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Background During the Sudan war, healthcare workers have encountered extraordinary challenges, including physical assaults and the immense strain of delivering care with critically limited resources. These conditions are likely to intensify burnout among healthcare professionals. This study aimed to determine the prevalence of burnout among Sudanese healthcare workers and investigate the coping mechanisms they employ during the ongoing conflict. Methods A cross-sectional study was conducted among Sudanese healthcare workers using the standardized Maslach Burnout Inventory – Human Services Survey (MBI-HSS). Multivariable linear regression analysis was conducted to identify independent predictors of burnout domains. A significance level of p  < 0.05 was considered for all statistical tests. Results High emotional exhaustion was reported by 13.7% of participants, while 56.5% experienced high depersonalization, and only 4.4% reported low levels of personal accomplishment. The leading coping mechanism was talking with friends and family, adopted by 28.8% of participants, while 15.5% turned to spiritual or religious practices. Conclusion Sudanese healthcare workers demonstrate high levels of burnout, particularly in the depersonalization domain, with talking to friends and family being the most commonly used coping mechanism. Future research is needed to explore the unique stressors faced by healthcare workers in conflict-affected settings like ours.

The benefits of antibiotics are under threat by self-medication, which culminated in economic burdening of developing countries, treatment failures, the emergence of antibiotic-resistant strains of bacteria and an increased probability of exposure and infection of the general population by antibiotic-resistant bacterial strains. This study aimed to evaluate the knowledge and attitude of medical students in Sudan towards the use of antibiotics, the prevalence of self-medication with antibiotics among medical students in Sudan and to identify risk factors which promote self-medication with antibiotics. This was a cross-sectional, descriptive and institution-based study, between November 2020 and May 2021. 1,110 medical students were selected by multistage cluster sampling. Logistic regression was used to identify risk factors of self-medication with antibiotics among the study participants. The median knowledge score was 7 out of a maximum of 10 (IQR: 5-8). A moderately positive attitude was observed among the participants (Median: 7/10; IQR: 6-8). Knowledge and attitude scores were significantly associated with academic year and monthly allowance (p < 0.05). 675 (60.8%) self-medicated with antibiotics within the previous 12 months, mostly from community pharmacies (321/675; 47.5%). Antibiotics were most commonly used to treat respiratory tract infections (38.1%) and cough (30.4%). Chi-square analysis demonstrated that self-medication with antibiotics was significantly associated with gender, year of study and monthly income. Undergraduate medical students had moderate knowledge and attitude towards antibiotic use and antibiotic resistance, and an alarmingly high prevalence of self-medication with antibiotics. This highlights the urgent need for tighter legislation regarding the sales of antibiotics in community pharmacies by the state and federal health ministries.

Background Colorectal cancer (CRC) is one of the most common malignancies worldwide, with increasing evidence linking metabolic dysregulation, such as insulin resistance and chronic inflammation, to its development and progression. A potential useful predictor of CRC risk is the triglyceride-glucose (TyG) index, a marker for insulin resistance that is determined using fasting triglyceride and glucose levels. The purpose of this systematic review was to assess the relationship between the TyG index and CRC and ascertain whether the TyG index is associated with the development and outcomes of CRC. Methods A systematic review and meta-analysis was reported in accordance with the PRISMA guidelines. Comprehensive searches of PubMed, Web of Science, Scopus, and World Health Organization Virtual Health Library were conducted in 24th March 2025 to find studies assessing the relationship between the TyG index and CRC. Results of association between TyG index and CRC were summarized and a meta-analysis was done to calculate pooled hazard ratio (HR) with 95% confidence interval (CI). Results A total of eight studies were included in the systematic review, of which five met the criteria for inclusion in the quantitative synthesis. The pooled analysis showed that the hazard of developing CRC was significantly greater for those with a higher TyG index (HR = 1.18; 95% CI: 1.12–1.25; P  <.001). In addition, meta-analysis indicated that hazard of developing CRC significantly increased for each one-unit increase in the TyG index (HR = 1.28, 95% CI: 1.18 to 1.39, P  <.001). Conclusion Higher TyG index level is substantially linked to an elevated hazard of developing CRC. Therefore, the TyG index can be a useful tool for CRC risk identification. Standardizing cut-off values and researching clinical applicability in various populations should be the main goals of future research. Due to the limitations posed by the small number of studies, further prospective studies are needed to generate more robust and generalizable evidence.

