High prevalence of hypertension among an ethnic group in Sudan: implications for prevention.

OBJECTIVE: Hypertension is an emerging non-communicable disease in developing countries. Due to its silent nature and serious complications, active screening is essential in order to prevent complications. For instance, premature mortality from cardiovascular diseases could be prevented by the effective control of hypertension. The aim of this study was to determine the prevalence of undiagnosed hypertension among Nuba ethnic group living in Atbara city, north Sudan and to identify the associated risk factors. SUBJECT AND METHODS: All consenting 500 adults from Nuba tribe who live in El Wihda District, Atbara were included. Blood pressure (BP) and body mass index were measured. Standard interviewing procedures were used to record medical history, socio-demographic data, and lifestyle characteristics. RESULTS: Among the 500 participants, females were 364 (72.8%) and males were 136 (27.2%). The overall prevalence of undiagnosed hypertension was 49.4% (30.8% stage 1 hypertension and 18.6% stage 2 hypertension). In addition, 41% of the population was having prehypertension. The significant risk factors for high BP were: male sex, age above 45 years, overweight, illiteracy, and alcohol consumption. CONCLUSION: Undiagnosed high BP is very common among Nuba ethnic group; therefore, active screening and early management are recommended to prevent complications.

Undiagnosed hypertension in a rural community in Sudan and association with some features of the metabolic syndrome: how serious is the situation?

BACKGROUND: Hypertension is the leading risk factor for death and disability globally. Its prevalence is increasing worldwide especially in low and middle income countries. It is considered a silent killer because it has no specific symptoms and thus can go unnoticed for many years, only presenting for the first time with serious complications. The situation of undiagnosed hypertension in Sudan has not been fully investigated before. OBJECTIVE: To determine the prevalence of undiagnosed hypertension in the rural communities of River Nile State (RNS), Sudan and to assess the associated risk factors. METHODS: A cross-sectional community-based study, in which 1099 volunteer adult participants from the rural communities in RNS, not known to be hypertensive, were included. Blood pressure was measured as well as anthropometric measurements. The WHO stepwise approach for non-communicable diseases surveillance was used for data collection. A p value below 0.05 was considered statistically significant. RESULTS: There were 461 males (41.9%) and 683 females (58.1%). The male to female ratio was 1:1.4. The age range was 18-90 years, with a mean age of 39.6 (STD ± 15.9). The prevalence of undiagnosed hypertension was 38.2%, with a prevalence of 36.7% among males and 39.3% among females. There were significant associations between undiagnosed hypertension and increasing age, obesity, illiteracy and diabetes mellitus (p < 0.05). CONCLUSION: This study uncovers a hidden epidemic of a silent killer in the rural communities of RNS. Urgent interventions are required to address this serious health epidemic.

An outbreak of measles in gold miners in River Nile State, Sudan, 2011.

BACKGROUND: Despite the wide use of vaccination, measles outbreaks still occur. AIMS: This study assessed cases notified during a measles outbreak in northern Sudan in 2011 and the response of the health authorities to contain the outbreak. METHODS: The records of all measles cases reported to the River Nile State health ministry in 2011 from the Abu Hamad locality, a gold-mining area, were reviewed together with the actions of the health authorities at the time of the outbreak. Seventeen gold-mining clusters were included. Data on demographic, clinical, geographic and chronological characteristics of the cases were extracted. RESULTS: The outbreak occurred from 27 January to 3 May 2011 with the peak in epidemiological week 9. A total of 445 measles cases were recorded, giving an incidence of 27.1 per 10 000 of the mining and resident population. Most cases (87.4%) were aged between 15 and 34 years. High fever was the most common symptom (99.3% of the cases), followed by conjunctivitis (80.4%); haemorrhage was recorded in 29.4%. Most cases (84.9%) were unvaccinated. Six deaths occurred (case fatality: 1.3%); two from cerebral coma and four from haemorrhagic shock. Severity of disease was significantly associated with place of origin of the cases (P = 0.003). CONCLUSION: The measles outbreak in the gold-mining areas in Abu Hamad had serious consequences attributed to poor environmental conditions, overcrowding, poor nutrition and lack of vaccination. The health authority response helped end the outbreak. The local health authority should consider the gold-mining areas as a potential risk to public health in their future plans.

Comparison of serum lipid profile in type 2 diabetes with and without adequate diabetes control in Sudanese population in north of Sudan.

