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.

The Relationship Between Blood Culture, C-reactive Protein, and Neonatal Sepsis: A Cross-Sectional Study.

Background Sepsis is one of the most common causes of morbidity and mortality in newborns. Diagnosis of neonatal sepsis may be difficult because the clinical presentations are often nonspecific. Neonatal sepsis may have an early onset (zero to three days) or a late onset (four days or later). Onset is most rapid in premature neonates. In this study, we aimed to assess the correlation between positive cultures, high C-reactive protein (CRP) levels, and the diagnosis of neonatal sepsis. Methodology This descriptive, prospective, cross-sectional study was undertaken over four months starting from December 15, 2019, to April 15, 2020, in Atbara Teaching Hospital, Sudan. Data were collected from 71 patients. CRP levels were measured, and blood cultures were performed. Results High CRP level >10 mg/L was seen in patients having positive blood culture (55.3%), mainly in preterm babies (CRP >10 mg/dL (61.1%), positive culture (55.6%)) and very low birth weight babies (CRP >10 mg/dL (83.3%) and positive culture (67%)). Conclusions Our findings suggest that Klebsiella is an important cause of neonatal sepsis. CRP was positive in babies mainly with proven sepsis. There is a high correlation between CRP and blood culture in patients with neonatal sepsis which may give access to remodeling the prioritization of the management options in the clinical setting.

Vitamin D Levels Among Rheumatoid Arthritis Sudanese Patients: Prevalence and Correlation to Disease Activity - A Bicentric Study.

Purpose: To evaluate vitamin D levels among adult Sudanese RA patients and identify its correlation with RA disease activity. Patients and Methods: A bicentric cross-sectional analytical hospital-based study was performed in two Khartoum State Hospitals between October 2019 and January 2020, enrolling 90 Sudanese patients with RA. Serum vitamin D levels were measured with a standard reference level of 30ng/mL-100ng/mL. A detailed interview-based questionnaire was used to collect the patient's information, clinical data and lab results-disease activity was assessed via the DAS-28 score. The data was then analyzed using SPSS v-24. Results: Vitamin D levels were low in 79 candidates (87.8%), 53 of which (67.1%) showed moderate insufficiency (10-30ng/mL), and 26 candidates (32.9%) had severe deficiency (less than 10 ng/mL). Regarding the disease activity, 57 participants (63.3%) had moderate disease activity (DAS-28=3.2-5.1), and 22 participants (24.4%) had high disease activity (DAS-28 >5.1). A significant negative correlation was reported between high DAS-28 scores and low vitamin D levels with p-value = <0.001 (95% CI: -0.8591 to 0.0015) and r = -0.44. Conclusion: Most adult Sudanese rheumatoid arthritis patients showed low vitamin D levels (87.8%), which was also significantly correlated with increased disease activity (P-value <0.05). Moreover, the prevalence of low vitamin D levels was significantly higher than in numerous countries worldwide.

Risk factors associated with fasting during Ramadan among individuals with diabetes according to IDF-DAR risk score in Atbara city, Sudan: Cross-sectional hospital-based study.

BACKGROUND: Ramadan is a holy month for Muslims. The aim of this study was to assess risk associated with Ramadan fasting among Sudanese individuals with diabetes (high, moderate, and low risk) according to International Diabetes Federation in collaboration with Diabetes and Ramadan International alliance (IDF-DAR) Practical Guidelines 2021 risk score. METHODS: This was a cross-sectional hospital-based study recruited 300 individuals with diabetes (79% have type 2 diabetes) from diabetes centers in Atbara city, the River Nile state, Sudan. RESULTS: The risk score was distributed as low risk (13.7%), Moderate risk (24%), and High risk (62.3%). T-test showed a significant difference in mean risk score by gender, duration and type of diabetes (p values = 0.004, 0.000, & 0.000, respectively). One-way ANOVA revealed a statistically significant difference in the risk score by age groups (p = 0.000). Logistic regression revealed that the odds of being in the 41-60 years age group had lower probability to be categorized in the moderate risk group of fasting rather than low risk by 4.3 times than being in the age more than 60 years. (p = 0.008), the odds of being in the age group 41-60 years lower probability to be categorized in the high risk of fasting rather than low risk by 8 times than being in the age more than 60 years. (p = 0.000). CONCLUSION: The majority of patients in this study have a high risk for Ramadan fasting. IDF-DAR risk score is of great significance in assessing individuals with diabetes for Ramadan fasting.

