Sudan HIV/AIDS Working Group (SHAWG) & University of Kassala
Kassala Chikungunya Outbreak
(Report of SHAWG Volunteer visit to Kassala during the epidemic)
19/10/2018
By
Yusri Abdalla Taha and Abdalla Ali Mohammed
Table of Contents
Preface 2
Background 3
Terms of reference 3
Methodology 3
Outcomes (Details of the main activities) 5
1. Meeting UFOS Study team 5
2. Public Health Laboratory in Kassala 6
3. Clinical Meetings and Observations 7
4. The First CHIKV/Arbovirus Research Meeting 8
5. Engagement with Political Leadership and the Public 8
6. Lobbying for CHIKV/Arbovirus Research 9
7. National Public Health Laboratory in Khartoum 10
Conclusions and Recommendations 10
Appendices 12
Appendix I: Schedule summary 12
Appendix II: Photogallary 15
Appendix IV: Minutes of first CHIK research meeting 19
Preface
SUDAN HIV/AIDS WORKING GROUP (SHAWG) is a group of Sudanese professionals with special expertise in Infectious Diseases and Medical Microbiology and Virology; and a prominent player in “Transfer of knowledge” activities to counterparts in Sudan over the last decade. Previous endeavours have largely focused on HIV and blood borne viruses, but the groups’ clinical and research interests are wide. In response to University of Kassala request to SHAWG for working together in research following Chikungunya epidemic, they send a member form the group to visit Kassala during the epidemic. Here is a summary of the assessments made by Dr Yusri Taha, an expert in Infectious Diseases and Medical virology based in the United Kingdom. He visited Kassala in October 2018 .
Dr Taha carried out the assessments as an emissary of SHAWG and a visiting consultant to the University of Kassala and the National Public Health Laboratory in Khartoum. He is a graduate from the University of Khartoum (1992). He completed the internship in Khartoum and Suba University Hospitals before moving to the United Kingdom where he completed his training obtaining the membership of the Royal College of Physicians (MRCP-UK) and later on the Fellowship of the Royal College of Pathologists (FRCPath), obtaining the first ever simultaneous accreditation granted to a physician in Infectious Diseases and Medical Virology (2008). Dr Taha received a medical Doctorate (MD) from the University of London on a thesis entitled: The genetic viral and host factors in herpes zoster virus (2009). He worked for over a decade as a consultant in Internal Medicine, Infectious Diseases and Medical Virology. He is currently the designated virologist for Public Health England (North East of England) and the High Consequence Infectious Diseases (HCID) Unit in Newcastle upon Tyne University Hospitals where he works. Dr Taha, an active researcher, authored many scientific papers, textbook chapters and served as editor of the Journal of Medical Microbiology.
We much appreciate the efforts made by Dr Taha and his colleagues and have the pleasure of writing this preface to the SHAWG/University of Kassala report on chikungunya outbreak.
Kind regards
Professor Abdalla Ali Mohammed
Vice-Chancellor
Abstract:
This report summarises the outcomes of the Sudan HIV/AIDS Working Group, SHAWG, recent visit to Kassala, eastern Sudan. Information about the ongoing Chikungunya virus (CHIKV) epidemic was initially collected through literature search and numerous personal communications. The Group then developed a provisional plan of action and proceeded, as per our standard practice, to identify appropriate partners in the Sudan. A joint plan with the University of Kassala and Virology Section at the National Public Health Laboratory (PHL) was quickly agreed and a SHAWG volunteer, Dr Yusri Taha – an expert in Infectious Diseases and Medical Virology, was sent to Sudan to carry out the first mission. The main elements of the plan were: 1. evaluation of the situation on the ground, 2. review of clinical management guidelines, 3. appraisal of public health laboratories’ preparedness to deal with emerging viral infections, and 4. facilitating rapid establishment of a framework for CHIKV and emerging viral infections research. The visit took place between 6th and 16th of October 2018. The four objectives above were tackled with varied success. In summary, the official figures of reported cases appear to severely underestimate a massive epidemic. Furthermore, a lot of uncertainties remain with regard to the spectrum of clinical features, case fatality rate, long-term impact of virus-induced arthritis and the potential interaction between CHIKV and malaria and/or other co-circulating arboviruses. Visits to the National and State’s PHLs were informative and resulted in drafting specific recommendations for improving diagnostic capabilities. Major steps were also taken towards forming research groups to study different aspects of CHIKV and arbovirus disease in Kassala and beyond. Potential collaborating research centres and other important stakeholders such as the World Health Organization team in the Sudan were informed of the plan and invited to support and join various research strands. We successfully lobbied the Federal Government to support the research effort spearheaded by University of Kassala. Finally, we carried out a number of educational activities to healthcare staff and the public through formal lectures, TV interviews and social media outlets.
