The prevalence and associated factors for primary headache disorders in adolescents in eastern Sudan: a community-based cross-sectional study.

Background: Headache disorder is the second-highest cause of disability worldwide; however, data are scarce on headache among adolescents, especially in Africa. There has yet to be published data on headache among adolescents in Sudan, the third-largest country in Africa. This study aimed to assess the prevalence of primary headache disorders and associated factors among adolescents (10-19 years) in eastern Sudan. Methods: A community-based cross-sectional study was conducted in the city of Gadarif in eastern Sudan. Questionnaires were used to gather the adolescents' sociodemographic characteristics. Headache diagnostic questions were based on the beta version of the International Classification of Headache Disorders-III (ICHD-3). Multivariate analysis was conducted to assess the associated factors for primary headache disorders, and the results were expressed as risk ratios (RRs) and 95.0% confidence interval (CI). Results: Of the 401 enrolled adolescents, 186 (46.4%) and 215 (53.6%) were male and female, respectively. The median (IQR) age was 14.0 (12.1-16.2) years. Eighty-one (20.2%) of the 401 adolescents reported experiencing primary headache disorders, including migraine with aura in 16 (4.0%), migraine without aura in 33 (8.2%), tension-type in 14 (3.5%), and undifferentiated headache in 18 (4.5%) adolescents. The prevalence of primary headache disorders was significantly higher in females than in males [55/215 (67.9%) vs. 26/186 (32.1%), p = 0.004]. In the multivariate analysis, increased age (RR = 1.09, 95.0 CI = 1.02-1.16) and being female (RR = 1.75, 95.0 CI = 1.14-2.67) were associated with increased RR of primary headache disorders. Parents' education level and occupation, smoking/snuff use, and body mass index were not associated with primary headache disorders. Conclusion: One-fifth of the adolescents in eastern Sudan reported experiencing primary headache disorders, which was more common in females and with increased age.

Mid-upper arm circumference as a screening tool for identifying underweight adolescents.

Background: Mid-upper arm circumference (MUAC) is a potentially credible alternative method for body mass index (BMI) to assess nutritional status. We aimed to assess the correlation between MUAC and BMI- Z-score and to identify a reliable MUAC cut-off point to detect underweight (BMI- Z-score of < -2 standard deviation) Sudanese adolescents. Methods: A cross-sectional study was conducted in eastern Sudan. After obtaining adolescents' age and sex, their weight, height, and MUAC were measured using the standard procedures. The MUAC (cm) cut-off corresponding to underweight was calculated using receiver operating characteristic (ROC) curve analysis. Results: In total, 390 adolescents were enrolled in the study and 205 (52.6%) of them were females. The median (interquartile range, IQR) age was 15.1 (14.0-16.3) years. The medians (IQR) of MUAC and BMI- Z-score were 22.0 (20.0-24.0) cm and - 0.62 (-1.5-0.3), respectively. MUAC was positively correlated with BMI Z-score in all participants (r = 0.534, p < 0.001), in females (r = 0.715, p < 0.001), and in males (r = 0.404, p < 0.001). Of the 390 enrolled adolescents, 61(15.6%) were underweight. The MUAC cut-off for underweight was ≤21.2 cm in all participants (Youden's Index, YI = 0.50; sensitivity = 82.0%; specificity = 68.0%, AUROCC = 0.78), in females (YI = 0.66, sensitivity = 86.0%, specificity = 80.0%, AUROCC = 0.87), and in males (YI = 0.32, sensitivity = 80.0%, specificity = 52.0%, AUROCC = 0.69). Conclusion: MUAC has good accuracy results and can be adopted for community-based screening of underweight adolescents.

Ethnicity, Age, and Gender Differences in Glycated Hemoglobin (HbA1c) Levels among Adults in Northern and Eastern Sudan: A Community-Based Cross-Sectional Study.

