. SF-36 questionnaire was used to assess the patients' QoL. Data were collected from patients' records in addition to the hand-delivered questionnaire. Data were analyzed using ANOVA test and logistic regression; p ≤ 0.05 was considered statistically significant. Results: The majority of patients were females from north Sudan (92.2%). The mean age was 28.2 ± 6.5. Relapsing–remitting was the most diagnosed MS type (65.6%). Fatigue and urinary incontinence were the most observed symptoms. All patients had vitamin D deficiency (5–20 ng/ml). Disease-modifying therapies (DMTs) were prescribed to 37.5% of patients. The overall mean QoL was 53.9 ± 14.7 with fair physical and mental health (51.8 ± 19.2 and 57.0 ± 10.9, respectively). Patients on DMTs showed a significantly good QoL compared to azathioprine (p ≤ 0.01), corticosteroids (p ≤ 0.01.), and no medications (p ≤ 001). Azathioprine (OR = 0.12; p ≤ 0.05), corticosteroids (OR = 0.14; p ≤ 0.05) and no treatment (OR = 0.01; p ≤ 0.001) negatively affected MS patients' QoL when compared to DMTs. Vitamin D supplementation was significantly (p ≤ 0.01) associated with good QoL. Conclusions: MS was prominent in young females' descendants of Sudanese northern tribes. DMTs improve the devastating effect of MS on patients' QoL, and vitamin D supplementation was significantly associated with good QoL of MS patients. [ABSTRACT FROM AUTHOR]

The recent research aims to investigate the petrophysical and hydrogeological parameters of the Nubian aquifer system (NAS) in Northern Khartoum State, Sudan, using integrated geophysical methods, including surface electrical resistivity and geophysical well-logging. The Nubian aquifer is a transboundary regional aquifer that covers vast areas in Sudan, Egypt, Libya and Chad. The welllogs, including self-potential (SP), natural gamma ray (GR), and long normal resistivity (RS), are integrated with Vertical Electrical Sounding (VES) measurements to delineate the hydrostratigraphical units. As a result, two aquifers are detected. An upper aquifer comprises coarse sand with an average thickness of 50 m and a lower aquifer of sandstone with more than 200m thickness. For a thorough evaluation of the aquifers, in the first stage, the petrophysical and hydrogeological parameters, including formation factor, total and effective porosity, shale volume, hydraulic conductivity, and transmissivity, are measured solely from geophysical well-logs. In the second step, the results of geophysical well logs are combined with VES and pumping test data to detect the spatial variation of the measured parameters over the study area. As a result, the hydraulic conductivity of the Nubian aquifers ranged from 1.9 to 7.8 m/day, while the transmissivity varied between 120 and 733m²/day. These results indicated that the potentiality of the Nubian formation is high; however, in some regions, due to the sediment heterogeneity, the aquifers have intermediate to high potential. According to the obtained results, it can be concluded that the Nubian Aquifer in Khartoum state is ideal for groundwater development. This research discovered that geophysical approaches can be used to characterize moderately heterogeneous groundwater systems by comparing the Nubian aquifer with similar aquifer systems that have similar hydrogeological settings. This study emphasized the application of universal principles in extrapolating hydraulic parameters in hydrogeophysical surveys. This approach aims to reduce the costs and efforts associated with traditional hydrogeological approaches. [ABSTRACT FROM AUTHOR]

Introduction: Lack of awareness about reproductive disorders and their importance in the economic viability of farms in Sudan causes challenges among the majority of small farmholders. The present study was conducted to investigate the risk factors of production and reproduction in Kuku and Saig dairy camps in Khartoum State, Sudan. Materials and methods: In December 2017, a random selection of 100 farms was carried out. The current cross-sectional study was based on a structural questionnaire and direct interviews with the farm owners. Results: Vaccination against contagious diseases was practiced in 80% of the farms in the Kuku and Saig dairy camps in Khartoum State, Sudan. Quarantine of sick animals and newly introduced cows to the herd was practiced only in 23% of the farms. The study found a high prevalence of mastitis (95 farms), the spread of tick infestation (86 farms), and theileriosis (53 farms). There have been 58 farms, where animals showed signs of lameness and 67 farms showed signs of jaundice disease. In the case of selected dairy camps, natural mating was predominant at 98% and bulls from outside the herd accounted for 89% of farms. Besides, 75% of the selected farms suffered from repeat breeders' syndrome. The culling strategy was used in 86% of the dairy farms. There was a low risk of association between the treatment of diseases by the veterinarian, washing labor's hands and udders of cows before and after the milking process, and between the type of mating and repeat breeders. In addition, there was a moderate risk of a correlation between the treatment of the disease by the veterinarian and the contact of other species of animals with the cows in the pen, monitoring of estrus and repeat breeders, abortions, and calving intervals as well. Moreover, a high risk of correlation was obtained between the isolation of animals and the use of vaccination. Conclusion: Control of the disease was unsatisfactory, especially in the Saig camp, with traditional basis management. Hence it is highly recommended to train the farm workers, improve their management, and enhance the animals' health level. [ABSTRACT FROM AUTHOR]