Background Since the outbreak of armed conflict in Sudan on April 13, 2023, 13 million have been displaced, with young people bearing a significant share of the psychological burden. Despite growing awareness, the mental health impact of this crisis remains underexplored, especially among internally displaced persons (IDPs) and refugees aged 15 to 35. Methods This cross-sectional study assessed the prevalence and associated factors of depression, anxiety, and post-traumatic stress disorder (PTSD) among the displaced Sudanese youth, using validated screening tools (PHQ-9, GAD-7, and PC-PTSD-5). Participants were reached via an online questionnaire between September 2024 and January 2025. Multivariate logistic regression was conducted to identify key predictors for each mental health condition. Results Depression and anxiety were widespread, affecting over half the respondents, while PTSD symptoms were present in 19%. Financial loss, bereavement, job loss, and disruption of education were significantly associated with both depression and anxiety. PTSD was more likely among individuals displaced for over two years, those who experienced personal loss, and those whose education was interrupted. Females were disproportionately affected across all mental health outcomes. Conclusion The mental health toll of the ongoing conflict in Sudan is severe among displaced youth, with a high prevalence of depression and anxiety driven by financial insecurity, loss, and disrupted life trajectories. These findings underscore the urgent need for integrated mental health services within humanitarian responses. Addressing trauma through community-based interventions and psychosocial support is critical to prevent long-term harm.

The objective of the study was to assess the effect of warm compresses in preserving perineal integrity in women who delivered a single baby vaginally with cephalic presentation. We searched PubMed, Scopus, and the ISI Web of Science databases. Two researchers worked independently and conducted the study’s search, selection, and extraction. We calculated the pooled risk ratio (R.R.)- for our categorical outcomes- and mean difference (M.D.)-for our continuous outcomes- using random or fixed-effect meta-analysis according to heterogenicity status. I2 test was used to detect heterogenicity. Studies were assessed for methodological quality using the Cochrane risk of bias assessment tool. Our study analyzed 13 controlled trials (n= 3947) to compare warm compresses versus not using it during vaginal delivery. The analysis revealed that warm compresses group had better outcomes regarding episiotomy, degree of perineal trauma (third and fourth degree), perineal trauma requiring suturing, and also in behavioral pain scales (severe muscle tense, being very restless, and constant grimacing) with the following R.R. and confidence intervals: (R.R.= 0.56, 95% C.I.[0.23, 1.37]), (R.R.= 0.69, 95% C.I.[0.54, 0.89], p= 0.004),((R.R.= 0.37, 95% C.I.[0.18, 0.77], p= 0.004), and ((R.R.= 0.42, 95% C.I.[0.23, 0.78], p= 0.006) respectively. We conclude that among primiparous women, warm compresses group showed better outcome in improving perineal comfort than a the good of women who did not receive warm compresses after delivery.

Sudan's healthcare system has been severely disrupted by the ongoing humanitarian crisis, limiting access to essential services and medications. Understanding health-seeking behaviors during such disruptions is critical to informing culturally appropriate public health responses, particularly regarding traditional medicine use. This study aimed to assessPatterns of Herbal Medicine Utilization for Hypertension During the Sudanese Crisis of 2025. This cross-sectional study was conducted from February to June 2025 among adults with physician-diagnosed hypertension who were prescribed antihypertensive medication at diagnosis. Data were collected using a structured validated questionnaire administered face-to-face using Kobo Toolbox. Convenience sampling yielded 749 valid responses. Data were analyzed using SPSS v27, with statistical significance set at p < 0.05. The mean age was(56.8 ± 11.9) years; (54.1%) were female, (29.8%) were displaced and (50.5%) reported difficulty accessing antihypertensive medications. Herbal medicine use was reported by (91.2%); 65.2% used herbs before and during the crisis, and (19.8%) initiated use after the crisis began. Concurrent use of herb-drug use was reported by (71.7%), while adverse effects were uncommon(5.7%), and mostly mild. Lower income and rural residence were significantly associated with herbal use (p < 0.05). Herbal medicine use was wide spread among hypertensive Sudanese adults during the crisis, largely driven by affordability, accessibility challenges, and cultural familiarity. Given the high rate of concurrent use, public health messaging and clinician training on herb-drug safety should be prioritized.

