Health in Sudan

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Sudan is still one of the largest countries in Africa even after the split of the Northern and Southern parts. It is one of the most densely populated countries in the region and is home to over 30 million people. With this rise in population and bearing in mind the political issues that have plagued the country with war and hostility for the last 25 years, Health care has become an afterthought and basically lost in the midst of what the government might believe to be more pressing matters. Sudan still has a long way to go to achieve its millennium developmental goals and to establish an adequate and efficient health care system that benefits every individual in the country.

Health Situation[edit]

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 78 out of every 1000 children born do not live to see their fifth birthday. The maternal mortality estimated at 216 deaths per 100 000 live births in 2010. 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]

Health Policies and Systems[edit]

Sudan is currently dealing with the socioeconomic hit after the separation of South Sudan, while there is still conflict in Darfur, South Kordofan and Blue Nile states. Sudan’s economy has suffered a great deal from this. Firstly from a fall in oil prices and more recently from the loss of revenue from South Sudan for oil transportation. In addition, there are continuing sanctions and a trade embargo. Due to these happenings, funds for health have been cut, adding to the fragility of the health sector. The health services are provided in addition to the ministries of health (federal, state and localities), by health sub-systems like insurance schemes, armed forces, and private providers. For provision of service, health care is organized at three levels: primary, secondary and tertiary level. The national health insurance fund, in addition to being an actor for financing, has its own health facilities. The armed forces and parastatal organizations like railways and Sudan Air etc. have their own network of health facilities and insurance schemes. The private sector, which is growing at a rapid pace, is concentrated in major cities and focuses on curative care. Sudan developed its national health sector strategy (2012–16) and currently, it is reviewing its national health policy (2007) with the objective to develop a new policy for 2014-2018. The country has also reviewed health system financing using OASIS approach as a prelude to framing its national strategy for health financing. Also, the country has embarked on developing detailed roadmap for providing universal health coverage to its population.[2]

Disease[edit]

Nodding disease or nodding syndrome is a new, little-known disease which emerged in Sudan in the 1980s.[3] It is a fatal, mentally and physically disabling disease that only affects young children. It is currently restricted to a small region of southern Sudan.

Malaria[edit]

Malaria is one of the most deadly and epidemic diseases that affects Sudan and the African region in general. This is mainly due to the high temperatures and inadequate infrastructure regarding drainage and sewer systems. Stangnant and still water that builds up and is not drained becomes a reservoir and breeding ground for mosquitoes. This leads to their large numbers in the affected area. Still, we have reason to believe that the effect and burden of Malaria is somewhat underestimated. 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.[4] 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.[5] 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.

Yellow Fever[edit]

The World Health Organization were notified by the The Federal Ministry of Health of Sudan that there was an outbreak of Yellow Fever in 2013 which affected 12 localities in West and South Kordofan States.[6] The Yellow Fever Outbreak had 44 suspected cases including 14 deaths resulting from this fever. In order to reduce the spread of Yellow Fever, The World Health Organization is working with The Federal Ministry of Health in Sudan to come up with a vaccination campaign.

Maternal and Child Healthcare[edit]

In June 2011, the United Nations Population Fund released a report on The State of the World's Midwifery. It contained new data on the midwifery workforce and policies relating to newborn and maternal mortality for 58 countries. The 2013 maternal mortality rate per 100,000 births for Sudan is 2054. This is compared with 306.3 in 2008 and 592.6 in 1990. The under 5 mortality rate, per 1,000 births is 109 and the neonatal mortality as a percentage of under 5's mortality is 34. The aim of this report is to highlight ways in which the Millennium Development Goals can be achieved, particularly Goal 4 – Reduce child mortality and Goal 5 – improve maternal death. In Sudan the number of midwives per 1,000 live births is 1 and the lifetime risk of death for pregnant women 1 in 7.

Levels and trends in under-5 and infant mortality[edit]

  • In Sudan, under-five mortality declined by 43 percent (on average, 1.5 percentage points per year)

between 1965 and 2008 - from 157 to 89 deaths per 1000 live births. Improvements in under-five mortality during this period were driven primarily by reductions in child mortality (deaths among children aged 1–5). Progress in reducing infant mortality was slower by contrast – falling from 86 to 59 infant deaths per 1000 live births – at a rate of 0.7 percent per year.

  • Under-five mortality levels for Sudan are 30 percent lower than the average for Africa and 51 percent

higher than the global average. Sudan’s under-five mortality rate is at the average for low-middle income countries

  • Mortality among children is heavily concentrated during their first year. An estimated 65 percent of deaths

occurring before the age of five, happen during infancy (before children reach one year of age) and approximately 33 percent of deaths occurring before the age of five happen during the neonatal period (in the first 30 days after birth).

