Gamal K. Adam

Background: Dengue fever (DF) is an arthropod-borne disease caused by dengue virus (DENV). DENV is a member of the genus Flavivirus in the family Flaviviridae. Recently, DENV has been reported as an important emerging infectious viral pathogen in Sudan. Multiple outbreaks and sporadic cases of DF have been frequently reported in the eastern region of Sudan. The present study was conducted to confirm DENV outbreak in Kassala State, eastern Sudan, 2019, and to provide some information on the molecular characterization of the DENV isolate associated with the disease outbreak. Methods: A hundred serum samples were collected during the outbreak from residents of Kassala State, Sudan, 2019. ELISA was used to detect DENV non structural protein NS1 (DENV-NS1) in acute phase sera sampled during the disease outbreak. RT-PCR assays were used to amplify a fragment of the capsid/pre-membrane region (CprM) of the viral polyprotein gene. The PCR products of the amplified CprM region of the viral polyprotein gene were purified and partial sequences were generated and used to confirm the specificity of DENV sequences and to identify the virus serotype. Phylogenetic tree was constructed to determine the genotype of DENV associated with the outbreak. Results: Using DENV-NS1 ELISA assay, DENV infection was confirmed in 23% sampled sera. The detection of DENV RNA was made possible using group-specific RT-PCR assay. The virus was serotyped as DENV serotype 3 (DENV-3) using DENV serotype-specific RT-PCR assay. Phylogenetic analysis of the partial CprM sequences of the viral polyprotein gene indicates that the virus belonged to genotype III of DENV-3. Conclusion: The scientific data presented in this investigation confirmed that genotype III of DENV-3 was associated with the disease outbreak in eastern Sudan, 2019. The study represents the first report on molecular characterization of DENV-3 in Sudan.

Background: Acute arboviral infections are distributed worldwide including Sudan, and dengue fever (DENV) is not an exception. The virus activity has recently been frequently reported in Kassala State, eastern Sudan. However, an appropriate epidemiological study would be necessary to provide accurate and precise estimates of the magnitude of recent DENV transmission in this area of endemicity. Methods: In the present investigation, a cross sectional study was conducted to advance beyond the current knowledge of the epidemiology of the disease in Kassala State. The prevalence of the disease was estimated and associated risk factors were determined. Sampled sera were collected and screened for recent dengue transmissionas as determined by DENV-IgM enzyme-linked immunosorbent assay (ELISA). The collection of data for risk assessment was supported by a well designed structured questionnaire. Results: The prevalence of recent DENV infection was estimated to be (11.42%). Potential risk factors to DENV seropsitivity include, age (OR = 3.24, CI = 1.81–5.77,p-value = 0.001); low income (OR = 3.75, CI = 1.57–8.93, p-value = 0.027); mosquito control (OR = 4.18, CI = 2.33–7.51, p-value = 0.004); and localities. Conclusion: The present study showed a high rate of circulating DENV IgM antibodies among the participants of the study (11.42%), suggesting recent transmission of DENV in Kassala State, eastern Sudan. The frequent occurrence of DENV infections necessitates the need for improved surveillance programs and prevention measures to combat this important arboviral disease in Sudan.

Background: Dengue fever, caused by dengue virus (DENV), has become one of the most important mosquito-borne viral diseases with a steady rise in global incidence, including the Sudan. Sporadic cases and frequent acute febrile illness outbreaks, compatible with Dengue fever, have been reported in El-Gadarif State, Sudan. However, diagnosis was based almost exclusively on clinical signs without confirmatory laboratory investigations. Despite the magnitude of the problem in El-Gadarif State, no information is currently available with regard to the epidemiology of the disease in this State. El-Gadarif State is one of the largest commercial centers in the Sudan. The objective of the present investigation is to estimate the prevalence of DENV antibodies, and determine the potential risk factors associated with seropositivity among residents of El-Gadarif State. Methods: A cross sectional study was conducted in a total of 701residents randomly selected from all 10 localities in El-Gadarif State. The sera from the 701 residents were tested for the presence of DENV-specific immunoglobulin G (IgG) antibodies using a commercially available Anti-dengue IgG enzyme-linked immunosorbent assay (ELISA). Results: Among the 701 residents, 334 residents (47.6%) were seropositive for DENV. Mosquito control (OR = 2.73, CI = 1.37–5.87, p-value = 0.001); low income (OR = 2.31, CI: 1.71–6.36, p value = 0.032); sleeping out-doors (OR = 3.73, CI = 2.63–6.23, p-value = 0.013), and localities were determined as potential risk factors for contracting DENV infection. Conclusions: The prevalence rate of DENV antibodies among residents of El-Gadarif State is significantly high (47.6%). Further epidemiologic studies including, distribution of mosquito vectors and implementation of improved surveillance are urgently warranted for better prediction and prevention of a possible DENV outbreak in El-Gadarif State, Sudan.

