BackgroundAnaemia during pregnancy is major health problem. There is conflicting literature regarding the association between anaemia and its severity and maternal and perinatal outcomes.MethodsThis is a retrospective case-control study conducted at Kassala hospital, eastern Sudan. Medical files of pregnant women with severe anaemia (haemoglobin (Hb) < 7 g/dl, n = 303) who delivered from January 2008 to December 2010 were reviewed. Socio-demographic and obstetric data were analysed and compared with a similar number of women with mild/moderate anaemia (Hb = 7-10.9 g/dl, n = 303) and with no anaemia (Hb > 11 g/dl, n = 303). Logistic regression analysis was performed separately for each of the outcome measures: preeclampsia, eclampsia, preterm birth, low birth weight (LBW) and stillbirth.ResultsThere were 9578 deliveries at Kassala hospital, 4012 (41.8%) women had anaemia and 303 (3.2%) had severe anaemia. The corrected risk for preeclampsia increased only in severe anaemia (OR = 3.6, 95% CI: 1.4-9.1, P = 0.007). Compared with women with no anaemia, the risk of LBW was 2.5 times higher in women with mild/moderate anaemia (95% CI: 1.1-5.7), and 8.0 times higher in women with severe anaemia (95% CI: 3.8-16.0). The risk of preterm delivery increased significantly with the severity of anaemia (OR = 3.2 for women with mild/moderate anaemia and OR = 6.6 for women with severe anaemia, compared with women with no anaemia). The corrected risk for stillbirth increased only in severe anaemia (OR = 4.3, 95% CI: 1.9-9.1, P < 0.001).ConclusionsThe greater the severity of the anaemia during pregnancy, the greater the risk of preeclampsia, preterm delivery, LBW and stillbirth. Preventive measures should be undertaken to decrease the prevalence of anaemia in pregnancy.

BackgroundIn the developing countries millions of women in the reproductive age who don’t use contraceptives prefer to postpone or limit their birth. This indicates their failure to take necessary decision to prevent and avoid unwanted pregnancy.MethodsA community-based cross sectional household survey was conducted to investigate unmet need for family planning and associated factors and total demand for family planning in Kassala, Eastern Sudan between 1st May and 31st July 2012.ResultsA total of 812 married women were enrolled in this study. Their mean age and parity was 31.8 (7.3) and 3.4 (1.8) respectively. Ever use of contraception was 25.4% (206/812) and 26.2% (213/812) were currently using contraception. Unmet need for spacing was 15.1% while unmet need for limiting was 0.7%. The pregnant and amenorrheic women whose the pregnancy or birth was unwanted and mistimed were 105 (13%) and 130 (16%) respectively. Using Westoff model the total unmet need was estimated as 44.8%. The total demand for family planning was 71%.In logistic regression model, while age, age at marriage, parity, residence and experience of child death were not associated with total unmet need for family planning, women education < secondary level (OR=7.8; CI=5.6-10.9; P=0.00), husband education < secondary level (OR=1.9; CI=1.3-2.6, P = 0.00) and woman’s occupation; housewife (OR=4.3; CI=2.5-7.2; P=0.00) were associated with the total unmet need.ConclusionsUnmet need for family planning in Eastern Sudan was significantly higher among women with less than secondary education. Also; it is influenced by couple’s educational status and woman’s occupation. The results of this study necessitate the need for the programme managers to take into account the concept of reproductive health education.

