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Background: Asthma is the third most common cause of hospital visits in Sudan. Sudan has a pluralistic health care system, with a strong and varied private sector. While research examining public sector asthma services exists, very little is known about which asthma services are available in the private sector.   Methods: An explanatory sequential mixed-method social ecological approach was used to examine influencing factors of asthma service utilisation in the private sector, considering five levels: policy, organisational, community, familial, individual environment. Quantitative research involved surveying private healthcare facilities to describe asthma services. Qualitative research involved in-depth interviews with asthma patients to explore facility decision-making. Nine private chest clinics, 44 pharmacies, and 21 private hospitals offering asthma services in Khartoum were studied - 46 female and 28 male health providers were surveyed; 7 male and 7 female asthma patients were interviewed.   Results: At the health policy level, there is no current asthma management policy for the private sector. At the organisational and health systems level, the survey found low rates of diagnostic equipment available, little asthma-specific training, and little use of asthma treatment cards, guidelines, and registers. At the community level, high levels of stigma from the community were felt by most of the patients interviewed. At the familial level, asthma was often viewed as a hereditary condition, and, as a long-term condition, there were worries about marriage potential and impact on jobs/future activities. At the individual level, patients sought frequent, short-term care at private facilities for acute attacks. The severity of the disease and the major impact it had, particularly on younger adults’, was striking.   Conclusions: Applying an ecological framework to examine asthma care management enables review of all levels of service provision: inclusive health policy, government commitment, high quality service delivery, uninterrupted affordable drug supply, community involvement, and patient empowerment.

Background: Asthma is the third most common cause of hospital visits in Sudan. Sudan has a pluralistic health care system, with a strong and varied private sector. While research examining public sector asthma services exists, very little is known about which asthma services are available in the private sector.   Methods: An explanatory sequential mixed-method social ecological approach was used to examine influencing factors of asthma service utilisation in the private sector, considering five levels: policy, organisational, community, familial, individual environment. Quantitative research involved surveying private healthcare facilities to describe asthma services. Qualitative research involved in-depth interviews with asthma patients to explore facility decision-making. Nine private chest clinics, 44 pharmacies, and 21 private hospitals offering asthma services in Khartoum were studied - 46 female and 28 male health providers were surveyed; 7 male and 7 female asthma patients were interviewed.   Results: At the health policy level, there is no current asthma management policy for the private sector. At the organisational and health systems level, the survey found low rates of diagnostic equipment available, little asthma-specific training, and little use of asthma treatment cards, guidelines, and registers. At the community level, high levels of stigma from the community were felt by most of the patients interviewed. At the familial level, asthma was often viewed as a hereditary condition, and, as a long-term condition, there were worries about marriage potential and impact on jobs/future activities. At the individual level, patients sought frequent, short-term care at private facilities for acute attacks. The severity of the disease and the major impact it had, particularly on younger adults’, was striking.   Conclusions: Applying an ecological framework to examine asthma care management enables review of all levels of service provision: inclusive health policy, government commitment, high quality service delivery, uninterrupted affordable drug supply, community involvement, and patient empowerment.

Introduction: National strategies to control COVID-19 pandemic consisted mostly of social distancing measures such as lockdowns, curfews, and stay-home guidelines, personal protection such as hand hygiene and mask wearing, as well as contact tracing, isolation and quarantine. Whilst policy interventions were broadly similar across the globe, there were some differences in individual and community responses. This study explored community responses to COVID-19 containment measures in different countries and synthesized a model. This exaplains the community response to pandemic containment measures in the local context, so as to be suitably prepared for future interventions and research. Methodology: A mutlinational study was conducted from April-June 2020 involving researchers from 12 countries (Japan, Austria, U.S., Taiwan, India, Sudan, Indonesia, Malaysia, Philippines, Myanmar, Vietnam and Thailand). Steps in this research consisted of carrying out open-ended questionnaires, qualitative analyses in NVivo, and a multinational meeting to reflect, exchange, and validate results. Lastly, a commuinty response model was synthesized from multinational experiences. Results: Effective communication is key in promoting collective action for preventing virus transmission. Health literacy, habits and social norms in different populations are core components of public health interventions. To enable people to stay home while sustaining livelihoods, economic and social support are essential. Countries could benefit from previous pandemic experience in their community response. Whilst contact tracing and isolation are crucial intervention components, issues of privacy and human rights need to be considered. Conclusions: Understanding community responses to containment policies will help in ending current and future pandemics in the world.