A total of 647 eligible subjects participated in the study. Two week incidence of diarrhoeal rates were estimated by a community survey some four months before and again four months after provision of the LifeStrawY. In addition counts were kept of people attending at the community clinic with diarrhoea. Compliance rates were good with 86.5% of people saying they always used it and only 3.7% saying they had never used it. In a before implementation survey 15.3% of participants reported diarrhoea in the previous 2 weeks compared with only 2.3% in a survey after implementation. Similarly 58 people presented to the clinic as a new case of diarrhoea in the four months before compared with only six in the four months after implementation. When compared with diarrhoeal attendances at the regional hospital, this was a statistically significant decline in attendances ( p , 0.0001). The LifeStrawY is likely to find a role as an adjunct to water quality interventions aimed at the home. However, more research is needed to assess the long-term impact and uptake of these devices before their definitive value can be assessed.
Eumycetoma (mycotic mycetoma) is the fungal form of mycetoma, a subcutaneous infection occurring in individuals living in endemic areas of the disease. The Sudan is hyperendemic for mycetoma, with the highest incidence being reported from Gezira State, Central Sudan. The present study was conducted at the Gezira Mycetoma Center and aimed to determine the cause of black-grain eumycetoma in the state and describe its epidemiology. Blackgrain specimens were collected during the surgical operation and direct detection of the causative agent was performed using M. mycetomatis species-specific PCR and ITS PCR followed by sequencing. Black-grain was reported from 93.3% of all confirmed mycetoma cases (n = 111/119), with a prevalence in young males. Of the 91 samples subjected to direct PCR, 90.1% (n = 82) gave positive results. The predominant species (88.2%) was Madurella mycetomatis. One sample was identified as M. fahalii, one as M. tropicana, and one matched the phytopathogenic species Sphaerulina rhododendricola. The highest endemic zones were Southern Gezira (76.6%) and Northern Sinnar (23.4%). The study confirmed that direct molecular detection on grains provides rapid and specific diagnosis of agents of eumycetoma.
SummaryThe direct agglutination test (DAT) based on freeze-dried (FD) Leishmania donovani antigen was evaluated for the serodiagnosis of kala-azar in a rural setting in eastern Sudan. The performance of the FD-DAT was compared with standard liquid antigen (LQ) by testing serum samples and blood samples collected on filter paper of microscopically and PCR-confirmed VL patients, apparently healthy endemic controls and patients with other relevant infectious diseases for the region. In the present study, the FD-DAT had a sensitivity of 96.8% and a specificity of 96.2%. The LQ-DAT had a sensitivity of 91.0% and a specificity of 96.6%. A high degree of agreement (97.3%; r-value 0.94) was observed between the FD-DAT and the LQ-DAT, as well as between the FD-DAT performed on serum samples and corresponding blood samples collected on filter paper (agreement 97.8%; r-value 0.79). The FD-DAT is very suitable as diagnostic test for kala-azar in remote rural conditions as it is sensitive, specific and stable. The antigen is affordable, reproducible and available, which contributes to the sustainability of the DAT as a diagnostic test for VL.
Although poor water quality is recognized as a public health threat, it has been little investigated in Sudan. In this paper, water sources in Gezira State, Greater Wad Medani locality, have been categorized as safe, intermediate safe and high-risk unsafe sources using the compartment bag test (CBT) to detect E. coli, which is an indicator of fecal contamination of water. The CBT is simple, portable and self-contained, and it can be done in the field environment. A total of 122 samples were collected from different water sources and included rivers, water treatment plant, boreholes/tube wells, hand pumps, public water taps, public water coolers, public elevated water tanks and household elevated water tanks. It was found that 69% (84/122) of investigated water sources were safe to drink. The sources most likely to be contaminated were those close to industrial points and factories or open sources exposed to pollution. The result showed that the highest level of contamination of water sources (high risk and unsafe) was observed in rural area (9.1%) followed by urban (5.7%) and peri-urban (1.6%). Frequent and routine qualitative analysis of water sources using CBT is recommended to improve human health and hence the country’s development.
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