This study aims to determine how vulnerable groundwater in Khartoum is to contamination. For this purpose, the DRASTIC Index idea was used. A descriptive cross-sectional analytical analysis is designed in this study. A total of 279 boreholes were sampled from a total of 1015 boreholes (27.5 percent). The following criteria were utilized to define the DRASTIC Index: depth, net recharge, aquifer media, soil texture, terrain, video media, and soil conductivity. Standard bacteriological test methodologies were used for groundwater. The biological data from the 279 boreholes revealed that total coliform, thermo-tolerant coliform, and E. coli were found in 34.4 percent, 18.6 percent, and 0.36 percent of the boreholes, respectively. Bacteriological contamination is common in Sharge Elnile, although only a few cases have been reported in Khartoum. According to the study, the bulk of boreholes in Khartoum State were built without any criteria. Many sources of contamination were discovered within a radius of less than 120 meters, which was deemed to violate Khartoum State’s Environmental Health Law of 2002. For this reason, bacteriological contamination is common in Sharge Elnile, although only a few cases have been reported in Khartoum. [ABSTRACT FROM AUTHOR]

Background: Antibiotics play an important role in decreasing morbidity and mortality worldwide. However, inappropriate use of them by patients or healthcare professionals contributes to their resistance rendering them less efficacious. Community pharmacists (CPs) have a significant part in reducing antibiotic resistance. Therefore, this study aimed to investigate the dispensing of antibiotics without prescription in community pharmacies with an emphasis on cefixime dispensing.Methods: A cross-sectional, simulated patient (SP) study was conducted in the Khartoum locality. A total of 238 community pharmacies were randomly chosen using simple random sampling. One scenario of uncomplicated urinary tract infection was designed, and six female pharmacy students who were trained to act as SPs presented the scenario. Descriptive statistics were applied to report the study outcomes.Results: In the 238 pharmacy visits, at least one antibiotic was dispensed without a prescription in 69.3% of the simulated visits. Among the dispensed antibiotics, ciprofloxacin was the most dispensed antibiotic followed by cefixime representing 51.5% and 41.8%, respectively, of total dispensed antibiotics. Cefixime was dispensed as a first choice by CPs in 29% of the visits, and in the rest of the visits, only 37.3% of CPs refused to dispense cefixime after SP demand.Conclusion: The findings revealed a high rate of antibiotics dispensing without prescription by CPs in Khartoum state, and cefixime was obtained with ease before and after the patient's demand. Urgent corrective actions such as imposing strict regulations, monitoring pharmacists' practice, and endorsing educational programs for pharmacists are needed to prevent inappropriate antibiotic dispensing practices. [ABSTRACT FROM AUTHOR]

Background: The objective of this study is to utilize the ILAE 2017 to classify epilepsy patients and determine its applicability in Sudan. Methods: This study is a prospective, descriptive, cross-sectional research conducted in two pediatric epilepsy clinics in Khartoum State, Sudan. Results: In this cross-sectional study, 350 pediatric patients with epilepsy were included, with a mean age of 8.4 ± 4.7 years and a mean illness duration of 4.71 ± 3.91 years. The ILAE classification was applied, showing that 71.11% of patients had generalized onset seizures, 27.7% had focal onset seizures, and only 1.1% had unknown onset seizures. Among patients with focal onset seizures, 56.4% had intact awareness, while 43.6% had impaired levels of awareness. The majority of patients who had generalized onset seizures experienced motor onset seizures, with tonicclonic seizures being the most common (44.2%). Nearly all patients with unknown onset seizures experienced tonic-clonic convulsions. These findings provide insights into the prevalence and types of seizures among pediatric epilepsy patients in Sudan and can guide clinicians in developing appropriate treatment plans. Conclusion: This study highlights the importance of utilizing the latest ILAE classification 2017 in epilepsy classification and its potential utilization in resourcelimited areas like Sudan. [ABSTRACT FROM AUTHOR]

