Background: Political instability, economic sanctions and substandard quality of health care negatively affect tuberculosis (TB) control in the Middle East and North Africa (MENA) region. Aims: We aimed to elucidate factors contributing to delays in TB diagnosis and treatment in MENA countries. Methods: Two reviewers independently appraised eligible articles identified through comprehensive searching and extracted data which were subjected to meta-analysis. Results: Delays in TB diagnosis were associated with older age and low income [(OR = 1.49; 95% CI: 1.31-1.70) and (OR = 1.26; 95% CI: 1.09-1.45)] respectively (n = 17 studies). Being female was associated with patient delay and health system delay [(OR = 1.24; 95% CI: 1.02-1.50) and (OR = 1.68; 95% CI: 1.18-2.38)] respectively. Knowledge and perception of TB, having employment and low levels of crowding were each protective against patient delay. The GRADE system rated the evidence as of low quality. Conclusion: This review provides evidence for facilitators and barriers to TB diagnosis and health system delays. For successful TB control in the MENA region, TB awareness and interventions targeting the elderly and those from lower-income settings, particularly directed at gender differences, are essential.

Introduction: Following emergency approval of COVID-19 vaccines, several studies have investigated COVID-19 vaccine acceptance and hesitancy especially among healthcare workers (HCWs). Nevertheless, the acceptability of the COVID-19 vaccine by HCWs in Sudan remains unclear. This study aims to investigate the acceptability of the COVID-19 vaccine and it’s determinants among the HCWs. Methods: A web-based cross sectional study design was used to study COVID-19 vaccine hesitancy and its associated determinants. The semi-structured questionnaire was distributed electronically, data collection took place from March-April 2021. Results: A total of 576 HCWs have responded to the survey with mean age of 35 years. The majority were females (53.3%), Medical Doctors (55.4%), and located in the capital state; Khartoum (76.0%). The absolute refusal of COVID-19 vaccine was expressed by 16% of the respondents while 57% were willing to get vaccinated. Males were twice to four times more likely to accept the vaccine. Lower acceptability of COVID-19 vaccine was significantly associated with the nursing profession (OR= 0.35, 95% CI:0.15-0.82, P<0.00), increased perceived harm from the vaccine (OR= 0.11, 95% CI: 0.05-0.23, P <0.00), lack of confidence in the source of vaccine (OR= 0.16, 95% CI:0.08-0.31, P=0.00), organizations and government supervising COVID-19 vaccination process ( OR=0.31, 95% CI:0.17-0.58 P=0.00). Conclusion: This study highlights a moderate level of COVID-19 vaccine acceptability by the HCWs in Sudan. Effective communication of correct, regular, up-to-date evidence on the safety and effectiveness of vaccines is crucial to building trust in vaccines. Special consideration should be in place to address vaccine hesitancy among female HCWs and the nursing profession.

Sudan has about 87% of females aged 15–49 years living with female genital mutilation (FGM), mostly performed by midwives (64%). In 2016, the Federal Ministry of Health (FMoH) adopted the WHO’s global strategy to stop healthcare providers from performing FGM. Our review of activity reports from 2016 to 2018 found the format of activities (N=95) was mainly meetings (58%) and trainings (31%) with median costs of US$10 645 and US$14 964, respectively. The FMoH (57%) and student/professional associations (25%) implemented activities at national (36%) and state (62%) level. The costs of activities were highest for FMoH compared with student/professional associations and academia, respectively.Sudan addressed WHO’s global strategy pillars through FGM-related policies and plans (pillar 1), trainings (pillar 2) and monitoring, evaluation and accountability materials (pillar 3) targeting mainly community midwives (N=16 183) as well as creating supportive legislative and regulatory environment (pillar 4). Governmental funding on training was comparable to donor’s resulting into 31% of community midwives trained on FGM complications management. Further, 31% of community midwives signed declarations or petitions to end FGM practice, while 19% were sensitised on punitive administrative measures for conducting FGM.Although Sudan implemented a laudable health sector response to address FGM, there is a need to evaluate the quality and effectiveness of past and ongoing interventions. Particular attention to costs and quality assurance data is essential to identify cost efficient implementation approaches to reach the remaining sizeable number of health professionals to stop their involvement in FGM.

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Historically, global efforts to accelerate progress toward achieving health and well-being for women and children have appeared separate, despite the inextricable links among maternal, perinatal, and newborn health outcomes.n Accelerating progress demands that the maternal and newborn health (MNH) community more rapidly and effectively share learning, new evidence, and program experiences. nA new global initiative, AlignMNH, will establish a country-driven, multidirectional knowledge hub and series of convenings to promote purposeful knowledge sharing and problem solving and align on priorities for action. These efforts are intended to facilitate increased application of evidence and regular review of progress ultimately contributing to improved MNH and prevention of stillbirths.