A Conceptual paper Challenges facing Medical Parasitology in Sudan:

1. A Conceptual paper Challenges facing Medical Parasitology in Sudan: Education, Service and Research. Abdellatif Eldaw; PhD Symposium on: Advances in Parasitology “Education and Research in Parasitology in the service of Mankind “

2. A Conceptual paper Challenges facing Medical Parasitology in Sudan: Education, Service and Research. This presentation summarizes the Challenges facing Medical Parasitology education, service and research in Sudan and it opens discussion on many issues that need to be addressed.

3. Introduction • Despite the huge public health importance of medical parasitology sciences and its clear impact on health of the Sudanese population , economy , wasted working days development and…

4. Introduction • ..even the cognitive capabilities of children affected by parasitic infections , the resources allocated for prevention , diagnosis ,control , and education is still little compared to resources allocated to other diseases having less impact on Sudan population .

5. Of the 17 Neglected tropical diseases (NTDs) identified by the WHO, 11 are of parasitic origin distinctly thrive mainly among the poorest populations living in remote rural areas, urban slums or conflict zones. • Beyond their negative impact on health, NTDs contribute to an ongoing cycle of poverty and stigma that leaves people unable to work, go to school or participate in family and community life.

6. Medical parasitology, has attracted many students and researchers. But the number of students choosing this specialty is steadily declining despite the need for such specialists in this country ,where (a part of malaria) Leishmaniasis, schistosomiasis, amoebiasis, soil-transmitted helminths, onchocerciasis, taeniasis and African trypanosomiasis are still hitting hard

7. Statistics are lacking, and no one is sure about the numbers affected by each of the previously mentioned disease. • Epidemiologic information including reports on these infections following the separation of South Sudan is urgently needed.

8. Updated statistics and epidemiologic data on parasitic diseases are needed for better planning and budgeting. • There is a clear need to increases the number of parasitology students at the BSc and post graduate levels.

9. Development of better parasitology laboratories, teaching resources and curricula. • More experimental researches are needed in areas of diagnosis, control and vaccine development . That requires use of laboratory animals.

10. Commitment of Faculties of Medical laboratory Sciences, whether governmental or private, towards encouraging medical laboratory students to specialize in parasitology needs to be sustained and even with provision of scholarships.

11. Training in the modern sciences, particularly molecular biology, molecular parasitology and immunology that enhance better understanding on the physiological, metabolic, immunologic, biochemical, nutritional, and chemotherapeutic aspects of parasites and host-parasite relationships.

12. Training on the standards parasitology methods is also in need of revision specially there are real modifications being made to the old methods. Execution of parasitology practicals in most of FMLSc is really tedious , boring and dull .It needs to be vitalized.

13. More research is needed in areas of : • Diversity of parasite population and drug resistance • natural anti-parasitic agents • natural agents for control of vectors • vaccine development • specific and sensitive and yet cheaper diagnostic tests

14. For development of parasite vaccines better understanding of the structure, biosynthesis, degradation, properties and function of DNA, RNA, proteins, lipids, carbohydrates and small molecular-weight substances are mandatory. • Education that provides such skills is costly and shared efforts are required. Most of what have been mentioned above require team work with different specialities . But we should trigger these efforts.

15. For better diagnoses and development of sensitive and specific diagnostic tests, analysis of variation in parasite populations relevant to genetic exchange, pathogenesis, drug target characterization, and drug resistance is really needed and these are points that need working in teams of different specialities.

16. Lack of quality control within parasitology laboratories is an urgent need that must be urgently rectified . • Different results obtained from different laboratories on the same cases (even some times on the same samples ) are only partially justified. This is a major drawback on the service we provide to our community. We need to sit on this and examine reasons and provide solutions.

17. As for malaria, there is a pressing need for more rapid tests without sacrificing sensitivity and the specificity . • Diagnosis of malaria in Sudan is just a mess (whether through microscopy or Rabid tests) By itself, the diagnosis of malaria needs a workshop for identifying the reason for this mess and further to suggest remedies and solutions.

