War-time mortality in Sudan: a multiple systems estimation analysis.

Background: The mortality impact of war in Sudan, which began in April 2023, remains largely unmeasured due to sparse and methodologically weak data that reflect sparse pre-war vital registration systems and actively restricted access to affected communities. Our study aimed to quantify undocumented war-time mortality levels and patterns in Sudan.

Methods: We conducted a retrospective observational study collecting lists of people deceased since April 15, 2023, from three sources: a public social media survey, a survey disseminated through private networks, and public social media obituaries.

Salience and perceptions of epidemic-prone diseases in two communities: Findings from freelisting interviews in Khartoum State, Sudan.

The frequency and severity of disease outbreaks disproportionately impacts settings affected by conflict or with weak health systems. Sudan, facing frequent and recurrent epidemics, struggles with limited resources. Understanding local perceptions of epidemic-prone diseases is vital for designing effective epidemic responses.

SWOT Analysis of Communicable Disease Surveillance in Sudan.

Effective communicable disease surveillance is critical in Sudan to addressing the compounded health impacts of concurrent epidemics, health systems collapse and acute conflict. This article aims to map the strengths, weaknesses, opportunities and threats of Sudan's communicable disease surveillance systems before the current conflict to inform future health system rebuilding efforts. Despite existing for 50 years, little is published on Sudan's disease surveillance systems.

Decision-making for childhood vaccination in crisis settings: a survey of practice & barriers.

Background: Children, particularly those who have received no routine vaccinations (zero-dose children), are at high risk of vaccine-preventable diseases in humanitarian crisis settings. However, the decision-making processes underlying vaccine intervention design and delivery in such settings are poorly understood. The present study investigated the decision-making practices of organisations involved in childhood vaccination in humanitarian crisis settings globally via an online survey.

Vaccination strategies to identify and reach zero-dose and under-immunized children in crisis-affected states in Sudan: a qualitative study.

Background: Globally, 21 million children were un- or under-vaccinated with Diphtheria-Tetanus-Pertussis (DTP)-containing vaccines in 2023. Around 20% of zero-dose children, those who had not received any DTP doses, live in conflict-affected settings in low and middle-income countries. There is insufficient evidence on vaccination interventions to identify and reach zero-dose children in these settings.

Changes in social mixing and attitudes and practices to precautionary measures in a maturing COVID-19 pandemic in six communities in Sudan: a qualitative study.

Introduction: With low COVID-19 vaccination coverage, non-pharmaceutical interventions were critical to mitigating the COVID-19 pandemic in Sudan. We explored changes in social contact patterns, risk perception, attitudes, and practices toward protective measures during an evolving COVID-19 outbreak in six illustrative communities in Sudan.

Methods: This qualitative study took place in six communities in five Sudanese states using focus group discussions with community members and non-participant structured observations in public spaces between March 2021 and April 2021.

Population mortality before and during the COVID-19 epidemic in two Sudanese settings: a key informant study.

Background: Population mortality is an important metric that sums information from different public health risk factors into a single indicator of health. However, the impact of COVID-19 on population mortality in low-income and crisis-affected countries like Sudan remains difficult to measure. Using a community-led approach, we estimated excess mortality during the COVID-19 epidemic in two Sudanese communities.

Assessing Vaccination Delivery Strategies for Zero-Dose and Under-Immunized Children in the Fragile Context of Somalia.

Somalia is one of 20 countries in the world with the highest numbers of zero-dose children. This study aims to identify who and where zero-dose and under-vaccinated children are and what the existing vaccine delivery strategies to reach zero-dose children in Somalia are. This qualitative study was conducted in three geographically diverse regions of Somalia (rural/remote, nomadic/pastoralists, IDPs, and urban poor population), with government officials and NGO staff ( = 17), and with vaccinators and community members ( = 52).

A Systematic Review of Vaccination Guidance for Humanitarian Responses.

Delivering vaccines in humanitarian response requires rigourous and continuous analysis of evidence. This systematic review mapped the normative landscape of vaccination guidance on vaccine-preventable diseases in crisis-affected settings. Guidance published between 2000 and 2022 was searched for, in English and French, on websites of humanitarian actors, Google, and Bing.

Measuring supply-side service disruption: a systematic review of the methods for measuring disruption in the context of maternal and newborn health services in low and middle-income settings.

Objectives: During the COVID-19 pandemic, most essential services experienced some level of disruption. Disruption in LMICs was more severe than in HICs. Early reports suggested that services for maternal and newborn health were disproportionately affected, raising concerns about health equity.

Alternative epidemic indicators for COVID-19 in three settings with incomplete death registration systems.

Not all COVID-19 deaths are officially reported, and particularly in low-income and humanitarian settings, the magnitude of reporting gaps remains sparsely characterized. Alternative data sources, including burial site worker reports, satellite imagery of cemeteries, and social media-conducted surveys of infection may offer solutions. By merging these data with independently conducted, representative serological studies within a mathematical modeling framework, we aim to better understand the range of underreporting using examples from three major cities: Addis Ababa (Ethiopia), Aden (Yemen), and Khartoum (Sudan) during 2020.

What we do know (and could know) about estimating population sizes of internally displaced people.

