Sudan

Activities

Understanding vector control sustainability and acceptance
  • Operational research
Summary

KalaCORE teamed up with researchers from the University of Khartoum, Gedarif University and the Blue Nile Health Institute (Sudan) and University of Gondar (Ethiopia) to investigate multiple aspects of vector control in East Africa: 

 

  • Efficacy of different control measures on the vector of VL, Phlebotomus orientalis, and on transmission of visceral leishmaniasis in East Africa
  • Vector bionomics and behaviour of the vector that influence the impact of these
  • Acceptability of vector control tools under different cultural and socioeconomic contexts (migrant populations from Ethiopia and resident populations in Sudan).

Publications from these studies are expected after the end of the KalaCORE programme.

Health education
  • Health education
Outputs

Health education in Sudan was implemented by the WHO with support from KalaCORE. Innovative and cost-effective strategies for health education were developed in close collaboration with the MoH and began in early 2016 in the state of Gedarif.. After further development of the health education strategy, an array of Behaviour Change Communication (BCC) and Social and Behaviour Change Communication (SBCC) interventions also started and by April 2018, sensitisation on VL reached not only populations in endemic Gedarif and Sinnar states and in new VL foci locations in Kassala and Red Sea states, but also seasonal workers from Ethiopia and Eritrea, refugees from South Sudan and IDP populations. Health education of patients was undertaken in all 44 KalaCORE-supported VL treatment centres in 12 states across the country. Health promotion training was also provided to women volunteers, community workers, teachers and 'kala azar ambassadors' (former patients).

 

A range of activities have taken place to increase community awareness of VL: from home visits, child-to-child activities, distribution of BCC materials (street banners, posters, T-shirts, side caps) to organisation of forum theatres and mobile cinemas, participation in local festivals and radio programs. An estimated 2 million people were reached by October 2018.

 

The clinical mentoring teams have also actively contributed to health education activities in Sudan during visits to VL treatment facilities. On top of supporting VL clinical management they have also trained health promoters, conducted community awareness during supervision visits and met with local stakeholders to advocate and encourage community commitment on VL control.

Improving reporting and surveillance
  • Improving surveillance
Outputs

In order to improve data collection and documentation, KalaCORE, along with WHO and the Federal Ministry of Health, first focused on updating the standardised surveillance tool for VL (included in patient files). Though reporting of VL was being done in KalaCORE-supported facilities, the quality of reporting was low and data collected often incomplete. With the help of trained personnel allocated in each health facility and the clinical mentoring teams, timely reporting on case data on VL and PKDL and stock reports increased across all KalaCORE health facilities.

 

To improve surveillance, two VL surveillance officers, one working nationally in Khartoum and one in Gedarif, were seconded through WHO. KalaCORE has also been collaborating with the WHO for introduction of an improved health information system – the District Health Information Software (DHIS2) – in Sudan, with a dedicated interface for VL. Roll-out of DHIS2 started in 2018 together with staff training in the use of the software and supply of equipment needed.

 

The Kala Azar Hotline has also supported of monitoring VL and assisting in the referral of VL/suspected cases. In response to considerable influx of refugees from VL endemic areas of South Sudan, in March 2015 KalaCORE conducted VL training in 2 clinics in White Nile camps. Following this training, the Kala Azar Hotline received an increasing number of calls regarding patients diagnosed with VL, allowing for emergency intervention to transport patients to treatment centres.

Strengthening health facilities
  • Case management
  • Training health workers
  • Operational research
Outputs

Comprehensive health facility assessments of 36 facilities in Sudan were conducted at the start of the programme in 2015 and results from these assessments were used to guide facility strengthening, provision of basic equipment, drugs and diagnostics and training plans.

 

By 2016, each of these facilities had received equipment and a key trained contact person was nominated. Meanwhile, 23 clinics began to provide decentralized VL services in camps for South Sudanese refugees and internally displaced persons (IDPs) in the White Nile, South Kurdufan, North Darfur and South Darfur states. Seven new treatment centres (4 in Red Sea state and 3 in Kassala state) were established by March 2018 and rehabilitation of 2 VL wards in Gedarif teaching hospital and in Gedarif paediatric hospital was also initiated.

 

By October 2018, each of the  VL treatment centres supported by KalaCORE and WHO, had at least one person trained in the last year, rapid tests and first and second line drugs available with no stock ruptures in last 3 months, VL guidelines and SOP's present, wards and a laboratory with basic standards in place.

 

Health facility strengthening has been largely facilitated by the clinical mentoring (CM) teams and the creation of a “Kala-azar hotline”. The CM teams have been visiting facilities to give on-site training, bedside monitoring and help address drug and diagnostic kit supply gaps, while the “Kala-azar hotline”, accessible 24/7, provides advice via mobile phones and immediate support for health personnel managing patients under treatment to.

 

Also, of note was the establishment of the Kala-azar Research Centre (KRC) in 2016. It is the first such centre on VL research allowing for the formation of collaborations between the University of Gedarif (UoG)(Sudan) and the University of Gondar (Ethiopia). KalaCORE M&E activities and studies on understanding access to VL care have been conducted there.

Health provider training
  • Training health workers
Outputs

VL care provision has often suffered in Sudan due to high staff turnover in facilities. In response KalaCORE has been providing ongoing training of health providers - health workers at refugee and IDP camps, medical staff (medical doctors, medical assistants, nurses and lab techs) at health facilities, senior medical doctors, and separate laboratory training. Training materials and delivery have been developed through inter-agency cooperation, coordinated by KalaCORE and WHO and including Federal Ministry of Health, the University of Gedarif, Institute of Endemic Diseases, DNDi and MSF. By October 2018 over 2,000 health workers have been formally trained.

Clinical Mentoring
  • Case management
  • Training health workers
Outputs

Three clinical mentoring (CM) teams were formed in June 2017 for the provision of on-the-job training and mentoring on VL case management at health facilities, stock management and support for surveillance. CM teams have been instrumental to VL care delivery via supervisory visits. In addition to the training of health staff of multiple health cadres (e.g. medical, laboratory staff, pharmacists), reporting and checking drug stocks and supplies, CM teams have also actively encouraged community engagement through the training of health promoters and participation in activities like radio programmes on VL.