BACKGROUND: Diabetes mellitus (DM) is a major health problem in Sudan and is a leading cause of morbidity and mortality. Dyslipidemia is a major complication of diabetes and an important risk factor for cardiovascular disease (CVD). The objective of this study was to determine the prevalence of dyslipidemia and its co-relation with the glycemic control in individuals with diabetes in River Nile State, Sudan. METHODS: Individuals with diabetes attended, Naserudin Karamalla Diabetic (NKDM) Centre, in Atbara teaching hospital during study period, who volunteered to participate were included. Only those on treatment for DM for at least one year were included. Venous samples were collected for cholesterol, triglycerides, HDL, LDL, blood glucose and Glycosylated hemoglobin. Participants were interviewed using standardized pretested questionnaire to record medical history and sociodemographic characteristics. Blood pressure, body mass index (BMI) and waist circumference were measured. RESULTS: A total of 188 individuals were included. The mean age was 49.5 + 13.9 and (128) 68.1% were females. Most patients were having DM for at least 3-5 years 69 (36.7%). Poor diabetes control (HbA1c >7) was recorded in 87.2%, hypercholesterolemia, hypertriglyceridemia and high LDL were identified in 36.6%, 27.7% and 26.6% respectively. In addition, HDL was low in 61.2% of patients. CONCLUSION: Low HDL is a prominent feature in two thirds of individuals with diabetes, while high cholesterol and high triglyceride were seen in over one quarter.

Prevalence and determinants of undernutrition among children under 5-year-old in rural areas: A cross-sectional survey in North Sudan.

BACKGROUND: Child malnutrition is a major public health problem in developing countries. Therefore, the aim of this study was to estimate the prevalence of undernutrition among children <5 years in River Nile state (RNS) in North Sudan. SUBJECTS AND METHODS: A cross-sectional household survey was done in four localities in RNS. Using Multistage Cluster sampling, 1635 under 5 years' children had participated. Pretested questionnaire and anthropometric measures were used during data collection. The analysis was done using SPSS software program version 21 and World Health Organization (WHO) Anthro 2005 software. Indices were reported in z-scores and compared with the WHO 2005 reference population to determine the nutritional status of children. RESULTS: Among 1,447 surveyed children, the prevalence of stunting, underweight, and wasting were 42.5%, 32.7%, and 21%, respectively. Stunting was highest among the 48-60 months of age group (82.5%). Boys had poorer indicators of undernutrition in comparison to girls. Geographically stunting was more prevalent in Berber locality. Infectious diseases (gastroenteritis and respiratory symptoms) and incomplete vaccination were significantly associated with wasting (P = 0.007, P = 0.013, and P = 0.008). Poor socioeconomic status (P = 0.043), poorer household sanitation (P = 0.022), large family size, lack of family spacing, and infants weaned suddenly were regarded as risk factors for undernutrition. CONCLUSION: There was a high prevalence of undernutrition in the 4th and 5th year of life in RNS population, with significant gender imbalance. Our survey highlighted the importance of urgent need to improve child health in this region.

Prevalence of tuberculosis among children in North Sudan: Are we only seeing the tip of the iceberg?

INTRODUCTION: Tuberculosis (TB) is a significant cause of morbidity and mortality among children. The vague symptoms, the uncertain diagnostic tests and lack of adequate awareness among families all contributed in masking the actual prevalence of the disease. The objective of this study was to describe the epidemiology of childhood TB in River Nile State (RNS), North Sudan. METHODS: All registered cases of TB aged 15 years and below, at the 13 management units in RNS during 3 years, 2011-2013 were included. The records included epidemiological, clinical, and microbiological data. RESULTS: Out of the 1221 total TB notified cases, children were 187 (15.3%); almost equally distributed across the 3 years of the study period. Males were 56.7%. Most of the cases (89.9%) were newly diagnosed; among them, pulmonary TB (PTB) constituted 61.5%. Sputum specimen was tested in 59.4% (111/187) of cases, and only 15.3% (17/111) of specimens were sputum smear positive for new cases. The cure rate was (76.5%), and the treatment success rate was (88.2%). The death rate was 6.1% among PTB cases and 5.6% among extra-pulmonary cases. All the 20 (10.7%) children tested for HIV were negative. CONCLUSION: TB is under-reported in RNS and treatment outcomes are sub-optimal. Strategies to identify the active case-detection among children are recommended.

Non-Alcoholic Fatty Liver Disease in Africa and Middle East: An Attempt to Predict the Present and Future Implications on the Healthcare System.

