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Endemic African malaria vectors are poorly adapted to typical urban ecologies. However, Anopheles stephensi, an urban malaria vector formerly confined to South Asia and the Persian Gulf, was recently detected in Africa and may change the epidemiology of malaria across the continent. Little is known about the public health implications of An. stephensi in Africa. This study is designed to assess the relative importance of household exposure to An. stephensi and endemic malaria vectors for malaria risk in urban Sudan and Ethiopia. Case-control studies will be conducted in 3 urban settings (2 in Sudan, 1 in Ethiopia) to assess the association between presence of An. stephensi in and around households and malaria. Cases, defined as individuals positive for Plasmodium falciparum and/or P. vivax by microscopy/rapid diagnostic test (RDT), and controls, defined as age-matched individuals negative for P. falciparum and/or P. vivax by microscopy/RDT, will be recruited from public health facilities. Both household surveys and entomological surveillance for adult and immature mosquitoes will be conducted at participant homes within 48 hours of enrolment. Adult and immature mosquitoes will be identified by polymerase chain reaction (PCR). Conditional logistic regression will be used to estimate the association between presence of An. stephensi and malaria status, adjusted for co-occurrence of other malaria vectors and participant gender. Findings from this study will provide evidence of the relative importance of An. stephensi for malaria burden in urban African settings, shedding light on the need for future intervention planning and policy development.

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.

Little is known about the pattern and outcome of Acute Kidney injury (AKI) in Sudan. This study aimed to determine the etiology and outcome of AKI among Sudanese adults. A retrospective cohort study was conducted in a tertiary level hospital, Soba University Hospital, Sudan. The medical records of all adults admitted to hospital from the 1 of January to 31 of December 2014 were reviewed. The diagnosis and severity of AKI was defined as per the Kidney Disease Improving Global Outcomes (KDIGO) recommendations. The medical records of 6769 patients were reviewed. AKI was diagnosed in 384 patients (5.7%); being community acquired in 82.6% of cases. Sepsis, volume depletion, obstructive uropathy, heart failure, acute glomerulonephritis and severe malaria were the commonest causes of AKI diagnosed in 44%, 38.5%, 8.9%, 5.7%, 4.7% and 3.1% of patients, respectively. Following treatment complete renal recovery was seen in 35.7% of patients; whereas 31.2% of patients died. Predictors of increased risk of death were old age [OR 1.03, 95% CI (1.01-1.057); P=0.003], presence of chronic liver disease [OR 2.877, 95% CI (1.5-5.5); P=0.001], sepsis [OR 2.51, 95% CI (1.912-4.493);P=0.002] and the severity of AKI [OR 3.873, 95% CI(1.498-10.013);P=0.005]. AKI was diagnosed in 5.7% of adults admitted to hospital. Most patients were having community acquired AKI. Old age, the presence of chronic liver disease, sepsis, and the severity of AKI as per KDIQO staging were significant predictors of mortality.

The purpose of this study is to pragmatically examine cryptic language Palestinian inmates employ on daily basis to communicate coded, secret messages among themselves and to mislead Israeli jailers. The pragmatic meaning of this special language reflects the harsh conditions of Palestinian security prisoners in all aspects of their routine social, military, and security life inside Israeli prisons. The data of the study have been collected from interviews with five newly freed Palestinian prisoners who served long sentences in the Israeli jails. For a better analysis, the data have been classified into metaphoric and non-metaphoric based on their situational use in the prison environment. The study found that although these terms have drifted from their original semantic usages and acquired new pragmatic applications initiated by Palestinian prisoners' needs for socializing, maneuvering, and security concerns, they still exhibit strong connection between their literal and pragmatic meanings. Put differently, in some cases, the pragmatic meaning of the terms used inside the prison conceptually maps their literal meaning outside the prison context. The study also has revealed that these terms convey different (indirect) speech acts of warning, threatening, command, and request in the prison context. We recommend other researchers to focus on the cryptic language of Palestinian female prisoners who might have needs and concerns that are different from those of the males'.

Inflammatory bowel disease is associated with higher rates of anxiety and depression compared to the general population. We aimed to determine the prevalence of anxiety and depressive symptoms among patients with ulcerative colitis and correlation to disease activity. In this cross-sectional study, we collected data from 70 consecutive ulcerative colitis patients over one year at our inflammatory bowel disease outpatient clinic through an interview and a questionnaire containing patient demographics and disease characteristics. Anxiety and depressive symptoms were characterized using the Generalized Anxiety Disorder-7 questionnaire and Patient Health Questionnaire-9, respectively, with ulcerative colitis disease severity assessed by the Partial Mayo scoring system. The majority of our patients were females (68.6%) and the mean age was 39.3 years. Rates of anxiety and depressive symptoms among ulcerative colitis patients were 65.7% and 58.6%, respectively. Depressive symptoms were significantly associated with patient-reported disease activity ( r  = 0.361; p  = 0.010). Significant percentages of ulcerative colitis patients were appreciated to have anxiety and depressive symptoms, and there was a correlation between patient-reported disease activity and depressive symptoms. At this high rate of prevalence, it is justified to screen patients for the presence of psychiatric comorbidities.