BACKGROUND: The level of association between glycated hemoglobin (HbA1c) level and ethnicity, age, and gender is not yet settled. This study aimed to investigate the association between ethnicity, age, and gender and HbA1c level among adults who were known not to have diabetes mellitus in northern and eastern Sudan. METHODS: A comparative community-based cross-sectional study was conducted. Sociodemographic and clinical characteristics data were collected. HbA1c levels were measured, and multiple linear regression analysis was performed. RESULTS: A total of 898 adults (363 in northern Sudan and 535 in eastern Sudan) were included; 349 (38.9%) were males. The HbA1c level was significantly higher in eastern Sudan, and there was no significant difference in HbA1c levels between genders. In multiple linear regression, for adults with HbA1c <6.5%, ethnicity and BMI were associated with HbA1c, but age and gender were not associated with HbA1c. In northern Sudan, age was positively associated with HbA1c, and there was no association between gender, BMI, and HbA1c in adults with HbA1c <6.5%. In eastern Sudan, BMI was positively associated with HbA1c, and there was no significant association between age and gender and HbA1c level in adults with HbA1c <6.5%. CONCLUSION: HbA1c levels are influenced by ethnicity and age but not by gender.

COVID-19 vaccine acceptance among pregnant women: a hospital-based cross-sectional study in Sudan.

Introduction: Pregnancy increases the risk of developing a severe illness due to COVID-19 infection. To the best of our knowledge, no previous study has been conducted on COVID-19 vaccine acceptance among pregnant women in Sudan. Hence, this study aimed to determine COVID-19 vaccination acceptance and its predictors among pregnant women. Methods: A cross-sectional study was conducted among 623 pregnant women attending Gadarif maternity hospital in eastern Sudan through a structured questionnaire. Data were obtained on sociodemographic characteristics, obstetric and health-related characteristics, COVID-19 infection, and vaccination-related information, as well as beliefs about and acceptance of COVID-19 vaccination. Results: COVID-19 vaccine acceptance among the pregnant women was 2.7%. The vaccine acceptance was higher if their husband's education was secondary school or higher [adjusted odds ratio [AOR] 4.30, 95% confidence interval (CI) 1.11-16.65, p = 0.035] and discussion of COVID-19 vaccine with the pregnant women by a health care professional in the hospital (AOR 5.46, 95% CI 1.94-15.35, p < 0.001). The most common reasons for resistance to the vaccine were concerns about the side effects of the vaccine for the mother and her baby. Conclusion: Acceptance of the COVID-19 vaccination among the pregnant women was very low. Discussions with pregnant women and their husbands by health care professionals regarding the safety of COVID-19 vaccine for the mother and her baby are highly recommended.

The Mid-Upper Arm Circumference as a Substitute for Body Mass Index in the Assessment of Nutritional Status among Pregnant Women: A Cross-Sectional Study.

To compare mid-upper arm circumference (MUAC) with body mass index (BMI) and propose MUAC cut-off points corresponding to BMIs of <18.5 kg/m2 (underweight) and ≥30.0 kg/m2 (obesity) for pregnant Sudanese women, a cross-sectional community-based study was conducted in the city of New Halfa, Sudan. Healthy pregnant women were recruited. Body parameters such as height, weight, and MUAC were measured. The MUAC (cm) cut-off values for underweight and obesity were determined using receiver operating characteristic (ROC) curve analysis. Of 688 pregnant women, 437 were in early pregnancy (<20 weeks of gestation) and 251 were in late pregnancy (≥20 weeks of gestation). There was a significant positive correlation between BMI and MUAC among women in both early pregnancy (r = 0.734) and late pregnancy (r = 0.703). The cut-off points of MUAC for detecting underweight and obesity were found to be 24.0 cm and 29.0 cm, respectively, for women in early pregnancy, with good predictive values. For women in late pregnancy, the cut-off points for detecting underweight and obesity were 23.0 cm and 28.0 cm, respectively. We concluded that for Sudanese pregnant women, the MUAC cut-off points identified in the study for diagnosing underweight and obesity are both sensitive and specific.

Mid-upper arm circumference as a substitute for body mass index in the assessment of nutritional status among adults in eastern Sudan.