  • Mortality among children is heavily concentrated during their first year. An estimated 65 percent of deaths

occurring before the age of five, happen during infancy (before children reach one year of age) and approximately 33 percent of deaths occurring before the age of five happen during the neonatal period (in the first 30 days after birth).[7]

Maternal health[edit]

  • Complications during pregnancy affect one three pregnant women and complications during labor or up to

six weeks after delivery affect one in two pregnant women. Close to 50 percent of female deaths occurs during pregnancy, delivery or two months after delivery. In this high risk setting, access to a continuum of effective antenatal, intrapartum and post-partum care for pregnant women is critical.

  • In 2010, evidence-based maternal survival interventions (including professional antenatal and delivery

care) covered 40 percent of women in need. (up from 35 percent in 2006).

  • Family planning and effective ante-natal care are among the maternal survival interventions with the

lowest population coverage: In 2010, 11 percent of married or cohabiting women used some form of contraception. Unmet demand for contraception is particularly large among cohorts of women older than 30 years of age.

  • Between 2008 and 2010, while 73 percent of pregnant women reported attending at least one antenatal

check-up, only 14 percent of pregnant women reported obtaining an effective package of antenatal services including four antenatal care visits, an assessment for blood pressure, urine screen for protein, a blood screen for anemia and two doses of tetanus toxoid vaccine.

  • Between 2008 and 2010, among women of reproductive age with a pregnancy, 73 percent of all births

were delivered with the support of a skilled professional (births attended by a doctor, nurse midwife or village midwife) - up from 63 percent between 2004 and 2006. This increase in coverage was driven by an increase in the proportion of births delivered by auxiliary or village midwives. The gains in professional support during childbirth have benefitted women in rural and urban areas alike.

  • As 75 percent of women reside in rural areas and births primarily occur in the home (in 2010, 75 percent of

births occurred in the home), a significant challenge in this setting is to ensure women have access to emergency obstetric care if needed. Emergency care requires the availability of unscheduled 24 hour services close to the home. In Sudan, only one in five women delivers in a facility. Expanding the availability [8]

Vital statistics [9][edit]

The vital statistics below include South Sudan.

Period Live births per year Deaths per year Natural change per year CBR* CDR* NC* TFR* IMR*
1950-1955 452 000 233 000 219 000 46.5 24.0 22.5 6.65 160
1955-1960 510 000 251 000 259 000 46.7 23.0 23.8 6.65 154
1960-1965 572 000 268 000 304 000 46.6 21.8 24.7 6.60 147
1965-1970 647 000 281 000 365 000 46.5 20.3 26.3 6.60 137
1970-1975 737 000 298 000 438 000 46.2 18.7 27.5 6.60 126
1975-1980 839 000 317 000 522 000 45.1 17.1 28.1 6.52 116
1980-1985 950 000 339 000 611 000 43.6 15.5 28.0 6.34 106
1985-1990 1 043 000 361 000 682 000 41.7 14.4 27.3 6.08 99
1990-1995 1 137 000 374 000 763 000 40.1 13.2 26.9 5.81 91
1995-2000 1 242 000 387 000 855 000 38.6 12.0 26.6 5.51 81
2000-2005 1 324 000 373 000 951 000 36.5 10.3 26.2 5.14 70
2005-2010 1 385 000 384 000 1 001 000 33.8 9.4 24.4 4.60 64
* CBR = crude birth rate (per 1000); CDR = crude death rate (per 1000); NC = natural change (per 1000); IMR = infant mortality rate per 1000 births; TFR = total fertility rate (number of children per woman)

See also[edit]

External links[edit]

References[edit]

  1. ^ (WHO 2014)
  2. ^ (WHO 2014)
  3. ^ Lacey M (2003). "Nodding disease: mystery of southern Sudan". Lancet neurology 2 (12): 714. doi:10.1016/S1474-4422(03)00599-4. PMID 14649236. 
  4. ^ "The burden of malaria in Sudan: incidence, mortality and disability – adjusted life – years". 2007. 
  5. ^ "The burden of malaria in Sudan: incidence, mortality and disability – adjusted life – years". 2007. 
  6. ^ "Yellow fever in Sudan - update" (Press release). The World Health Organization. 3 December 2013. 
  7. ^ Maternal & Child Health in Sudan by Paul Gubbins & Damien de Walque
  8. ^ Maternal & Child Health in Sudan by Paul Gubbins & Damien de Walque
  9. ^ World Population Prospects: The 2010 Revision