Non-alcoholic fatty liver disease (NAFLD) encompasses a group of hepatic diseases that range in severity. NAFLD is increasingly recognized as an epidemic among different populations, including those in Africa and the Middle East. The objective of this narrative review is to document the prevalence of and risk factors for NAFLD in Africa and the Middle East and the potential implications on the healthcare systems. An in-depth search on Google Scholar, Medline and PubMed was conducted using the terms "non-alcoholic fatty liver disease" and "non-alcoholic steatohepatitis", in addition to "prevalence and risk factors for NAFLD", with special emphasis on Africa and the Middle East countries. There were three types of epidemiological studies that included prevalence, risk factors and management/complications of NAFLD. There was noticeable variation in the prevalence of NAFLD among different countries, based on the variation in the prevalence of risk factors (type 2 diabetes, obesity, metabolic syndrome and dyslipidemia) and the diagnostic tool used in the study. However, the highest prevalence rate was reported in some Middle East countries. In Africa, there were few studies about NAFLD and most reported variable prevalence rates. There is an increasing prevalence of NAFLD as a result of the increasing risk factors, particularly in the Middle East, while in Africa, the situation is still unclear. Health providers in these regions are faced with many challenges that need urgent plans.

Metabolic control targets in Sudanese adults with type 1 diabetes: A population-based study.

BACKGROUND: Type 1 diabetes is a challenging metabolic disorder for health authorities in Sudan. The objective of this study was to assess the level of glycemic control and to determine the prevalence of dyslipidemia and complications among individuals with type 1 diabetes in Sudan. MATERIALS AND METHODS: Individuals with type 1 diabetes, who were having the disease for at least 1 year, were invited to participate in this study. Data were collected from two diabetes centers, in the Capital Khartoum and Atbara City, North of Sudan. Participants were interviewed using standardized pretested questionnaire to record medical history, sociodemographic data, and life style characteristics. Blood pressure, body mass index, and waist circumference were measured. Blood samples were taken for measurement of lipid profile and glycosylated hemoglobin. RESULTS: A total of eighty individuals with type 1 diabetes volunteered to participate in this study, 37.5% of males and 62.5% of females. Majority of the patients were aged between 40 and 70 years old. There was poor glycemic control (glycosylated hemoglobin >7%), in 83.8%. Age and sex were significant factors associated with poor glycemic control in this cohort. High cholesterol, triglyceride, and low density lipoprotein were seen in 76.2%, 27.5%, and 48.8% of participants, respectively. Low high density lipoprotein was seen in 33.8%. Hypertension was determined in 21.3%. Peripheral neuropathy, visual impairment, diabetic foot, and myocardial infarction were seen in 50%, 48.8%, 18.8%, and 2.5% of patients, respectively. CONCLUSION: Sudanese adults with type 1 diabetes have poor glycemic control, high prevalence of dyslipidemia, and long-term complications.

Glycaemic control in Sudanese individuals with type 2 diabetes: Population based study.

BACKGROUND: Diabetes mellitus (DM) is a major health problem in Sudan and is a leading cause of morbidity and mortality. The objective of this study was to determine the prevalence of glycaemic control among individuals with type 2 diabetes across different cities in Sudan. METHODS: Individuals with type 2 diabetes attending selected diabetes centres in Sudan, who had been on treatment for DM for at least one year and volunteered to participate were included. Participants were interviewed using standardized pretested questionnaire to record medical history, sociodemographic and life style characteristics. Lipid profile and glycosylated hemoglobin were tested by calibrated laboratory methods. Blood pressure, Body mass index (BMI) and waist circumference were measured. Chi squared and logistic regression were used as statistical methods. RESULTS: A total of 387 individuals with T2DM were included in this study (50.4% males and 49.6% females). The glycemic control indicator (HbAIc>7) was poor in 85% of patients. Factors associated with poor glycemic control were prolonged duration of diabetes (p=0.03), high plasma triglyceride (p=0.02), low high density lipoprotein (HDL) level (p=0.04) and low glomerular filtration rate (GFR) (P=0.01). Logistic regression analysis showed that low GFR is independent factor with poor diabetes control. CONCLUSION: High prevalence of uncontrolled diabetes (85%) is noted in Sudanese individuals with type 2 diabetes.

Prevalence of diabetes mellitus and its risk factors in urban communities of north Sudan: Population-based study.