Background: Burnout prevalence and its consequences on healthcare workers during the Omicron wave are not well investigated in Sudan. This study aims to assess the prevalence of burnout and its associated factors among doctors and nurses during the omicron wave in COVID-19 isolation centres in Khartoum, Sudan. Method: This cross-sectional survey study was conducted at multiple COVID-19 isolation centres in Khartoum state during the omicron wave of Coronavirus Disease 2019 between 20th February 2022 and 10th April 2022. A total of 306 doctors and nurses filled out the questionnaire, with a response rate of 64.8℅. They were recruited from 5 isolation centers scattered in the three cities of Khartoum Metropolis. The level of burnout was assessed using an online semi-structured questionnaire based on the Oldenburg Burnout Inventory questionnaire. Descriptive statistics were used for continuous variables and frequencies with percentages for categorical variables. The Chi-square test and Fisher exact test were used to identify variables associated with burnout. Logistic regression was used to determine the factors associated with burnout, and the p-value of ≤.05 is considered statistically significant. Results: The prevalence of burnout was 45.7%. Doctors were more likely to have burnout than nurses (OR: 2.01, CI 95% 1.24–3.27; p = 0.005). Also, married healthcare workers were more likely to suffer burnout than single healthcare workers (OR: 3.89, CI 95% 1.41–12.5; P = 0.013). The number of household members (p = 0.035) was associated with burnout among participants. Conclusion: There is a high prevalence of burnout among healthcare workers in Khartoum Isolation Centers, which is more apparent among doctors. [ABSTRACT FROM AUTHOR]

Plasmodium vivax Duffy Binding Protein (PvDBP) is essential for interacting with Duffy antigen receptor for chemokines (DARC) on the surface of red blood cells to allow invasion. Earlier whole genome sequence analyses provided evidence for the duplications of PvDBP. It is unclear whether PvDBP duplications play a role in recent increase of P. vivax in Sudan and in Duffy-negative individuals. In this study, the prevalence and type of PvDBP duplications, and its relationship to demographic and clinical features were investigated. A total of 200 malaria-suspected blood samples were collected from health facilities in Khartoum, River Nile, and Al-Obied. Among them, 145 were confirmed to be P. vivax, and 43 (29.7%) had more than one PvDBP copies with up to four copies being detected. Both the Malagasy and Cambodian types of PvDBP duplication were detected. No significant difference was observed between the two types of duplications between Duffy groups. Parasitemia was significantly higher in samples with the Malagasy-type than those without duplications. No significant difference was observed in PvDBP duplication prevalence and copy number among study sites. The functional significance of PvDBP duplications, especially those Malagasy-type that associated with higher parasitemia, merit further investigations. [ABSTRACT FROM AUTHOR]

Background: Waste disposal and management is a global concern affecting both high- and low-income countries. This research assessed the health impact of burning household waste in Khartoum State, Sudan. Methods: An online community-based cross-sectional study was implemented on a sample of 844 participants selected through a stratified random sampling technique across Khartoum State. The data were collected through a standardized pre tested online questionnaire. The data file was georeferenced through Google Earth Pro and analysed with SPSS 23 and ArcGIS 10.3. The data were summarized numerically and graphically. The appropriate frequency tables were used in ArcGIS to generate geographical distribution maps of household waste burning and predictive health risk maps of waste burning in Khartoum State. Statistical tests performed for association carried out were Chi-square and ANOVA. A binary regression analysis established the relationship between burning of household waste and its associated factors. All statistical tests were considered significant when p < 0.05. Results: The practice of burning household waste was performed by 74.5% (619/831) of the participants with 50.8% (311/612) who reported burning the waste weekly. The health conditions related to household waste burning were predominately asthma (57.0%) and respiratory manifestations (38.0%). Of the ten contributing factors of health risks related to burning household waste, the two statistically significant were the frequency of waste collection (OR = 0.720, 95% [CI: 0.593– 0.875], p = 0.001) and the place of waste disposal (OR = 0.791, 95% [CI: 0.651– 0.961], p = 0.018). Conclusion: The practice of burning household waste in Khartoum State was a public health concern. Sociodemographic and managerial factors exposing residents to health risks appeal political, health authorities and communities to establish a partnership to manage household waste for public safety and good quality of life. [ABSTRACT FROM AUTHOR]