Prevalence of obesity related hypertension among overweight or obese adults in River Nile State in Northern Sudan: a community based cross-sectional study.

Background: Reducing excess body weight is important for control and management of high blood pressure (BP) in adults. Previous studies showed high prevalence of hypertension in River Nile State-north of Sudan, hence this study to establish whether obesity can be among the main risk factors and to study the prevalence of obesity related hypertension among Sudanese adults in River Nile State. Methods: This was a cross sectional community-based study conducted in River Nile State, Northern Sudan from January to June 2021. Obese and overweight, aged 18 years and above and accepted to participate in the study were included in the study. Convenience sampling method was used to select the participants. Data was collected through structured questionnaire filled by the patients after taking informed consent. Anthropometric measurements were taken. Two measurements of BP were obtained. Data was analyzed using SPSS version 23.0 (IBM, Chicago, USA). Chi-square test was used to determine the associations between categorical variables while logistic regression test was used to predict the presence of hypertension among studied population. Results: A total of 1,295 participants were enrolled in this study. Obesity was reported in 1,118 (86.3%) of the participants. The prevalence of hypertension among the participants was 1,027 (79.3%). Central obesity was reported in 951 (92.6%) among hypertensive patients (P<0.001). Moreover, among hypertensive patients 470 (45.8%) were obese class I, 334 (32.5%) overweight, 139 (13.5%) obese class II and 84 (8.2%) obese class III (P<0.001). Obesity, BMI are risk factor of hypertension (P<0.001). Other risk factors were age above 40 years (P<0.001), unemployment (P<0.001), low education level (P<0.001) and being married (P<0.001). Logistic regression analysis showed that increasing age [P<0.001; odds ratio (OR) =1.055; 95% confidence interval (CI): 1.041-1.068], central obesity (P<0.001; OR =5.16; 95% CI: 3.4-7.8) and high body mass index (BMI) (P<0.001; OR =3.7; 95% CI: 1.7-7.9) were associated with uncontrolled hypertension. Conclusions: The study showed that the prevalence of obesity related hypertension was high. Common risk factors were age above 40 years, unemployment, and marriage. Importantly, central obesity, gross obesity and increasing age can be associated with uncontrolled BP management.

Assessment of lifestyle modifications among Sudanese individuals with diabetes: The situation so far and the need to do more.

BACKGROUND: Inadequate lifestyle practices among individuals with diabetes may influence the progression of diabetes and its complications. The aim of this study was to assess the lifestyle practices among individuals with diabetes in Sudan. METHODOLOGY: This was a descriptive, cross-sectional, health facility-based study conducted in 3 diabetes centers treating individuals with diabetes. The data were collected using a standardized pretested metabolic questionnaire about lifestyle and were analyzed by performing descriptive and inferential statistics through SPSS program version 23. RESULTS: A total of 528 patients with diabetes answered the questionnaire. There were 52.1% of female participants and 72.9% of urban residents. 23.9% were obese, regular exercise was reported by 27.7%, and no exercise by 17%. There was a statistically significant association between lifestyle practices and gender (P < 0.001), age (P < 0.001), educational level (P = 0.002), marital status (P < 0.001), duration of diabetes (P < 0.001), hypertension (P < 0.001), high-density lipoprotein (P < 0.001), low-density lipoprotein (P < 0.001), and HbA1c level (P < 0.001). Logistic regression analysis showed male gender and education were significantly associated with lifestyle changes. Men were more likely to engage in favorable lifestyle practices than women (P < 0.001), while those with no formal education were less likely to engage in healthy lifestyle (P < 0.001). CONCLUSIONS: Health authorities in Sudan will need to put more efforts into education for promoting self-awareness and good lifestyle practices in the population with diabetes.

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.

Hypertension in Sudanese individuals and associated risk factors: the critical intersection between salt and sugar intake.

