Gamal K. Adam

Maternal and perinatal outcomes of visceral leishmaniasis (kala-azar) treated with sodium stibogluconate in eastern Sudan

To investigate maternal and perinatal outcomes when pregnant women with visceral leishmaniasis (VL, also known as kala‐azar) are treated with the antimonial sodium stibogluconate.

Placental malaria and lack of prenatal care in an area of unstable malaria transmission in eastern Sudan.

Abstract A cross-sectional study was conducted in Gadarif Hospital in eastern Sudan to determine the prevalence, and evaluate the risk factors, of placental malaria. Two hundred and thirty-six delivering women were enrolled in the study. Socio-demographic characteristics were gathered through questionnaires. Maternal hemoglobin was measured, ABO blood groups were determined, and placental histological examinations for malaria were performed. The birth weight of the newborn was also recorded. The mean (SD) maternal age was 25.5 (6.0) yr and the mean (SD) hemoglobin was 9.8 (0.9) g/dl. Placental histology showed acute malaria infections in 13 (5.5%) and chronic infections in 5 (2.1%) women; 28 (11.9%) of the placentas revealed past infection and 190 (80.5%) indicated no infection. Lack of prenatal care was significantly associated with placental infections (OR = 12.0, 95% CI = 2.3–16.2; P = 0.003). There was no significant association between placental malaria infections and maternal age, parity, and blood group. Thirty-two (13.5%) of these pregnancy outcomes resulted in low birth-weight babies. There was, however, no significant association between placental malaria and low birth weight (OR = 2.0, 95% CI = 0.4–4.1; P = 0.1). Thus, placental malaria infections affect pregnant women in this area of eastern Sudan regardless of their age or parity. Prenatal care should be encouraged to reduce malaria in the area. Much more research regarding malaria and pregnancy is needed.

Maternal and perinatal outcome in teenage pregnancies in Sudan

Pregnancy and childbirth in teenage women pose special risks for both mother and baby. As well as significant medical nutritional social and economic risks teenage pregnancy is associated with increased risks for adverse pregnancy outcomes such as preterm birth low birth weight and death in the neonatal or postnatal periods. There is a paucity of literature regarding the maternal and perinatal outcome of teenage pregnancies in Sudan Africa. The aim of the present study was to assess the risk of anemia operative delivery and perinatal complications (mainly low birth weight) among primiparous teenagers with a singleton delivery compared with a similar group of women aged 20-24 years. (excerpt)

Anaemia, folate and vitamin B12 deficiency among pregnant women in an area of unstable malaria transmission in eastern Sudan.

A cross-sectional study was carried out between October 2007 and January 2008 to investigate the prevalence and types of anaemia among pregnant women of eastern Sudan. Socio-demographic and obstetrical data were collected using a questionnaire. Haemoglobin (Hb), serum ferritin, serum folate and vitamin B(12) were assessed using standard laboratory methods. Two hundred and seventy-nine pregnant Sudanese women were recruited. Anaemia (Hb <11 gdl) and iron deficiency (ferritin <15 microg/l) were prevalent in 80.3 and 14.3% of the study sample, respectively. Of the total sample, 11.1% had iron-deficiency anaemia. Serum folate (<6.6 ng/ml) and vitamin B(12) (<150 pg/ml) deficiency was reported in 57.7 and 1%, respectively, and none of the women had both folate and vitamin B(12) deficiencies. Univariate and multivariate analyses showed that ferritin, serum folate and vitamin B(12) levels were not significantly associated with anaemia. Thus, there was a high prevalence of anaemia and folate deficiency. Measures to control these should be considered.

Maternal and perinatal outcomes of eclampsia in Gadarif hospital, Sudan

Summary This study aimed to investigate the incidence of eclampsia and its maternal and perinatal outcome in the Hospital of Obstetrics and Gynecology at Gadarif, Sudan from March 2007 to April 2009. There were 45 cases of eclampsia in 8,894 deliveries (5/1,000). Some 62% of first convulsions occurred antepartum, 15.5% occurred intrapartum, and the rest (11.1%) occurred postpartum. Ten patients died and there were 16 (35.5%) perinatal deaths; eight of these were stillbirths and eight were early neonatal deaths.

Estimating malaria parasite density among pregnant women at central Sudan using actual and assumed white blood cell count.

BackgroundMicroscopic 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.MethodsParasitaemia was estimated using assumed WBCs (8,000), which was compared to parasitaemia calculated based on each woman’s WBCs in 98 pregnant women with uncomplicated Plasmodium falciparum malaria at Medani Maternity Hospital, Central Sudan.ResultsThe geometric mean (SD) of the parasite count was 12,014.6 (9,766.5) and 7,870.8 (19,168.8) ring trophozoites /μl, P <0.001 using the actual and assumed (8,000) WBC count, respectively. The median (range) of the ratio between the two parasitaemias (using assumed/actual WBCs) was 1.5 (0.6-5), i e, parasitaemia calculated assuming WBCs equal to median (range) 1.5 (0.6-5) times higher than parasitaemia calculated using actual WBCs. There were 52 out of 98 patients (53%) with ratio between 0.5 and 1.5. For 21 patients (21%) this ratio was higher than 2, and for five patients (5%) it was higher than 3.ConclusionThe estimated parasite density using actual WBC counts was significantly lower than the parasite density estimated using assumed WBC counts. Therefore, it is recommended to use the patient`s actual WBC count in the estimation of the parasite density.

Reliability of rapid diagnostic test for diagnosing peripheral and placental malaria in an area of unstable malaria transmission in Eastern Sudan

BackgroundDiagnosing 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.MethodsP. 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.ResultsAmong 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.ConclusionsThe RDT kit used in this study has poor performance for peripheral and placental P. falciparum malaria detection in this setting.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1092363465928479

Monocytes and macrophages and placental malaria infections in an area of unstable malaria transmission in eastern Sudan

BackgroundMaternal immunity is thought to play a major role in the increased susceptibility of pregnant women to Plasmodium falciparum malaria. 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.MethodNinety three placentae were investigated for malaria histological changes and immunohistochemical study for monocytes and macrophages (CD68).ResultsWhile 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.ConclusionSignificantly 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.

Factors associated with perinatal mortality in Kassala, Eastern Sudan: a community-based study 2010-2011.

This study investigated the factors associated with perinatal mortality in eastern Sudan from 2010 to 2011. Among 808 deliveries, there were 15 pairs of twins, giving 823 babies at risk of perinatal deaths. There were 761 live births and 62 perinatal deaths. Of the 62 perinatal deaths, 25 (40.3%) were stillbirths and 37 (59.7%) were early neonatal deaths. The stillbirth risk, early neonatal mortality risk and perinatal mortality rate were 30.9 per 1000 pregnancies, 48.6 per 1000 live births and 75.3 per 1000 births, respectively. In the logistic regression model, home delivery [odds ratio (OR) = 5.1; confidence interval CI = 1.8-14; p = 0.001] and parity ≥3 (OR = 4.5; CI = 2.2-8.8; p < 0.001) were predictors for perinatal deaths, whereas use of antenatal care (OR = 0.3; CI = 0.1-0.6; p = 0.002), use of a mosquito net (OR = 0.07; CI = 0.03-0.1; p < 0.001) and antenatal iron supplementation for at least 3 months (OR = 0.06; CI = 0.02-0.1; p < 0.001) were significant protective factors of perinatal deaths.

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.