South Sudan Medical Journal

Hepatocellular carcinoma and aflatoxin in Sudan: The way forward

2024-02-19T09:35:41+00:00

Hepatocellular carcinoma (HCC) is the sixth most common type of cancer and the third leading cause of death worldwide. It is especially prevalent in developing countries, with around 80% of cases occurring in Asia and Africa. Aflatoxin B1 is a well-documented risk factor for HCC, among other factors. In Sudan, there is limited reliable and comprehensive data on cancer epidemiology, including HCC. This paper focuses on the current status of HCC in Sudan, specifically in relation to aflatoxin. Additionally, recommendations are provided to enhance the control measures for HCC in the country.

Stroke rehabilitation in low resource countries: time to provide an organised service

2024-02-19T09:41:05+00:00

Introduction: Stroke is one of the leading causes of death and disability in lowand middle-income countries (LMICs). The proven efficacy for rehabilitation interventions in improving stroke outcomes in LMICs supports the need to strengthen the rehabilitation workforce. Low-cost physical rehabilitation interventions requiring minimal resources, self-rehabilitation, tele-rehabilitation and involvement of family and other carers can be a solution and improve functional outcomes.

Method: A literature search using the terms Stroke and Rehabilitation were carried out by the Chief Librarian at St. Richard’s Hospital, the University Hospital Sussex. Four databases, namely Ovid Medline, EMBASE, CINAHL and Ebsco CINAHL, were searched using appropriate subject headings and free text terms such as stroke and rehabilitation . We used free text terms to look for concepts synonymous with rehabilitation in LMICs. We did not search for individual countries or continents/sub-continents.

Results: Relevant results from 2015 to current were included. Twenty articles were finally chosen which included the most relevant and useful information for the purpose of this article.

Conclusion: Populations in LMICs are exposed to health systems which do not include rehabilitation services. In addition, there are personal barriers to accessing quality stroke rehabilitation that could improve stroke survival and functional outcomes. Although there have been some improvements in the development of stroke rehabilitation in some LMICs, further investment is required to ensure that LMICs continue to receive the best quality rehabilitation services. There are measures that can be put in place to reduce these deficiencies. Collaboration between LMICs and developed countries has been growing but this needs to be extended, especially in training doctors in Rehabilitation Medicine and upskilling therapists. The World Health Organisation Rehabilitation 2030 is an action plan to scale up rehabilitation so that countries, especially LMICs, can be better prepared to address the evolving rehabilitation needs of populations by 2030.

Risk factors for stroke in the African populace: need for action

2024-02-19T09:52:55+00:00

The burden of stroke cannot be overemphasized especially in low and middle-income countries (LMICs). More than two-thirds of stroke deaths arise from these countries as well as nearly 90% of stroke-related morbidities. Unfortunately, it has been suggested that there might be up to a three-fold increase in stroke incidence and a higher prevalence in Africa in the year 2021. The known risk factors for stroke are similar to those in developed countries: age, hypertension, diabetes mellitus, hypercholesterolaemia, and central obesity. These risk factors have often been overlooked in patients who present with stroke in Africa. Other important risk factors for stroke include high salt intake and red meat consumption, low consumption of green leafy vegetables, air pollution, undernutrition in infancy and genetic factors. Possibly the most efficient way of curbing the impact of stroke in Africa is to address the risk factors. The aim of this article is to shine some light on these risk factors in sub-Saharan Africa and proffer some solutions to address the menace of stroke

Address risk factors as part of clinical practice to prevent stroke

2024-02-19T08:38:26+00:00

No Abstract

Stroke units in low and middle income countries (LMICs) save lives: application of the western model of stroke care

2024-02-19T09:57:57+00:00

Stroke is defined as a syndrome of rapidly developing clinical signs of focal or global disturbance of cerebral function with symptoms lasting 24 hours or longer or leading to death with no apparent cause other than of vascular origin. In the current management of stroke in developed countries, stroke units form a vital part of the care pathway. Stroke units save lives, reduce disability, mitigate against complications such as aspiration pneumonitis, facilitate early discharge home with timely interventions by a Multidisciplinary Team. Whilst the burden of stroke has decreased in high income countries, this decrease is lowest in sub-Saharan Africa.