BACKGROUND: Diabetes mellitus (DM) is a major health problem in Africa and worldwide. The prevalence of diabetes is expected to increase at alarming rate in Africa. Its estimated that around 20 million Africans are now living with diabetes, comprising a challenge for health systems at present and in the future. The aim of the present study was to determine the prevalence of undiagnosed and diagnosed DM and impaired glucose tolerance (IGT) in adult urban communities of the River Nile State (RNS), north Sudan. METHODS: The present study was a cross-sectional community-based study in which participants were randomly selected from the four main cities of the RNS, on a house-to-house basis. Blood glucose was tested and all participants completed a questionnaire to obtain demographic, clinical and social data. Blood pressure and anthropometric measures were also recorded. RESULTS: In all, 954 adults (518 females; 54.3%; mean [±SD] age 39.5 ± 16.7 years; range 18-90 years) participated in the survey. The overall prevalence of DM was 19.1% (182/954), whereas that of IGT was 9.5% (91/954). Among the diabetic group, 125 (68.7%) had known diabetes, whereas 57 (31.3%) were newly diagnosed during the study. Increasing age, a family history of diabetes, central obesity, abnormal body mass index, and hypertension were significant risk factors for DM. CONCLUSIONS: There is high prevalence of DM and glucose intolerance in the urban population of the RNS. Screening for diabetes in individuals with any feature of metabolic syndrome is recommended.

Prevalence of and risk factors for hypertension among urban communities of North Sudan: Detecting a silent killer.

BACKGROUND: Hypertension is a common global health problem in many countries including Sudan. The objective of this study was to determine the prevalence of and risk factors for high blood pressure (BP) in River Nile State (RNS), Sudan. MATERIALS AND METHODS: A community-based, cross-sectional study was conducted by a house-to-house survey; all consented adults from the main four cities, Atbara, Shendi, Ed Damer, and Berber, were interviewed using standardized pretested questionnaire to record medical history, sociodemographic and lifestyle characteristics. BP was measured using the standardized technique. Body mass index, waist circumference, and blood glucose were also determined. RESULTS: A total of 954 individuals were included in the study. The mean age was 39.5 ± 16.6 years and 54.3% were females. The prevalence of hypertension was 35.7% and the newly diagnosed cases were 22.4%. Increasing age, low educational level, diabetes mellitus, obesity, and central obesity were found to be risk factors for hypertension. CONCLUSION: Hypertension is diagnosed in more than one-third of the population living in urban communities of RNS and correlates well with features of the metabolic syndrome.

The Changing Pattern of Hospital Admission to Medical Wards: Burden of non-communicable diseases at a hospital in a developing country.

OBJECTIVES: This study aimed to determine the pattern of hospital admissions and patient outcomes in medical wards at Atbara Teaching Hospital in River Nile State, Sudan. METHODS: This retrospective cross-sectional study was conducted from August 2013 to July 2014 and included all patients admitted to medical wards at the Atbara Teaching Hospital during the study period. Morbidity and mortality data was obtained from medical records. Diseases were categorised using the World Health Organization's International Classification of Diseases (ICD) coding system. RESULTS: A total of 2,614 patient records were analysed. The age group with the highest admissions was the 56-65-year-old age group (19.4%) and the majority of patients were admitted for one week or less (86.4%). Non-communicable diseases constituted 71.8% of all cases. According to ICD classifications, patients were admitted most frequently due to infectious or parasitic diseases (19.7%), followed by diseases of the circulatory (16.4%), digestive (16.4%) and genito-urinary (13.8%) systems. The most common diseases were cardiovascular disease (16.4%), malaria (11.3%), gastritis/peptic ulcer disease (9.8%), urinary tract infections (7.2%) and diabetes mellitus (6.9%). The mortality rate was 4.7%. CONCLUSION: The burden of non-communicable diseases was found to exceed that of communicable diseases among patients admitted to medical wards at the Atbara Teaching Hospital.

Bone marrow aspiration in north Sudan: the procedure, indications and the diagnostic value.

INTRODUCTION: Bone marrow aspiration (BMA) is a common and useful investigation tool in clinical practice to obtain information about both hematological and non-hematological disorders. The aim of the work was to identify the main indications for BMA in Atbara city, north Sudan and to determine the common diagnoses encountered. METHODS: All reports of BMA carried out during a 6-year period from 2009 to 2014, in the Modern Specialized Laboratory (the only site where BMA is conducted in Atbara) were reviewed. The information extracted included the main indications for performing this procedure, age groups involved, and the most common diagnoses established. A specially designed form was used for this purpose and the data were analyzed using SPSS computer program. RESULTS: A total number of 112 cases were subjected to bone marrow aspiration. The most frequent indications were: pancytopenia 43(38.4%), anemia 39 (34.8%), and suspected leukemia 13 (11.6%). In 86(76.8%) cases, BMA provided either the diagnosis or diagnostic clues to the disease process, while 26 (23.2%) of the aspirates revealed a normally functioning marrow. CONCLUSION: Bone marrow aspiration is an important investigation for establishing the diagnosis in many medical conditions. The most common indication for this procedure in our study was pancytopenia and the most common finding was aplastic anemia.