BackgroundFemale Genital Mutilation (FGM) or cutting caries legal and bioethical debates and it is practiced in many developing countries.MethodsRandom selection of 154 midwives was used for the study during June 2012 and through July 2012 aiming to assess knowledge and attitudes of the midwives towards FGM in Eastern Sudan.ResultsA total of 157 midwives enrolled in this study. They had been practicing for 3 – 44 years (mean SD 19.2 ± 10.3). More than two third of them experienced practicing FGM sometime in their life (127/157, 80.9%). There was low level of awareness of types of FGM practice since only 7% (11/157) identified the four types correctly. 53.5% (84/157) identified type 1 correctly while 18.5% (29/157), 17.8% (28/157) and 15.9% (25/157) identified type 2, 3 and 4 as correct respectively. While 30 (19.1%) of the midwives claimed that all types of FGM are harmful, 76.4% (120/157) were of the opinion that some forms are not harmful and 7 (4.5%) reported that all types of FGM are not harmful. Likewise while 74.5% (117/157) of the interviewed midwives mentioned that the FGM is a legal practice only 25.5% (40/117) were of the opinion that FGM is illegal practice. The vast majority of the respondents (64.3%, 101/157) have an opinion that FGM decreases the sexual pleasure. More than half (53.5%, 84/157) of the participants affirmed that FGM does not increase the risk of HIV transmission. High proportion of the respondents (71.3%, 112/157) did not know whether or not infertility could complicate FGM.ConclusionsThus a substantial effort should be made to discourage the continuation of FGM practice among midwives in Sudan. This might be achieved by improving knowledge and awareness among the midwives and the community

BackgroundAntenatal care is named as one of the four pillars initiatives of the Safe Motherhood Initiative. While many of routine antenatal care procedure have little effect on maternal mortality and morbidity, some of these have been ascertained as beneficial. The aim of this study was to investigate coverage of antenatal care and identify factors associated with inadequacy of antenatal care in Kassala, eastern Sudan.MethodsA cross-sectional community-based study was carried out in Kassala, eastern Sudan during September-October 2009. Household surveys were conducted. Structured questionnaires were used to gather data from women who had been pregnant within the last year, or pregnant more than 14 weeks.ResultsOut of 900 women investigated for antenatal care coverage, 811(90%) women had at least one visit. Only 11% of the investigated women had ≥ four antenatal visits, while 10.0% had not attended at all. Out of 811 women who attended at least one visit, 483 (59.6%), 303 (37.4%) and 25 (3.1%) women attended antenatal care in the first, second and third trimester, respectively. In logistic regression analyses, while maternal age and residence were not associated with inadequacy of antenatal care (<2 visits), high parity (OR = 2.0, CI = 1.1-3.5; P = 0.01) and husband education ≤ secondary level (OR = 2.4, CI = 1.3-4.2; P = 0.002) were associated with inadequacy of antenatal care.ConclusionsAntenatal care showed a low coverage in Kassala, eastern Sudan. This low coverage was associated with high parity and low husband education.

BackgroundViolence against women is one of the major public health problems in both developed and developing worlds. The aim of this study was to investigate the prevalence of current (occurred in one year preceding the survey) domestic violence and socio-demographic factors associated with domestic violence against women.MethodsThis was a cross sectional household survey (face to face interview) conducted in Kassala, eastern Sudan, from 1st March to 1st June 2014. Multivariable analyses were performed, Confidence intervals of 95% were calculated and P < 0.05 was considered significant.ResultsOf the 1009 women, 33.5% (338) reported current experience of physical violence and, of these 338 women, 179 (53%) and 159 (47%) reported moderate and severe form of physical violence respectively. The prevalence of sexual coercion, psychological violence and verbal insult was 17% (172\1009), 30.1% (304\1009) and 47.6% (480\1009) respectively. In the majority of cases, violence was experienced as repeated acts, ie, more than three times per year. For verbal insult 20.1% (203\480) and 27.5% (277\480) reported yelling and shouting respectively. Again 251 (24.9%) and 270 (26.8%) women reported that they experience divorce threat and second marriage threat respectively. In logistic regression model, husband’s education (OR = 1.5; CI = 1.0-2.1; P = 0.015), polygamous marriage (OR = 1.9; CI = 1.3-2.9; P = 0.000), and husband’s alcohol consumption (OR = 13.9; CI = 7.9-25.4; P <0.000) were significantly associated with domestic violence.ConclusionsDomestic violence was found to be highly prevalent in eastern Sudan and strongly associated with the educational status, polygamous marriage and husband’s alcohol consumption. We recommend more research to include men.