Voluntary medical male circumcision (VMMC) is one of the key interventions against heterosexual spread of HIV. However, its prevalence in South Sudan is not clearly understood. This study aimed to assess the prevalence and perceptions of VMMC among University of Juba students.
Chronic rhinosinusitis is inflammation of the nasal cavity and paranasal sinuses that lasts for at least twelve weeks. Paranasal sinus variations account for various pathologies, including chronic rhinosinusitis. This study assessed the anatomical variations of paranasal sinuses among patients with chronic rhinosinusitis attending otorhinolaryngology services in a tertiary hospital in Tanzania.
Serum creatinine and urea levels are affected by numerous factors such as ethnicity, environment, age, sex, and anthropometric measurements. The Clinical and Laboratory Standards Institute (CLSI) recommends that each laboratory should establish its own reference intervals for biochemistry and haematology. There are no local reference intervals for serum creatinine and blood urea in Sudan; instead, intervals derived from worldwide research are used. The purpose of this study was to determine the blood urea and serum creatinine reference intervals for healthy adults in the Western Sudanese population.
Hepatitis B virus (HBV) is a deoxyribonucleic acid (DNA) virus that belongs to the family of Hepadnaviridae that causes acute and chronic diseases of the liver. HBV infection is a dangerous worldwide public health problem, which usually affects the liver and may cause acute hepatitis, fulminant hepatitis, hepatic encephalopathy and chronic conditions like liver cirrhosis and hepatocellular carcinoma (HCC).
Eclampsia is one of the clinical manifestations of a hypertensive disorder of pregnancy. The American College of Obstetricians and Gynaecologists guidelines include elevation of liver enzymes as a criterion for the diagnosis of pre-eclampsia/eclampsia. The difference between pre-eclampsia and eclampsia is that a woman with eclampsia has had a seizure.
Hoarseness of voice is the disturbance of normal voice pitch by an abnormal vibration of the vocal cords, it is a term used to describe an unnaturally harsh, rough or deep voice. It is a common symptom in otolaryngological practice and it is an early manifestation of a large variety of conditions directly or indirectly affecting the larynx, ranging from inflammatory to malignant.
Middle ear effusion (MEE) is a common childhood disorder characterized by the presence of fluid in the middle ear which causes hearing impairment due to reduced ability of the middle ear to conduct sound. This necessitates prompt and appropriate management to avoid the associated complications of speech and learning delay which is detrimental to the quality of life of affected children who are mostly of pre-school age.
Systemic hypertension (SH) contributes the highest number of deaths from cardiovascular diseases worldwide. Patients with resistant hypertension (RH) are more prone to hypertension-mediated organ damage. RH has not been well-studied in Africa, despite the fact that the prevalence of SH is highest in Africa. The aim of the study was to establish the prevalence and predictors of RH among out-patients managed in the cardiology unit of the University of Ilorin Teaching Hospital, Ilorin, Nigeria.
Prostate cancer carries a high morbidity and mortality especially when not diagnosed early. Patients in resource limited countries tend to be diagnosed late and hence delayed surgery for benign prostate hypertrophy (BPH). This was a retrospective study, from 1st January 2019 to 31st December 2020, on patients who underwent prostatectomy. Demographic and clinical data were extracted from their medical records.
Access to medicines is a global problem due to rising prices. This affects the ability of health systems to provide full and affordable healthcare. With the persisting problems of shortages and stockouts of essential medicines for communicable and non-communicable diseases, there are increasing numbers of substandard and counterfeit medicinal products posing a serious risk to the public.
The Caesarean Section (CS) rate is dramatically increasing across obstetric populations. This study aimed to determine the adherence to criteria for standard diagnosis of the common indications for CS among women of a low-risk group. This group, known as group 3 in the Robson classification, is multiparous, term with singleton pregnancy and have not had a previous CS.
Anecdotal experience suggests that Ugandan patients complain infrequently of breathlessness. The Luganda language, spoken in Uganda, does not have one word to express breathlessness but uses various phrases. Therefore, many of these patients may not be able to express what they feel when they are breathless by a single English word.
Many patients with diabetes mellitus are not attaining optimal glycaemic control, although the rate is unknown in South Sudan. Maintaining adequate glycaemic control is the most effective means of preventing complications associated with diabetes. This record review assesses the proportion of patients with diabetes on follow-up not adequately controlled using glycated haemoglobin (HbA1c) and describes associated factors.
Tetanus is a major health problem in developing countries, and is associated with high a morbidity and mortality. There are no recent local data in Kenya on the impact of the disease in terms of morbidity and mortality. The objective of this study was to describe the type, severity, risk factors, immunization history and outcome of tetanus patients at Kenyatta National Hospital (KNH).
Armed conflict is devastating to the health system, is a public health concern and recovery is an enormous challenge. The independence of South Sudan in 2011 brought much hope. However, eight years later, the country is still at conflict with itself. Although rich in resources, it is ranked among the poorest in the world and depends on donor funding for most service delivery, especially health. In an international context, promoting the localisation of humanitarian aid and the integration of health services, there is a lot to learn from the roles being played by healthcare workers (HCWs) throughout the conflict in South Sudan.
Maternal perception of foetal movement ensures foetal wellbeing. Reduced foetal movement is associated with foetal hypoxia, stillbirths, and intrauterine foetal growth restriction (IUFGR). This study aimed at assessing factors that are associated with maternal perception of reduced foetal movements.
Hearing loss is a major public health problem in developed and developing countries. The objective of this study was to determine the causes and patterns of hearing loss at a private hospital that serves the largest number of patients with ear, nose and throat diseases in Tanzania’s largest city.
Around 80% of factors that determine population health sit outside the control of health services. It is essential we influence these factors in addition to those within the remit of health services in order to improve and protect the health of population in a developing country. Public health functions encompass working across the domains that constitute population health systems with various partners.
Blindness due to glaucoma is influenced by many factors including: the time of onset, natural history, access to eye health services, quality of care provided by health institutions, and compliance with treatment and follow up. Furthermore in Africa there is poor or no awareness of the condition and limited access to care. The availability of diagnostic equipment and medical and surgical management is frequently less than ideal. Insecurity, corruption and poor leadership in Africa have worsened the situation.
The number of patients attending outpatient clinics with musculoskeletal disorders is increasing globally and is an occupational related health care issue. The international Labour Organization (ILO) has reported nearly 160 million work-related disorders occurring around the world annually. “A musculoskeletal disorder is defined as an inflammatory and / or degenerative condition that affects muscles, tendons, ligaments, joints, peripheral nerves and supportive structures like in the spine vertebrae.”
Tonsillectomy is the commonest surgical procedure performed worldwide by otorhinolaryngologists. Studies have shown that patients who underwent tonsillectomy, with or without adenoidectomy, have shown significant improvement in quality of life. Advancement in technology and evidence from research have contributed greatly to the techniques of tonsillectomy and perioperative care. Earlier techniques such as cold steel dissection and utilization of ligature for haemostasis are being replaced by the introduction of microdebrider, coblation, laser and diathermy. These are faster and result in less bleeding. Nevertheless, there is a wide variability in practice even in developed countries.
The global fight against human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) is far from over. In 2020, out of 37.7 million people living with HIV, 1.5 million of these were newly infected and 680,000 HIV related deaths occurred. Nine percent of global new infections were attributed to vertical transmission in 2017 and over 90% of HIV infections among children less than 15 years is attributed to mother-to-child transmission (MTCT)
The provision of quality antenatal care (ANC) services involving men contributes to the empowerment of women and the achievement of the Sustainable Development Goals (SDGs) by reducing maternal and neonatal deaths.[1] However, the level of male participation in reproductive health issues, including ANC in sub-Saharan Africa (SSA), is still challenging.
