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

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.

Paranasal sinuses in patients with chronic rhinosinusitis,Tanzania

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.

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

Stroke is one of the leading causes of death and disability in low- and 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.

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

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 chronic infection among pregnant women attending the antenatal care in Bor State Referral Hospital, South Sudan

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).

Pattern of liver enzymes and maternal outcome in eclamptic patients admitted to the Intensive Care Unit, University College Hospital, Nigeria

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 and accompanying symptoms among patients at a tertiary hospital, Tanzania

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.

Prevalence of middle ear effusion among children with adenoid hypertrophy at a national referral hospital in Tanzania

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.

Prevalence and predictors of resistant hypertension among out-patients in Ilorin, Nigeria

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 in patients with suspected benign prostate hypertrophy in Juba, South Sudan: A retrospective study

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.

Cross-sectional study on the availability of essential medicines at public health facilities in Jur River County, South Sudan

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.

Indications for Caesarean Section for women of low obstetric risk - an audit

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.

What words best capture the symptom of breathlessness in Uganda?

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.

Glycaemic control and associated factors in adult patients with diabetes mellitus, South Sudan, 2021

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.

Morbidity and mortality of tetanus at Kenyatta National Hospital: a ten-year case audit

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).

Roles of local healthcare workers in the humanitarian response in South Sudan: a literature review

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.

Factors associated with reduced foetal movements in Iringa, Tanzania

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.

Characteristics of hearing loss in Dar es Salaam, Tanzania

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.

The impact of public health interventions in a developing nation: an overview

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.

Prevalence of glaucoma among patients attending Buluk Eye Centre, Juba, South Sudan: a one-year study

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.

Musculoskeletal disorders among patients during a one-day outreach at Juba Military Hospital

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.”

A survey of tonsillectomy care patterns in Tanzania

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.

Prevalence of HIV among pregnant mothers receiving antenatal care at Kator Primary Health Care Centre, Juba, South Sudan

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)

Social demographic determinants of male participation in antenatal care in Nyamagana District, Tanzania

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.

Audit of in-hospital mortality by age and time-of-day among patients presenting to a low-resource Ugandan hospital

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 implantation and outcomes in a resource–limited setting: experience from Tanzania

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.

Risk factors for vesicovaginal and rectovaginal fistulae in women treated at Juba Teaching Hospital in 2020-2021: A retrospective study

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.

Determinant factors of immediate outcomes of Neonatal Respiratory Distress Syndrome in Gondar, Ethiopia

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.

One year’s experience of extra-pulmonary TB in a county/regional hospital in South Sudan

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).

Predictors of fetal macrosomia in Iringa, Tanzania: a case-control study

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.

The association between body mass index and foot ulcer among patients with diabetes mellitus, Wad Medani, Sudan

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.

Community epidemic management strategies and COVID-19 in South Sudan

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.

COVID-19 clinical presentations: the modern mimic of other conditions

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.

Factors associated with non-adherence to standard diagnosis and treatment guideline in the management of malaria in pregnancy

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.

Prevalence and outcome of malaria among hospitalized children in Al Sabah Children Hospital, South Sudan

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.

Impact of Community Intermittent Preventive Treatment in Pregnancy (C-IPTp) approach on the uptake of IPTp3+: a randomized controlled trial in Karagwe, Tanzania

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.

Inguinodynia and inguinal hernia recurrence amongst Ugandan patients who underwent mesh versus non-mesh inguinal hernia repair

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 reporting of adverse drug reactions by healthcare providers in Kenya

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.

Perspectives from MSF snakebite programme implementation in Agok, Abyei region, South Sudan

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.

Knowledge about continuous positive airway pressure machine usage among nurses at a tertiary hospital in Tanzania

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.

Health seeking behaviour of small income market vendors: diabetes primary care in Gulu Municipality, northern Uganda

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.

Prevalence and factors associated with neonatal sepsis among hospitalized newborns at Ruvuma, southern Tanzania

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 hypertension and its associated factors among adults in Ruvuma, Southern Tanzania

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.

Introduction of postpartum and post abortion family planning into three hospitals in South Sudan

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.

Underreporting of Hepatitis E virus infection in Tanzania: a systematic review

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.

Mothers’ knowledge of mother-to-child transmission of HIV and infant feeding practices in Juba, South Sudan

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).

Contraception method following spontaneous abortion in N’djamena Mother and Child Hospital

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.

The effect of Female Genital Mutilation on perineal injuries among women in labour in Dodoma Region, Tanzania

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.

Abstracts from the Juba College of Nursing and Midwifery

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

Analysis of trends in SMART Nutrition Survey data from South Sudan between 2004 and 2016

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.

Nurses’ knowledge of the management of diabetic patients at Juba Teaching Hospital

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.

Pattern and causes of tympanic membrane perforation at a private hospital in Dar es Salaam, Tanzania

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.

Prevalence of chronic rhinosinusitis at Muhimbili National Hospital, 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 effects of maternal Body Mass Index on placental morphology and foetal birth weight: a study from Dodoma Central Region,Tanzania

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

Prevalence, clinical pattern and immediate outcomes of HIV-infected children admitted to Al Sabah Children’s Hospital, South Sudan

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.

