AbdelAziem A. Ali

Severe anaemia is associated with a higher risk for preeclampsia and poor perinatal outcomes in Kassala hospital, eastern Sudan

BackgroundAnaemia during pregnancy is major health problem. There is conflicting literature regarding the association between anaemia and its severity and maternal and perinatal outcomes.MethodsThis is a retrospective case-control study conducted at Kassala hospital, eastern Sudan. Medical files of pregnant women with severe anaemia (haemoglobin (Hb) < 7 g/dl, n = 303) who delivered from January 2008 to December 2010 were reviewed. Socio-demographic and obstetric data were analysed and compared with a similar number of women with mild/moderate anaemia (Hb = 7-10.9 g/dl, n = 303) and with no anaemia (Hb > 11 g/dl, n = 303). Logistic regression analysis was performed separately for each of the outcome measures: preeclampsia, eclampsia, preterm birth, low birth weight (LBW) and stillbirth.ResultsThere were 9578 deliveries at Kassala hospital, 4012 (41.8%) women had anaemia and 303 (3.2%) had severe anaemia. The corrected risk for preeclampsia increased only in severe anaemia (OR = 3.6, 95% CI: 1.4-9.1, P = 0.007). Compared with women with no anaemia, the risk of LBW was 2.5 times higher in women with mild/moderate anaemia (95% CI: 1.1-5.7), and 8.0 times higher in women with severe anaemia (95% CI: 3.8-16.0). The risk of preterm delivery increased significantly with the severity of anaemia (OR = 3.2 for women with mild/moderate anaemia and OR = 6.6 for women with severe anaemia, compared with women with no anaemia). The corrected risk for stillbirth increased only in severe anaemia (OR = 4.3, 95% CI: 1.9-9.1, P < 0.001).ConclusionsThe greater the severity of the anaemia during pregnancy, the greater the risk of preeclampsia, preterm delivery, LBW and stillbirth. Preventive measures should be undertaken to decrease the prevalence of anaemia in pregnancy.

High incidence of obstetric complications in Kassala Hospital, Eastern Sudan

Medical files of women delivered at Kassala Hospital, Eastern Sudan in the period of January–December 2009 were reviewed retrospectively. Out of 4,689 delivered women, 14.7% were teenagers, 67.1% had no antenatal care and 12.6% were grandmultiparous. Obstetric complications included: pre-term birth (2.6%); pre-eclampsia/eclampsia (4.2%); haemorrhage (2.9%); malpresentation (5.5%); obstructed labour (1.9%) and ruptured uterus (0.6%). Caesarean delivery rate was 31.1%. While 89.4% of the newborn babies were taken home, 6% were admitted to the nursery, 4.4% were stillbirths, and 0.2% immediate neonatal deaths. There were 26 maternal deaths (550 per 100,000 live births), mainly due to septicaemia (38.4%), haemorrhage (19.2%), embolism (15.3%) and malaria (11.5%). Thus, there is a high frequency of maternal morbidities and mortality which needs improvement in obstetric care. It is important to make visits from a tertiary hospital to the region to collect statistics and discuss management of the problems they reveal, with the local staff.

Maternal and perinatal outcomes of obstructed labour in Kassala hospital, Sudan

The medical files of 42 patients presented with obstructed labour to Kassala hospital over a period of 1 year were reviewed. The incidence of obstructed labour was 0.9%. The majority of these patients were primigravidae (52.4%), illiterate (69%), of rural residence (90.5%) and unbooked (64.3%) emergencies. Caesarean section was the mode of delivery in 95.2% and the rest (4.8%) were delivered by forceps. Ruptured uterus (14.3%) and vesico-vaginal fistulae (4.8%) were the main complications among these patients. There were 4.8% and 35.7% maternal and perinatal mortality, respectively. Thus, in this setting obstructed labour constitutes a major threat to both mother and fetus.