Admission to hospital outside of normal working hours is consistently associated with poorer patient outcomes. Our aim was to determine the association of patients’ age and time of presentation to a low-resource Ugandan hospital with admission rate and in-hospital mortality. Prospective observational non-interventional audit in the emergency and outpatient departments of Kitovu Hospital in Uganda, a low-resource sub-Saharan hospital. Data on age, sex, time of admission was collected from all non-pregnant patients during 2020 and 2021, and outcomes analysed. Out of 17,133 patients who presented to the hospital 189 died in hospital (1.1% of all presentations and 7.9% of all admissions); 46 (24.3%) patients died within 24 hours of arrival (0.3% of all presentations and 1.9% of all admissions). Deaths within 24 hours of arrival in hospital were more likely in the very young and the old, and in those who presented at night and on the weekend. As many in-hospital deaths occur shortly after arrival, resuscitation skills are needed even in low-resource settings for as much of the 24-hour day as possible.
Cochlear Implant is a small medical electronic device that is surgically inserted partially in the cochlear (inner ear) to restore some hearing in patients with severe to profound hearing loss. Cochlear implantation is considered a rehabilitative measure of choice that positively impacts on the quality of life of patients. The objective was to describe the clinico-demographic characteristics of cochlear implantees and the outcomes of the intervention among the implantees at Muhimbili National Hospital (MNH) in Tanzania. This was a hospital based cross-sectional study which involved a total of 39 patients who underwent cochlear implantation from July 2017 to May 2021 at MNH. Clinico-demographic characteristics and outcomes of the intervention among the implantees were collected using structured questionnaires and data were analysed using Statistical Package for Social Sciences Version 20. Results were then presented in frequency tables and figures.
Results: This study recruited 39 patients with bilateral hearing loss with their ages ranging from 2 to 55 years. Their mean age was 4.7 years and median of 3 years. More than half, 24(61.5%) of implantees aged 2-3 years. Males predominated with male to female ratio of 1.2:1. Majority 37(94.9%) had pre lingual hearing loss and 36 (92.3 %) had bilateral profound sensorineural hearing loss. Ototoxicity was the commonest cause of hearing loss among the implantees contributing 16(41%) followed by birth asphyxia, 8(20.5%). A total of 37(94.9%) of these patients were implanted with a single cochlear device due to the high cost associated with this type of intervention. Cochlear implantation in limited resource settings is possible and cost effective if there is enough support from the government and other charitable organisations. The availability of rehabilitative services remains key for better outcome after cochlear implantation.
Vesicovaginal fistulae (VVF) and rectovaginal fistulae (RVF) are major public health concerns globally and especially in sub-Saharan Africa. Obstetric complications are the leading cause of fistulae in sub-Saharan Africa in a review of articles published from 1987-2008. The high rates of VVF and /or RVF or both in the region reflects the poor quality and the level of perinatal care provided by the local health systems. Approximately 50-80 women/ year attend fistula campaigns in South Sudan with around half having a fistula and receiving a repair. It was estimated in 2013 that at least 30 women out of 100,000 deliveries have obstetric fistulae either VVF or RVF or both despite the efforts being made by both health partners and the Ministry of Health. These fistulae are a serious health burden on the women of South Sudan which has the highest maternal mortality rate in the world at 2,054 per 100,000 live births,[4] 90% of deliveries occur in rural areas with only 10% attended by skilled midwives.
Annually about 15 million preterm babies are born around the world and more than one million die soon after birth mainly due to respiratory complications. Respiratory Distress Syndrome (RDS) is a common and serious complication of preterm birth accounting for 50% of preterm deaths. RDS is responsible for 30-40% of admissions in the neonatal period. The prevalence of RDS varies with gestational age (GA), 30% among preterm, and 20% among post terms to 4% in term babies.
Mycobacterium tuberculosis (TB) competes with malaria for being the greatest killer of all time. Much of the first world has TB under control, but that is not true in South Sudan. The first world has the best diagnostic techniques, but where they are most needed, these are lacking. Most TB is in the lungs, but it is certainly not rare in other areas of the body (extrapulmonary) (EP TB).
Women with higher gestational age and gestational diabetes mellitus are at an increased risk of delivering a baby with macrosomia at Iringa Regional Referral Hospital. An early plan for the mode of delivery, such as labour induction, will aid the prevention of advanced gestational age. Ensuring a healthy diet and physical exercises in our communities will help to reduce diabetes mellitus and hence fetal macrosomia.
Globally about 463 million people are living with diabetes mellitus (DM) and 80% are in middle and low-income countries. The International Diabetes Federation has estimated that the number of diabetes patients will rise to 700 million by 2045. Almost half of adult type-2 diabetes patients are unaware they have this disease and 185.8 million undiagnosed diabetics are in middle-income countries. Worldwide every 30 seconds, a lower limb is lost because of diabetes. The incidence of DFU amongst those with DM is 2% (9.26 million) but the risk of recurrence for those with a history of DFU increases to 17–60% over the following three years.
Across South Sudan, communities have extensive experience and knowledge of infectious diseases and epidemic outbreaks. Because South Sudan’s clinical healthcare sector is fragmented, overstretched and under-resourced, South Sudanese people have themselves developed many methods of identifying cases, interrupting infection transmission and quarantining patients as safely as possible within local circumstances.
The coronavirus pandemic (COVID-19) has placed enormous challenges on the health sector. Diagnosis is one of these challenges, where a clinical presentation may suggest a disease other than COVID-19. In this review we describe many presentations unrelated to the respiratory system. The ACE2 receptor is present in a wide variety of body tissues and it appears that this may be a link with the clinical pathology. To find these data we searched the major academic research engines, Google Scholar, and Pubmed, as well as the most recent case reports and original research published in specialized journals.
Poor adherence to standard malaria diagnosis and treatment guidelines has resulted to the spread of antimalarial drug resistance. This exposes more pregnant women to malaria, which increases the risk of poor health outcomes for mothers and infants. Placental parasitaemia can cause maternal anaemia and low birth weight, both of which are risk factors for neonatal mortality. In areas of Africa where malaria is endemic, the World Health Organization (WHO) recommends three approaches to malaria prevention and control: - uptake of Intermittent Preventive treatment in Pregnancy (IPTp), - sleeping under an insecticide-treated bed net (ITN), - effective clinical diagnosis and treatment of malaria.
According to the World Malaria Report of 2019, there were 228 million cases of malaria globally. The estimated number of malaria deaths were 405,000 in the same year. The World Health Organization (WHO) report showed that Africa carries a high proportion of the global malaria burden. Overall, there were 93% of malaria cases and 94% of malaria deaths in Africa.[3] In the same year, children aged under five years were the most affected accounting for 67% of all malaria deaths globally. Therefore, reducing the malaria burden would contribute to progress towards achieving the Sustainable Development Goals.
Many studies of IPTp uptake have not reported on the impact of Community IPTp (C-IPTp) administration to increase adherence by pregnant women, although some have reported a higher percentage of ANC attendance as a means to increase IPTp uptake. The objective of this study was to assess the impact of C-IPTp in increasing IPTp3+ coverage compared to using routine ANC visits to increase coverage of IPTp.
This was a cohort retrospective study conducted at St Francis Hospitals Nsambya and Naggalama. The sample size was two hundred and two patients. A consecutive sampling technique with replacement of missing charts was used. The Principal Investigator and the research assistants then made telephone calls to the patients inviting them for an interview in the two hospitals, and for those who could not attend questionnaires were administered to them on phone. This was done sequentially until the sample size for each hospital was reached. If a given telephone was not available or went unanswered, we telephoned the next patient in the sequence on the register. Inguinodynia was assessed using the Numerical Rating Pain Score (NPS). Recurrence was assessed by physical examination.