Background The ongoing conflict in Sudan has severely disrupted dental service delivery, highlighting the urgent need for alternative communication between patients and dental professionals. In this context, tele-dentistry has emerged as a critical, yet underexplored, solution for sustaining oral healthcare delivery. This study aimed to assess the acceptance and readiness for tele-dentistry among dental professionals in Sudan. Methods A cross-sectional study was conducted among 497 Sudanese dental professionals using a self-administered questionnaire based on the Tele-dentistry Acceptance Survey– Dentist Version (TAS-D). Data were analysed using R statistical software (version 4.3.2). Descriptive statistics were used to summarize participant characteristics. Bivariate analyses were conducted using the Wilcoxon rank-sum and Pearson’s Chi-square tests. Multivariable logistic regression was performed to identify predictors of acceptance of tele-dentistry. Results Overall, 59.8% ( n  = 297) of respondents reported a favourable attitude toward the future use of tele-dentistry. Acceptance of tele-dentistry use was significantly associated with academic qualification and work setting. Denttal professionals with an MSc degree had higher odds of acceptance compared to those with a BDS (OR = 3.00, 95% CI: 1.39–7.10, p  = 0.007). Working in an academic setting also increased the likelihood of acceptance (OR = 1.74, 95% CI: 1.18–2.59, p  = 0.005). Conversely, specialists were less likely to accept tele-dentistry than general practitioners (OR = 0.38, 95% CI: 0.15–0.90, p  = 0.033). Stratified analysis indicated that academic qualification and work setting remained significant predictors only among general practitioners. Conclusions A significant proportion of Sudanese dental professionals favour the use of tele -dentistry in the future, particularly those with postgraduate qualifications and those working in academic settings. These findings provide important insights to guide the development of tele-dentistry policies and capacity-building initiatives in Sudan.

Background Online learning has emerged as an alternative to continuing higher education during the ongoing conflict in Sudan. Despite its numerous benefits, online learning is often associated with challenges like stress, anxiety, and depression. Satisfaction plays a pivotal role in shaping students’ perceptions of online education quality and their mental well-being, especially under adverse conditions like conflict. Hence, this study aimed to evaluate the satisfaction of Sudanese medical students with online learning and its association with psychological distress issues, including anxiety, depression, and stress, during the current Sudan war. Methods A cross-sectional study was conducted among Sudanese medical students who transitioned to online learning during the conflict. Satisfaction with online learning was assessed using a validated questionnaire consisting of eight dimensions, while depression symptoms were measured with the Patient Health Questionnaire-9, anxiety with the Generalized Anxiety Disorder-7, and perceived stress with the Perceived Stress Scale-10. Associations between demographic factors and key outcomes were analyzed using independent t-tests, chi-square tests, and one-way ANOVA, with statistical significance set at p  < 0.05. Results Among the 1,891 medical students surveyed, the mean satisfaction score for online learning was 26.2 out of 40. Mild to moderate depression was reported by 59.4% of students, while 62% experienced mild to moderate anxiety, and 21% reported high stress levels. Lower satisfaction was significantly associated with higher levels of depression, anxiety, and stress (all p  < 0.001). Conclusion Sudanese medical students reported positive satisfaction with online learning during the conflict, yet this was accompanied by high levels of depression, anxiety, and stress. These findings highlight the need for integrated mental health support and improved digital access to enhance online education. Addressing these challenges is essential to ensuring student well-being and sustaining quality education in conflict settings. Further research across different settings can help develop more effective interventions.