Early diagnosis and treatment is the principal strategy to control visceral leishmaniasis (VL), or kala-azar in East Africa. As VL strikes remote rural, sparsely populated areas, kala-azar care might not be accessed optimally or timely. We conducted a qualitative study to explore access barriers in a longstanding kala-azar endemic area in southern Gadarif, Sudan. Former kala-azar patients or caretakers, community leaders, and health-care providers were purposively sampled and thematic data analysis was used. Our study participants revealed the multitude of difficulties faced when seeking care. The disease is well known in the area, yet misconceptions about causes and transmission persist. The care-seeking itineraries were not always straightforward: “shopping around” for treatments are common, partly linked to difficulties in diagnosing kala-azar. Kala-azar is perceived to be “hiding,” requiring multiple tests and other diseases must be treated first. Negative perceptions on quality of care in the public hospitals prevail, with the unavailability of drugs or staff as the main concern. Delay to seek care remains predominantly linked to economic constraint: albeit treatment is for free, patients have to pay out of pocket for everything else, pushing families further into poverty. Despite increased efforts to tackle the disease over the years, access to quality kala-azar care in this rural Sudanese context remains problematic. The barriers explored in this study are a compelling reminder of the need to boost efforts to address these barriers.

The rate of blood pressure (BP) control in adult hypertensive patients is poor and the reasons for poor control of BP pressure are not fully understood globally. This study aimed to assess the rate and factors associated with BP control in adult hypertensive patients in Sudan. A hospital-based cross-sectional study was conducted in adult hypertensive Sudanese patients at Gadarif Hospital in eastern Sudan from November 2016 to March 2017. Information on sociodemographic characteristics of the participants, comorbidities, antihypertensive medication, and adherence to antihypertensive medication was gathered from patients using a questionnaire. Fasting cholesterol and triglyceride levels were measured. A total of 380 patients were enrolled. Of them, 234 (61.6%) were women. The mean (SD) age of the participants was 57.8 (11.1) years (range: 25–93 years). Over one-third (n = 147, 38.7%) of the participants were taking more than one antihypertensive medication. Approximately one-third (29.5%) of the participants were non-adherent to medication. The rate of BP control was 45.3%. In binary logistic regression analyses, age, sex, physical inactivity, adding salt to food, drinking coffee, body mass index, and the lipid profile were not associated with uncontrolled BP. However, non-adherence to medication was the main factor associated with uncontrolled BP (odds ratio = 5.29, 95% confidence interval = 3.16–8.83, P < 0.001). Almost half of hypertensive patients in follow-up have uncontrolled BP, mainly due to non-adherence to medicine. We recommend further research on drug adherence to improve the rate of BP control in this setting (Gadarif) of the Sudan.

Since 1900s, visceral leishmaniasis (VL) has been among the most important health problems in Sudan, particularly in the endemic areas such as eastern and central regions. This was a cross sectional, hospital-based study conducted from 1st January 2015 to 31st December 2015 to investigate the epidemiological factors of VL in Gadarif hospital, eastern Sudan. During the study period there were 47 identified children with VL among 145 suspected cases. The most common clinical presentations were fever (47, 100%), pallor (47, 100%), weight loss (40, 85.1%), splenomegaly (37, 78.7%), lymphadenopathy (33, 70.2%), vomiting (32, 68%) cough (28, 59%), loss of appetite (22, 46.8%), diarrhoea (17, 36.1%) and jaundice (5, 10.6%). With regard to the outcome after short term follow up 37 patients (78.8%) improved without complications, while 3 (6.4%, 2 (4.3%), 2 (4.3%), 1 (2.1%), 1 (2.1%) and 1 (2.1%) developed pneumonia, otitis media, septicaemia, urinary tract infection, parasitic infestation and PKDL respectively. Lower mean of haemoglobin level was observed among the VL cases in comparison with the suspected cases (in whom VL was excluded) haemoglobin level {8.9 (3.1) Vs 11 (6.3), P = 0.021}. Again more proportion of anaemic (47 (100%) Vs 14 (14.2%), P = 0.000) and severely anaemic (23 (48.9%) Vs 2 (2%), P = 0.006) patients was detected among the infected children. Using logistic regression analyses there was significant association between rural residence (CI = 1.5–24, OR = 19.1, P = 0.023), male gender (CI = 6.6–18.7, OR = 6.4, P = 0.001) and VL among children. While there is an advance in prevention and management of visceral leishmaniasis our results indicate that VL is still a public health problem with its severe complications among children in eastern Sudan.