The Pharmacy and Poisons Board (PPB) in Kenya defines an ADR as a response to a drug which is noxious and unintended, that occurs at doses used in humans for the prophylaxis, diagnosis or therapy of disease, or for the modification of physiological function. Modern ADR reporting practice began in 1961 when thalidomide caused phocomelia among new-borns. The PPB in Kenya launched the Department of Pharmacovigilance (PV) in 2004 and started the National PV Centre in 2009 to report ADRs and product quality issues.
Every five minutes, somebody dies from a snakebite. According to the World Health Organization (WHO), an estimated 5.4 million people get bitten worldwide every year and around 81,000 to 138,000 people die each year because of snake bites. In Africa alone, 435,000 to 580,000 victims suffer snakebite envenoming and South Sudan could be one of the countries with the highest incidence. However, snakebite still receives less attention globally than other Neglected Tropical Diseases (NTDs) and comprehensive programmes and efforts to provide care to snakebite patients are limited.
Continuous Positive Airway Pressure (CPAP) provides an air pressure that maintains the patency of the airway in patients with a variety of breathing problems. Nurses provide the hour to hour management of patients who require CPAP. The aim of this study was to assess the knowledge of nurses about CPAP machine usage at the tertiary hospital in Tanzania which serves the largest number of patients who require CPAP.
Of the 56.4 million deaths occurring worldwide in 2015, more than half (54%) were due to the top 10 causes - of which diabetes was one. Diabetes is one of the multiple health challenges faced by developing countries. A 2006 US study noted that diabetes, not obesity, increases the risk of critical illness, organ failure and early deaths.
Neonatal sepsis is one of the most common causes of neonatal morbidity and mortality in developing countries. This study which aimed to determine the prevalence and factors associated with neonatal sepsis among hospitalized new-borns at Ruvuma, southern Tanzania, found that the prevalence of neonatal sepsis in this study setting is very high.
The burden of non-communicable diseases is increasing in developing countries. The World Health Organization estimates that by 2030, non-communicable diseases may cause up to46 % of deaths in sub-Saharan Africa. he objective of this study was to determine the burden of hypertension and assess associated factors among adults visiting the outpatient unit of a tertiary level health facility in Ruvuma, Tanzania.
Postpartum/post abortion family planning is a service provided for women who have given birth or had a spontaneous abortion. Due to low uptake of contraception in South Sudan, increasing contraceptive use is important to achieve Sustainable Development Goals. The study aimed to introduce postpartum/post abortion family planning to women who have delivered or undergone spontaneous abortion at Juba Teaching Hospital, Tambura Hospital, and Yei Hospital. It found that the training of health care staff to advocate and promote postpartum/post abortion contraception is effective and can contribute to family planning services.
In Africa HEV seroprevalence varies greatly from 0%-94% in the general population and outbreaks, with the case fatality rates of 17.8% and 42.1% in the general population and pregnant women respectively. The largest outbreak in Africa was reported in Uganda in 2007, which led to an attack rate of 25% of the population.
Tanzania, one of the most resource-constrained countries in Africa, has poor foeto-maternal outcomes and a high burden of HIV and HBV infections. Clear information on the actual extent of HEV infection is needed. In this study we reviewed the available literature on HEV infection to determine the current situation, and to identify future areas of study.
While exclusive breastfeeding for the first six months of life is recommended for HIV-infected mothers, this may not be practiced fully in South Sudan; exclusive formula feeding, which is the best alternative to breastfeeding, may not be practical. This study aims to assess the knowledge of mother-to-child transmission of HIV (MTCT) and practices of feeding infants in the first six months of life among HIV-infected mothers attending Antiretroviral Therapy Centres in Juba Teaching Hospital (JTH) and Juba Military Hospital (JMH).
In Chad, the prevalence of women using contraceptive methods is 6% which correlates with a high fertility rate of 6.4%. There is a high maternal mortality rate of 860 /100,000 live births. One way to help curb maternal mortality is by increasing contraceptive use and closing the gap on unmet needs for contraception among women of child bearing age. The proactive management of contraception following abortion is rare in Chad. This study aimed to describe the characteristics of patients accepting contraception and the main methods of contraception used after a spontaneous abortion.
Female genital mutilation (FGM) is a problem persisting in Tanzanian culture. The United Nations estimates that over 200 million women in the world have been subjected to FGM/cutting (FGM/C) and 3 million girls are at risk every year. In Tanzania FGM/C overall prevalence is around 15% in girls and women aged 15-49 years. It is estimated that 7.9 million women and girls in the country have undergone FGM. The objective of the study was to assess the association between FGM and perineal injury among women in labour in the Dodoma Region, Tanzania.
The researches were carried out in partial fulfilment of the requirement for the award of Diploma in Midwifery. The complete reports are available from the authors
Concern Worldwide has been implementing nutrition programmes in the former Northern Bar el Ghazal (NBeG) State in South Sudan since 1998. NBeG is the most rural state in South Sudan and sits on the present-day border with Sudan. It has faced conflict and war in the past. More recently, it has largely escaped the direct effects of the civil war and its population has freedom to move around the region. The objective was to identify and analyse changes in patterns of malnutrition and key factors associated with malnutrition from 2004 to 2016, including seasonal differences where data were available.
Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action, or both and is a major health problem. The International Diabetes Federation (IDF) estimated that there were 425 million people with diabetes in the world in 2017 with 431,000 in South Sudan. The aim of this study was to assess nurses’ knowledge on management of diabetic patients and the factors associated with it in JTH - the only referral hospital in South Sudan.
The tympanic membrane is an important structure lying obliquely between the external and middle ear. It has three layers: an outer squamous, middle fibrous and inner mucous layer. Causes of tympanic membrane perforation include trauma, infectious agents, neoplasms and iatrogenic causes. The aim of this study was to determine the pattern and causes of tympanic membrane perforations among patients attending an ENT clinic at the private hospital which serves the largest number of ENT clients in Dar es Salaam.
Chronic rhinosinusitis (CRS) has a significant impact on the quality of life. The recurrent nature of the problem presents a clinical and economic challenge in developing countries.
A number of studies have been carried out to assess the prevalence of CRS. A survey in USA estimated that about 16% of the population was affected by CRS. In a Sao Paulo (Brazil) study, CRS was found in 5.51%. A Nigerian study found a prevalence of CRS of 7.3%. In North-central Nigeria, a higher prevalence was reported at 24.7% similar to reports from Canada and USA [5-8]. The maxillary sinuses have been reported in most studies as the sites predominantly affected by CRS
The wellbeing of the foetus is influenced by a number of factors including maternal characteristics, the placenta and umbilical cord morphology and functions.
The placenta is a fantastic organ yet often neglected due to its transient existence; it performs functions that are later taken on by separate organs, including the lungs, liver, gut, kidneys and endocrine glands. It is the interface between mother and foetus and influences maternal and newborn mortality.
Careful examination of the placenta can shed light on the in-utero environment of the foetus and can help to explain an abnormal neonatal outcome and might have consequences for treatment
According to UNAIDS, approximately 36.7 million people were living with HIV globally in 2017, of which 2.1 million were children aged under 15 years. Most HIV-infected African children are never tested for HIV, although some symptoms such as non-specific generalized dermatitis, ear discharge, lobar pneumonia, and tuberculosis are associated with HIV. The prevalence of HIV for hospitalized children in Africa has ranged between (10%-12.5%). This study aimed to determine the prevalence of HIV infection, the clinical pattern of the illnesses, and the immediate outcomes of the admitted children in Al Sabah Children’s Hospital in Juba, South Sudan between January and April 2018.