The estimation of population denominators of internally displaced people (IDP) and other crisis-affected populations is a foundational step that facilitates all humanitarian assistance. However, the humanitarian system remains somewhat tolerant of irregular and inaccurate estimates of population size and composition, particularly of IDPs. In this commentary, we review how humanitarian organizations currently approach the estimation of IDP populations, and how field approaches and analytical methodologies can be improved and integrated.

Public and health professional epidemic risk perceptions in countries that are highly vulnerable to epidemics: a systematic review.

Background: Risk communication interventions during epidemics aim to modify risk perceptions to achieve rapid shifts in population health behaviours. Exposure to frequent and often concurrent epidemics may influence how the public and health professionals perceive and respond to epidemic risks. This review aimed to systematically examine the evidence on risk perceptions of epidemic-prone diseases in countries highly vulnerable to epidemics.

Acceptability and feasibility of strategies to shield the vulnerable during the COVID-19 outbreak: a qualitative study in six Sudanese communities.

Background: Shielding of high-risk groups from coronavirus disease (COVID-19) has been suggested as a realistic alternative to severe movement restrictions during the COVID-19 epidemic in low-income countries. The intervention entails the establishment of 'green zones' for high-risk persons to live in, either within their homes or in communal structures, in a safe and dignified manner, for extended periods of time during the epidemic. To our knowledge, this concept has not been tested or evaluated in resource-poor settings.

Healthcare governance during humanitarian responses: a survey of current practice among international humanitarian actors.

Background: Large international humanitarian actors support and directly deliver health services for millions of people in crises annually, and wield considerable power to decide which health services to provide, how and to whom, across a vast spectrum of health areas. Despite decades of reform aiming to improve accountability in the sector, public health practice among humanitarian actors is not heavily scrutinized in either the countries where they are headquartered or those where they provide healthcare. We surveyed current healthcare governance practice among large international humanitarian actors to better understand what organisations are doing to ensure oversight and accountability for health services in humanitarian responses.

Considerations for planning COVID-19 treatment services in humanitarian responses.

The COVID-19 pandemic has the potential to cause high morbidity and mortality in crisis-affected populations. Delivering COVID-19 treatment services in crisis settings will likely entail complex trade-offs between offering services of clinical benefit and minimising risks of nosocomial infection, while allocating resources appropriately and safeguarding other essential services. This paper outlines considerations for humanitarian actors planning COVID-19 treatment services where vaccination is not yet widely available.

IL-22 Binding Protein Promotes the Disease Process in Multiple Sclerosis.

Genome-wide association studies have mapped the specific sequence variants that predispose for multiple sclerosis (MS). The pathogenic mechanisms that underlie these associations could be leveraged to develop safer and more effective MS treatments but are still poorly understood. In this article, we study the genetic risk variant rs17066096 and the candidate gene that encodes IL-22 binding protein (IL-22BP), an antagonist molecule of the cytokine IL-22.

Deaths, injuries and detentions during civil demonstrations in Sudan: a secondary data analysis.

Background: Since December 2018, the latest wave of anti-government protests in Sudan has led to deaths, injuries and detentions. We estimated the number of people killed and described patterns of deaths, injuries and detentions up to 9 April 2019.

Methods: We tabulated data from three publicly available lists maintained by Sudanese civil society sources (the Independent Movement, the Sudan Doctors' Union and the "Lest We Forget" project), and applied to these a capture-recapture statistical technique that models the overlap among lists to estimate the number of deaths not on any list.

Effect of high-dose vitamin D supplementation on antibody responses against Epstein-Barr virus in relapsing-remitting multiple sclerosis.

Background: Elevated antibody levels against Epstein-Barr virus (EBV) and a poor vitamin D status are environmental factors that may interact in relapsing-remitting multiple sclerosis (RRMS) aetiology.

Objectives: To examine effects of high-dose oral vitamin D supplementation on antibody levels against EBV nuclear antigen 1 (EBNA1) in RRMS.

Methods: Serum 25-hydroxyvitamin D (25(OH)D) and immunoglobulin G antibody levels against EBNA1 (whole protein and amino acid 385-420 fragment), EBV viral capsid antigen (VCA), cytomegalovirus (CMV) and varicella zoster virus (VZV) were measured in 68 RRMS patients enrolled in a 96-week randomised double-blinded placebo-controlled clinical trial of oral vitamin D supplementation (20,000 IU/week) (NCT00785473).

Von Willebrand Factor Gene Variants Associate with Herpes simplex Encephalitis.

Herpes simplex encephalitis (HSE) is a rare complication of Herpes simplex virus type-1 infection. It results in severe parenchymal damage in the brain. Although viral latency in neurons is very common in the population, it remains unclear why certain individuals develop HSE.

Anoctamin 2 identified as an autoimmune target in multiple sclerosis.

Multiple sclerosis (MS) is the most common chronic inflammatory disease of the central nervous system and also is regarded as an autoimmune condition. However, the antigenic targets of the autoimmune response in MS have not yet been deciphered. In an effort to mine the autoantibody repertoire within MS, we profiled 2,169 plasma samples from MS cases and population-based controls using bead arrays built with 384 human protein fragments selected from an initial screening with 11,520 antigens.