Desertification is one of the most destructive climate-related issues in the Sudan–Sahel region of Africa. As the assessment of desertification is possible by satellite image analysis using vegetation indices (VIs), this study reports on the technical advantages and capabilities of scripting the 'raster' and 'terra' R-language packages for computing the VIs. The test area which was considered includes the region of the confluence between the Blue and White Niles in Khartoum, southern Sudan, northeast Africa and the Landsat 8–9 OLI/TIRS images taken for the years 2013, 2018 and 2022, which were chosen as test datasets. The VIs used here are robust indicators of plant greenness, and combined with vegetation coverage, are essential parameters for environmental analytics. Five VIs were calculated to compare both the status and dynamics of vegetation through the differences between the images collected within the nine-year span. Using scripts for computing and visualising the VIs over Sudan demonstrates previously unreported patterns of vegetation to reveal climate–vegetation relationships. The ability of the R packages 'raster' and 'terra' to process spatial data was enhanced through scripting to automate image analysis and mapping, and choosing Sudan for the case study enables us to present new perspectives for image processing. [ABSTRACT FROM AUTHOR]

Hot dry climate regions enjoy high solar irradiation, albeit with high ambient temperatures. These two factors have a contradictory effect on the power generated from PV systems. This work studies the combined effect of high ambient temperature and high irradiation on the net performance of PV systems. The study is based on monitoring a grid-connected 5 kW PV system installed on the rooftop of the Energy Research Center of the University of Khartoum, Sudan. The performance was monitored by meteorological and power measurement equipment from April 2017 to March 2018. The results showed stable power output from the PV system with an average final yield of 4.57 kWh/kWp and a 0.21 standard deviation from this average value. The stability in power output is due to the compensation of the efficiency degradation due to high temperature by high irradiation in summer. This is combined with the relatively low irradiation in winter compensated by the low temperature effect in winter. The annual deviation of the temperature and irradiation is small in Khartoum due to its proximity to the equator. The semi desert climate, offers Khartoum notably few annual cloudy hours. These characteristics were compared with the annual performance of other countries with different climates. The conclusion from this work on hot dry regions is that despite the negative effect of temperature, the annual output power from the system tends to be stable due to the substitution contributed by the regionally high radiation and the relatively cool winter climate. [ABSTRACT FROM AUTHOR]

Tuti Island is a river island located at the junction of the Blue and the White Nile in Greater Khartoum, the capital region of the Sudan. Through the process of documenting their genealogies, some of inhabitants of Tuti Island have constructed a historical narrative about the origins and early settlement of the island and of the Maḥas extended families who live there. For many of the Maḥas of Tuti, documenting their genealogies is a way of overcoming their fear about the island losing its uniqueness, because of urban master plans through which the island is envisioned as a waterfront development. By attaching their families' histories to the island, they hope to assert their sense of belonging. Moreover, some of the island's genealogists have traced their genealogical lines as far back as the time before their ancestors migrated from northern Sudan and ended up on Tuti island. The social alienation Maḥas Tuti are experiencing plays a vital role in driving people to attach their genealogies and family histories to Qāmī, the "original" land of the Maḥas of Tuti island and construct an imagined homeland. [ABSTRACT FROM AUTHOR]

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). [ABSTRACT FROM AUTHOR]

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

Background: The association between previous spontaneous abortion and preeclampsia is not yet fully understood. The current study was conducted to assess the association between previous spontaneous abortion and preeclampsia among pregnant women in Sudan.Methods: A case-control study (involving 180 women in each study group) was conducted at Saad Abuelela Hospital, Khartoum, Sudan. The cases were pregnant women with preeclampsia, while the control group included healthy pregnant women. The participants' sociodemographic, obstetric, and clinical characteristics were assessed via a questionnaire.Results: There was no significant difference in the age, parity, education level, employment status, blood group, body mass index, and hemoglobin level between the patient and control groups. Forty (22.2%) women with preeclampsia and 68 (37.8%) women in the control group had a history of spontaneous abortion (p = 0.001). Multivariate logistic regression analysis (adjusted) revealed that women with a history of spontaneous abortion had a lower risk of preeclampsia than those without a history of spontaneous abortion [adjusted odds ratio (AOR) = 0.44, 95% confidence interval (CI) = 0.26‒0.73]. However, women with a history of preeclampsia had a higher risk of recurrence of preeclampsia (AOR = 1.92, 95% CI = 1.11‒3.32).Conclusion: The present study revealed that previous spontaneous abortion reduced the risk of preeclampsia by 59.0%. [ABSTRACT FROM AUTHOR]