Caesarean Section (CS) is the surgical procedure by which a foetus is delivered through an incision in the mother’s abdomen and uterus. It is called a primary CS when it is done for the first time on a pregnant woman. Primary CS is of particular interest because it has an influence on future modes of delivery. There is also a concern about the indication for the procedure in a woman who has never tried her pelvis for vaginal delivery. It is a global issue because CS births are increasing, with short and long term maternal and newborn implications
South Sudan has a relatively low prevalence of HIV/AIDS at about 2.6%, with pockets of concentration in specific geographic zones. The government’s effort in combating the disease has been hampered by ignorance about HIV, with 45% of women aged 15-49 years having no knowledge of the virus. Most feared taking the test and said it is a death sentence
Pulmonary tuberculosis (TB) is an infectious disease causing high morbidity and mortality throughout the world. In 2015, reports showed an estimated 10.4 million cases of tuberculosis globally, including 1.2 million (11%) people living with Human Immunodeficiency Virus (HIV). Recent reports showed that 57% of TB among people living with HIV was not promptly diagnosed or treated, resulting in 390,000 tuberculosis-related deaths in 2015.
Renewed conflict in South Sudan has displaced 2.3 million people outside the country, of whom 789,098 (35%) have taken refuge in neighbouring Uganda. Eighty-two percent of South Sudanese refugees are women and children. With increasing barriers to operating within the country due to ongoing instability, some organisations supporting primary health care in South Sudan have also turned to exploring how South Sudanese refugees in neighbouring countries can be assisted.
Mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) accounts for 90% of infancy and childhood HIV infections. This study found that pregnant women’s knowledge on HIV/AIDS, specific knowledge on MTCT, MTCT risk factors during breastfeeding, and PMTCT were moderate.
Burnout syndrome, an occupational negative psychosomatic condition, has three components: emotional exhaustion, depersonalization and low personal achievement. This cross-sectional study conducted among 229 healthcare workers in Mekelle, Kay Kalkidan and Ben Meskerem General Hospitals showed that Prevalence of burnout syndrome was high among all respondents.
Orofacial tumours and tumour-like lesions occur at any age. An increasing occurrence has made these tumours a significant cause of morbidity and mortality in children. The study finds that haemangioma was the most common benign tumour. Dentigerous cyst was the most frequent tumour-like lesion observed, while Burkitt’s lymphoma and squamous cell carcinoma were the most common malignant lesions.
Typhoid fever (Enteric fever), caused by Salmonella typhi, presents with fever, chills, headache, abdominal pain and tenderness and can become a surgical emergency if medical treatment fails. This study determines that where urgent diagnostic radiological and laboratory investigations are not available promptly, clinical diagnosis of typhoid ileal perforation should justify an emergency laparotomy.
Caesarean section (CS) is a common procedure in obstetrics and has contributed immensely to improving maternal and foetal outcome. The study which seeks to assess the level of knowledge, attitude and acceptance of women about CS in Ogbomoso, Nigeria, concludes that mothers should be educated on the process involved in Caesarean delivery.
Inadequate education and the lack of efficient diabetes care centres compounded by high costs are common barriers for diabetes care. This study assesses the level of knowledge and adherence to guidelines for management of type 2 diabetes in South Sudan.
Obstetric Fistula (OF) among pregnant women remains a widespread condition with devastating consequences and poses a significant challenge in a community as well as globally. The study concludes that timely fistula repair by experienced fistula surgeons will improve outcomes and limit the clinical insult and distress that OF invariably causes.
Ocular injury is an important cause of poor vision and blindness worldwide. Ocular trauma is more common among males due to their aggressive nature and curiosity.The World Health Organization reported 1.6 million people were blind due to eye injuries. The prevalence of traumatic eye injury ranges from 2%-6% world-wide, and 97% is due to blunt trauma. The common causes of ocular injury include motor vehicle incident, sports, falls, and home and industrial accidents. A trivial ocular trauma may result in blindness from consequences such as retinal detachment, macular hole and vitreous haemorrhage.
Social factors such as mothers’ knowledge, attitudes and practices (KAP) related to the prevention of diarrhoea influence child health and survival. We used the World Health Organization (WHO) definition of diarrhoea. Diarrhoeal diseases are leading causes of young child morbidity and mortality in South Sudan. In 2014 the two-week point prevalence of diarrhoea among under-five year old children in Rubkona POCS, Unity State was estimated to be 43.6%.
South Sudan has one of the world’s youngest populations with 72 percent of the population below 30 years of age and 7 percent of adolescent age (15 to 19 years). After decades of political unrest and civil war, South Sudan’s population, especially girls and women, have been left impoverished, undereducated and underemployed with limited access to health services. Data from the 2010 South Sudan Household Health Survey found that 26 percent of adolescent girls (aged 15–19 years) are mothers. However, interventions targeting adolescent girls can both support and empower this group to make safe and healthy choices
Clefts are common birth defects and may be associated with oro-facial congenital anomalies. A review of 811 cleft lip and palate patients showed a low incidence of associated anomalies with a higher incidence in isolated cleft palate cases.
The study, to determine the prevalence and causes of blindness and visual impairment among patients in Akon payam, Warrap State, South Sudan, found that cataract and glaucoma remained major cause of blindness in this payam.
‘Essential newborn care’ is a set of recommendations from WHO designed to improve the health of the newborns through interventions pre-conception, during pregnancy, and postnatally. The study identified the knowledge and practices of essential newborn care among postnatal mothers at Juba Teaching Hospital.
Schizophrenia is a mental disease with inability to differentiate real from unreal. To explore the different attitudes and beliefs about schizophrenia, the study surveyed relatives of patients with schizophrenia treated at Butabika Mental Hospital, Kampala, Uganda. It found that beliefs about supernatural causes of schizophrenia and stigmatizing are still present, among others.
Introduction: Road traffic accidents (RTAs) are a major cause of death and disability in South Sudan. The purpose of this study was to investigate whether violation of traffic rules is the main cause of RTAs.
Trust in medical professionals is an important aspect of demand for health care in South Sudan, without which many patients may never attempt to access clinics and hospitals. This qualitative research study used in-depth biographical interviews to explore family health histories according to the experiences of South Sudanese mothers in Juba.
Background: Maternal near-miss describes a woman who almost died but survived a complication that occurred during pregnancy, childbirth or within the 42 days following pregnancy termination. The prevalence of maternal near-miss is variable around the world. In Chad no previous survey has been performed on maternal near-miss.
Breast milk is the optimal food for infants The World Health Organization (WHO) recommends that infants are breastfed exclusively (EBF) for their first six months, and then start complementary feeding while continuing to breastfeed for a minimum of two years [1].
Most deaths of children under 5 years old are due to conditions that can be prevented or treated with access to simple, affordable interventions. The leading causes of death are pneumonia, diarrhoea and malnutrition [1]. The quality of care provided in low-income countries is often poor. More than half of the diarrhoea cases are complicated by malnutrition. The World Health Organization (WHO) has guidelines for treating diarrhoea [2].
Severe acute malnutrition (SAM) is the most important risk factor for illness and death among young children being responsible for about half of all their deaths [1].
In the developing countries, 50.6 million children under the age of 5 years are malnourished [2]. One in seven South Sudanese children die before their fifth birthday, mainly from preventable diseases such as diarrhoea and malaria. The burden of disease attributable to malnutrition is also substantial with the malnutrition rate exceeding the World Health Organization (WHO) emergency threshold of fifteen percent [3].
Incomplete abortion contributes disproportionately to maternal morbidity and mortality in developing countries [1]. According to the World Health Organization 87,000 maternal deaths due to incomplete abortion are recorded yearly in developing countries [2]. Incomplete abortions can be managed expectantly, surgically and medically (using misoprostol with or without mifeprostone).
Hepatitis B is an infectious disease that affects many people worldwide. It may be acute or chronic. Age-specific prevalence varies by geographical region with highest endemicity levels in sub-Saharan Africa and prevalence below 2% in regions such as tropical and central Latin America, North America and Western Europe.
This study describes the infant feeding methods chosen by HIV-positive mothers in Yei County, South Sudan and the factors that influenced their choice.