Background:
An epidemic of acute febrile illness associated with severe muscle and joint pain has been ongoing since July 2018 in Kassala city, Kassala state, eastern Sudan. The cause of the illness was clinically suspected by local physicians and later confirmed by the National Public Health Laboratory (NPHL) in Khartoum as Chikungunya virus (CHIKV) – 11.08.2018. However, there have been conflicting reports about the size of the epidemic, the spectrum of the clinical manifestations and associated mortality. Many anecdotal and social media reports highlighted the presence of haemorrhagic features and a significantly high case fatality rate and questioned the stance that CHIKV is the sole agent responsible for the outbreak. In contrast, official reports from the Ministry of Health dismissed the epidemic as a limited CHIKV outbreak with virtually no associated mortality. As an active player in the field of ‘Transfer of Knowledge’ and a group with special expertise in the fields of Infectious Diseases and Virology, SHAWG members held a series of online meetings between 20th and 23rd September 2018 about the situation in Kassala. The main focus of the discussions was on what SHAWG could do to help people, healthcare staff and the authorities in Sudan in their fight to understand and control the outbreak. A blue-print of actions was then drafted and a decision was made to send a SHAWG expert urgently to Sudan to execute the agreed plan in collaboration with the University of Kassala, a long-term partner of SHAWG, and NPHL.
Terms of Reference:
1. Evaluation of the situation on the ground through direct observation and interviews of major stakeholders in Kassala.
2. Review and critical appraisal of the Clinical Management Guidelines of chikungunya and carrying out, where and when appropriate, teaching/ training of front-line medical staff.
3. Visit the National Public Health Laboratory in Khartoum and its subsidiary State’s laboratory in Kassala to identify areas that should be prioritized as targets for improving diagnostic services and capacity building for purposes of current and future outbreak management.
4. Facilitating establishment of a research framework and collaborative networks to study the outbreak with the main aims being better understanding of the epidemic size and dynamics and disease burden, with University of Kassala assuming a leading role in this endeavour.
Methodology
1. Terms of reference as detailed above were discussed in a “Cyber” platform and agreed.
2. The local partners: University of Kassala, represented by Professor Abdalla Ali Mohammed, vice Chancellor, and the National Public Health Laboratory (NPHL), represented by Dr Abdalla Abdulkarim Osman, Director General of NPHL and Professor Mubarak Karsani, consultant Virologist at NPHL, were identified and contacted with the details of the plan.
3. Dr Yusri Taha, a consultant in Infectious Diseases and Virology at Newcastle University Hospitals, and the High Consequence Infectious Disease (HCID) Unit, supported by Professor Abdalla Ali Mohammed, carried out the mission as a visiting consultant to the University of Kassala and Sudan’s NPHL.
Outcomes
(Details of the main activities): – for full list of activities and timetable, see Appendix I on pages 11-13.
1. Meeting UFOS Study team
The “Severe Undifferentiated Febrile illness outbreaks in Sudan – UFOS” study is a MoH approved and UK government-funded study. It is run by the UK-Public Health Rapid Support Team (UK-PHRST). The Study team, including Dr Tom Fletcher from PHE, UK, Professor Mubarak Karsani, from NPH, Mr Mohammed Elamin Alfaki, laboratory technologist and two members of Federal MoH epidemiology arrived in Kassala on 6th of October. We arranged beforehand to meet with them to discuss mutual interests. We worked closely together for a 3 days’ period.
1.1 Findings / observations:
1.1.1 This pre-approved study led by Dr Tom Fletcher and Dr Hilary Bower is a very important study. It should upon completion provide much needed epidemiologic, clinical and virological information about Kassala epidemic.
1.1.2 The study protocol was not designed originally with CHIKV in mind; and with Dar-Fur largely expected to be the region of next viral disease emergence, not eastern Sudan.
1.1.3 The Study had no local Kassala-based collaborators.
1.1.4 Sorting logistics for patient recruitment, data collection, specimen sorting and storage, performing baseline ancillary tests, etc. was at its early stages.
1.2 Actions:
1.2.1 We dedicated a couple of hours every day during our trip to attend the Study meetings and helped to sort some of the logistics and recruitment issues [Done].