Prevalence of primary Caesarean Section deliveries among primiparous and multiparous women at Iringa Regional Referral Hospital, Tanzania

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

The acceptability of HIV testing among women receiving post abortion care

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

Multiple-drug resistant (MDR) tuberculosis among HIV sero-positive and sero-negative populations in Ilorin, North-Central Nigeria

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.

Using livelihoods to support primary health care for South Sudanese refugees in Kiryandongo, Uganda

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.

Prevention of mother-to-child transmission of HIV: knowledge, attitudes and practice among pregnant women at Juba Teaching Hospital

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.

Prevalence and associated factors of burnout syndrome among healthcare workers in public and private hospitals in Mekelle City, Ethiopia

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 in children treated at Muhimbili National Hospital, Tanzania

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 ileal perforation in children: does clinical diagnosis alone justify laparotomy?

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.

Knowledge, attitude and willingness to accept Caesarean section among women in Ogbomoso, southwest Nigeria

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.

Knowledge of type 2 diabetes mellitus and adherence to management guidelines: a cross-sectional study in Juba, South Sudan

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 fistulae, birth outcomes, and surgical repair outcomes: a retrospective analysis of hospital-based data in Dodoma, Tanzania

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.

Importance of ultrasonography in evaluating eye injuries: data from Birnin Kebbi, Nigeria

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.

Mothers’ knowledge, attitudes and practices on preventing diarrhoea in Juba, South Sudan

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%.

How culture shapes the sexual and reproductive health practices among adolescent girls in Eastern Equatoria, South Sudan

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

Associated anomalies in cleft lip and palate: Analysis of 811 consecutive patients

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.

Eye diseases in Akon payam, South Sudan.

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.

Mothers’ knowledge on essential newborn care at Juba Teaching Hospital, South Sudan

‘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.

Attitudes and beliefs about mental illness among relatives of patients with schizophrenia

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.

Causes of road traffic accidents in Juba

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.

What causes patients to trust medical professionals? Insights from mothers in Juba

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.

Maternal near-miss in N’Djamena Mother and Child Hospital, Chad

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.

Knowledge and practice of exclusive breastfeeding among women with children aged between 9 and 12 months in Al Sabah Hospital, Juba, South Sudan

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].

Management of acute diarrhoea among children aged 6 - 59 months admitted at Juba Teaching Hospital

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].

Audit of care of severely malnourished children aged 6 - 59 months at Al-Sabah Children Hospital, Juba, South Sudan

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].

Comparison of manual vacuum aspiration and misoprostol in the management of incomplete abortion

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 among young people in Lere health department (Chad)

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.

Infant feeding methods among HIV-positive mothers in Yei County, South Sudan

This study describes the infant feeding methods chosen by HIV-positive mothers in Yei County, South Sudan and the factors that influenced their choice.

Endomyocardial fibrosis: is it a systemic disease?

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.

Household air pollution and childhood pneumonia in South Sudan: will clean cooking stoves reduce the incidence and mortality?

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.

Childbirth in South Sudan: Preferences, practices, and perceptions in the Kapoetas

Factors contributing to, and effects of, teenage pregnancy in Juba

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

Inhaled foreign body mismanaged as TB, finally removed using a rigid bronchoscopy after 6 years of impaction

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].

Abdominal pregnancy discovered during laparotomy for complications after attempted abortion

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.

Causes of maxillofacial patients mortality in a Nigerian tertiary hospital

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.

The importance of research in healthcare

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.

Epidemiological and antibiotic susceptibility profiles of infectious bacterial diarrhoea in Juba, South Sudan

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 ruptures: Epidemiological aspects and prognosis at N’djamena Mother and Child Hospital

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.

Assessment of knowledge of hand washing among health care providers in Juba Teaching Hospital, South Sudan

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.

Non-mental health workers’ attitudes and social distance towards people with mental illness in a Nigerian teaching hospital.

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.

Intestinal parasitic infections and the level of immunosuppression in HIV seropositive individuals with diarrhoea in Kilimanjaro, Tanzania: A cross-sectional study

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%.

Hepatitis B: The view from West Africa

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.

Immediate post-partum haemorrhage: Epidemiological aspects and maternal prognosis at South N’djamena District Hospital (Chad)

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.

A longitudinal study of MUAC as a measure of paediatric malnutrition in Yei, South Sudan: Lessons from a hospital link: Lessons from a hospital link

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.

HIV infection and its effects on fracture healing: a literature review

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].

HIV and TB co-infection in South Sudan: a three year retrospective study

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.

Utilization of PMTCT services at Juba Teaching Hospital, South Sudan

Objective: To determine the uptake of PMTCT services by mothers attending postnatal services at Juba Teaching Hospital.

The prevalence of HIV among blood donors at Juba Teaching Hospital Blood Bank, South Sudan

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.

