Health in Sudan

History of the medical research and providing professional medical health care in Sudan could be traced back to 1903, when The Wellcome Research Laboratory was established in Khartoum as a part of the Gordon Memorial College.[6]

The reorganization of the services dealing with scientific research in the Sudan in April 1935 made the Stack Medical Research Laboratories the official research organ of the Sudan Medical Service, and Dr. E. S. Horgan-Archibald's successor-was appointed Director to the laboratories and Assistant Director (Research) Sudan Medical Service. The Wellcome Tropical Research Laboratories ceased to exist as such, but thereafter continued to operate as the Wellcome Chemical Laboratories; and after being placed under the control of the Agricultural Research Service for the following four years, they were transferred back to the Sudan Medical Service in 1939.[7]

Amidst almost 100 days of fighting between the Sudanese army and the paramilitary Rapid Support Forces (RSF), increased violence against health workers in Khartoum is endangering the few hospitals still open, with Médecins Sans Frontières (MSF) considering withdrawing its support. The medical charity's employees were recently beaten and whipped by armed men while transporting medical supplies to the Turkish hospital, one of only two operational facilities in southern Khartoum. The attacks have led to injuries of MSF staff and have highlighted the urgent need for enhanced protection measures to safeguard healthcare facilities and personnel in Sudan.[8]

Sudan, with an increasingly ageing population, faces a double burden of disease with rising rates of communicable and noncommunicable diseases.

• The Sudan Household Survey 2010 showed that 26.8% of children aged 5 to 59 months had diarrhea, while 18.7% were sick due to suspected pneumonia in the two weeks before the survey was done.
• Protein energy malnutrition and micronutrient deficiencies continue to be a major problem among children under 5, with 12.6% and 15.7% suffering from severe wasting and stunting, respectively. The most common micronutrient deficiencies are iodine, iron and vitamin A.
• Concerning the MDGs, still 73 [range: 59–88] (Both sexes) out of every 1000 children born do not live to see their fifth birthday.[9] The Maternal mortality ratio per 100 000 live births estimated at 730 [380–1400] deaths per 100 000 live births in 2010.[9]
• The MDG target for malaria has been achieved, although it remains to be a major health problem. In 2010, malaria led to the death of 23 persons in every 100 000 population; while in total over 1.6 million cases were reported.
• The annual incidence of new TB cases for 2010 is 119 per 100 000, half of them smear-positive. TB case-detection rate of 35% is well below the target of 70%, but treatment success rate at 82% is close to the WHO target of 85%. With respect to HIV-AIDS, the epidemic is classified as low among the general population estimated prevalence rate of 0.24% with concentrated epidemic in two states.[1]

Water is a main cause to each of these.

• The vital statistics below include South Sudan.[10]

Source: UN World Population Prospects[11]

The health services provided in Sudan follow the classical three basic arrangements, primary, secondary, tertiary health care. The primary health care is the first encounter for the patients and includes as mentioned in the organizations the dressing stations, dispensaries, primary health care units and health centers, the latter forms the referral point from the lower facilities.[3] The importance of PHC is that it provides the essential care to all and improves the health status of the community as a whole. In 2003 a package of health care services was introduced to the PHC facilities. This package included vaccination of children, nutrition, reproductive health (RH), integrated management of childhood immunization (IMCI), management of common diseases and prescribing the essential medications. This line of care is almost entirely provided by the public sector.

On the other hand, both public and private sectors work together in the provision of the secondary and tertiary lines of care. Though, the private sectors has been functioning mainly in urban areas. Screening, diagnostic, and therapeutic services are being provided in both health centers and hospitals as secondary care, where major surgical, rehabilitative, and subspecialized tertiary care is being provided mainly at larger public hospitals including teaching hospital, private hospitals, and in specialized centers. These hospitals and centers accepts patients without being referred from the lower facilities indicating a poor referral system.[3]