BACKGROUND: Hypertension is common problem across the globe. The aim of this study was to assess the prevalence of hypertension and impact of salt and sugar intake in Sudanese population. METHODS: A descriptive cross sectional study, included 323 of participants in Khartoum state. The data collection was performed to gather demographic information, physical activity and dietary habits. In addition to measurement of blood pressure (BP), weight and height measurement for calculation of body mass index (BMI). RESULTS: Among the 323 respondents (males were 171), 29 (9%) are known hypertensive, 60 (18.6%) are diagnosed to be hypertensive. Therefore, the prevalence of hypertension is 27.6%. Hypertension was significantly associated with male sex, increasing age, obesity, low physical activity, salt and sugar intake. Logistic regression analysis showed that increasing age, obesity and high sugar intake are absolute predictors for hypertension in Sudanese population. CONCLUSIONS: The prevalence of hypertension was 27.6%. Hypertension in Sudanese individuals was associated with high sugar and salt intake, obesity and increase in age. Therefore, decreasing sugar and salt intake should be advocated by health authorities and the public in Sudan.

HIV-Associated Nephropathy in Africa: Pathology, Clinical Presentation and Strategy for Prevention.

The human immunodeficiency virus (HIV) infection can lead to progressive decline in renal function known as HIV-associated nephropathy (HIVAN). Importantly, individuals of African ancestry are more at risk of developing HIVAN than their European descent counterparts. An in-depth search on Google Scholar, Medline and PubMed was conducted using the terms "HIVAN" and "pathology and clinical presentation", in addition to "prevalence and risk factors for HIVAN", with special emphasis on African countries for any articles published between 1990 and 2017. HIVAN is characterized by progressive acute renal failure, proteinuria and enlarged kidneys. A renal biopsy is necessary to establish definitive diagnosis. Risk factors are male gender, low CD4 counts, high viral load and long use of combined antiretroviral medication (cART). There is a wide geographical variation in the prevalence of HIVAN as it ranges from 4.7% to 38% worldwide and little published literature is available about its prevalence in African nations. Microalbuminuria is a common finding in African populations and is significantly associated with severity of HIV disease progression and CD4 count less than 350 cells/µL. Other clinical presentations in African populations include acute kidney injury (AKI), nephrotic syndrome and chronic kidney disease. The main HIV-associated renal pathological lesions were focal segmental glomerulosclerosis, mainly the collapsing form, acute interstitial nephritis (AIN), and immune complex-mediated glomerulonephritis (ICGN). HIV infection-induced transcriptional program in renal tubular epithelial cells as well as genetic factors is incriminated in the pathogenesis of HIVAN. This narrative review discusses the prevalence, presentation, pathogenesis and the management of HIVAN in Africa. In low resource setting countries in Africa, dealing with HIV complications like HIVAN may add more of a burden on the health system (particularly renal units) than HIV medication itself. Therefore, the obvious recommendation is early use of cART in order to decrease risk factors that lead to HIVAN.

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.

Sugar intake in Sudanese individuals was associated with some features of the metabolic syndrome: Population based study.

AIM: The aim of this study was to assess the level of sugar intake among Sudanese individuals. MATERIALS AND METHODS: A cross-sectional study with 323 participants. Respondents were grouped by the total intake of added sugars into two groups, one group with sugar intake more than 200 calories per day and other group with sugar intake less than 200 calories per day. Demographic data were collected with anthropometric measurements like body mass index (BMI) and waist circumference. Chi square, T-Tests and stepwise logistic regression were used (a p-value <0.05 was considered significant). RESULTS: High sugar intake was noted among 74.6% participants and among overweight, normal weight, followed by obese (p<0.015) and then individuals with diabetes and hypertension (p <0.000 and 0.038 respectively).High sugar intake was also associated with abdominal obesity (p<0.016), mean age of 33 years old (p<0.00) and being married and single(p<0.003). Stepwise logistic regression showed diabetes and BMI<25 were absolute predictors for sugar consumption with p value of 0.001 and 0.039 respectively. Individuals with diabetes have more than five times probability to consume large amount of sugar (Odd ratio 5.6), while those with BMI<25 have two times risk of consuming more sugar compared to those with BMI>25 group (Odd ratio 2.1). CONCLUSION: A large percentage of Sudanese population uses a high amount of sugar. High sugar intake was associated with normal weight, overweight, abdominal obesity, diabetes and hypertension. Absolute predictors of high sugar intake were diabetes and normal body weight.