Risk factors associated with postpartum haemorrhage at Juba Teaching Hospital, South Sudan, 2011

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

Knowledge, Attitude and Practice(KAP) of tuberculosis patients enrolled on treatment in Juba City, South Sudan2010. A pilot study

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

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

Viral transfusion transmissible infections amongst blood donors in Maridi County Hospital, South Sudan

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.

Stroke in SSA: Review of current literature concerning the incidence, risk factors and mortality of stroke in this demographic

Polio supplementary immunization campaign evaluation: the Maban experience, Upper Nile state, South Sudan, August 2013

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.

Diabetes Mellitus: the increasing burden of disease in Kenya.

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].

Hypertension in Juba, South Sudan

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.

Pulmonary tuberculosis case detection in South Sudan

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.

Rehabilitation of patients with traumatic brain injuries in South Sudan

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.

Tuberculosis 1. Epidemiology of mycobacterium tuberculosis

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.

Safer caesarean sections at Juba Teaching Hospital

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.

Stuck objects on fingers: pattern seen in a Nigerian teaching hospital and technique for removal

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

Factors associated with patient and health service delays in the management of TB in Central Equatoria State in 2008

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.

Is poisoning a problem in South Sudan?

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.

Health workers stigmatise HIV and AIDS patients

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.

Summary of a KAP survey in Aweil East County-Highlands in 2010

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.

Carriage rates, circulating serotypes and antibiotic resistance among Streptococcus pneumoniae in healthy infants in Yei, South Sudan

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.

HIV prevalence in South Sudan: data from the ANC sentinel surveillance 2009

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

Conducting Health Services Research

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.

Preventing malaria during pregnancy: factors determining the use of insecticide-treated bed-nets and intermittent preventive therapy in Juba

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

Trauma, a new cause of death, disability and economic loss in Juba

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.

Risk factors for the transmission of kala-azar in Fangak, South Sudan

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.

Knowledge, attitudes and practises of caretakers of malnourished children in Aweil East and North counties, South Sudan

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.

Investigation into the Nodding syndrome in Witto Payam, Western Equatoria State in 2010

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.

SSCCSE Key Indicators for Southern Sudan

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...

The Cyclists Helmet Study in Juba, Southern Sudan, 2006

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...

Malnutrition in Akobo County

A nutrition survey of young children was carried out by Medair (see and Save the Children in Southern Sudan (SCiSS) (see 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:

Mapping the Specialist Medical Workforce for Southern Sudan: Devising Ways For Capacity Building

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...

Caesarean Sections at Juba Teaching Hospital 2008 - 2009

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...

Evaluation of surgical outcome after cataract surgery with lens implantation using air or viscoelastic to maintain the anterior chamber

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 in South Sudan: A Cross Sectional Observational Study

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...

HIV/AIDS: Update on Epidemiology, Prevention and Treatment - including Available South Sudan Literature

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...

MDR-TB is in town, and might be tugging along XDR-TB

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...

A Retrospective Analysis of Mortality Distribution in Juba Teaching Hospital, Southern Sudan

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...

Summary of a report on the Underlying Causes of Malnutrition in Twic County, Warap State, South Sudan. August 2007

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.

GOSS Southern Sudan Household Survey 2006

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.

Management of malaria at Juba Teaching Hospital: a clinical audit

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 and health care interventions in sub-Saharan African countries

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”

Assessing Information and Communication Technology in surgical training, Sudan as example

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.

Can primary health care staff be trained in basic life-saving surgery?

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

Evaluation of community-based surveillance for Guinea worm, South Sudan, 2006

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.

Midwives’ knowledge and use of partographs at Juba Teaching Hospital, South Sudan

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.

Frequency and causes of ocular trauma among children attending Mulago Hospital Eye Department

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.

Knowledge, Attitude, and Practice and service barriers in a tuberculosis programme in Lakes State, South Sudan: a qualitative study

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.

Knowledge of tuberculosis and factors responsible for low case detection in the Amansie Central District, Ghana

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.

HIV/AIDS: Knowledge, attitudes and practices among adolescents in Nimule, South Sudan

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.

Epidemiology of tuberculosis in South Sudan

Chronic suppurative otitis media: bacteriology, susceptibility and clinical presentation among ENT patients at Mulago, Uganda

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.

Missed opportunities for immunization among children attending a Paediatric Outpatient Clinic at Juba Teaching Hospital

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.

Foetal macrosomia: risk factors, maternal and foetal outcomes in N’Djamena Mother and Child Hospital, Chad

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.

Comparing the American and South Korean testing approaches for controlling the spread of COVID-19

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.

Pulmonary tuberculosis among young children with severe pneumonia at Al Sabah Children’s Hospital, Juba, South Sudan

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.

Hearing loss among patients on treatment for drug-resistant tuberculosis in Uganda

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.

Ectopic pregnancy managed medically at St. Paul's Hospital Millennium Medical College, Addis Ababa

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.

What can be done about adolescent pregnancy in South Sudan?

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.

Maternal socio-economic and neonatal medical characteristics associated with survival of preterm neonates in Torit State Hospital, South Sudan: a descriptive cross-sectional study

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.

Factors associated with maternal deaths in Bongor Provincial Hospital, Chad

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.