1.2.2 We recommended urgent amendment to the UFOS protocol to include more details about arthritis and extend the follow up time to study long-term impact [outstanding].
1.2.3 We recommended collaboration with University-based clinicians and researchers. Four (4) medical and paediatric registrars joined the Study group officially after discussion with their team leaders [Done].
1.2.4 Requested early access to the results of extended PCR analysis as that will form the basis for development of evidence-based repertoire / panels that are suitable for local diagnostic, surveillance and research purposes [Done].
1.2.5 Invited the UFOS team to attend and contribute to the proceedings of the first meeting of research groups into Chikungunya in Kassala [Done].
1.2.6 We received agreement from Dr Fletcher (and by email from Dr Bower) to collaborate in future, SHAWG-facilitated, research activities into vector-borne diseases in Kassala and beyond [Done].
2. Public Health Laboratory in Kassala State
We visited the Public Health laboratory in Kassala on 2 successive days to gain insights into the laboratory’s facilities and technical operation. The lab is run administratively by the State’s MoH with technical issues coming under the auspices of the National Lab in Khartoum.
2.1 Findings / observations:
2.1.1 The laboratory is built on a generous plot on the outskirts of the City. The building itself is sound and number of laboratories and rooms therein is adequate.
2.1.2 Biomedical technologists (6) appear to be competent and knowledgeable.
2.1.3 Operationally, the laboratory is in a very poor state with very limited services provided.
2.1.4 Developing a laboratory organization and management system, including documentation of standard operational procedures, a code of practice and a quality assurance plan are mandatory steps that are urgently needed.
2.1.5 After discussion with laboratory manager Mr. Mubarak Ibrahim Idris and Dr M. Karsani from NPHL, we agreed that the (minimum) equipment required to support the planned/future research and surveillance of arboviruses would include the following:
• Centrifuge(s) (not available).
• Freezers (-20C and -80C). These are available but not installed.
• Analyzers for routine blood counts (not available) and blood chemistry (available but needs setting up and reagents) and improving the facility for malaria testing (microscopy suite available).
• Analyzer/ kits for essential viral serology such as blood borne viruses (not available).
• Cryo-tubes and boxes suitable for sample freezing and storage (not available).
• IT support in shape of an Internet connected PC (not available).
• (A functioning Class I Biosafety Cabinet may be required)
2.2 Actions:
2.2.1 The role of the State’s Public Health Laboratory in prevention and control of infectious diseases outbreaks was emphasized with staff and authorities in Kassala and Khartoum. SHAWG declared the current situation of the lab, 2 months into the largest outbreak in the history of the city, as unacceptable [Done].
2.2.2 Currently unavailable essential laboratory items as described above were discussed with the Minister of Health and the State Governor (see below) who both kindly promised to make them available as soon as possible [outstanding].
2.2.3 The laboratory organization, management, safety, and quality issues will be addressed collectively with that of the National Lab in Khartoum (see below) [outstanding].
3. Clinical Meetings and Observations
We conducted 3 ward-rounds with registrars (Monday) and senior physicians. ICU and paediatric wards were visited on Tuesday while Accident and Emergency Department was attended on Wednesday. We convened one clinical meeting with hospital clinicians, after a formal lecture on arboviruses, to discuss the MoH CHIKV Guidelines. We also attended one outbreak management team meeting at the MOH.
3.1 Findings / observations:
3.1.1 Individuals with fever, nausea and severe muscle and joint pain in whom Malaria test is negative continued to arrive in Kassala Hospital (and Health Centre across the city).
3.1.2 The wards were very busy with no empty beds however the turnover is usually very high with admissions, for all causes, regularly exceeding 30 patients/ day.
3.1.3 Malaria is on the rise with many severe falciparum malaria cases seen during the week.
3.1.4 Co-infection with CHIKV or other viruses could not possibly be excluded in severe cases.
3.1.5 Severe arm cellulitis cases (IV fluid infusion site) were observed, 2 were in ICU.
3.1.6 There is no algorithm/mechanism to capture cases in which CHIKV contributed to death.
3.1.7 Inappropriate use of platelet transfusion was commonplace.
3.1.8 We noted that no posters or leaflets carrying information on CHIKV case definition or management of are available anywhere on the wards or admission unit.
3.1.9 The MoH Guidelines are not available in soft or hardcopy format and the junior doctors who are competent enough are unaware of any documents issued by the MoH.