Increasing prevalence of type 2 diabetes mellitus and impact of ethnicity in north Sudan.

BACKGROUND: Diabetes mellitus constitutes a global health threat, with increasing burden of disease in low and middle-income countries witnessing ongoing epidemiological transition including Sudan. AIMS: To study the prevalence of type 2 diabetes mellitus (T2DM) and prediabetes and determine the relationship to gender, age, waist circumference, body mass index, residence and ethnicity among the adult population in north Sudan. METHODS: A cross-sectional, population-based study in Northern State and River Nile State using random multi-stage cluster sampling targeting 5376 participants from 14 localities divided into 60 urban and 40 rural clusters. In each cluster, 60 households were studied. Blood glucose level and anthropometric measurements were recorded and a questionnaire containing demographic data was obtained from each participant. RESULTS: The prevalence of T2DM among participants was 18.7% and prediabetes was 12.9%. Among people living with T2DM, 694(71.0%) were known cases of T2DM, whereas 284(29.0%) were newly diagnosed cases. The significant associated risk factors for T2DM included urban residence (AOR 1.23, 95%CI 1.09-1.41), age above 60 years (AOR 4.77, 95%CI 4.04-5.63), obese BMI (AOR 1.26, 95%CI 1.03-1.55) and central obesity (AOR 1.39, 95%CI 1.14-1.68). Compared to indigenous population, individuals of Egyptian descents (AOR 1.28, 95%CI 1.04-1.57) and mixed origin (AOR 1.24, 95%CI 1.04-1.48) had increased risk of T2DM. CONCLUSION: The prevalence of T2DM and prediabetes in north Sudan have increased significantly since 1996 with variations between ethnicities which showed to be an independent risk factor for T2DM. Health authorities are recommended to set plans to meet the health needs of these communities.

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 and trends of obesity among adult Sudanese individuals: Population based study.

AIM: The prevalence of obesity has increased across the globe in particular in Africa. The aim of this study was to determine the prevalence of obesity in Sudan. MATERIAL AND METHODS: Descriptive, cross sectional study recruited 7239 individuals. Demographic and clinical data were collected by an interview using a pretested standardised questionnaire. Anthropometric measurements including body weight, height and waist circumference have been taken using standardized techniques and calibrated equipment. Body mass index (BMI) has been calculated. RESULTS: Total of 7239 persons completed the questionnaires; the results showed that prevalence of obesity was found to be 21.2%, with a higher rate of obesity in females than males (26.3% versus 13.8%). The prevalence of central obesity was also higher in women (36.7%) than men (17.6%).The prevalence of overweight was 34.9%. The overall prevalence of overweight/obesity was 56.1%. Obesity determined by BMI was associated with hypertension and diabetes. While central obesity was associated with an increase in age, female, diabetes and hypertension. CONCLUSION: The prevalence of obesity was 21.2%. Obesity and central obesity have a higher prevalence among Sudanese women. Obesity and central obesity were associated with diabetes and hypertension.

Diabetes and Ramadan: A concise and practical update.

Despite the fact that the month of Ramadan includes 29-30 days and the duration of fasting for each day can last for between 12 and 16 h, it was estimated that a large number of individuals with diabetes do fast during Ramadan. In light of recent advancement of new pharmacological agents, drugs such as vildagliptin, sitagliptin, and liraglutide were found to be safe to use during this month of fasting. These therapeutic agents can also be used in combination with metformin. The use of sulfonylureas, in most of the recent guidelines about diabetes and Ramadan, seems not to gain much support due to the risk of hypoglycemia. In this review, we also addressed the use of insulin injection, insulin pump, and education before, during, and after Ramadan. Further research is needed to determine (i) the therapeutic benefit of new antidiabetic agents and (ii) the benefit of new technologies for the treatment of diabetes.

Prevalence and Risk Factors for Acute Coronary Syndrome Among Sudanese Individuals With Diabetes: A Population-Based Study.