In the last decade, the number of hospitals has been an increasing trend and it continues to be. It is agreed that a core component of primary health care is health promotion which is limited in Sudan while health problems suitable for health awareness campaigns are present including the enormous communicable diseases, malnutrition, and even the non-communicable diseases.[3] Furthermore, in regard to the services provided at the PHC, these services are not achieving optimum utilization rates. For example, only 81.6% of PHC units provide vaccination for children and 67.3% provide family planning services. Although these numbers are improving in comparison to the past, they are not ideal and further emphasis on coverage, availability, and accessibility is required. Another notifiable weakness regarding PHC, is that unlike the secondary and tertiary services that are increasing in number, PHC units are decreasing either due to cessation of function or in comparison to the population growth.[3]

It is difficult to generalize about health care in Sudan because of the great disparity between the major urban areas and the rest of the country.[14] Indeed, the availability of health care in urban settings is one cause of rural to urban migration.[14] In terms of access to health care, Sudan can be subdivided into three categories: distinctly rural, rural near urban areas, and the capital region.[14] In rural areas, especially outlying provinces, standard health care is completely absent.[14] For the most part, there are neither doctors nor clinics in these regions.[14] When illness occurs, home remedies and rest are often the only potential “treatments” available, along with a visit to a faqih or to a sorcerer, depending on region and location.[14] Rural areas near cities or with access to bus or rail lines are slightly more fortunate.[14] Small primary-care units staffed by knowledgeable, if not fully certified, health workers dispense rudimentary care and advice and also issue referrals to proper clinics in urban areas.[14] Provincial capitals have doctors and hospitals but in insufficient numbers and of insufficient quality to meet rising demand.[14]

The Three Towns of the capital region boast the best medical facilities and doctors in the country, although many of these would still be considered substandard in other parts of the world.[14] Here, health care is available in three types of facilities: the overcrowded, poorly maintained, and underequipped government hospitals; private clinics with adequate facilities and equipment, often operated by foreign-educated doctors and charging prices affordable only by the middle and upper classes; and public clinics run by Islamist da’wa (religiously based charities) or by Christian missionaries, where adequate health care is available for a nominal fee.[14] Not surprisingly, many patients flock to the third category where it is available.[14]

WHO maintained offices in the capitals of each of Darfur’s three states in 2005 and oversaw the effort to provide health services there.[14] More than 13,000 national and international personnel were involved in providing food, clean water, sanitation, primary health care, and medical drugs to the region’s refugees.[14] In 2006, some 2.5 million Darfuri were in need of assistance, and an estimated 22 percent of children suffered from acute malnutrition.[14] One researcher reported that, as of 2011, reliable information on Eastern Sudan was scarce, but overall health conditions could be gauged from under-five child mortality rates per 1,000 live births.[14] In 2005 WHO reported that these ranged from 117 in Al-Gedaref State, to 165 in Red Sea, to 172 in Blue Nile, all high even by standards of comparable developing countries.[14]

Malaria is the leading cause of morbidity and mortality in Sudan, and the entire population is at risk.[2] It commands an inordinate amount of Sudan’s limited medical expertise.[2] In 2003 hospitals reported 3 million cases; malaria victims accounted for up to 40 percent of outpatient consultations and 30 percent of all hospital admissions.[2] In Darfur alone in 2005, doctors reported 227,550 cases; doctors, however, did report greater success in saving patients than in past years.[2] In 2007 a study was conducted in Sudan which revealed underreporting of malaria episodes and deaths to the formal health system, with the consequent underestimation of the disease burden.[15]

Children less than five years of age had the highest mortality rate and DALYs, emphasizing the known effect of malaria on this population group. Females lost more DALYs than males in all age groups, which altered the picture displayed by the incidence rates alone. The epidemiological estimates and DALYs calculations in this study form a basis for comparing interventions that affect mortality and morbidity differently, by comparing the amount of burden averted by them. The DALYs would mark the position of malaria among the rest of the diseases, if compared to DALYs due to other diseases. Uncertainty around the estimates should be considered when using them for decision making and further work should quantify this uncertainty to facilitate utilisation of the results.[15] More epidemiological studies are required to fill in the gaps revealed in this study and to more accurately determine the effect and burden of the disease.

