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.
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.
‘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.
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.
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.
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.
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.
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 .
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 . 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 .
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 .
In the developing countries, 50.6 million children under the age of 5 years are malnourished . 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 .
Incomplete abortion contributes disproportionately to maternal morbidity and mortality in developing countries . According to the World Health Organization 87,000 maternal deaths due to incomplete abortion are recorded yearly in developing countries . Incomplete abortions can be managed expectantly, surgically and medically (using misoprostol with or without mifeprostone).
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.
This study describes the infant feeding methods chosen by HIV-positive mothers in Yei County, South Sudan and the factors that influenced their choice.
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.
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.
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 , and this does not include births among girls aged under 15 years
Foreign body aspiration (FBA) is one of the leading causes of sudden death among children aged less than three years . Aspiration is common in this age group because of the less effective and protective mechanisms involved in coordination of breathing and swallowing . FBA resembles a number of pulmonary diseases and so poses a great challenge to clinicians for its management .
Chad is a sub-Saharan country where reproductive health problems are still acute . 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.
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.
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.
Diarrhoeal diseases are a major health problem in developing countries  and accounts for an approximate global mortality of two million people annually . 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 rupture is a non-surgical breach of the continuity of the myometrial wall of the uterus . It is now rare in industrialized countries thanks to improved ante- and peri-natal care . In the sub-Saharan Africa is a major obstetric emergency. Its frequency ranges from 0.6% in Central African Republic , 0.78% in Togo , 1.01% in Enugu (Nigeria) , 1.15% in Bamako (Mali) , 2.2% in Senegal  to 2.33% in Niger .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.
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.
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.
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%.
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.
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.
Paediatric malnutrition is a significant problem in South Sudan, with rates of wasting up to 22% reported in some areas . Severe acute malnutrition (SAM) is associated with a high mortality . Affected patients require thorough assessment and holistic care including appropriate therapeutic feeding, treatment of associated complications and rehabilitation in order to achieve good outcomes.
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 . 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 .
To determine the prevalence of HIV/TB co-infection among patients attending the HIV clinic at Juba Teaching Hospital (JTH) from 2011 to 2013.
Objective: To determine the uptake of PMTCT services by mothers attending postnatal services at Juba Teaching Hospital.
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 . 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.
Post-partum haemorrhage (PPH) is a leading cause of maternal mortality worldwide and is responsible for 34% of maternal deaths in Africa . It is defined as blood loss of more than 500 ml following vaginal delivery or more than 1000 ml following Caesarean delivery . 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 . Secondary PPH is abnormal or excessive bleeding from the birth canal between 24 hours and 12 weeks postnatally
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 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
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.
Although there are no confirmed polio cases in South Sudan since June 2009, vital indicators for polio eradication activities are not satisfactory . Hence, the recent huge polio outbreak in Somalia, Kenya and Ethiopia demanded a safety net SNIDs for four States, including Upper Nile.
Non-communicable diseases (NCDs) are the leading cause of death globally and diabetes mellitus is the 4th main contributor . It is characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, action or both . There are three main types: type 1 (TIDM) (10%), 2 (TIIDM) (85%) or gestational (5%) affecting 347 million people . There were about 1.3 million deaths in 2008  predicted to increase to over 2 million by 2030 . The burden of diabetes is disproportionately high in low-middle income countries [5,6].
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.
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 . 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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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
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.
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
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.
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.
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.
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.
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...
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...
A nutrition survey of young children was carried out by Medair (see http://www.medair.org) and Save the Children in Southern Sudan (SCiSS) (see http://savethechildren.org.uk) 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:
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...
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...
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 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...
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...
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...
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...
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.
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.
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 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”
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.
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
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.
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 ; 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.
Ocular trauma is damage to the eye as a result of mechanical, electrical, thermal, or chemical energy . 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 ; 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.