BACKGROUND: Acute coronary syndrome (ACS) is common with diabetes. The aim of this study was to establish prevalence and risk factors for ACS among Sudanese individuals with diabetes mellitus (DM). METHODS: A descriptive cross-sectional study was conducted in Khartoum State and Atabra (North of Sudan). The data collection was performed through pretested questionnaire, in addition to measurement of lipid profile and HbA1c. RESULTS: Among the 496 respondents, 234 (48.4%) were males and only 15 of them had ACS, while 255 (51.6%) were females and 12 had ACS. Therefore, the prevalence of ACS was 5.44% (95% confidence interval (CI): 3.45-7.44%). The unadjusted risk factors for ACS were age (P = 0.0008864), duration of DM (P = 0.01105) and presence of hypertension (P = 0.0006021). The presence of albuminuria, gender, and body mass index (BMI) was not associated with ACS. In addition, parameters like HbA1c, high-density lipoprotein (HDL), triglyceride and low-density cholesterol (LDL) were also not associated with ACS. Logistic regression analysis showed that duration of diabetes (odds ratio (OR) for below 5 years' history of DM = 0.175 (95% CI for OR: 0.180 - 0.835), P = 0.04051) and hypertension (OR = 2.462 (95% CI for OR: 1.007 - 6.500), P = 0.039) were absolute risk factors for ACS. CONCLUSION: The prevalence of ACS is estimated to be 5.44%. ACS in Sudanese individuals with DM was associated with hypertension, increase in age and increase in duration of DM.

Diabetes complications in Sudanese individuals with type 2 diabetes: Overlooked problems in sub-Saharan Africa?

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 is to determine the prevalence of complications of type 2 diabetes across different cities in the country. METHODS: Individuals with type 2 diabetes, who have been on treatment for DM for at least one year and volunteered to participate, were selected from two diabetes centers in Sudan (Khartoum and Atbara). Participants were interviewed using standardized pretested questionnaire to record medical history, socio-demographic, life style characteristics and presence of complications of diabetes. RESULTS: Four hundred and twenty four individuals with T2DM were included in this study (50.7% males and 49.3% females). Good glycemic control (HbA1c <7) was found in 15.7%. Hypertension was reported in 39.9% and myocardial infarction in 5.9%, while high cholesterol and triglyceride noted in 59.9%, 32.5% respectively. Low HDL was noted in 52.6%. Other complications like peripheral neuropathy, retinopathy and diabetic foot were observed in 68.2%, 72.6% and 12.7% respectively. Factors significantly associated with these complications were longer duration of diabetes (P<0.001), and living in urban areas (P<0.004). CONCLUSION: High prevalence of complications of type 2 diabetes were observed especially in those with longer duration of diabetes and poor control.

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.

Diabetes, metabolic syndrome and dyslipidemia in people living with HIV in Africa: re-emerging challenges not to be forgotten.

BACKGROUND: The current challenge in managing people living with human immunodeficiency virus (PLWHIV) includes the identification and monitoring for comorbid health risks associated with HIV and its treatment and longer survival. Dyslipidemia, diabetes mellitus and metabolic syndrome are increasingly seen in PLWHIV. OBJECTIVE: In this narrative review, we aimed to summarize the current knowledge about diabetes, dyslipidemia and metabolic syndrome in PLWHIV in Africa and also to discuss the challenges that patients as well as health authorities in Africa may face. METHODS: PubMed and Google scholar published-English literatures concerning earlier mentioned entities regardless of time limit were critically reviewed. RESULTS: The prevalence of metabolic disorders in HIV population in Africa was estimated to range from 2.1% to 26.5% for diabetes and 20.2% to 43.5% for pre-diabetes, 13% to 58% for metabolic syndrome and 13% to 70% for dyslipidemia. CONCLUSION: The management of metabolic disorders and cardiovascular disease risks related to HIV is complex especially in Africa due to healthcare resources, but our experience suggests that metabolic clinic is beneficial to patients and staff and should be an important part of HIV services especially as the older HIV population is increasing. In this context, cardiovascular risk assessment of HIV-infected patients will become an important component of care in developing countries in Africa and strategies are needed to deal with progressive increase in the epidemic of type 2 diabetes, dyslipidemia and metabolic syndrome.