A lack of safe water means that nearly 45 percent of children suffer from diarrhea, which leads to poor health and weak immune systems.[2]

The World Health Organization was notified by the Federal Ministry of Health of Sudan of an outbreak of yellow fever in 2012 which affected five states in Darfur.[16] The yellow fever outbreak resulted in 847 suspected cases including 171 deaths. To reduce the spread of yellow fever, The World Health Organization worked with The Federal Ministry of Health in Sudan on a vaccination campaign that halted the outbreak.[17]

Sudan is considered to be a country with an intermediate HIV and AIDS prevalence[18] by the World Health Organization (WHO).[19]

The main mode of transmission worldwide is through heterosexual contact, which is no different in Sudan.[18] In Sudan, heterosexual transmission accounted for 97% of HIV positive cases. As of January 5, 2011, the Adult(15-49) prevalence in Sudan was found to be 0.4%, an estimated 260,000 were living with HIV and there were 12,000 HIV related annual deaths.[20] A population based study was conducted in 2002 which estimated the sero-prevalence to be 1.6%. According to recent studies, the HIV and AIDS prevalence in Sudan among blood donors has increased from 0.15% in 1993 to 1.4% in 2000.[18]

Sudan has been polio-free since 2009 but is vulnerable to transmission from refugees from high-risk countries. A polio vaccination campaign was launched in 2018, supported by the World Health Organization. 5 million doses have been provided.[21]

In Sudan, sickle cell disease was first reported in 1926 by Archibald.[22] The disease is considered one of the major types of anemia especially in western Sudan where the sickle cell gene is frequent [23] Sickle cell disease is the major haemoglobinopathy seen in the Khartoum, the capital of Sudan. This may be attributed to the migration of tribes from western Sudan as a result of drought and desertification in the 1970s and 1980s, and the conflicts in Darfur in 2005. The rate is higher in Western Sudanese ethnic groups particularly in Messeryia tribes in Darfur and Kordofan regions.[24][25]

The Federal Ministry of Health issues an annual health statistical report that includes data on causes of hospital mortality. Over the past decade, cardiovascular disease has been consistently reported in the top 10 causes of hospital mortality, with malaria and acute respiratory infections as the first two causes.[26]

The SHHS reported a prevalence of 2.5% for heart disease. Hypertensive heart disease (HHD), rheumatic heart disease (RHD), ischaemic heart disease (IHD) and cardiomyopathy constitute more than 80% of CVD in Sudan. Hypertension (HTN) had a prevalence of 20.1 and 20.4% in the SHHS and STEPS survey, respectively. There were poor control rates and a high prevalence of target-organ damage in the local studies. RHD prevalence data were available only for Khartoum state and the incidence has dropped from 3/1 000 people in the 1980s to 0.3% in 2003. There were no data on any other states. The coronary event rates in 1989 were 112/100 000 people, with a total mortality of 36/100 000. Prevalence rates of low physical activity, obesity, HTN, hypercholesterolaemia, diabetes and smoking were 86.8, 53.9, 23.6, 19.8, 19.2 and 12%, respectively, in the STEPS survey. Peripartum cardiomyopathy occurs at a rate of 1.5% of all deliveries. Congenital heart disease is prevalent in 0.2% of children.[26]

In Sudan, the national prevalence of diabetes in adults is 7.7% and is expected to reach 10.8% in 2035.[1] There were  over 2.247.000 cases of diabetes in Sudan in 2017.[27]

On 20 June 2022, according to an analysis released by the Integrated Food Security Phase Classification (IPC), on food security in Sudan, it was assessed that nearly a quarter of the country's population (11.7 million people) faced acute hunger due to the increase in communal conflicts and other acts of armed violence, economic problems after the 2019 Sudanese coup d'état, the displacement of more civilians, and the arrival of more refugees from neighboring countries such as South Sudan, Eritrea, Syria, Ethiopia, Central African Republic, Chad, and Yemen.[28]

On 2023, UNICEF released, that Sudan has one of the highest majority rates of malnutrition among children in the world. There are more than 3 million malnourished children, of which 611,000 are harshly wasted and at high risk of death.[29]

The decay-missing-filled index are indicators used to determine the status of dental caries. The table below is from a 1993 report reporting on such data.[31][33]

* A total of 275 pre-school children in kindergartens from Khartoum were studied.

[37]

This malformation showed a prevalence of 0.9 per 1000 in Sudan. More girls are affected than boys, with a male:female ratio of 3:10. (44% cleft lip with cleft palate, 30% only cleft palate, and 16% cleft lip alone).[38]