Microscopic examination using Giemsa-stained thick blood films remains the reference standard for detection of malaria parasites and it is the only method that is widely and practically available for quantifying malaria parasite density. There are few published data (there was no study during pregnancy) investigating the parasite density (ratio of counted parasites within a given number of microscopic fields against counted white blood cells (WBCs) using actual number of WBCs.

Background: Diagnosing Plasmodium falciparum malaria during pregnancy is a great challenge for clinicians because of the low density of parasites in the peripheral blood and parasite sequestration in the placenta. Nevertheless, few data on the use of malaria rapid diagnostic test (RDT) during pregnancy have been published. Methods: P. falciparum infections were assessed in 156 febrile pregnant women by microscopic examination of their blood smears and by RDT and polymerase chain reactions (PCR). In addition, 150 women were assessed at the time of delivery by microscopy, RDT, PCR and placental histology investigations. The study was conducted at the Gadarif Hospital, Eastern Sudan. The SD Bioline P. f / P. v (Bio Standard Diagnostics, Gurgaon, Korea) RDT kit was evaluated in this study. Results: Among the febrile pregnant women, 17 (11.0%), 26 (16.7%) and 18 (11.5%) positive cases of P. falciparum were detected by microscopy, RDT, and PCR, respectively. The sensitivity and specificity of the microscopy was 94.4% and 100%, respectively. The corresponding values for RDT evaluation were 83.3% and 92.0%, as compared with PCR as the gold standard. While there were no detected cases of malaria by microscopic examination of blood smears, 27 (18.0%), 21(14.0%) and 46 (30.7%) out of the 150 placentae investigated had P. falciparum as determined by RDT, PCR, and histology, respectively. The sensitivity and specificity for RDT was 17.4% and 81.7%, respectively. The corresponding values for PCR were 6.5% and 82.7%, where histology was used as the gold standard. Conclusions: The RDT kit used in this study has poor performance for peripheral and placental P. falciparum malaria detection in this setting. Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1092363465928479

Blood platelet levels are being evaluated as predictive and prognostic indicators of the severity of malaria infections in humans. However, there are few studies on platelets and Plasmodium falciparum malaria during pregnancy.

Background: Maternal immunity is thought to play a major role in the increased susceptibility of pregnant women toPlasmodium falciparummalaria. Few studies exist on immunohistochemical characterization of the placental inflammatory infiltrate. The current study was conducted in Gadarif hospital in an area characterized by unstable malaria transmission in eastern Sudan.Method: Ninety three placentae were investigated for malaria histological changes and immunohistochemical study for monocytes and macrophages (CD68).Results: While 1(1.1%), 2(2.2%) and 20(21.5%) of the 93 placentae had acute, chronic and past malaria infections, 70(75.2%) had no malaria infections. Monocytes and macrophage (CD 68) were detected in 29 (31.2%) of these 93 placentae. Significantly higher rate of monocytes and macrophage were detected in placentae with malaria infections [11/23 (47.8%) vs. 18/70 (25.7%);P= 0.047] especially in placentae with past malaria infections. Placental malaria infections and monocytes and macrophages cells infiltration were not different between primiparae and multiparae. There was no significant difference in the birth weight between the women with placental malaria infections/monocytes and macrophages cells infiltration and those who had no placental malaria infections/cellular infiltrations.Conclusion: Significantly higher rate of monocytes and macrophage were detected in placentae with malaria infections. Neither placental malaria infections nor cellular infiltrates were associated with parity or lead to reduction of birth weight.