Due to a lack of sufficient resources, COVID-19 surveillance data fell short of providing the information needed to support effective public health interventions in Sudan. These statistical gaps became evident to the Federal Ministry of Health (MOH) when comparing Sudan’s data with international trends and considering the country’s limitations on testing capacity. Seeing an increase in the mortality level and that limited data was not telling the full story of COVID-19 in the country, in May, the MOH decided to take a new approach. In order to obtain epidemiological information to determine the magnitude and spread of the COVID-19 outbreak and to better guide policies and response activities, the MOH decided to carry out targeted testing through the Field Epidemiology Training Program (FETP). This approach focused on testing at the epicenter of the outbreak and among high-risk populations, utilizing fewer resources.
On May 29, the state of Khartoum, the outbreak’s epicenter, had 3,809 confirmed cases, or 79 percent of the total cases in Sudan. From May 22 to July 5, the FETP collected data for a survey that screened 22 neighborhoods and eight health facilities in Khartoum. In order to recruit participants, health workers relied on neighborhood committees known as Resistance Committees, formulated during Sudan’s revolutionary period, which acted as gatekeepers to their communities.
In total, the FETP administered 1,135 reverse transcription polymerase chain reaction (RT-PCR) tests, for which samples are collected using nasopharyngeal swabs, and rapid antibody immunochromatography (ICT) tests, for which samples are collected using a finger prick. The FETP also collected information through a questionnaire that asked participants’ demographics, symptoms, contact histories, and more.
Among its findings, the study revealed that few (1.4 percent) of cases reported seeking medical attention, reflecting the stigmatization of COVID-19 and barriers to accessing health care facilities. The 1,014 participants who took an RT-PCR test had a positivity rate of 35 percent, and 51 percent of those who tested positive were asymptomatic. The 967 who took the ICT tests had a positivity rate of 18.3 percent, and 56 percent of those who tested positive were asymptomatic. Most of the infections occurred in people under age 29. The study demonstrated the need to address the ongoing outbreak as Sudan assesses the actual burden of COVID-19 on its health system. It also demonstrated the need to assess the epidemiology in different states in Sudan and to set tailored plans for each state depending on its local context.
FETP residents and alumni have been working diligently to analyze accurate epidemiological data regarding the targeted testing conducted in Khartoum state. They are also continuing to promote self-hygiene and safe behavioral practices to effect change in Sudan. Sudan’s FETP demonstrates the impact that collaboration and commitment can have on advancing the health of their nation.