3.1.10 (IV quinine is used preferentially despite the availability of artesunate injection).
3.2 Actions:
3.2.1 Highlighted to the Outbreak Team that the decline in registered CHIKV numbers may be a reflection to the fact that most of the people living in mosquito-infested households were already infected [Done].
3.2.2 Warned against creeping complacency into the ongoing vector control efforts [Done].
3.2.3 Requested that posters carrying the MoH Clinical Guidelines bullets be printed and distributed in admissions units in all hospitals [Outstanding]. Not too late.
3.2.4 Advised that blood samples for CHIKV / DENV PCR and serum save be sent from all severely ill patients, especially those in ICU, and from those with CNS disease, profound thrombocytopenia and/or bleeding. This is imperative in order to gain insight into case fatality rates and potential impact of co-infections [Done].
3.2.5 Advised strongly against platelet transfusion for patients who are not actively bleeding and in whom platelet counts are in excess of 20,000cell/ml. Discussed during ward rounds / clinical meeting and through WhatsApp to the public in Kassala [Done].
3.2.6 Suggested review of IV quinine practice and appraisal of barriers to the use of the superior drug artesunate [Done].
4. The First CHIKV/Arbovirus Research Meeting
The first research meeting was arranged and chaired by Professor Abdalla Ali Mohammed at the University. The meeting was attended by representatives from various academic units in the University, MoH, Vector Control Task Force, NPHL and Dr Tom Fletcher from the UFOS study (separate minutes of the meeting available from University of Kassala).
4.1 Findings / observations:
4.1.1 The meeting was addressed by SHAWG representative, introducing SHAWG, its aims and role in ‘transfer of knowledge’ and support of various clinical and research activities in the country and, in particular, in Kassala since 2009.
4.1.2 We emphasized the “research and community service” roles expected, by definition, from University and academia. Policy makers require the right, adequate and timely information in order to take effective and appropriate decisions. Providing such information is the responsibility of the Universities and research centres.
4.1.3 Excellent accounts were given by physicians, epidemiologists, vector-control team, and laboratorians on their views and overall impressions about the outbreak.
4.1.4 Personal accounts about the disease manifestations were presented by two senior physicians, emphasizing the disabling nature of virus-induced arthritis and other interesting clinical features.
4.2 Outcomes:
4.2.1 The meeting recommended the immediate formation of at least three teams with defined themes: Epidemiology / Medical / and Obstetric. [Done]
4.2.2 The responsibility of the teams is to formulate a priority list of research questions, identify partners and collaborators and seek funding for executing specific projects. [Outstanding]
4.2.3 It was agreed that efforts must be broad and directed ideally towards all vector-borne infections with emphasis on viral agents. [Done]
4.2.3 It was agreed that the University of Kassala must make the best of a terrible incident by taking advantage of the high coverage of the outbreak to improve the research infrastructure in the University. [Outstanding]
4.2.4 It was recommended that University leadership, helped by SHAWG, start urgent communications with higher levels to secure support for planned research activities. [Done]
4.2.5 More teams, including vector control and mosquito fauna mapping, economics and land topography study, among others, to be formed later. [partly done]
5. Engagement with Political Leadership and the Public
5.1 We have visited the State’s Ministry of Health and Social Security and spoken to the minister, Mr Abdalla Adam Abbas. We gave a presentation about SHAWG, its mission and our impressions about the epidemic. The minister showed interest and asked many questions about the virus and the nature of outbreaks. We specifically explained that CHIKV outbreaks have become frequent in recent years and have thus far affected so many countries. These outbreaks are by their very nature explosive and may affect hundreds of thousands in one wave. We postulated on the causes of the epidemic in Kassala pointing specifically to the largely unplanned growth in city buildings and population and the high temperatures and wet weather in recent years. These factors, along with weak public health infrastructure, appeared to have combined to fuel the out-of-control rise in Aedes mosquito population. The overall conditions provided the right environment for the outbreak once a case (or cases) of CHIKV was introduced in this susceptible population. Kassala is a border city and traffic volume through it, to and from other parts of Sudan or neighboring countries, is one of the highest in the country.
The Minister kindly arranged for us to see Mr Jammaa Adam Jammaa, the State Governor (Walli) and accompanied us to the meeting.
The sentiments above were reiterated and our specific messages included:
5.1.1 The figures quoted by MoH should be qualified as “numbers of patient attended and registered” rather than the true figure of the affected persons.