Prevalence of and predictive factors for nonalcoholic fatty liver disease in Sudanese individuals with type 2 diabetes: Is metabolic syndrome the culprit?

BACKGROUND AND STUDY AIM: Non-alcoholic fatty liver disease (NAFLD) is a common global chronic liver condition. The prevalence of NAFLD among individuals with type 2 diabetes is estimated to be as high as 75%. The aim of this study was to determine the prevalence of NAFLD among individuals with type 2 diabetes in Sudan. PATIENTS AND METHODS: This was a cross-sectional hospital-based study, which was carried out at the Jabir Abu-Elizz diabetic centre in Khartoum; 167 outpatients with type 2 diabetes were enrolled. NAFLD was diagnosed based on ultrasound, following exclusion of significant alcohol intake and secondary causes of liver diseases. NAFLD was defined as hepatic steatosis in the absence of alcohol intake, medication, previous liver disease and negative results for the serological test for hepatitis B and C. Logistic regression analysis was used to determine independent risk factors for the development of NAFLD in individuals with type 2 diabetes. RESULTS: The number of female subjects was 89 (53.3%), and most subjects (145, 86.8%) were between the ages of 40 and 70 years. The overall prevalence of fatty liver among individuals with type 2 diabetes was found to be 50.3%. Age, duration of diabetes, hypertension and HbA1c levels appeared to have no impact on the prevalence of NAFLD. The possible predictors of NAFLD were overweight, obesity, central obesity, high triglyceride level and low high-density lipoprotein cholesterol (HDL-c) level. A higher prevalence of NAFLD was observed in individuals with three components of the metabolic syndrome. CONCLUSION: NAFLD was observed in half of the diabetic population, and its occurrence correlates positively with metabolic syndrome risk factors.

A preliminary survey of un-diagnosed hypertension among Nubians and Coptics in Atbara and Eldamer Cities, Sudan: does ethnicity affect prevalence?

INTRODUCTION: Hypertension is a non-communicable disease of increasing importance in developing countries. Due to its silent nature and serious complications, active screening is essential in case detection. The aim of this study was to determine the prevalence of undiagnosed hypertension and to find out whether there are ethnic variations in prevalence between two Sudanese ethnicities. METHODS: This is a cross-sectional community-based study in which 100 subjects from Nuba tribe and 70 Coptics not previously known to have hypertension volunteered to participate. Blood pressure was measured and a questionnaire delineating demographic, clinical and social data was obtained from each participant. RESULTS: Female to male ratio was 2:1. The mean age was 39.5 ± 8 years for Nubians and 40.5 ± 5.5 years for Coptics. High blood pressure was detected in 48% of Nubians and 24.3% of Coptics (p>0.001). The prevalence of stage II hypertension was higher in Nubians compared to Coptics (25% vs. 3.8%; p<0.001). Besides the ethnic variation, other significant differences between the two groups were illiteracy and alcohol consumption, both of which were significantly commoner among Nubians. CONCLUSION: Undiagnosed high blood pressure is common in our local community, with some variations in prevalence and severity among different ethnic groups. Key words: Coptics; Nubians; River Nile State; Sudan; Undiagnosed hypertension.

Situation analysis of schistosomiasis and soil-transmitted helminthes in River Nile State, Sudan.

BACKGROUND: Infection with schistosomiasis and soil-transmitted helminthes (SSTH) constitutes a major health problem worldwide, yet the burden of disease is in the tropical countries. The disease is endemic in River Nile State, Sudan but the exact prevalence rate is unknown. METHODS: A survey of 2490 pupils in 103 basic schools in River Nile State, Sudan was conducted to determine the prevalence and distribution of SSTH infections. Stool and urine samples were collected and examined for ova of Schistosoma haematobium, S. mansoni and intestinal worms.Questionnaires were used to obtain demographic data, to quantify exposure to surface waters and to assess the perception of pupils and stakeholders about risk behviours and control strategies. RESULTS AND CONCLUSION: The prevalence of S. haematobium in the River Nile State was 1.7% with variation between localities (range= 0.58-3.5%). No S. mansoni infection was detected and the prevalence rate for intestinal helminthes was 0.1%.