BACKGROUND: Body mass index (BMI) remains the most used indicator of nutritional status despite the presence of a potentially credible alternative. Mid-upper arm circumference (MUAC) is an anthropometric measure that requires simple equipment and minimal training. The aim of this study was to compare MUAC with BMI and propose a MUAC cut-off point corresponding to a BMI of < 18.5 kg/m2 (underweight) and ≥ 30.0 kg/m2 (obesity) among Sudanese adults. METHODS: A cross-sectional study using multistage cluster sampling was conducted in New-Halfa, eastern Sudan. Participants' age and sex were recorded and their MUAC, weight and height were measured using the standard procedures. The MUAC (cm) cut-offs corresponding to < 18.5 kg/m2 and ≥ 30.0 kg/m2 were calculated and determined using receiver operating characteristic (ROC) curve analysis RESULTS: Five hundreds and fifty-two adults were enrolled in the study. The median (interquartile range, IQR) of the participants age was 31.0 (24.0 ̶ 40.0) years and 331 (60.0%) of them were females. The medians (IQR) of BMI and MUAC were 22.4 (19.1 ̶ 26.3) kg/m2 and 25.0 (23.0 ̶ 28.0) cm, respectively. There was a significant positive correlation between MUAC and BMI (r = 0.673, p < 0.001). Of the 552 enrolled participants, 104 (18.8%), 282 (51.1%), 89 (16.1%) and 77 (13.9%) were normal weight, underweight, overweight and obese, respectively. Best statistically derived MUAC cut-off corresponding to a BMI < 18.5 kg/m2 (underweight) was ≤ 25.5 cm in both males and females (Youden's Index, YI = 0.51; sensitivity = 96.0%; specificity = 54.0%), with a good predictive value (AUROCC = 0.82). Best statistically derived MUAC cut-off corresponding to a BMI ≥ 30.0 kg/m2 (obesity) was ≥ 29.5 cm in both males and females (YI = 0.62, sensitivity = 70.3%, specificity = 92.0%), with a good predictive value (AUROCC = 0.86, 95.0% CI = 0.76 - 0.95). CONCLUSION: The results suggest that the cut-offs based on MUAC can be used for community-based screening of underweight and obesity.

Gene polymorphisms of cyclin-dependent kinase inhibitor and matrix metalloproteinase-9 in Sudanese patients with esophageal squamous cell carcinoma.

BACKGROUND: The polymorphisms of the cyclin-dependent kinase inhibitor (CDKN1A) gene and matrix metalloproteinase-9 (MMP9) gene may increase one's susceptibility to malignancies. In this study, the association of the single nucleotide polymorphisms (SNPs) CDKN1A rs1059234 c.70C>T at the 3' untranslated region and MMP9 rs17576 (c.836A>G, p.Gln279Arg) with esophageal squamous cell carcinoma (ESCC) in Sudanese individuals were investigated. MATERIALS AND METHODS: A case-control study involving age- and gender-matched groups were conducted in a cancer center in eastern Sudan (Gadarif) between April and October 2020. The case group consisted of ESCC patients, whereas the control group comprised healthy subjects. Polymerase chain reaction-restriction fragment length polymorphism was performed for the genotyping of the CDKN1A rs1059234 and MMP9 rs17576 SNPs. The genotyping results were confirmed by Sanger sequencing. RESULTS: The genotype distributions for CDKN1A rs1059234 and MMP9 rs17576 were in agreement with the Hardy-Weinberg equilibrium. The variant allele T in CDKN1 rs1059234 c.70C>T was significantly more prevalent in the ESCC patients than in the healthy controls [51.3% vs. 19.2%; OR = 4.4; 95% CI (2.6-7.4); p < 0.001]. Moreover, in CDKN1A rs1059234, the genotype TC + TT [76.9% vs. 38.4%; OR = 5.3; 95% CI (2.6-10.7); p < 0.001] was more frequent in the cases than in the controls, and it was significantly associated with ESCC risk. In MMP9 rs17576, the variant allele G was also significantly prevalent in the cases relative to the controls, and it was significantly associated with increased ESCC risk in the cases compared with the controls [27.5% vs. 1.9%; OR = 19.4; 95%CI (5.8-64.1); p < 0.001]. Both genotypes containing the allele G (AG + GG) were the most common genotypes in the cases [48.7% vs. 3.8%; OR = 23.7; 95%CI (6.8-81.7); p < 0.001], and they significantly increased the risk of ESCC. CONCLUSION: A significant increase in ESCC risk is associated with the SNPs CDKN1A rs1059234 and MMP9 rs17576.

Pattern and Trends in Adult Hospitalization/Admission and Mortality Among Medical Ward Inpatients at Gadarif Hospital in Eastern Sudan: A Four-Year Retrospective Study.