5.1.2 Morbidity is very high; diseases do not have to kill to be regarded as significant.
5.1.3 Arthritis may have a long lasting effect on a community consisting mainly of laborers / manual workers who already suffer from malnutrition and other chronic diseases.
5.1.4 Efforts made to control the vector finally appeared to be successful, but more resources should still be provided as this is the ONLY thing people could do at present time to control the epidemic. complacency therefore is dangerous.
5.1.5 The decline in number of cases counted at hospitals and health centres may be a reflection of the fact that most of the population had already been infected.
5.1.6 The public health laboratory is in a dire state two months into the biggest infectious disease outbreak in the history of the State and that is difficult to understand.
5.3 We were hosted on Live TV (Kassala satellite TV station) for one hour in a popular and widely viewed show. We spoke about the outbreak and answered questions regarding the nature of the disease and the most appropriate management steps. Anecdotally, we received positive feedback.
5.4 The efforts made by various community groups in Kassala have been immense. We have recorded a WhatsApp message in support of these great efforts. We took the opportunity to highlight the dangers of inappropriate use of IV fluids and platelets transfusions as many physicians were reluctant to voice such advice because of fear of vilification in social media.
6. Lobbying for CHIKV/Arbovirus Research in the Centre
6.1 SHAWG team travelled to Khartoum and had an audience with the Minister of Higher Education and Scientific Research, Dr El-Sadiq El-Mahdi. The meeting was attended by Mr Osman Jaafar, President of University of Kassala. The meeting was very good. The Minister, a fellow physician, was very supportive of the blue-print of our research plans. He kindly invited the Kassala research leads to come over to Khartoum to discuss the details of the plan and to announce it as a “University of Kassala Initiative”. We designed a slogan for the meeting that captured the bigger picture of “vector-borne infection” in preparation for media coverage and invited potential collaborators from MoH, University of Khartoum, Blue Nile Project, and others, to attend the second meeting with the Minister.
The second meeting was successful and was widely covered by National media. The Minister for Scientific Research announced the start of the Initiative and declared the Ministry’s full support for it. Response from partners was very encouraging.
6.2 We also held a 3-hour meeting in Khartoum with the World Health Organization’s team responsible for Kassala outbreak and met Dr Naeema Al-Gasseer, the WHO representative in Sudan. WHO Kassala team is a newly appointed trio of vastly experienced physicians, led by Dr Ahmed Shadoul. We shared our impressions about the current situation in Kassala with them and discussed our research and other plans to boost public health laboratories capacity.
We agreed to coordinate research efforts as much as possible. While WHO will naturally lead support for the Federal MoH in evaluating the situation through implementation research (Operational Research), they are happy to do so as part of a road-map that includes all elements of University of Kassala research plan. We explained to the team our determination to take advantage of the current epidemic to improve the infrastructure of healthcare research in the University and to adhere to the highest standards of research. The WHO team agreed, in principle, to support and advise the teams undertaking research in Kassala and reciprocally involve University of Kassala and partners as appropriate in the Operational Research side.
6. National Public Health Laboratory in Khartoum – NPHL (separate confidential
report)
We visited the NPHL in central Khartoum and met Drs Abdalla Abdulkarim Osman and Mubarak Karsani and Virology laboratory biomedical staff. The NPHL is one of the oldest institutions for diagnostic and medical research in Africa and has so many strengths. We spent half a day at the laboratory, undertaking a lab tour and a debrief meeting at the end of the visit.
NPHL is the only identified VHF facility in the country. In the debrief meeting, we discussed lab safety issues, lab organization, sample flow and storage, improving standards in the PCR lab and participation of EQA schemes. We also discussed a plan to expand diagnostic repertoire and maintain proficiency of staff.
Conclusions and recommendations:
1. The visit to Kassala was short but it was generally useful.
2. Out-of-control growth in Aedes mosquito species population in Kassala, coupled with occurrence of other conducive conditions, was clearly behind this explosive vector-borne viral disease epidemic.
3. The Chikungunya outbreak was very large, and we have concern that it may have significant long-term impact on the livelihood of the people in the community.
4. Great efforts were made by many governmental and non-governmental agencies to control the outbreak. The ongoing community efforts are particularly exemplary. All activities should be described with proper documentation of the human and financial resources used.
5. However, two months after the onset of the outbreak, there are still many gaps in the processes and procedures of management and control. Well designed “implementation research” is of the essence.