18. Extensive use of malaria rapid diagnostic tests and the over diagnosis of malaria and the false negative RDT require that we carefully scrutinize the specificities, sensitivities, numbers of false positives, numbers of false negatives and temperature tolerances of these tests . fPlasmodium falciparum histidine-rich protein 2 (PfHRP2), plasmodial aldolase and plasmodial lactate dehydrogenase (pLDH) - are currently used for RDTs

19. Standardized reagents, quality and sources of reagents, validation of methods, reference samples are all need to be well looked after. • Modern equipment are costly but are desperately needed to promote teaching and research in parasitology. Examples include: Means and equipment for parasites cultures, good light microscopes, fluorescent microscopes, PCR machines, ELISA …etc.

20. With few exceptions the majority of current parasitology researches carried for degrees at different Sudanese universities are repeated and replicated at different locations and time. • There is a great need for a single registry nationwide for all researches executed. That helps avoiding repetition and keeps better utilization of the scarce resources and strengthens the quality of researches.

21. Ministry of Higher Education may impose a regulation or add a web link that shows all research carried for obtaining academic degrees in Sudan universities. Lack of any easily accessible database of the Sudan scientific efforts or any inventory of the country scientists is another hindrance facing communication among parasitology scientists

22. Another problem associated with student researches for degrees is the weak research questions or points of research. The reason is the very high number of the master students compared to the small number of supervisors and the scarce and costly research materials Post graduate students are under heavy burden to secure the cost of material for their research (any suggestions!!!?).

23. The suggestion of team research is an acceptable way out if the research point is wide and deep (and addressing important issue) and can be branched so each one , two or even three students can work on that branch. However, this is an issue that needs to be carefully studied. We know it is done now but how perfect is it ?

24. Funds: • Master and PhD students bear very high costs for their researches. Loans for PhD students can be sought by banks or even by their universities if the research is addressing issues cared for by the university, the MOHE, MOH or even private sectors.

25. Funds: • It is sad to say that many universities are taking the post graduate programmes mainly as means for financial interests. That is ok but still we all need to make real use of these researches. The country, the university, the student and the science must benefit.

26. Funds: • Professors of parasitology along with the faculties of medical laboratory sciences have to be more aggressive in their search for research funds. • Some international universities have specific researches and are ready to fund post graduate students to work on such projects. However …

27. Funds: • …. this is good as means of securing research funds but it demolishes the interests of the students to work with researches that of interest to them and of value to Sudan.

28. Knowledge gaps • Knowledge gaps are wide between parasitology scientists in the developed countries and developing countries and this is reflected in the quality of researches produced here and there.

29. Knowledge gaps • The technology gap also exists between elderly professors who prefer to use old technology and the young researchers who prefer to go for modern more accurate technologies. • That means a technology gap will always be a conflict between supervisors and upcoming parasitology scientists

30. Suggestions that need discussion • 1 • Specify a time frame , say 3 years, to be specified for capacity building in parasitology laboratories within all FMLSC. • Specific sophisticated costly equipment may be shared and made available and shared within more than a university

31. Suggestions that need discussion • 2 • Bridging the technology gap between researchers in Sudan and in other developed countries. • International relation department in different Sudanese universities may lead this.

32. Suggestions that need discussion • 3 • Compose an expert team in the different advanced Sciences and techniques with clear objectives to enhance the skills of ML scientists in the different modern technology and of sciences that are seen mandatory for modernization of medical parasitology

33. Suggestions that need discussion • 4 • Develop with the aid of MOHE or the Institute of Endemic Diseases a single registry nationwide for all researches executed • Or • Development of easily accessible database of the Sudan scientific efforts or any inventory of the country researches.

34. Suggestions that need discussion 5 Initiation of PhD Students Research fund

35. Suggestions that need discussion 6 Due to the ongoing problems associated with diagnosis of malaria in Sudan I do suggest that we gather again for a (Malaria Workshop : Diagnosis of malaria in Sudan) to study problems associated with malaria diagnosis and suggest solutions.

36. Thanks Abdellatif Eldaw Dean, Faculty of Medical laboratory Sciences, Sudan International University [abdellatif.eldaw @gmail.com]