Background: Patients with endomyocardial fibrosis (EMF) characteristically present with gross ascites and absent or minimal pedal oedema. This has long puzzled clinicians, especially since this clinical picture remains the same regardless of whether there is left, right or biventricular ventricular heart failure. The development of ascites, therefore, may not be directly and solely related to changes in the heart, but to local changes in the peritoneum. In order to investigate this possibility we performed peritoneal biopsies on 28 EMF patients.
In 2012, exposure to household air pollution (HAP) caused by cooking and heating with unprocessed biomass (solid) fuels such as wood, charcoal, crop waste, animal dung, and coal claimed 4.3 million lives worldwide. This mostly occurred in low and middle income countries with almost 600,000 deaths in Africa, and out of all the global deaths attributable to HAP, 534000 occurred among children under the age of five years.
Teenage pregnancy is a public health concern in both developed and developing countries. It is defined as any pregnancy that ends before the age of 20 years. About 16 million girls aged 15 to 19 years old give birth each year, which is about 11% of all births worldwide [1], and this does not include births among girls aged under 15 years
Foreign body aspiration (FBA) is one of the leading causes of sudden death among children aged less than three years [1]. Aspiration is common in this age group because of the less effective and protective mechanisms involved in coordination of breathing and swallowing [2]. FBA resembles a number of pulmonary diseases and so poses a great challenge to clinicians for its management [3].
Chad is a sub-Saharan country where reproductive health problems are still acute [1]. There is a high maternal mortality ratio, a low contraceptive prevalence, a high prevalence of induced abortions among teenage girls (18.4 % of all teenage pregnancies) due to the restrictive abortion law, poor perinatal care, difficult access to ultrasound services, and poverty.
One of the major aims of patient management is the prevention of mortality but it is still encountered in clinical practice [1, 2]. Mortality in maxillofacial patients often result from involvement of other systems as may be seen in Ludwig's angina or severe brain injury following craniofacial trauma and stage IV malignancies [2, 3, 4]. Intraoperative deaths may also occur from anesthetic and/or surgical complications occasionally.
International Clinical Trials Day is celebrated on the 20th May each year to commemorate the day that James Lind started his important trial on scurvy. The day aims to highlight research in healthcare and how vital it is in the delivery of high-quality medical practice.
Diarrhoeal diseases are a major health problem in developing countries [1] and accounts for an approximate global mortality of two million people annually [2]. Globally, 88% of diarrhoea cases are attributable to unsafe drinking water, inadequate sanitation or insufficient hygiene. In Africa, an average morbidity rate of 912.9 million diarrhoeal episodes per year in children has been reported with four out of 10 deaths annually caused by diarrhoeal disease
Uterine rupture is a non-surgical breach of the continuity of the myometrial wall of the uterus [1]. It is now rare in industrialized countries thanks to improved ante- and peri-natal care [2]. In the sub-Saharan Africa is a major obstetric emergency. Its frequency ranges from 0.6% in Central African Republic [3], 0.78% in Togo [4], 1.01% in Enugu (Nigeria) [5], 1.15% in Bamako (Mali) [6], 2.2% in Senegal [7] to 2.33% in Niger [8].In Chad, there are no previous data on this serious subject.
Our objective was to identify the main causes of uterine rupture and so improve management and reduce morbidity and mortality.
Background: Nosocomial infections increase mortality and morbidity although adherence to simple hand washing procedures is suggested to reduce these.
Purpose: To assess knowledge of hand washing among health care providers in Juba Teaching Hospital (JTH) in South Sudan and establish associations with demographic, professional and clinical factors.
Background: Studies on attitudes towards mental health in Nigeria have been mainly community-based surveys.
Objective: To determine the knowledge and attitudes towards mental illness (MI) of health workers in a Nigerian Teaching Hospital.
Background: Opportunistic and non-opportunistic intestinal parasites play a significant role in the morbidity and mortality of HIV/AIDS-infected patients. The frequency of their occurrence strongly correlates with the patient’s level of immunity. The most common clinical manifestation of these intestinal parasites is diarrhoea. Prevalence of intestinal parasites among HIV-infected patients has been found to be as high as 95%.
The Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) study began in 2011 in The Gambia, Sénégal and Nigeria. The study aims to reduce the risk of hepatocellular carcinoma (HCC) in West Africa through the suppression of the Hepatitis B virus (HBV). The biological samples collected allow for the detection of novel liver cancer biomarkers in the hope of improving the diagnostic ability of early disease states. The PROLIFICA platform hopes to improve cancer diagnostics whilst simultaneously providing the training, skills and infrastructure necessary to develop the quality of liver cancer care in West Africa.
Background: Post-partum haemorrhage defined as blood loss after delivery over 500mls, affects all countries and is the commonest cause of maternal mortality. It is a frequent obstetric emergency in developing countries.
Paediatric malnutrition is a significant problem in South Sudan, with rates of wasting up to 22% reported in some areas [1]. Severe acute malnutrition (SAM) is associated with a high mortality [2]. Affected patients require thorough assessment and holistic care including appropriate therapeutic feeding, treatment of associated complications and rehabilitation in order to achieve good outcomes.
The Human Immunodeficiency Virus (HIV) is a virus that causes Acquired Immunodeficiency Syndrome (AIDS). The disease was discovered in 1983 in the Pasteur Institute, Paris by Barre and colleagues [1]. The causative agent is a Lentivirus, a subgroup of Retroviruses that is transmitted through body fluids. The main routes of entry include sexual intercourse, shared needles, and vertical transmission from mother to child during childbirth or breastfeeding. The World Health Organization (WHO) provides a staging system for HIV infection based on the clinical manifestations of the disease [2].
Objective
To determine the prevalence of HIV/TB co-infection among patients attending the HIV clinic at Juba Teaching Hospital (JTH) from 2011 to 2013.
Objective: To determine the uptake of PMTCT services by mothers attending postnatal services at Juba Teaching Hospital.
Objectives
The aim of this study is to determine the prevalence of HIV among blood donors in Juba Teaching Hospital Blood Bank, South Sudan in 2013.
Sarcoidosis is a multisystem granulomatous disease of unknown cause. It occurs worldwide but there are higher incidences in certain racial groups, being three to four times more common in African-Americans [1]. It can also aggregate in families. Most patients do not need treatment and the disease often regresses spontaneously, but a minority have potentially life-threatening progressive organ dysfunction; these patients need active management including oral corticosteroids.
Post-partum haemorrhage (PPH) is a leading cause of maternal mortality worldwide and is responsible for 34% of maternal deaths in Africa [1]. It is defined as blood loss of more than 500 ml following vaginal delivery or more than 1000 ml following Caesarean delivery [2]. Blood loss can occur during the first 24 hours (primary PPH) or from 24 hours up to 6 weeks after delivery (secondary PPH). Primary PPH classified by site is either placental or extra-placental bleeding [3]. Secondary PPH is abnormal or excessive bleeding from the birth canal between 24 hours and 12 weeks postnatally
Study setting: Juba Teaching Hospital, Juba city, Republic of South Sudan, 2010.
Objective: To examine, knowledge, attitude and practices of tuberculosis (TB) patients enrolled on tuberculosis treatment, Juba, South Sudan.
Design: Descriptive study
The current crisis in human resources for health in Africa has reached a serious level in many countries. A complex set of reasons has contributed to this problem, some exogenous, such as the severe economic measures introduced by structural adjustment, which often result in cutbacks in the number of health workers while some endogenous reasons, including misdirected human resource and training policies, weak institutions, and inappropriate structures
The Republic of South Sudan gained independence in July 2011 after nearly two decades of civil war. The increase in cross border traffic following independence and the return of displaced nationals, may have unforeseen effects on the health of the population. The pattern of diseases across East Africa is defined by infectious conditions such as malaria and HIV. It has been suggested that the relocation of individuals from hyperendemic countries, such as Uganda, may influence the prevalence rates of these infections in South Sudan.
