South Sudan Medical Journal

Prevalence and associated risk factors of hepatitis B virus infections among women of reproductive age in Juba, South Sudan

Ezbon WApary, Akway M. Cham, Oromo F. Seriano — Fri, 28 Feb 2025 00:00:00 +0000

Introduction: Hepatitis B virus (HBV) is a partially double-stranded, enveloped virus with a circular DNA genome. This virus increasingly infects the population. Information on HBV infections in South Sudan is limited. This study aimed to examine the prevalence and major risk factors of HBV infections among women of reproductive age in Juba City, South Sudan.

Method: This study adapted a quantitative cross-sectional research design to assess prevalence and risk factors of HBV infections among these women. The study sites were seven health facilities in Juba. A validated semi-structured questionnaire was used to collect data from the 1808 randomly selected women. The study used EpiData software v4.7 to control data entry and Stata v15 for analysis. Chi squared tests and regression model were performed to determine association and likelihood respectively.

Results: Among the 1808 women, the burden of HBV infections was 11.2% and nearly half were unaware of their HBV status. The HBV infections were significantly associated with blood transfusion (p <0.001), surgical operations (p <0.001), and close contact with a case of HBV (p < 0.001). The women who had close contact with a case of HBV infections were 2.5 times more likely to be infected (OR: 2.487, 95% CI: 1.549 - 3.995). Women who had a history of surgical operations were more likely to be positive for HBV by 12.6% compared to those who had had no surgery (OR: 1.126, 95% CI: 0.614 - 2.067). The women who receive blood transfusions were more likely to be infected HBV (OR: 1.134, 95% CI 0.594 - 2.166).

Conclusion: The prevalence of HBV infections among these women was high and nearly half of them were unaware of their HBV status. It is associated with blood transfusion, surgical operations, and close contact with cases of HBV. The study recommends the improvement of tailored health promotion, antenatal HBV screening, birth dose vaccines.

Management and outcome of women requiring massive blood transfusion after childbirth: A cross-sectional study at Muhimbili National Hospital, Tanzania

Peter Joseph Wangwe, Eshi-Fisha Linda Sawe, Elineema Robson Meda — Fri, 28 Feb 2025 00:00:00 +0000

Introduction: Massive Obstetric Haemorrhage is the leading cause of maternal morbidity and mortality in sub-Saharan Africa. The management of obstetric haemorrhage requires a systematic and standardized approach to have a favourable maternal outcome. We describe the prevalence, aetiology, current management and outcomes of women with obstetric haemorrhage at Muhimbili National Hospital (MNH).

Method: A two-year retrospective review of cases with a diagnosis of obstetric haemorrhage whose gestation age was ≥ 24 weeks and blood loss ≥ 2L or required a blood transfusion of ≥ 4L. Data were analysed using SPSS version 23 and summarized into proportions as well as measures of central tendencies (mean and median) where appropriate. The case fatality rate was calculated using the number of deaths of women with obstetric haemorrhage to the total number of women who were diagnosed to have obstetric haemorrhage.

Results: The prevalence of women who had obstetric haemorrhage was 1%. Triggering of massive blood transfusion protocols by informing physician, blood bank, theatre team, pre-transfusion laboratory test and administration of intravenous fluid was performed in more than 98%. About 2.3% of patients received a proper ratio of blood and blood products during management. The percentage of patients with acute kidney injury (AKI), disseminated intravascular coagulopathy (DIC) and heart failure were 13.6%,7.0% and 4.3% respectively. Calcium gluconate was not administered to patients who had obstetric haemorrhage. During the study period the case fatality rate was 4.7%.

Conclusion: Management of patients with obstetric haemorrhage was deficient resulting in high rates of maternal mortality and morbidity. Standardised practice by adopting and use of massive transfusion protocol should reduce the adverse maternal outcomes.

Addressing barriers in paediatric tuberculosis reporting: A qualitative study of private healthcare providers’ perspectives

Suryanti Chan, Idris Adewale Ahmed, Hamzah Hamzah — Fri, 28 Feb 2025 00:00:00 +0000

Introduction: Tuberculosis (TB) in children poses a global health challenge, contributing to high morbidity and mortality rates. In 2020, approximately 208,000 TB-related deaths occurred in children under 15 years, many due to under-reporting, particularly in the private healthcare sector. Barriers to TB notification include hesitancy and misconceptions, lack of awareness and training, technological challenges, stigma, and regulatory issues.

Method: This qualitative study examined primary care physicians’ perspectives on the under-reporting of TB cases through in-depth semi-structured interviews with 15 physicians from private practices and clinics in Indonesia. Data collection was between May and July 2024. Thematic analysis, supported by NVivo 12 software, was used to identify key themes, and findings were reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Results: The analysis revealed two primary themes: Barriers to Tuberculosis Notification and Social and Policy Impacts on Tuberculosis Notification. Under the first theme, five sub-themes were identified: Hesitancy and Misconceptions, Lack of Awareness and Training, Technological and Logistical Barriers, Stigma and Confidentiality Concerns, and Regulatory and Enforcement Issues. These findings highlight the complex factors influencing TB notification practices in the private sector.

