Background: Self-medication with antibiotics (SMA) is one of the common factors which precipitate antimicrobial resistance, yet if effective implementations are amended it can be effortlessly controlled. The present study aimed to estimate the prevalence and predictors of SMA in Sudan. Methods: The study adopted a cross-sectional study design conducted in all Sudan states between June and December 2021. Multi-stage stratified cluster sampling was used. A semi-structured questionnaire was used for data collection. Descriptive statistics were used to present the data. Binary logistic regression was computed to investigate the possible factors which associated with SMA. Results: Out of 1492 participants surveyed, 71.3% utilize antibiotics as self-medication. The derived reasons for SMA were convenience (63.3%) and cost-saving (34.8%). Tonsillitis was the most common ailment behind SMA (55.5%). Log-binominal regression revealed that non-insured and low level of education participants were more likely to predict SMA. Regarding the practice, 40% changed the dose and/or antibiotics mainly owing to improvement (53.7%) or worsening of the condition (37.9%). The most commonly used antibiotic was amoxicillin/clavulanic acid (32.5%). Conclusions: Two out of three individuals in Sudan practice SMA mainly to manage upper respiratory tract ailments. Thus, the necessity of implementing an antimicrobial stewardship program throughout the country, as well as implementing effective legislation to prohibit dispensing antibiotics without prescription is urgently required.

Background: Anemia is a deleterious complication of end stage renal disease (ESRD). It is highly prevalent in sub-saharan Africa. The predictors of control of hemoglobin levels in ESRD patients in Sudan are unknown. Methods: A prospective observational study was conducted to evaluate the prevalence of anemia and factors affecting the control of hemoglobin levels in ESRD patients. A standardized data collection form was used for collecting patient information. A total of 1015 hemodialysis patients were recruited from twelve centers. Results: The 534 (52.6%) patients were included in the final analysis. Those were excluded, including, 194 (19.1%) patients were transferred to other centers before completion of the study, 165 (16.3%) died, 38 (3.7%) underwent renal transplantation and 84 (8.3%) were lost to follow-up. Among the patients who included in the final analysis, 307 (57.5%) were males and the mean age was 48.7±16.1 years. All the analyzed patients were anemic (hemoglobin level<12 g/dL), 67% had a hemoglobin level <10 g/dL. In multivariate analysis the variables which had statistically significant associations with hemoglobin levels equal or higher than 10 g/dL were insured patients [OR = 1.53, 95% CI (1.04–2.25)]; and two drug combinations: "Erythropioesis simulating agent (ESA), intravenous (IV) iron, oral iron, and vitamins" [OR = 1.87, (1.27–2.76)] and "ESA, oral iron and vitamins" [OR = 6.67, (2.98–14.94)]. While, a family history of ESRD [OR = 0.57, (0.35–0.94)] and duration of hypertension for "6-9 years" [OR = 0.47, (0.25–0.87)]; Female patients were identified as being more likely to have lower hemoglobin in both univariate and multivariate analyses. Conclusion: There was suboptimal treated anemia requiring attention in this population. Patients with a family history of ESRD and duration of hypertension for "6-9 years" were predicted to have lower hemoglobin levels. More concern should be paid to uninsured patients and anemia drugs, including the ESA and iron preparations. The results of this study increase our knowledge about the prevalence of anemia and the factors that contribute to control of hemoglobin levels in Sudan. Keywords: Prevalence, Anemia in ESRD, Hemodialysis, Erythropioesis Stimulating Agents, Hemoglobin Level, Health Insurance, Hypertension, Family History of ESRD, Sudan, Khartoum.