6. Questions about the precise size and dynamics of the outbreak, clinical manifestations, impact on vulnerable groups, morbidity and mortality and potential interactions with malaria and other viral infection, known and unknown, remain unanswered.
7. The Public Health Laboratories require “significant” technical and financial support in order to adequately carry out their responsibilities in controlling infectious disease epidemics and inform preparedness for it.
8. Excellent progress was made in streamlining research agendas, establishing teams, identifying and contacting partners and securing political support for that.
9. Writing research proposals of the highest quality is urgently needed in relation to issues raised in the points 2,3,4,5, and 6 above. Potential sponsors are expecting submissions before the end of the year.
10. SHAWG’s role in supporting University of Kassala and National Public Health Laboratories in Sudan must continue through regular visits and project-based collaborations.
Appendices:
08.10.2018
First Chikungunyua Meeting
10.10.2018
Received an award of recognition and thanks from University Deans Committee on behalf of SHAWG
10.10.2018
Received an award of recognition and thanks from University Deans Committee on behalf of SHAWG
Meeting Adam Jamaa, Wali (Governor) of Kassala State, who gave full support for the mission.
Ust. Abdalla Adam Abbas, Kassala State Minister of Health.
Background and title coined by SHAWG for the announcement of the Research Initiative discussed with the Minister for High Education and Scientific Research, Dr Al-Sadiq Al-Mahdi, during a meeting with his excellency on Thursday 11th October (13:00 – 13:45).
Section 6 in the report
Visit to the National Public Health Laboratory in Khartoum
13th October (Section 7 in report)
Photograph with Virology Lab Staff; from left:
Nuha Al-Aagib, Ilham Mohammed, Ben Gannon, Mawahib Al-Digail, Mubaral Al-Karsani, Yusri Taha and Rihab Al-Aagib
Announcement of Kassala Initiative for research in CHIKV and arboviral diseases at Ministry of Higher Education & Scientific Research
14th October (14:00 – 15:30)
Right: The Minister with University research team, Mr Osman Jaafar, Dr AlKarib (State minister FMoH, and Ms Somia Okood (Epidemiologist, State Minister of Tourism).
Left : YT with Professor Ahmed Hassan Fahal, Director of Scientific Research & Innovation at Ministry of High Education
Appendix III:
Excerpts of messages sent via WhatsApp to the public in Kassala
These messages were sent in response to queries that reached us from public
Appendix IV: The First CHIKV/Arbovirus Research Meeting
8th October 2018
The First CHIKV/Arbovirus Research Meeting Venue: VC Meeting Room Time: 13:00
Attendance:
1. Prof. Abdalla Ali Mohammed: the Vice Chancellor, University of Kassala,
2. Dr. Yusri Abdalla Taha: SHAWG representative
3. Prof. Mubarak Karsani: National Medical Laboratory
4. Dr. Tom Fletcher: Severe Undifferentiated Febrile illness outbreaks in Sudan (UFOS).
5. Dr. Awadia Khojali Mohamed: Associate Professor of Obstetrics & Gynaecology , Dean Faculty of Medicine & Health Sciences (FMHS).
6. Dr. Fatima Abbas Khalid: Associate Professor of Molecular Biologist (Dean Faculty of Science).
7. Dr. Asmal Mahmoud Hamza: Assistant professor (Entemolgy) Faculty of Education.
8. Dr. Hamza Mohamed Ali (OBGYN), Head Dept. of Obs & Gynae Faculty of Medicine & Health Science
9. Dr. Mohamad Mudawi Elamin Assistant Professor of Obstetrics & Gynaecology. Director of Kassala New Hospital (Maternity)
