Sudan (1,886,068 km2), has 18 states after separation of South Sudan in 2011. The geostatistical and the socioeconomic model will be an inclusive framework that takes various aspects of the study area, such as economic status, social and the geospatial distribution of TB into consideration. Climate change may have effects in the spread of TB, where the environment can be seen as a biosocial determinant of the diseases, it provides a direct space in which infection can take place, predominantly through increased exposure.
Sudan population is 32 million according to 2008 census excluding the separated South Sudan. The prevalence of Tuberculosis is very high especially among Eastern states’ populations; namely Kassala (2,519,071), Al-Gedarif (2,208,385) and The Red Sea (1,482,053) respectively. These populations were chosen for a survey and/or experiment using World Health Organization recommended Sample Size Calculator and Sampling Spreadsheet (The STEPS) that can assist in first determining the size of sample and then in drawing a sample from sampling frame (https://www.who.int/ncds/surveillance/steps/resources/sampling/en/). This will construct a 95% confidence interval with a margin of error of about ± 4.4% (for large populations).
Medical intervention for tuberculosis infections:
Onsite clinical testing and investigations
Tuberculin skin test (TST) and/or interferon-gamma release assay (IGRA) were used to test for LTBI, both tests measure immune sensitization (type IV or delayed-type hypersensitivity) to mycobacterial protein antigens that occurs following infection by M. tuberculosis. Antibiotic susceptibility testing to isoniazid or rifampicin will be done by using CLSI guidelines and the second-line drugs considered are those listed in the WHO Guidelines for the Management of Drug Resistant Tuberculosis(21).
Medical Assessment of Tuberculosis Patients:
1-Patient Registration: of both healthy and sick patients.
2-Appointment Management: with routine reminders to notify patients about appointments and delays.
3- Reports and Dashboards: To facilitate improved efficiencies through metric measurement. 4-Computer software: To enable patients’ relationship management especially for chronic patients who visit the clinics more often.
The inclusion criteria included the following: (a) Tuberculosis diagnosis (b) tuberculosis treatment fully conducted at field site during infection pandemic and (c) being African citizens or residents.
The exclusion criteria included the following: (a) death within the first 15 days of treatment, (b) treatment default during the first 30 days after treatment initiation, (c) change of Tuberculosis diagnosis during treatment, (d) transfer to other health unit, or (e) unknown treatment outcome. The project also will provide information on socio-demographic variables, presence of comorbidities, tuberculosis features and treatment, which we included as covariates.
Management of Mobile Emergency health intervention:
Using well equipped mobile clinics, labs and pharmacies for emergency intervention is essential especially in those areas who lack for regular health facilities, outreach clinic mobiles aim to provide primary and emergency health care services for poor communities.
Data Collection methods, instruments used, measurements:
Networking and media and communication:
Data that has been collected and analyzed must be passed on to decision makers, the staff involved, and partners. This communication aspect is an essential component of a surveillance system and includes: feedback, dissemination of information, specific communications.
Surveillance data collection
Public health surveillance in points of care for communities/migrants operates inside camps with daily collection of epidemiological data for selected syndromes/health conditions that are important from a public health point of view. Data recorded refer to consultations for each syndrome/condition under surveillance in primary health care facilities in community/migrant reception centers. Data are sent daily to the Department of Surveillance and Intervention of communities by doctors, nurses and other health professionals from services and NGOs staffing primary care facilities.
Data quality assurance methods, data management and analysis plans:
All official statistical activities shall be conducted in accordance with a Data Quality Framework that shall be developed by the National Centre for Statistics and Information in consultation with other government units that conduct official statistical activities. Once developed, the Data Quality Framework will be promulgated by Regulation/Government Decree (need to specify the legal process involved)”
Developing the national level policy of treatment, vaccination and prevention:
1-Developing drug delivery to lower levels and the cost of supervision of the communities.
2- Community based TB care developed together with implementing partners (Conduct situational analysis, establish partnership & coordination mechanism and Developing surveys).
3- Conducting a needs analysis, administering surveys, conducting interviews and developing curriculum.
Administering regular evaluation of the disease situation
1- Organize community base and multidisciplinary teams.
2- Regular Survey and Monitoring
3- Quarterly Review Meeting.
4-Dissemination of training materials.
Strategies to increase community access:
1- Education: Patient consulting, social marketing,
2-Management: Financial management, business management.
3-Regulation: Standards development, task-shifting.
4-Economic: Insurance plans, pooled procurement.
Major workplan and Budget
The work plan identified tasks, time and period of the activity took place and executive responsible person as scheduled in appendix (B). An outline of the financial costs involved in implementing the proposed study and any other essential resources was declared in appendix (C).