Reference intervals for serum creatinine and urea in the adult western Sudanese population

2024-02-19T08:41:55+00:00

Introduction: 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.

Method: Randomly selected adult Sudanese residents of Al Fashir City who were from the Western Sudan states of Kordofan and Darfur were the subjects of a cross-sectional study conducted in September and October 2018. We recruited 153 participants. After giving their consent, they were evaluated using a questionnaire that collected medical history and demographic information. We used standard techniques to measure blood pressure, body mass index, urea, and creatinine. Kolmogorov-Smirnov tests were used to assess the distributions of the creatinine and urea values, and reference intervals calculated. T-tests were used to investigate differences of mean creatinine and urea levels by sex and age. IBM SPSS Statistics version 25 was used to analyse the data and p ≤ 0.05 was considered significant.

Results: Overall, the reference intervals (Mean±1.96*SD) for serum creatinine and urea levels were 0.45-0.92 mg/dL and 7.6-27.9 mg/dL respectively, compared to international reference intervals adopted from the American Board of Internal Medicine (ABIM) serum creatinine (males 0.7-1.3, females 0.5-1.1 mg/dL) and blood urea (17.12-42.8 mg/dL for both sexes) and The Western Sudanese population’s mean serum creatinine and urea levels were, respectively, 0.69 mg/dL and 17.8 mg/dL. Male sex was associated with higher levels of both creatinine and urea (p<0.001).

Conclusion: This study documented lower reference intervals for creatinine and urea in the Western Sudanese population.

Prevalence and perceptions of voluntary medical male circumcision among University of Juba students, South Sudan

2024-02-19T08:51:49+00:00

Introduction: 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.
Method: A cross sectional descriptive study design was adopted. Data from randomly selected students from six schools of the University of Juba were collected using a respondent-administered structured questionnaire. IBM SPSS Statistics version 23.0 was used for data analysis. Chi-squared tests were performed to determine variables significantly associated with VMMC.
Results: Amongst 390 students interviewed, the prevalence of VMMC was 41.8% and the overall male circumcision rate was 83.8%. Most respondents expressed positive attitudes and perceptions towards VMMC. The respondents believe VMMC is an important health programme. The decision to get circumcised is associated with age, marital status, religion and state of origin (p<0.001).
Conclusion: Most participants were circumcised and perceive VMMC positively. A countrywide study and scale up of the current VMMC programme are recommended.

Paranasal sinuses in patients with chronic rhinosinusitis,Tanzania

2024-02-19T09:09:30+00:00

Introduction: 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.

Method: This was a descriptive prospective cross-sectional study of 120 patients aged 15 years and above who fulfilled the Rhinosinusitis Task Force criteria. A structured checklist was used to collect socio-demographic characteristics and clinical presentations. Cone-beam computed tomography scan and the Lund-Mackay scoring system were used. Data analysis was done using SPSS version 26, and p-values <0.05 were considered statistically significant.

Results: A total of 120 patients were enrolled with a median age of 37 (IQR 27-52) years, with 40% aged 30-49 years. There were 65 (54.2%) males, and 55 (45.8%) females. Maxillary sinuses were affected in 85.8% of all patients with chronic rhinosinusitis. The overall proportion of anatomical variation was 53.3%, with concha bullosa, deviated nasal septum, Onodi cells, and septal spur being the most common, accounting for 40.6%, 25.0%, 23.4%, and 20.3%, respectively. Twenty-four patients with concha bullosa had chronic maxillary rhinosinusitis, with 14 (58.3%) having ipsilateral rhinosinusitis.

Conclusion: Half of the patients had one or more paranasal sinus anatomical variations. The most common variants were concha bullosa followed by deviated nasal septum. Onodi cells and septal spurs were rarely identified. Most patients with concha bullosa had ipsilateral maxillary sinusitis.