Although there are no confirmed polio cases in South Sudan since June 2009, vital indicators for polio eradication activities are not satisfactory [1]. Hence, the recent huge polio outbreak in Somalia, Kenya and Ethiopia demanded a safety net SNIDs for four States, including Upper Nile.
Non-communicable diseases (NCDs) are the leading cause of death globally and diabetes mellitus is the 4th main contributor [1]. It is characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, action or both [2]. There are three main types: type 1 (TIDM) (10%), 2 (TIIDM) (85%) or gestational (5%)[3] affecting 347 million people [4]. There were about 1.3 million deaths in 2008 [4] predicted to increase to over 2 million by 2030 [1]. The burden of diabetes is disproportionately high in low-middle income countries [5,6].
South Sudan is thought to be undergoing an epidemiological transition with an increasing burden of non-communicable diseases such as hypertension. No current data exist on the prevalence of these diseases. Blood pressure readings of 5660 blood donors during 2010-12 at Juba Teaching Hospital were analysed. Prevalence of hypertension was 19.3%, positively associated with older age and being male. This has implications for public health policy, indicating a need for prevention, screening and treatment to prevent complications of hypertension.
Tuberculosis (TB) is a chronic inflammatory lung disease caused by Mycobacterium tuberculosis. Sick people with the TB germs (or bacilli) transmit the germs into the air during coughing, sneezing, talking, or spitting. Inhaling a small number of the bacilli leads to infection [1]. When a person with active pulmonary TB disease does not receive treatment, that person will infect on average between 10 and 15 people in a year.
Traumatic brain injury (TBI) is defined as brain injury due to externally inflicted trauma which may result in significant impairment of an individual’s physical, cognitive and psychosocial functioning (1). In an analysis of patients admitted with trauma to Juba Teaching Hospital, Dario Kuron Lado (2) showed that of 652 patients presenting with different patterns of injury due to trauma 12% (47) had suffered head injury.
An understanding of the epidemiology of Mycobacterium tuberculosis is critical for effective control. In this, the first article of a series, the global burden of tuberculosis (TB), risk factors for transmission and the epidemiology of Mycobacterium tuberculosis in South Sudan are reviewed.
This article describes a completed audit cycle of the mode of anaesthesia used for caesarean section at Juba Teaching Hospital (JTH).
There is a large body of evidence available that highlights the benefits of regional anaesthesia over general anaesthesia for caesarean sections (CS). The UK National Institute for Clinical Excellence (NICE) guidelines suggest that “women who are having CS should be offered regional anaesthesia because it is safer and results in less maternal and neonatal mortality than general anaesthesia”(1). In 2006, the Royal College of Anaesthetists proposed standards for best practice, suggesting that a minimum of 95% of elective CS and a minimum of 85% of emergency CS are conducted under regional anaesthesia.
An ordinary ring can get stuck on a finger if it has been worn for a long time. This is most often due to swelling of the finger. Different techniques have been described for removal of such rings but when the finger is grossly swollen and the ring is very thick or a band, these methods are not successful
Background: Tuberculosis (TB) is caused by the bacterium Mycobacterium tuberculosis. Delays in diagnosis and treatment increase morbidity and mortality from tuberculosis, and the risk of transmission in the community.
When I was working in Uganda I saw several cases of poisoning with organophosphates and was horrified by the mortality. Here I report on a simple study we carried out nearly 10 years ago to find how widespread poisoning was in Uganda.
HIV stigma and discrimination are a daily reality for people living with HIV (PLHIV) and their families. Stigma is prevalent in all countries experiencing HIV epidemics, including South Sudan. It is found within families, in communities, institutions such as health care facilities and places of employment, in the media and in government policies, laws and legislation.
Extract from ‘KAP Survey Report: Aweil East County-Highlands, Northern Bahr el Ghazal state. November 2010’. By Jane Gune, Project Manager (Tearfund DMT South Sudan). Funded by the Canadian International Development Agency.
The carriage of Streptococcus pneumoniae, serotypes, antimicrobial susceptibility patterns and disease development are poorly understood in Yei. Availability of affordable antibiotics over the counter, lack of laboratory infrastructure and high rates of penicillin resistance have the potential to aggravate rates of childhood mortality associated with Streptococcus pneumoniae. There is an urgent need to strengthen microbiological and public health services.
Extract from ‘South Sudan Antenatal Care Clinics Sentinel Surveillance Report 2nd Round September - December 2009’ HIV/AIDS/STI Directorate, Ministry of Health, Republic of South Sudan
The purpose of this beginner’s guide is to start you off on the research journey by outlining the sequence of steps along the research process (see Figure 1) and providing guidance, including signposting other useful resources that can help support each stage of the process.
The study was carried out among 334 pregnant and newly delivered women seen at Juba Teaching Hospital in 2009. The objective was to assess the coverage of insecticide-treated bed-nets (ITN) and Intermittent Preventive Therapy (IPT) among these women and the factors associated with their use. Overall 87% of the women used ITN and 61% used IPT. ITN use was positively associated with buying nets, indoor spraying of insecticide and higher household income. IPT use was positively associated with more frequent antenatal clinic visits, indoor spraying and buying
Five years ago we were seeing an increasing number of trauma cases in Juba Teaching Hospital and the situation is even worse today in 2011. The objectives of this study were to:
Determine the magnitude and type of trauma injury as seen in Juba, examine its causes, explore possible solutions.
This article reports a case controlled study of kala-azar done in Fangak County in 2007. Fifty-six percent of the cases were under 5 years old. Most patients came for treatment two months or more after the onset of symptoms.
Outdoor night-time activities and the use of “Smoking” (non-insecticide treated) bed nets were associated with kala-azar infection whereas the use of bed nets during the rainy season decreased the risk of infection.
It is recommended that there should be a greater distribution of treated bed nets and more kala-azar treatment centres in the county.
Malnutrition is a chronic public health problem in Aweil East and North counties with an estimated prevalence of between 15% and 25%.
Underlying contributing factors include: political instability, poor infrastructures, droughts and floods resulting in low crop yields, poverty and limited awareness of good nutrition and health practices.
At the time of the survey there were six decentralised centres feeding severely and moderately malnourished children below 5 years. As well as feeding activities, nutrition and health education was given in order to improve health and nutrition awareness.
The objective of this survey was to assess knowledge, attitudes and practices of mothers (or caretakers) of children admitted in the feeding programme.
Observations and reports of the nodding episodes both from this study and from others in Tanzania and Uganda lead us to speculate that the nodding syndrome may be a particular form of epilepsy found mainly, perhaps only, in this area of Africa. The study in Tanzania, which did MRI scans and EEG recordings (4), concluded that head nodding is “possibly a new epilepsy disorder in sub-Saharan Africa”. A previous study in Lui indicated that EEG results were consistent with a specific encephalopathy, which progresses in well-defined stages, and nodding represents the onset of symptoms and the ictal events common to all stages of epilepsy (5). However until this condition can be further investigated by a clinical neurologist and by doing more EEGs it is difficult to come to definite conclusions.
Fast Facts: Total Population of South Sudan is 8.26 million
Total Area of South Sudan is 644,329 sq. km More than half (51%) of the population is below the age of eighteen. 72% of the population is below the age of thirty 83% of the population is rural 27% of the adult population is literate
51% of the population live below the poverty line 78% of households depend on crop farming or animal husbandry as their primary source of livelihood 55% of the population
has access to improved sources of drinking water...
Juba has a poor road network and few public transport options, with an increasing number of people riding motorised or non-motorised cycles This study seeks to characterise the cyclists (including helmet wearing) and to use the findings to make recommendations to the concerned authorities.
The study found that most of the 3564 observed cyclists were adult males; the proportion using helmets was very small (1%). Many cyclists had an extra passenger, or were carrying a load. More than half the cyclists were riding in the middle of the road. Only 18% of the motorcycles were licensed...