Provider-initiated HIV testing and counseling among tuberculosis patients in Kassala, Eastern Sudan

Because of the overlapping global incidence of tuberculosis (TB) and human immunodeficiency virus (HIV) infections, collaborative efforts are required for successful TB and HIV control programs. The current study was conducted at Kassala Hospital in Eastern Sudan and investigated the implementation of provider-initiated HIV testing and counseling (PITC) for patients infected with TB. Using a cross-sectional study design, patients who had been recently diagnosed with TB between January and December 2010 were consecutively enrolled. A total of 858 newly infected TB patients were enrolled in the study. Of these patients, 152 patients (17.7%) were given counseling, and 109 patients (12.7%) underwent HIV testing. The overall HIV infection rate among those tested was 18.3%. From a multivariate analysis, female sex (OR=17.0, 95% CI=8.7-33.1; P<0.001), education level below secondary education (OR=2.6, 95% CI=1.6-4.1; P<0.001), rural residency (OR=1.7, 95% CI=1.3-2.9; P=0.001), and non-governmental employee status (OR=10.4, 95% CI=6.7-16.3; P<0.001) were each associated with lower rates of PITC. Thus, in this setting, the frequency of PITC is low among TB-infected patients and is especially low for females, those of low educational status, and non-governmental employees.

Clinical presentation and epidemiology of female genital tuberculosis in eastern Sudan

To describe the epidemiology and clinical presentation of female genital tuberculosis (FGTB) among women in eastern Sudan.

Anaemia among adults in Kassala, Eastern Sudan

BackgroundThe increased heterogeneity in the distribution of social and biological risk factors makes the epidemiology of anaemia a real challenge. A cross-sectional study was conducted at Kassala, Eastern Sudan during the period of January — March 2011 to investigate the prevalence and predictors of anaemia among adults (> 15 years old).FindingsOut of 646, 234 (36.2%) adults had anaemia; 68 (10.5%); 129 (20.0%) and 37 (5.7%) had mild, moderate and severe anaemia, respectively. In logistic regression analyses, age (OR = 1.0, CI = 0.9–1, P = 0.7), rural vs. urban residency (OR = 0.9, CI = 0.7–1.3, P = 0.9), female vs. male gender (OR = 0.8, CI = 0.6–1.1, P = 0.3), educational level ≥ secondary level vs. < secondary level (OR = 1.0, CI = 0.6–1.6, P = 0.8) and Hudandawa vs. non-Hudandawa ethnicity (OR = 0.8, CI = 0.6–1, P = 0.1) were not associated with anaemia.ConclusionThere was a high prevalence of anaemia in this setting, anaemia affected adults regardless to their age, sex and educational level. Therefore, anaemia is needed to be screened for routinely and supplements have to be employed in this setting.

Trend in cumulative cases and mortality rate among visceral leishmaniasis patients in Eastern Sudan: a 14-year registry, 2002-2015.

BACKGROUND Leishmaniasis is one of the neglected infectious diseases of the world. This disease largely affects individuals of low socio-economic level, mainly in developing countries. METHODS The aim of this study was to investigate the cumulative number of cases, case fatality rate, and trend in incidence and mortality rate of visceral leishmaniasis (VL) in Eastern Sudan. A retrospective descriptive study was performed through analysis of the database managed by the Ministry of Health in Gadarif State, which includes all cases of VL. RESULTS Over the 14-year study period (2002-2015), a total of 51773 patients were registered in Gadarif State with clinical and laboratory evidence of proven VL. The trend in VL was considerably higher over the years 2003-2005 as compared to the last 5 years of 2011-2015. The highest fatality rate was observed in 2002 (4.8%) and it had declined in 2014 (1.1%) and 2015 (1.7%). Rural residence was statistically associated with death related to VL (p=0.021). CONCLUSIONS This study showed a high number of cumulative cases of VL in Eastern Sudan. The fatality rate was found to be highest among rural residents and has declined in the last 5 years. Thus immediate interventions are needed in terms of health education and the implementation of preventive measures, with a specific focus on people residing in rural areas.