Background The currently used malaria vaccine, RTS,S, is designed based on the Plasmodium falciparum circumsporozoite protein (PfCSP). The pfcsp gene, besides having different polymorphic patterns, can vary between P. falciparum isolates due to geographical origin and host immune response. Such aspects are essential when considering the deployment of the RTS,S vaccine in a certain region. Therefore, this study assessed the genetic diversity of P. falciparum in Sudan based on the pfcsp gene by investigating the diversity at the N-terminal, central repeat, and the C-terminal regions. Methods A cross-sectional molecular study was conducted; P. falciparum isolates were collected from different health centres in Khartoum State between January and December 2019. During the study period, a total of 261 febrile patients were recruited. Malaria diagnosis was made by expert microscopists using Giemsa-stained thick and thin blood films. DNA samples were examined by the semi-nested polymerase chain reaction (PCR). Single clonal infection of the confirmed P. falciparum cases, were used to amplify the pfcsp gene. The amplified amplicons of pfcsp have been sequenced using the Sanger dideoxy method. The obtained sequences of pfcsp nucleotide diversity parameters including the numbers of haplotypes (Hap), haplotypes diversity (Hapd), the average number of nucleotide differences between two sequences (p), and the numbers of segregating sites (S) were obtained. The haplotype networks were constructed using the online tcsBU software. Natural selection theory was also tested on pfcsp using Fuand Li’s D, Fuand Li’s F statistics, and Tajima’s D test using DnaSP. Results In comparison with the different pfcsp reference strains, the Sudanese isolates showed high similarity with other African isolates. The results of the N-terminal region showed the presence of 2 different haplotypes with a Hapd of 0.425 ± 0.00727. The presence of the unique insertion of NNNGDNGREGKDEDKRDGNN was reported. The KLKQP motif was conserved in all the studied isolates. At the central repeat region, 11 haplotypes were seen with a Hapd of 0.779 ± 0.00097. The analysis of the genetic diversity in the C-terminal region showed the presence of 10 haplotypes with a Hapd of 0.457 ± 0.073. Several non-synonymous amino acids changes were also seen at the Th2R and the Th3R T-cell epitope regions including T317K, E317K, Q318E, K321N, I322K, T322K, R322K, K324Q, I327L, G352N, S354P, R355K, N356D, Q357E, and E361A. Conclusions In this study, the results indicated a high conservation at the pfcsp gene. This may further contribute in understanding the genetic polymorphisms of P. falciparum prior to the deployment of the RTS,S vaccine in Sudan.

Background Event-based surveillance (EBS) is an essential component of Early Warning Alert and Response (EWAR) as per the International Health Regulations (IHR), 2005. EBS was established in Sudan in 2016 as a complementary system for Indicator-based surveillance (IBS). This review will provide an overview of the current EBS structure, functions and performance in Sudan and identify the gaps and ways forward.  Methods The review followed the WHO/EMRO guidelines and tools. Structured discussions, observation and review of records and guidelines were done at national and state levels. Community volunteers were interviewed through phone calls. Directors of Health Emergency and Epidemic Control, surveillance officers and focal persons for EBS at the state level were also interviewed. SPSS software was used to perform descriptive statistical analysis for quantitative data, while qualitative data was analysed manually using thematic analysis, paying particular attention to the health system level allowing for an exploration of how and why experiences differ across levels. Written and verbal consents were obtained from all participants as appropriate. Results Sudan has a functioning EBS; however, there is an underestimation of its contribution and importance at the national and states levels. The link between the national level and states is ad hoc or is driven by the need for reports. While community event-based surveillance (CEBS) is functioning, EBS from health facilities and from non-health sectors is not currently active. The integration of EBS into overall surveillance was not addressed, and the pathway from detection to action is not clear. The use of electronic databases and platforms is generally limited. Factors that would improve performance include training, presence of a trained focal person at state level, and regular follow-up from the national level. Factors such as staff turnover, income in relation to expenses and not having a high academic qualification (Diploma or MSc) were noticed as inhibiting factors. Conclusion The review recommended revisiting the surveillance structure at national and state levels to put EBS as an essential component and to update guidelines and standard operation procedures SOPs to foster the integration between EBS components and the overall surveillance system. The need for strengthening the link with states, capacity building and re-addressing the training modalities was highlighted.