Purpose: Sub-Saharan Africa suffers from a dual impact of communicable (CDs) and non-communicable diseases (NCDs). There is scarce data on causes, trends of admission, and deaths among patients in Sudan. We aimed to determine the causes, trends of admission, and mortality among adult patients admitted to Gadarif Hospital in Eastern Sudan. Patients and Methods: The medical records of adult patients admitted to Gadarif medical wards from January 2017 to December 2020 were reviewed for age, gender, causes of admission, and outcomes. Multivariate Cox regression analysis was used to analysis factors (age, sex, years, and disease) associated with the mortality. Results: Of the 7230 patients who were admitted, 2221 (34.7%) were females and 5009 (69.3%) were males. The median age (interquartile range, IQR) was 47.0 (35.0) years. Of these 7230 patients, 3167 (43.8%) and 4063 (56.2%) patients were admitted with CDs and NCDs, respectively. Cardiovascular diseases (18.4%), snakebites (12.9%), and visceral leishmaniasis (12.0%) were the most common causes of admission. The overall in-patient adult deaths were 674 (9.3%). Cardiovascular diseases (22.3%), neurological diseases (16.9%), sepsis (15.9%), renal diseases (13.9%), and snakebites (8.3%) were the most common causes of inpatient mortality. Malignancy (20.7%), sepsis (20.9%), neurological diseases (17.4%), and cardiovascular diseases (13.8%) comprised the highest case fatality rates among the admitted patients. Using a Cox regression model (adjusted), age (adjusted hazard ratio = 1.02, 95% confidence interval = 1.01‒1.03) was associated with increased mortality hazard. However, the gender and years of admission were not associated with increased mortality hazard. Conclusion: Admissions and mortality rates for CDs and NCDs are high compared with other African countries. Preventive measures are required to avert the high burden of these diseases. Health care systems in Sudan need to be prepared to deal with the dual burden of the diseases.

Prevalence and associated factors of erectile dysfunction in men with type 2 diabetes mellitus in eastern Sudan.

BACKGROUND: Diabetes mellitus (DM) is a global health threat and burden that is associated with many chronic complications. Erectile dysfunction (ED) among patients with DM is one of these complications. There is no published data on ED in Sudan; hence, we conducted this study to evaluate the prevalence of ED and the associated factors in patients with type 2 diabetes mellitus (T2DM) in eastern Sudan. METHODS: We performed a cross-sectional study. Data on blood glucose level, cholesterol level, anthropometric and demographic characteristics, results of the International Index of Erectile Function (IIEF-5) questionnaire, and clinical history were obtained. RESULTS: A total of 334 men with T2DM with a median (interquartile range [IQR]) age of 55.0 (±10.0) years were enrolled in the study. The median (IQR) of the duration of DM was 7.0 (±8) years, and 260 (77.8%) had uncontrolled T2DM. The median (IQR) body mass index was 24.5 (±4.9) kg/m2. Of the participants, 81 (24.3%) had severe ED, 52 (15.6%) had moderate ED, 75 (22.5%) had mild to moderate ED, and 63 (13.9%) had mild ED. Of the 334 men, 271 (81.1%) had ED. Logistic regression analysis showed that age (adjusted Odds Ratio [AOR] = 1.07, 95% confidence interval [CI] = 1.01-1.14), duration of DM (AOR = 1.26, 95% CI = 1.06-1.51), and cholesterol levels (AOR = 3.53, 95% CI = 1.75-7.11) were positively associated with ED. Moreover, poor glycaemic control (AOR = 3.38, 95% CI = 1.70-6.71, P < 0.001) was significantly associated with ED. CONCLUSION: There is a high prevalence of ED among patients with T2DM in eastern Sudan. Age, duration of DM, and cholesterol were positively associated with ED.

The association between glycosylated haemoglobin and newly diagnosed hypertension in a non-diabetic Sudanese population: a cross-sectional study.

BACKGROUND: Glycosylated haemoglobin (HbA1c) is considered reliable for diagnosing and monitoring diabetes mellitus (DM). It also indicates cardiovascular complications related to DM. However, only a few studies have been conducted on this topic. METHODS: We conducted a cross-sectional study to investigate the association between newly diagnosed hypertension and HbA1c among non-diabetic Sudanese adults. The sociodemographic characteristics of the participants in the sample were gathered using a questionnaire, and HbA1c was measured using an Ichroma machine. RESULTS: Three hundred and eighty-four healthy participants were enrolled in this study. The median (interquartile range [IQR]) age was 56.0 (14.0) years, and 72.1% of the participants were female. The median (IQR) body mass index (BMI) was 31.2 (8.7) kg/m2. One hundred and fifteen (29.9%) participants presented newly diagnosed hypertension. The results of the multivariate analysis showed that age (adjusted odd ratio [AOR] = 1.03; 95% confidence interval [CI] = 1.01‒1.05); BMI (AOR = 1.09; 95% CI = 1.05‒1.14); HbA1c levels (AOR = 2.18; 95% CI = 1.29‒3.67) was positively associated with newly diagnosed hypertension. For an HbA1c level of 5.0% or more, the sensitivity and specificity of newly diagnosed hypertension were 91.3% and 28.2%, respectively (area under the curve = 0.61; 95% CI = 0.55-0.67; P ˂ 0.001). Participants who presented HbA1c levels of 5.0% or more were found to be at higher risk for newly diagnosed hypertension (AOR = 2.53; 95% CI = 1.14‒5.61). CONCLUSION: The results of this study indicated a high prevalence of newly diagnosed hypertension, and HbA1c levels were positively associated with newly diagnosed hypertension.