Correlation of measles and dengue infection in Kassala, Eastern Sudan

Using the clinical case definition adopted by the World Health Organization, a total of 275 suspected cases of measles were enrolled in this study during January–March 2012 in Kassala Teaching Hospital, Eastern Sudan. Various clinical manifestations (fever, headache, cough, coryza, conjunctivitis, skin rash, vomiting, diarrhoea, convulsion, and hemorrhagic manifestations) were reported among these patients. Blood was withdrawn from the first 64 (23.3%) patients. Two samples were hemolyzed and only 60 samples (21.8%) were investigated for measles and dengue IgM antibodies. Antibodies for measles, dengue, and co‐infection were detected in the plasma of 12 (20%), seven (11.7%), and 10 (16.7%) samples, respectively. Although there was no significant difference in age, residence, occupation, and vaccination status among the different groups, a high proportion of male patients (P = 0.011), severe cases (P = 0.004), and death ((P = 0.001) were reported among co‐infected cases. J. Med. Virol. 87: 76–78, 2015.

Acute-phase proteins in pregnant Sudanese women with severe Plasmodium falciparum malaria

A case-control study was carried out in Kassala and Medani Maternity Hospitals in Sudan to investigate acute-phase proteins [haptoglobin, C-reactive protein (CRP), ferritin and albumin] in three groups of pregnant women (32 in each arm) comprising those with severe Plasmodium falciparum malaria or uncomplicated P. falciparum malaria and healthy controls. Whilst there was no significant difference in the levels of albumin and haptoglobin, ferritin and CRP levels were significantly higher in pregnant women with severe P. falciparum malaria. There were significant positive correlations between parasite count and haptoglobin, and medium positive correlations between parasite count and CRP.

Maternal and perinatal outcomes of pregnancies associated with tuberculosis in eastern Sudan

Tuberculosis during pregnancy can lead to poor maternal and perinatal outcomes, and it is one of the causes of the high maternal mortality rate in Sudan [1–3]. There are few published data concerning tuberculosis during pregnancy [1,2]. The aim of the present study was to investigate the maternal and perinatal outcomes of pregnancies associated with tuberculosis in eastern Sudan. The medical files of all pregnant women with tuberculosis attending the Kassala Maternity Hospital, Kassala, Sudan, from January 2008 to December 2010 were reviewed. Maternal and perinatal data were retrieved and compared with those of the same number of pregnant women unaffected by tuberculosis. Means and proportions were compared using t and χ tests, respectively. Pb0.05 was considered to be statistically significant. The present study was approved by the Health Research Board of the Ministry of Health, Kassala, Sudan. In total, 42 of the 15 252 pregnant women who presented to the hospital during the study period had tuberculosis (an incidence rate of 275 per 100 000 pregnant women). The mean age and parity of the affected women were 30.7±3.7 years and 3.4±1.6, respectively. Compared with the healthy women, significantly higher numbers of women with tuberculosis were of rural residence (P=0.008), were educated below secondary level (P=0.001), and had not received prenatal care (P=0.01) (Table 1). Pulmonary and extrapulmonary tuberculosis affected 35 (83.3%) and 7 (16.7%) women, respectively. In total, 32 (76.2%) women had been diagnosed with tuberculosis prior to the index pregnancy. The women were all treated with rifampicin, isoniazide, ethambutol, and pyrazinamide. Hemoglobin levels and infant birth weight were significantly lower for women with tuberculosis (P=0.001); there were also higher numbers of preterm births (b37 weeks) and infants with low birth weight (b2.5 kg) among these women (P=0.04 and P=0.03, respectively; Table 1). HIV co-infection was found in 5 (11.9%) patients and there were 2 (4.8%) maternal deaths; both women had HIV co-infection. In Kassala Maternity Hospital, there is a high maternal mortality rate (644 per 100 000 live births), with tuberculosis one of the most common indirect causes [3]. In the present study, 5 (11.9%) women were co-infected with HIV. It is not known whether the women contracted HIV before or during the index pregnancy; however, HIV and other immunocompromised conditions represent high-risk factors for tuberculosis in the nonpregnant population [4]. The findings of the present study are consistent with those from other studies investigating increases inmaternal deaths, pretermbirths, and low-birth-weight deliveries associated with tuberculosis [1,2].