BackgroundTuberculosis (TB) remains a leading cause of morbidity and mortality in Nigeria, particularly among people living with HIV (PLWH), who face significantly higher risks of developing active TB. Conventional diagnostic methods such as sputum smear microscopy and chest radiography often fail to detect TB accurately in this population due to smear-negative presentations and atypical radiographic findings. Recent diagnostic innovations, including the Xpert MTB/RIF Ultra, TB lipoarabinomannan (TB-LAM) and TB loop-mediated isothermal amplification (TB-LAMP) tests, offer improved sensitivity and specificity, but their cost-effectiveness in resource-limited settings remains unclear.MethodsIn this economic evaluation, we combined a decision tree with cost-effectiveness analysis to compare three TB diagnostic algorithms tailored for PLWH in Nigeria: (1) Xpert MTB/RIF Ultra following chest radiography (chest X-ray; CXR), (2) TB-LAM following CXR and (3) TB-LAMP following CXR. Data on test accuracy, costs and TB prevalence were obtained from systematic reviews and meta-analyses, with costs adjusted for inflation and local purchasing power. We estimated the incremental cost-effectiveness ratios (ICERs) for the three diagnostic approaches. Sensitivity analyses were conducted to assess the robustness of results across varying input parameters.ResultsTB/LAM was found to be the most cost-effective option at a cost of US$17 per TB case detected when compared with US$20 and US$22 per TB case detected for the baseline strategy of Xpert MTB/RIF Ultra and TB-LAMP, respectively. These ICERs are consistent with willingness-to-pay thresholds set at three times Nigeria’s gross domestic product (GDP) and remained robust over a wide range of costs and epidemiological parameter inputs.ConclusionAmong PLWH in Nigeria, the TB-LAM algorithm represents the most cost-effective diagnostic strategy. However, the Xpert MTB/RIF Ultra may provide additional value in settings with sufficient infrastructure and funding. This study underscores the need for tailored diagnostic approaches that balance accuracy, scalability and affordability to enhance TB detection and management in vulnerable populations.

Children’s sun safety habits have been studied globally, but there is a significant research gap in the western region of Saudi Arabia. This study aimed to assess caregivers’ knowledge and attitudes about sun safety for children and adolescents in the Western region of Saudi Arabia. We conducted a cross-sectional study through a validated online questionnaire directed to caregivers living in the Western region of Saudi Arabia. Using 50% and 75% as cutoff thresholds, individuals were divided into three knowledge levels: low (scores from 15 to 44), average (from 45 to 59), and high (from 60 to 75). The study included 940 caregivers (53% were mothers). The majority of caregivers (73%) demonstrated an average level of knowledge about sun protection, with notable misconceptions such as the belief that sun protection is unnecessary in winter. Most of the participants could accurately identify health risks associated with excessive sun exposure such as the risk of skin cancer. Binary logistic regression analysis revealed that having a child aged 1 year or younger was an independent predictor of higher knowledge levels regarding sun exposure and protection (OR = 1.27; 95% CI: 1.01–1.6). Sun protection practices were inconsistent; 28.7% of caregivers never used sunscreen themselves, 34.9% never used them for their children and 23% used it exclusively in the summer months. In conclusion, while most participants exhibited average knowledge about sunlight exposure and protection, only 23.1% of caregivers applied sunscreen regularly on their children.

Background: Kidney diseases requiring haemodialysis are becoming an emerging public health problem. This study aimed to determine the burden, socio-demographic and other risk factors associated with haemodialysis in Northwest Nigeria. Methodology: The study was a retrospective multicentre review of secondary data from the dialysis centres of public hospitals in northwestern Nigeria. Risk factors for renal failure were examined in 1329 patients who were enrolled for haemodialysis between 2019 and 2022 in the four public dialysis centres in Kano and Jigawa state. Data were analysed using IBM SPSS Statistics for Windows, version 22.0, with statistical significance set at P ≤ 0.05. Results: The minimum age of the patients was 2 years and the maximum was 100 years with a median of 48 (interquartile range = 31, 60) years. Chronic kidney disease (CKD) was found amongst more than two-thirds 998 (75.1%) of the patients. Up to 51 (3.8%), 62 (4.7%) and 10 (0.8%) were seropositive for HIV, hepatitis B and hepatitis C, respectively. Acute kidney injury (AKI) was significantly higher (67.9%, P < 0.001) amongst patients with post-partum haemorrhage (PPH), and were 24 times more likely to develop AKI when compared with those with no PPH (adjusted odds ratio [aOR] =24, 95% confidence interval [CI] = [13.5-44.5]). CKD was significantly higher amongst patients with hypertension (HTN) (84.9%, P < 0.001), and were 3.2 times more likely to develop CKD compared with non-hypertensives (aOR = 3.2, 95% CI = [2.4-4.1]). Acute on CKD (AOCCKD) was significantly higher amongst patients with chronic glomerulonephritis (CGN) (28.1%, P < 0.001), and were three times more likely to develop AOCCKD than those without CGN (aOR = 3, 95% CI = [2.1-4.2]). Conclusion: PPH was the major reason for AKI related haemodialysis while diabetes and HTN were the major causes of CKD-requiring haemodialysis. CGN was more amongst patients who had dialysis due to acute exacerbation of CKD. The government and relevant stakeholders should ensure a favourable policy for the screening and management of patients.