10. Dr. Ikhlas Suliman Elkheir: Senior Physcian: Kassala Teaching Hospital.
11. Ms Bahga Mustafa Abdelgadir: Lecturer, Head of Medical laboratory Sciences Program, FMHS
12. Dr. Mohamed Abdelrazig Dassogi: Assistant Professor of Paediatrics, Director of Kassala Children Hospital.
13. Dr. Khadija Suliman Zaroog: Assistant Professor of Parasitology, FMHS.
14. Dr. Malak Abdelmajid Elhaj: Lecturer, Medical Laboratory Science Program, FMHS.
15. Mohamed Elamin Ahmed Elfaki: National Laboratory Science – Khartoum.
16. Mohmoud Mohamed Elhaj: Lecturer, Medical Laboratory Science Program, FMHS.
17. Dr. Ahmed Ibrahim Abdelfattah: Associate Professor, Obstetrics & Gynaecology.
18. Mr. Abdelhadi Adam Mohammed: Lecturer, Medical Laboratory Science Program, FMHS.
19. Dr. Abdelhafeez Osman Mahmoud: Associate Professor of Community Medicine, Vice Dean FMHS.
20. Dr. Abuelgassim Osman Karoum: Associate Professor of Pathology, Head Dept of Pathology, FMHS.
21. DR. Mohamed Faroug Siddig: Associate Professor of Paediatrics, FMHS
22. Mr. Mubarak Ibrahim Idris: Director of Kassala Public Health Lab.
23. Ms Shadia Abdalla Suliman: Lecturer, Nursing Program, FMHS.
24. Ms Marwa Elsadig Alansari: Lecturer, Medical Laboratory Science Program, FMHS.
25. Dr. Amna Ahmed Eltayeb, Assistant Professor of Nursing, FMHS.
26. Dr. Maha Mohammed Elamin: Assistant Professor of Nursing, FMHS.
27. Dr. Abuobida Osman Ibnoof: Epidemiologist: Federal Ministry of Health.
28. Dr. Hamoda Koko Kafi: Head of Vector Control, Federal Minstry of Health
29. Dr. Hatim Abdelateef Hussain: Obstetrician & Gynaecologist: Kassala State Ministry of Health
30. Dr. Omer Abdelhammed Gasm Alla: Assistant Professor of Obstetrics & Gynaecology, FMHS.
31. Professor Tajeldeen Mohamadain Abdalla: Professor of Medicine, Head of Tuberculosis Research Centre.
32. Dr. Elbashier Gasmelbari: Assistant Professor of Medicine, Director of Renal Dialysis Centre.
33. Professor Abdelazeem Abdalla: Professor of Obstetrics & Gynaecology, FMHS
34. Ms Asma Abdeleahab Ibrahim: Lecturer, Medical Laboratory Science Program, FMHS.
35. Ms Faiza Abdalla Shareef: Lecturer, Medical Laboratory Science Program, FMHS.
Agenda:
1. Introduction of participants
2. University of Kassala & SHAWS Collaboration and University of Kassala research initiative: Professor Abdalla Ali Mohammrd
3. (SHAWG) representative mission: Dr. Yusri Abdalla Taha
4. (UFOS) activity in Kassala. Dr. Tom Fletcher
5. Update about the epidemic: Professor Mubarak Karsani
6. Participants’ comments
7. Recommendations.
University of Kassala & SHAWS Collaboration:
The meeting is addressed by the University Vice Chanvellor, who expressed his thanks and gratitude to SHAWG and Dr. Yusri. He showed the long journey for Yusri from Newcastle UK on Saturday to Kassala, with the long connection time in Dubai to reach Khartoum on Monday night and have overnight night car trip to Kassala. He reached Kassala 04:00 Monday. He explained to the meeting the relationship and collaboration with SHAWG, that dated to 2009. At that time, when he was the Dean of FMHS first joined SHAWS as a member. He pushed the relationship forward towards by inviting SHAWG to conduct training workshops and participate in conjoint research. Several visits to members of SHAWG to Kassala (Zahir, Herika, Elgoni, Yusri ). A memorandium of Understanding was signed and it is in effective implementation since then. When Chengunyua outbreak, emerged in Kassala, SHAWG group asked him about how to assist in this epidemic. He communicated with SHAWG while he and his family, like many of his folk, suffering the devastating pain of Chekungunuya. His answer was “I want SHAWG to lead with University of Kassala, the research of this epidemic, as there are many questions to be answered”. A fruitful discussion with the group on the WhatApp “SHAWG Group” resulted in the decision to send Dr. Yusri to Kassala to evaluate the situation, discuss with the University SHAG’s role in establishing a research network of collaborators led by the university. He explained that, the disease is devastating, came in an explosive wave. Twenty five of the thirty nine consultants in the hospital (64.1%) were affected. Eighyt percent of this meeting attendee from Kassala are affected, and all of them had at least one member of their household had the disease (hand rising vote). They should be the most dedicated team to study this outbreak. For this reason, staff members organized themselves in research teams as follows:
1. Epidemiology Research: Chaired by Dr. Abdelhaffez Osman (00249912996912 hafeezos72@gmail.com).
2. Entomology research team : Dr. Fatima Abbas Khalid: 00249912692925 fatma_arb_a@yahoo.com )
3. Ecology team: Dr. Osam Mustafa: 00249912563220
4. Medicine team: Prof Tajeldeem Mohamadain Abdalla: 00249912820929
5. Paediatrics Team: Dr. Mohamed Abdelrazig Dassogi 00249918827077
6. Obstetrics & Gynaecology team: Professor Abdelazeem Abdalla Mohammed 00249912351175
7. Economic & Social Science team: Mohamed Elhaj Mustafa 00249909005726
The responsibility of the teams is to formulate a priority list of research questions, identify, partners and collaborators and seek funding for executing specific projects. And he announced one team (The ecology team) has already submitted a research proposal for Ministry of Higher Education for funding.
