Experience and perspectives of Sudanese pediatricians in delivering telemedicine services to children during armed conflict in Sudan

Telemedicine is defined as the delivery of medical services remotely through communication technology. It is a critical strategy for enhancing healthcare. The public health infrastructure, healthcare manpower, and community development were severely affected in Sudan due to the armed conflict that broke out in April 2023, resulting in only 14% of households having access to comprehensive healthcare services. International humanitarian law requires physicians to uphold their ethical responsibilities in such crises. This study aimed to evaluate the experiences of Sudanese pediatricians with telemedicine in caring for pediatric cases during the armed conflicts in Sudan in 2023. A structured, well-tested, validated questionnaire was designed into a Google form and distributed to all in-service pediatricians and physicians caring for children in Sudan from August to December 2023. The questionnaire included demographic information, acceptance for enrolment, and ten questions regarding the experiences with telemedicine during the war in Sudan. Frequencies and percentages were used to summarize the results through descriptive statistics. A total of 114 pediatric physicians participated in this study. Most participants were male, with 85.0% of them having relocated outside of Sudan due to the war. Communication tools used with the patients included WhatsApp, direct calls, Facebook Messenger, and Telegram. Over half of the physicians (52.6%) served less than 10 patients each, with a total of 353 children benefiting from telemedicine consultations for various diagnoses. Almost all pediatricians expressed satisfaction with various parameters, including history-taking, physical examinations, investigations, medication prescriptions, patient education, and psychological support. Moreover, most of them encourage telemedicine for daily practice, with 50% favoring media communication. However, despite this support, many concerns still exist. The medicolegal issues, as well as the recurrent unnecessary calls, remain an obstacle. Infectious, respiratory, and diarrheal diseases were the most common diseases encountered. Telemedicine was viewed by some physicians as a cost-effective option and was recommended for use in conjunction with in-person visits. Possible recommendations included verifying caregivers’ personal information, ensuring well-structured consultations, and providing more training for telemedicine practice. Pediatricians exploit telemedicine to serve their patients during armed conflict. Means of communication included WhatsApp, direct calls, audio, text messages, and videos. Physicians reported satisfaction with the virtual history-taking process, investigation, prescription, and patient education; however, they were dissatisfied with the physical examination. Despite the positive perception of physicians towards telemedicine, they still remain concerned about their lack of awareness of regulatory guidelines. It is highly recommended that training in telecommunications be provided to overcome ethical issues and drawbacks.