Introduction. Knowledge of local and regional antimicrobial resistance (AMR) is crucial in clinical decision-making, especially with critically ill patients. The aim of this study was to investigate the rate and pattern of infections in valvular heart disease patients admitted to the intensive care unit (ICU) at the Salam Centre for Cardiac Surgery in Khartoum, Sudan (run by EMERGENCY NGO). Methods. This is a retrospective, observational study from a single, large international referral centre (part of a Regional Programme), which enrolled patients admitted to the ICU between 1 January and 31 December 2019. Data collected for each patient included demographic data, operating theatre/ICU data and microbiological cultures. Results. Over the study period, 611 patients were enrolled (elective surgery n = 491, urgent surgery n = 34 and urgent medical care n = 86). The infection rate was 14.2% and turned out to be higher in medical than in surgical patients (25.6% vs. 12.4%; p = 0.002; OR = 2.43) and higher in those undergoing urgent surgery than those undergoing elective (29.4% vs. 11.2%; p = 0.004; OR = 3.3). Infection was related to (a) SOFA score (p < 0.001), (b) ICU length of stay (p < 0.001) and (c) days from ICU admission to OT (p = 0.003). A significant relationship between the type of admission (elective, urgent surgery or medical) and the presence of infections was found (p < 0.001). The mortality rate was higher among infected patients (infected vs. infection-free: 10.3% vs. 2.1%; p < 0.001; OR = 5.38; 95% CI: 2.16–13.4; p < 0.001). Conclusions. Hospital-acquired infections remain a relevant preventable cause of mortality in our particular population. [ABSTRACT FROM AUTHOR]

Background: Visceral leishmaniasis (also known as Kala-azar) is a systemic parasitic infection with many clinical presentations. The present study assesses the variation in presentations among patients who attended the Tropical Diseases Teaching Hospital (TDTH) in Khartoum, Sudan. Methods: This analytical cross-sectional, hospital-based study was conducted at the TDTH between November 2019 and September 2020. Medical records of patients who presented at the TDTH were reviewed using a structured data extraction checklist. The Chi-square test was used to determine the associations between sociodemographic and clinical presentations of patients. P-value < 0.05 was considered as statistically significant. Results: Out of 195 patients, 79.5% were male and 48.2% were <31 years old. Fever was the main clinical presentation (90.2%) while 53.3% presented with weight loss and 72.3% and 39% presented, respectively, with splenomegaly and hepatomegaly. HIV was detected in 4.6% of the patients. RK39 was the main diagnostic test. We found a significant association between the abdominal distention and the age of the patients (P < 0.05) – age groups 11–20 and 41–50 years were more likely to present with abdominal distention than other age groups. Conclusion: There is no exact clinical presentation or routine laboratory findings that are pathognomonic for visceral leishmaniasis; therefore, it should be considered in the differential diagnosis of any patient with fever, weight loss, and abdominal distention, and among patients with HIV. [ABSTRACT FROM AUTHOR]

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This study investigates malaria incidence during the hot-wet summer (June to September) and cool-dry winter (January to March) seasons in Khartoum, Sudan. Using data on malaria cases, LandScan gridded population data, and temperature data from the Global Historical Climatology Network, malaria incidence in Khartoum city in 2015 was 1,629.2 per 100,000 population in cool-dry winter months compared to 924.7 in hot-wet summer months, with temperatures rising faster in the winter season. Future research should focus on poor urban sanitation and water infrastructures that supply breeding grounds for the mosquito vector and overcrowding that may exacerbate the mosquito-human malaria transmission cycle. [ABSTRACT FROM AUTHOR]