A nutrition survey of young children was carried out by Medair (see http://www.medair.org) and Save the Children in Southern Sudan (SCiSS) (see http://savethechildren.org.uk) in February 2010 (the mid-dry season) in Bilkey and Nyandit Payams, Akobo County. This was in response to a previous evaluation of the nutrition situation in Akobo town in January 2010. This had found that lack of rain had led to a high level of food insecurity, and increasing levels of malnutrition. The objectives of the survey were:
The basic hospital package of care service (BHPCS)1, commissioned by the Department of Curative Medicine in the Government of Southern Sudan (GOSS) and written by specialists of the St Mary’s Hospital–Juba Teaching Hospital Link in January 2010, identified a severe lack of doctors at specialist level. It recommends that the minimum requirements of specialists at each of the three main hospitals in South Sudan over the next five years are...
A summary and analysis of all recorded emergency and elective caesarean sections (CS) performed at Juba Teaching Hospital (JTH), Juba, Southern Sudan from October 2008 to September 2009 was made. During this period 430 CS were performed giving a mean of 1.2 each day, the main reason being cited as obstructed labour. Thirty of the babies delivered by CS died giving a neonatal morality rate of 7%. Due to various /non-comprehensive reporting methods it is difficult to measure the maternal mortality rate associated with CS...
Findings from specular microscope studies have demonstrated increased endothelial cell loss associated with the use of air for lens implantation. The objective of this study was to evaluate the surgical outcome after cataract surgery with lens implantation using air or viscoelastic to maintain the anterior chamber
Motorcycle related trauma is a major cause of morbidity in those of working age in the developing world1. One hundred and sixteen patients involved in motorcycle related accidents were identified over four weeks at the Juba Teaching Hospital in South Sudan. Of these 84% were male with an average age of 26.7 years...
South Sudan borders countries with significant HIV epidemic profiles. Data on the status of HIV in South Sudan is limited. More than two decades of war have relatively sheltered the country from experiencing an epidemic similar to that in the neighbouring countries. Ironically the coming of peace has the potential of accelerating the development of an epidemic in South Sudan as a result of increased movement of people and altered economic and social activities...
Multi-drug resistant tuberculosis (MDR-TB) is defined as TB that is resistant to the two main first-line drugs (isonaiazid and rifampicin).
Extensively drug resistant TB (XDR -TB) is a relatively rare type of MDR-TB and is defined as TB which is resistant to...
Southern Sudan has one of the highest rates of maternal mortality in world1. However there is very little reliable published data on admissions and mortality rates in secondary and tertiary care. Despite being a large teaching hospital, documentation at JTH is often poor and official statistics on admissions and mortality are sparse and their reliability is sometimes questionable. For this reason we undertook a retrospective descriptive analysis...
Consecutive surveys in Twic County have shown constantly high levels of malnutrition despite the interventions currently being carried out. GOAL, together with other NGOs, has been carrying out feeding responses to alleviate malnutrition, and more recently food security awareness. Programme coverage and meeting international emergency feeding standards have been a challenge due to the low attendance in the various feeding sites.
The first Southern Sudan Household Health Survey (SHHS) was a joint effort of the Ministry of Health, Government of Southern Sudan (MOH-GOSS) and the Southern Sudan Commission for Census, Statistics and Evaluation (SSCCSE). The survey was part of a wider activity that covered the 25 states of Sudan. Whereas this report focuses on the 10 states of Southern Sudan, it includes findings from the 15 remaining States of Sudan. This was considered necessary by the stakeholders for
ease of comparison and reference.
Worldwide there are 247 million cases of malaria annually and nearly a million deaths [1,2]. In South Sudan, especially during the rainy season, malaria is responsible for most admissions and is the leading cause of mortality in the Medical Department of Juba Teaching Hospital (JTH).
Health psychology is a specialty within the discipline of psychology concerned with individual behaviours and lifestyles affecting physical health. The discipline strives to “enhance health, prevent and treat disease, identify risk factors, improve the health care system, and improve public opinion regarding health issues”
The Internet has enabled increasing numbers of healthcare professionals to access flexible, convenient and interactive forms of continuing medical education. The advantages of these computer-based technology tools are clear but they are expensive, may not be available and there is a lack of Information Technology (IT) skills.
Two billion people in low- and middle-income countries have no access to basic surgical care. Surgical conditions account for a significant proportion of the global health burden. Surgery is still not considered a public health priority even though surgical services may be as cost-effective as other well-accepted preventive procedures
Background: Guinea worm disease (dracunculiasis) is an ancient parasitic disease and is set to be the next disease eradicated from the world and the first to be overcome without a vaccine or treatment. South Sudan and Ghana account for more than 95% of global dracunculiasis.
In 2015, about 830 women died every day due to complications of pregnancy and childbirth. Almost all of these deaths occurred in low and middle-income countries [1]; 550 occurred in Africa and 180 in Southern Asia, compared to only 5 in high income countries. The risk of a woman dying in a developing country from a maternal-related cause during her lifetime is about 33 times higher compared to a woman living in a developed country.
Ocular trauma is damage to the eye as a result of mechanical, electrical, thermal, or chemical energy [1]. It is a frequent and avoidable cause of visual impairment. Injuries range from a small corneal epithelial abrasion to pen¬etrating and globe rupture. Over 55 million eye injuries occur each year [2]; 1.6 million people go blind from these injuries, 2.3 million suffer bilateral low vision and 19 million remain with unilateral or low vision.
Background: The World Health Organisation (WHO) estimates the incidence of tuberculosis (TB) in South Sudan to be 79 per 100,000 for new sputum smear positive TB and 140 per 100,000 for all forms of TB cases. The case detection rate of 53% for all forms of TB in South Sudan is below the WHO target of 70%.
Objective: To explore knowledge, attitude, and practice barriers as well as service barriers to implementing TB programme in Lakes State, South Sudan.
Method: This was a qualitative study conducted in May 2015.
Results: Despite some understanding of the symptoms, causes, and consequences of TB, the stigma for TB and lack of disclosure of the disease, is very high among the local community. The limited network of TB facilities for case detection, lack of community distribution of TB drugs and lack of food at hospitals when patients were admitted for treatment, are key barriers to TB service delivery.
Conclusion: To overcome barriers it is recommended that the local community worldview should be incorporated into TB awareness, testing, and treatment, and attention should be paid to areas where traditional practices, such as elimination of maize, clash with modern treatments.
Background: Tuberculosis (TB) case detection rate has remained consistently low in the Amansie Central District despite the implementation of the National TB Programme (NTP).
Objective: To assess the factors influencing this low case detection of TB.
Method: Information was collected from 120 individuals and 40 health workers were randomly selected from four health facilities that provided TB treatment.
Results: All patients had a good knowledge of TB. There was no statistical association between patients knowledge and educational level (p>0.05). However, knowledge on the causes of TB was strongly associated with occupation (p<0.05). 53% of patients indicated health facilities as the first place of visit when sick and how they are received was dependent on education (p=0.005) and marital status(p<0.05); 60% of health workers were not trained on the NTP despite 93% being aware of the programme, and 62.5% reported not initiating contact tracing after disease confirmation. Only 34 of the 120 patients reported health workers visiting them regarding TB.
Conclusion: Development of interventions such as HCW training on TB treatment and care, and establishing referral networks that bring TB information and services closer to community members can contribute to improved TB case notification.
Background: HIV is an infectious virus commonly transmitted through body fluids mostly semen and blood. It causes a serious and non-curable disease with grave consequences especially in sub-Saharan Africa. In South Sudan the prevalence rate of HIV was estimated at 2.6% in 2016. The treatment options are scarce and educational programs limited. This is of great concern since limited knowledge and awareness of HIV is a major risk factor particularly, among young people.
