SummaryIntroduction:Non-adherence to medication among cardiac patients is often the major risk factor for poor clinical outcomes, increased mortality rates and higher healthcare costs. The literature evaluating the prevalence of and reasons for non-adherence in resource-poor settings is extremely limited compared to resource-rich settings. There is a scarcity of data about medication adherence in Sudan hence this study was performed to identify prevalence, predictors and barriers of non-adherence to medication among cardiac patients in Khartoum State.Methods:A descriptive, cross-sectional survey was performed using a pre-tested, self-administered questionnaire on a sample of 433 randomly selected cardiac patients attending the largest three cardiac centres located in Khartoum State. Descriptive and multivariate logistic regression analyses were used for data analysis.Results:The response rate was 89.1%. The mean (± SD) number of chronic diseases among respondents was 2.3 (± 1.3) and that of medication use was 4.2 (± 1.9). The mean (± SD) duration of medication use among participants was 6.4 (± 5.4) years. Optimal adherence was defined as having a score of greater than six on the eight-item Morisky medication adherence scale. Using this cut-off point, 49% (95% CI: 43.9–54.1) of respondents had optimal adherence and 51% (95% CI: 45.9–56.1) had poor adherence. Respondents with a high level of education, low and middle income levels, and those taking five or more medications daily were found to be significantly more non-adherent to medication use than those with low to intermediate education levels (p < 0.001), those with high income levels (p < 0.001), and those taking one to four medications daily (p = 0.039). The top four barriers for poor medication adherence among the study participants were the high cost of drugs, polypharmacy and lack of pharmacist and physician communication with patients about their drug therapy.Conclusions:The current findings highlight the need for urgent, multifaceted interventions, given the burden of cardiovascular diseases and the clinical and economic consequences of medication non-adherence. These interventions include affordable medications, easy-to-use medication regimens with fewer daily doses, ongoing communication between patients and healthcare providers, and improvement of the patient– provider partnership.

Information on marine litter in general and beach litter in particular from Sudan and to some extent from the Red Sea region is insufficient. The aim of this study is to assess the beach litter composition, distribution, and abundance in some selected beaches of the World Heritage Site of Dungonab Bay and Mukkawar Island National Park (DMNP) located in Sudan, Red Sea coast, and to examine the rate of beach litter flux and the cleanliness of its beaches in order to provide baseline information for beach litter management at DMNP. A total of 6 sites were investigated for beach litter over a 10-month period from January to October 2017 on a quarterly basis. A total of 24 collections of beach litter were performed covering a stretch of 600 m or 7700 m2 of DMNP coastline. In total, 3037 beach litter items were collected during the study time from DMNP with an overall average of 506.2 ± 409.8 items/100 m (0.4 items/m2). Plastic beach litter was the most abundant (1738 items), constituting 57.23% with an average density of 289.7 ± 242.2 items/100 m (0.23 items/m2). The beaches of DMNP were clean (CCI = 4.6) at the time of the study. The rate of flux of the beach litter decreased steadily from 21.9 to 16.43 items/100 m/day with an overall average of 18.82 ± 2.8 items/100 m/day. The gradual decrease in the net accumulation of beach litter over the period of the study suggests that the beach litter at DMNP was likely of a local land-based origin and the beaches of DMNP are not a potential sink of marine litter. The determination of the rate of flux of beach litter is a reasonable indicator of the dynamics of beach litter in DMNP. Accordingly, application of preventive measures accompanied with awareness activities and investment in plastic collection and recycling would further enhance and preserve the present status of beach cleanliness and encourage tourism activities.

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