The current study evaluated the efficacy of indigenous isolates of entomopathogenic fungi against the third larval instar of tomato leaf miner (Tuta absoluta Meirick; Lepidoptera: Gelechiidae). Four virulent isolates were subject to morphological and molecular identification and they were identified as; Beauveria bassiana isolate Hammad-R7 (Sudan) accession (MN598666); Beauveria bassiana isolate-Sud-afro-18ITS accession (MK046654); Beauveria bassiana isolate Sud-afro-2oITS accession (MK046652) and Purpureocillium lilacinum isolate Khartoum accession (MK046655). Efficacy test was done by larval dipping in the fungal suspension along with the commercial product Eco-Bb®. Mycosis test was performed to confirm the growth of fungus from the cadaver. Treated larvae died within three days after the appearance of the symptoms. The four indigenous isolates showed medium mortality responses (LT50 ranged between 4.1–4.3 days) close to or slightly even better than that induced by the commercial product ECO-Bb (LT50 4.2 days) however three of them induced superior responses (LT90 ranged between 9.5–11.7 days) to the commercial product ECO-Bb (LT90 14.4 days) at higher doses measured at the LT90. Endophytic capability of the isolates was tested by seed dipping and soil drenching methods and the fungal mycelia was detected microscopically in the leaves and stems without apparent negative effects on plant growth. The current results indicate the promising potential of these isolates in the regulation of T. absoluta. [ABSTRACT FROM AUTHOR]

Introduction: Spatial presentation is considered a useful tool for analyzing and mapping the frequencies of incidences of different pathogens. Khartoum State accounted for 78% of the overall cases of COVID-19 in Sudan. The aim of this study was to present the spatial extent of healthcare services of a private isolation center during the pandemic at the locality level.Materials and Methods: A spatial descriptive study was conducted using ArcGIS to present the locations of all COVID-19 patients who attended Imperial Hospital isolation center on November-December 2020 in Khartoum, Sudan.Results: Patients diagnosed with COVID-19 during the study period were 188; they had attended Imperial Hospital from 9 states. Patients from Khartoum State were 167 patients. Of those 167 patients, 75 were from the Khartoum locality; it is the locality in which Imperial Hospital is located, followed by Khartoum Bahri (34 patients), Omdurman (19 patients), and South Khartoum (14 patients), while 10 patients each were from the Sharg En Nile and Karary localities.Conclusion: Patients from 8 different states of Sudan had travelled to reach Khartoum State to get health services. At the state level, Khartoum State was the most benefited state from the healthcare services of Imperial Hospital. At a locality level, Khartoum locality was the most benefited one. [ABSTRACT FROM AUTHOR]

This study aims to explain the attitude and perception of Sudanese EFL secondary school students towards learning literature to enrich their vocabulary. The study is unique as the researchers believe that no significant research in the undertaken area has been conducted in secondary schools in Sudan. The study sample consists of seventy-nine subjects: thirty girls, thirty-five boys, and fourteen teachers from Ahfad Secondary School in Khartoum. This study investigated vocabulary acquisition challenges faced by secondary school students of Ahfad due to lack of interest, lack of good study material for literature, lack of experienced and well-qualified teachers, lack of modern techniques in the EFL classroom, and the implementation of a designed curriculum. Secondary students can engage in meaningful active communication in English if they have good vocabulary, and literature is the most effective way to expand vocabulary. The study adopted qualitative methodology using a questionnaire and vocabulary building activities to perceive how literature helps vocabulary acquisition. The study results showed that the EFL subjects positively enriched their vocabulary through the existing curriculum. EFL teachers should use innovative methods to inculcate vocabulary acquisition in the heart of the EFL students to develop the spirit of reading sections. [ABSTRACT FROM AUTHOR]

Vaccine uptake is one of the indicators that has been used to guide immunization programs. This study aimed to evaluate whether measles vaccine uptake is predicted by measles vaccine hesitancy. A community-based cross-sectional study was conducted in urban districts in Khartoum state in February 2019. Measles vaccine uptake among children was measured as either fully vaccinated or partially/not vaccinated. The Parent Attitudes about Childhood Vaccines (PACV) scale was used to measure measles vaccine hesitancy. Multivariate logistic regression was run to identify the predictors of measles vaccination uptake, controlling for sociodemographic variables, and the adjusted odds ratios (aORs) with 95% CI were calculated. The receiver operator characteristic (ROC) curve was created, and the area under the curve (AUC) for the PACV was computed. Data were collected from 495 participants. We found that measles vaccine hesitancy (PACV scores) predicts the uptake of measles vaccine after controlling for other potential social confounders, such as the mother's age and the number of children (aOR 1.055; 95% CI 1.028–1.028). Additionally, the ROC for the PACV yielded an area under the curve (AUC 0.686 (95% CI 0.620–0.751; p < 0.001)). Our findings show that measles vaccine hesitancy in Sudan directly influences the uptake of the measles vaccine. Addressing the determinants of vaccine hesitancy through communication strategies will improve vaccine uptake. [ABSTRACT FROM AUTHOR]