Conclusion: Addressing these barriers through targeted interventions is essential for improving paediatric TB notification rates. This study underscores the need for enhanced training, better regulatory frameworks, and improved collaboration between private practitioners and public health authorities to ensure timely diagnosis and treatment of paediatric TB.

Knowledge, attitudes, and practices of caregivers of malnourished children at the Al Sabbah Children’s Hospital, Juba, South Sudan

Francis Beek Akook, Nyok Daniel Ngor — Fri, 28 Feb 2025 00:00:00 +0000

Introduction: Malnutrition results from insufficient, excessive, or imbalanced intake of nutrients. The contributory factors include poverty, lack of access to food and family knowledge, inadequate healthcare, and recurring illnesses. This study aimed to gather data on the nutrition-related knowledge, attitudes, and practices of the caregivers of young, malnourished children at the Al- Sabbah Children’s Hospital, Juba, South Sudan

Method: This cross-sectional study was conducted in April 2024. A pretested questionnaire was used to collect information from the calculated sample size of 50 caregivers. The data were analysed using Statistical Packages for Social Sciences (SPSS).

Results: Data taken from the hospital registers showed that, at the time of the survey, the mid-upper-arm circumference of the children indicated that 35 were not malnourished and 15 were still moderately malnourished. Most caregivers had heard about malnutrition and said they had got this information from their husbands; most had previously used malnutrition services at health facilities having been encouraged by their families although transport was expensive, and many paid for the service. More than half felt family and traditional perceptions of malnutrition had a negative impact on the condition.

Conclusion: The information provided by caregivers of children attending hospital malnutrition services indicate that, although they have some knowledge of malnutrition and malnutrition services, there is need for improvement.

Epidemic keratoconjunctivitis (Pink Eye) in South Sudan: A review

Wani Mena — Fri, 28 Feb 2025 00:00:00 +0000

Epidemic keratoconjunctivitis is an adenoviral infection that is highly contagious occurring in overcrowded settings where hygiene conditions are poor. Common symptoms include a gritty sensation, tearing, membranous conjunctivitis, and subconjunctival haemorrhage. It is a self-limiting disease but its spread can be limited by observing hygiene, avoidance of overcrowded spaces and not sharing formites. Health education and isolation of the infected individual is recommended.

The Establishment of the National Public Health Institute (NPHI) in South Sudan

Nyinypiu Tong, Anthony Garang, Joseph Lako — Fri, 28 Feb 2025 00:00:00 +0000

No abstract.

The third community health workers’ symposium, Liberia, 2023: What are the implications for South Sudan’s Boma Health Initiative?

Kon Alier, Solomon Anguei, William Kuon, Christopher Ajumara — Fri, 28 Feb 2025 00:00:00 +0000

Community health workers (CHWs) are defined by the International Labour Organization (ILO) as healthcare workers who ‘provide health education, referral and follow-up, case management, basic preventive health care and home visiting services to specific communities. This paper is a synthesis report on the third CHWs’ symposium held in Monrovia, Liberia in March 2023 and its implications for the South Sudan version, the Boma Health Workers (BHWs). It documents the notes on the conference deliberations supplemented by literature on the Boma Health Initiative in particular and CHWs in general. The key thematic areas were institutionalization and integration of CHW programmes into the health system, human resource recruitment, training and retention, CHWs in conflict and complex emergencies, effect of gender, and measuring performance. The Symposium was a platform for sharing information on best practices and challenges facing CHW programmes across nations. In the Monrovia Call to Action, the Symposium urged stakeholders to invest in country-led strategies, professionalize and integrate CHWs into the national human resources and health sector plans, galvanise political support and track progress.

South Sudan cholera outbreak: A call to improve sanitation

Ruot Garjiek Teny — Fri, 28 Feb 2025 00:00:00 +0000

No abstract.

South Sudan’s journey to defeat Guinea Worm Disease: The role of President Jimmy Carter and the Carter Center

Makoy Samuel Yibi Logora — Fri, 28 Feb 2025 00:00:00 +0000

No abstract.

Evaluation and surgical repair of retroperitoneal duodenal perforation following blunt trauma: A case report

Rashmi Ranjan Sahoo, Abhinav Voona, Nalini Naik, Jyotirmay Jena — Fri, 28 Feb 2025 00:00:00 +0000

Isolated horizontal duodenal injuries resulting from blunt abdominal trauma are exceedingly rare, primarily due to the retroperitoneal location of the duodenum. This anatomical characteristic often leads to delayed diagnoses. A 61-year-old man presented to the emergency room following an assault by a bull. He complained of severe abdominal pain, vomiting, and fever. Imaging revealed a perforation on the anterior wall of the third part of the duodenum. However, during the laparotomy after Kocherisation (a way of exposing the duodenum to get better access), an additional posterior wall perforation at the same duodenal site was identified. Tension-free transverse primary repair was performed for the anterior and posterior wall perforations, with duodenal decompression procedures. Drains were placed accordingly. The patient recovered well, with gradual resumption of feeding and subsequent removal of drains. He was discharged after 15 days, demonstrating successful recovery without complications.