Genomics in Sudan's Health Planning: Opportunities and

Challenges

Ghaiath HusseinGenomics Course. March 3, 2008

Outline of Presentation

• Sudan’s Health Profile• Examples of genetic/genomic research • What are the challenges facing

introduction/utilization of genomics? Political challenges Economical challenges Scientific challenges

• Steps forward

Sudan at a glance• Infant mortality rate: 91.78

deaths/1,000 live births• Life expectancy at birth:

male: 48.24 Y, female: 50.03 Y (2007 est.)

• Total fertility rate:4.69 (2007 est.)

• HIV/AIDS - adult prevalence rate:2.3% (2001 est.)

• HIV/AIDS - people living with HIV/AIDS:400,000 (2001 est.)

• Prevalence of child malnutrition 2000-06 (% of underweight U-5 children) 41 %

•Area:total: 2,505,810 sq km Population:39,379,358 (2007 est.)

Major Causes of Death (2002)

•

5517Tuberculosis

8517Measles

8619Diarrhoeal diseases

7620HIV/AIDS

9622Malaria

3828Ischaemic heart disease

% Years of Life Lost%Deaths(1000)

Source: Death and DALY estimates by cause, 2002http://www.who.int/entity/healthinfo/statistics/bodgbddeathdalyestimates.xls

Global Fund

$14,458,591$36,961,894$75,055,623TB

$29,516,727$58,920,846$161,671,134HIV/AIDS

$19,973,804$131,613,679$33,240,453Malaria

Total Funds Disbursed

Approved Funding:

Total Funding Request:

Source: http://www.theglobalfund.org/programs/countrysite.aspx?countryid=SUD&lang=en

Examples of recent genetic research

• BRCA1 and BRCA2 status in a Central Sudanese series of breast cancer patients: interactions with genetic, ethnic and reproductive factors (Breast Cancer Res Treat (2007) 102:189–199)

• Onchocerca volvulus: Genetic Diversity of Parasite Isolates from Sudan (Experimental Parasitology 97, 24–34 (2001))

• Different genetic patterns of Y chromosome and mitochondrial DNA variation, with implications to the peopling of Sudan (Hisham Hassan, 2006)

• Ethnicity and molecular fingerprints in sub-Saharan African breast cancer: studies in Central Sudan - Renato Mariani-Costantini (2007)

“There can be no peace until people have enough to eat… investments in agricultural research today can cultivate peace tomorrow… biotechnology is not the enemy, starvation is.”

Jimmy Carter

Opportunities

North American edition: 31 July 2000 Asian edition: 12 February 2001

Opportunities

• Translating the knowledge being created by genomics and basic research into applications that improve clinical practice and public health.

• HIV/AIDS, malaria and tuberculosis – development of effective disease interventions,

• Combating resistance to antibiotics and other drugs

• Combating, cardiovascular disease, diabetes cancer and other NCDs

• Microbial ecology - epidemiology• Control of hospital acquired infections

Genomic Research Strategy to confront HIV/AIDS, Malaria and Tuberculosis

Pre-clinical

Discovery

Genomics

• Vaccines

• Microbicides

• Vaccines

• Drugs

EUROPEAN DEVELOPING COUNTRIES CLINICAL TRIALS PARTNERSHIP (EDCTP)

Clinical Trials(Phase II/III)

H I G H R I S K P R O J E C T S

•Vaccines

•Drugs

HIV/AIDS Malaria TB

NEW INSTRUMENTS

CROSS-CUTTING TOPICS

Phase I trials

Source: Confronting the major communicable diseases linked to poverty. Anne Degrand-Guillaud

Challenges facing introduction/utilization of genomics

Political challenges

• Political transition• CPA commitments• International players• Political

decentralization vs. scientific centralization

• Ongoing conflict and instabilities in some regions.

Economical challenges

• Uncertainty associated with biotechnology

• Dichotomy of Private and Public sectors: difference in values, cultures, mechanisms and tolerance of risk

• Poor IP and patenting system• Economic sanctions, including science

Scientific challenges

• Academia-MOH dichotomy • Lack of infrastructure (equipments)• Lack of training on genomics• Scientific sanctions (limited western

investigation/investment) although theoretically lifted

“Under the new ruling, U.S. citizens are no longer required to seek a license from OFAC for any transactions with individuals in Iran, Cuba, and Sudan that "directly support the publishing and marketing of manuscripts, books, journals, and newspapers." (Science, 24 December 2004)

Bridging Gaps

• Involvement of academia in health policy setting

• Advocacy for genomics “It can help”• “genomic education” in under- and

postgraduate medical curricula• Public Engagement

Discussion

Thank You