He gave the chance for Yusri.
(SHAWG) representative mission: Dr. Yusri Abdalla Taha
Dr. Yusri, gave introduction to SHAWG and their role in transferring the knowledge and support to their colleagues in Sudan. They are collaborating with the Federal Ministry of Health, the National Health lab and other educational and health institutions in Sudan, who, beside University of Kassala are effective partners. He emphasized on the role of the University on research as its main function beside teaching and community service. This role is expected by the community and policymakers, who demands the right, adequate and timely information in order to take effective and appropriate decisions. Providing such information falls on university and research centers. He showed support of SHAWG, and their ability to assist the research teams to develop strong competitive proposals. He explained in details his three days program in Kassala, beside visiting the hospitals and health centers and meeting health professionals, to address the public through the media, meet volunteer groups and most important to meet the policy makers (Minister of Health and the Walli).
UFOS activiyt in Kassala. Dr. Tom Fletcher:
Dr. Tom Fletcher, from Department of Clinical Sciences, Liverpool School of Tropical Medicine, UK, explained his mission to Kassala. He came to Kassala to select cases for study about undifferentiated febrile outbreaks in Sudan (UFOS). This study is approved by Sudan Federal Ministry of Health and the UK Government. It is funded by UK-Public Health Rapid Support Team (UK-PHRST). His study team includes beside him, Professor Karsani from National Public Health Lab and Mr. Mohammed Ali from Federal Ministry of Health. His plan was to head to Darfur, but hearing about Kassala outbreak a rapid change of plan was made to change to Kassala. He showed a good impression about this gathering and showed his strong support for University of Kassala to be a lead in this epidemic research.
Update about the epidemic: Professor Mubarak Karsani
Prof Karsani gave an update about the epidemic, as he is closely working with Kassala State Ministry of Health. He said the National Public Health Lab has received from Kassala, five blood samples for cases clinically suspected Chekungunuya, on 12th August 2018. Four of them were positive with RT-PCR Chikungunuya virus, while the fifth was IgM positive for Chikungunuya virus antibody. Hence Chekungunuya epidemic was confirmed. The Federal Ministry of Health work with the State Ministry of Health on vector control. He explained that dengue fever is endemic in Kassala and also malaria, with many cases of vivax malaria. He stressed on the need for strong collaboration with the National Public Health Lab and University of Kassala for capacity building in compacting infectious disease outbreaks.
Participants’ comments:
Important comments came from participants. Dr. Hamoda, the Head of Vector Control Department gave a detailed account about the effort of Kassala State Ministry of Health in vector control. He showed that at the start of the epidemic more than 80% of households show breeding sites for Aedes aegypti mosquito, which now come to less than 10%. He stressed about community participation in vector control. Most of participants commented in this meeting showing their personal experience. Most of them mentioned the local name given to this disease by the public “Kankasha” which literally mean stiff body and inability to walk.
The most impressive comment was from Dr. Ikhlas, the senior physician who showed her personal and her patients’ experience especially the severity of joint pains. She raise a question “Is it only Chekungonuya?”. Dr. Karoum who was ill for last four week, only to come to the meeting walking with difficulty, commented about the importance of personal documentation of health professionals personal experience.
Recommendations:
All participants acknowledged SHAWG and Dr. Yusri for this important step to help University of Kassala leading the research of the epidemic. They reach the following recommendations:
1. Agreed of the teams, and each teams is to formulate a priority list of research questions.
2. To work with SHAWG for proposal writing.
3. Contact Ministry of Higher Education and Scientific Research to extend the submission deadline for research proposal concerning the outbreak.
4. To seek political commitment in supporting the University of Kassala as a lead.
5. Identification of national, regional and international partners and collaborators and potential funders.
Appendix I: Schedule for Dr Yusri Taha (YT) and Professor Abdalla Ali Mohammed (AA)