Method: A cross-sectional survey using self-administered questionnaires among adolescents was carried out in November 2016.
Results: Sixty-five students participated in the study. In general they had good knowledge about HIV/AIDS with the majority having heard of HIV. Majority stated that HIV spreads through sex (82%), blood transfusion (95%), and from mother to child during pregnancy and delivery (66%). Several misconceptions were present with 43% responding that HIV can be transmitted through mosquito bites and 18% stating that the virus can be spread through shaking hands, hugging and living in the same house.
Conclusion: Though the respondents showed fair knowledge about HIV/AIDS, there are still some areas in which they lack knowledge especially regarding spread of the disease and practice. More information about HIV/AIDS and sexual education should be made available.
Chronic Suppurative Otitis Media (CSOM) is a major health concern in developing countries due to its association with hearing impairment, particularly among children as it may affect their communication skills. Serious complications like meningitis and brain abscess have been reported as a cause of death. The commonest isolates implicated in causation of CSOM in this study was Klebsiella pnuemoniae and Pseudomonas aeruginosa, followed by Proteus mirabilis, E.coli and Staphylococcus aureus.
Immunization prevents child morbidity and mortality through the universal access to routinely recommended childhood vaccines. This study which aimed to determine the prevalence and factors associated with missed opportunities for immunization in South Sudan, found that Home delivery and failure to attend antenatal clinic were independently associated with MOI. Lack of information was the most common reason given by the caretakers for incomplete immunization.
Macrosomia is a birth weight above the 90th percentile corrected for gestational age and sex, or birth weight of 4000-4500g. This was a cross-sectional study showed that macrosomic neonates are more often delivered by Caesarean Section than normosomic babies. There is a clear need during prenatal care and delivery to minimise maternal and perinatal complications.
Recent observation studies have shown that while the majority of COVID-19 patients have mild symptoms (81%) that don't require hospital admission, some developed severe symptoms that required hospitalization (19%). Out of those admitted, 14% were seriously ill and required oxygen therapy; 5% of the critically ill patients needed admission to an intensive care unit. Of those sick critically, most required mechanically assisted ventilation.
Tuberculosis (TB) is a major public health problem globally. It ranks fourth among the top infectious disease killers, after acute respiratory infections, diarrhoeas, and human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS). According to World Health Organization (WHO), approximately 10 million people developed TB in 2017, of which 1.0 million (10%) were children.
Tuberculosis (TB) still accounts for the highest mortality from any infectious diseases worldwide, even surpassing HIV/AIDs. Uganda has an incidence of TB of about 20/100,000 population where the prevalence of Multi-Drug Resistant TB (MDR –TB) in 2015 was estimated to be 1.6% among newly diagnosed TB cases and 12% among previously-treated cases.
An ectopic pregnancy (EP) results from implantation outside the uterine cavity. It is an obstetric emergency. Undiagnosed it leads to rupture and haemorrhage. Despite the improvement in diagnostic techniques haemorrhage from EP remains the leading cause of pregnancy-related maternal mortality in the first trimester, accounting for 4% of all such deaths. The recurrence rate is as high as 15%. Studies in Ethiopia reported a higher incidence among 20 to 29-year-olds and unmarried and nulliparous women.
The World Health Organization (WHO) defines ‘adolescents’ as individuals aged 10-19 years. The national family planning policy of South Sudan states that “by the age of 19, one out of three girls is already married or in union; and the same proportion has already started childbearing”. The causes of adolescent pregnancy can be attributed to social, cultural, political and health systems gaps. This review article looks at the contributory factors for adolescent pregnancy in South Sudan, the effects of these pregnancies and describes some solutions and recommendations.
Deaths among under-5 year old children have reduced significantly in recent years but this reduction has been slow for deaths during the neonatal period. Neonatal deaths contribute up to 53.1% of all deaths among children aged under five in low and middle-income countries. Complications due to preterm birth constitute a major cause (36%) of neonatal deaths. Globally 15 million babies are born preterm every year (1 in 10 babies born) and about one million of these die while many who survive face lifetime disability including cerebral palsy, learning disabilities, visual and hearing problems, and respiratory illness.
Maternal death refers to the death of a woman during pregnancy or within 42 days of termination, regardless of duration or location, from any cause determined or aggravated by the pregnancy or its management, but not accidental. Global estimates for 2017 indicate that there were 295,000 maternal deaths, 35% less than in 2000 when they were estimated at 451,000, of which 86% (254,000) were in sub-Saharan Africa and South Asia.
MUAC (mid-upper arm circumference) is a simple and easily taught screening tool for identifying malnutrition in children. South Sudan use a MUAC of 12.5 cm for children aged between six months and five years as a cut-off for moderate acute malnutrition. Currently, in South Sudan, children from six months to five years have the same MUAC cutoff for malnutrition.
The World Health Organization (WHO) defines family planning (FP) as the “ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their birth”. It involves a wide spectrum of methods ranging from short-term to permanent techniques. The short-term methods include pills, condoms, lactational amenorrhoea, diaphragms, and emergency contraceptive pills while long-term methods encompass injectables, implants, and intra-uterine devices. Permanent methods incorporate female and male sterilisation.
The model street method was developed in 2015 to provide a framework for delivering high-impact, low-cost, scalable community health interventions for communities affected by poverty in Africa. Since then, the method has been adapted to other contexts, including sustainable redevelopment of urban areas in Europe and North America. Therefore, the suitability of the model as a template from which other contexts could benefit should be considered. Post-conflict settings have several features in common with poverty settings, where this model has been well demonstrated as effective.
The Most healthcare professionals (HCPs) face numerous ethical challenges while performing their tasks, regardless of clinical ethics support structures (CESS) in many health facilities. There has been little research on CESS in Africa. This study sought to determine how often Cameroonian HCPs in the Southwest Region (SWR) faced ethical issues, how many health institutions have CESS and whether those with no CESS are willing to have one created.
The South Sudan health sector strategic plan indicates that only 1.2% of women aged 15-49 years have their need for family planning met, and the contraceptive prevalence rate of 6% is lower than the rate of 17% in the whole of sub-Saharan Africa. The use of modern contraceptives contributes to women’s health and reduces maternal mortality related to pregnancy and childbirth complications globally. The study investigated the utilization of modern contraceptives among women of reproductive age (WRA) in Terekeka County of South Sudan.
Hepatitis B is a viral disease caused by the hepatitis B virus (HBV). This virus increasingly infects the population each year. The evidence focusing on the validity of a research tool in the South Sudan context is scant. This study examined the validity of the questionnaire for prevalence and risk factors of HBV infection among women of reproductive age in South Sudan.
Chronic hepatitis B affects about 240 million people worldwide, with significant complications including liver fibrosis and hepatocellular carcinoma. We aimed to study the prevalence of liver fibrosis and its associations among people with hepatitis B at Mbarara Regional Referral Hospital (MRRH).
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (MTB) or Koch’s bacillus. It remains a global public health emergency and a leading cause of death. In 2022, it ranked as the second leading cause of mortality from a single pathogen after COVID-19, far exceeding deaths caused by HIV/AIDS. Algeria reported an incidence rate between 53 and 88 per 100,000 in 2017.
University students are particularly vulnerable to mental health illnesses. Access to mental health services in Sudan is limited. Digital mental health presents a promising approach that young people widely accept. The study aimed to assess the attitude of university students in Sudan toward digital mental health.
The use of improvised explosive devices (IED) poses a significant threat, particularly in low- and middle-income countries. These homemade explosives incorporate certain objects that create unique injury patterns that present diagnostic and therapeutic challenges. This study examines the maxillofacial wounds and patterns of Boko Haram IED victims treated at the University of Maiduguri Teaching Hospital (UMTH). Understanding the different wounding patterns these injuries cause and management options will help with proper planning and management.