The Concern of COVID-19 Vaccine Safety Is behind Its Low Uptake among Patients with Diabetes Mellitus in Sudan.

Diabetic patients are vulnerable to developing severe complications and have a higher risk of death due to COVID-19 infection. Vaccination remains the mainstay during the current situation to mitigate the risks related to COVID-19 infection. Therefore, the aim of the current study was to assess the vaccination status and the factors associated with COVID-19 vaccine uptake among patients with diabetes mellitus (DM) in Sudan. A hospital-based cross-sectional study was conducted from January to February 2022 at Gadarif Hospital in eastern Sudan. Information on sociodemographics, the contracting of COVID-19 during the pandemic, beliefs toward COVID-19 vaccinations, and barriers related to COVID-19 vaccinations was obtained through an interview questionnaire among adult (≥18 years) patients with DM. Bivariate and multinomial logistic regression analyses performed. A total of 568 diabetic patients were enrolled, with a mean (SD) age of 53.07 (12.69) years. The majority of the participants were female (67.6%), urban residents (63.4%), uneducated (60.6%) and employed (73.2%). There was a history of COVID-19 in 97.4% of participants, and 29.2% of them had hypertension along with DM. About 31% received the vaccine, out of which 17.9% received the first dose, 13.2% received the second dose, and 0.2% received the third dose. Multinomial logistic regression analysis showed a significant association between belief in the safety of the COVID-19 vaccine and having had two doses of it (adjusted Odds ratio = 20.42, p < 0.001). The prevalence of COVID-19 infection was high, while the rate of COVID-19 vaccination uptake was low and inadequate among the participants. Appropriate health education and targeted interventions toward awareness of safety concerns are highly recommended.

Prevalence of depression and associated factors among patients with type 2 diabetes mellitus in eastern Sudan.

BACKGROUND: Diabetes mellitus (DM) represents a global health threat and burden. It is associated with medical and psychological complications, especially depression. Depression among patients with DM may affect the general prognosis. Hence, we conducted a cross-sectional study in Gadarif, eastern Sudan to evaluate the prevalence of depression and its associated factors among patients with type 2 DM (T2DM). METHODS: We performed a cross-sectional study. Data on anthropometric parameters, demographic characteristics and blood glucose levels were collected via questionnaire. Depression was assessed using the Patient Health Questionnaire (PHQ-9). RESULTS: Three hundred and fifty patients with T2DM were enrolled in the study and 205 (58.6%) were women. The median (interquartile range) age and duration of diabetes were 56.0 (14.0) years and 8 (8) years, respectively. The prevalence of depression in patients with T2DM was 35.6%. Logistic regression analysis showed significant associations between depression and rural residence (adjusted odds ratio [AOR] = 2.11, 95% confidence interval [CI] = 1.20-3.72), non-employee (AOR = 2.32, 95% CI = 1.34-4.00), co-morbidity (AOR = 2.35, 95% CI = 1.43-3.86) and obesity AOR = 2.19, 95% CI = 1.48-4.18). CONCLUSION: The prevalence of depression is high among Sudanese patients with T2DM. Rural residence, unemployment, co-morbidity and obesity are significant risk factors for developing depression among patients with T2DM.

The calculated versus the measured glycosylated haemoglobin (HbA1c ) levels in patients with type 2 diabetes mellitus.

BACKGROUND: Diabetes mellitus (DM) is a chronic metabolic disorder that is increasing globally. It is associated with chronic complications that are more common among patients with poor glycaemic control. Glycosylated haemoglobin (HbA1c ) is the gold standard for monitoring glycaemic control. Measurements of HbA1c are relatively expensive and not available in some remote areas of developing countries. METHODS: We conducted a cross-sectional study to evaluate the agreement between the calculated and measured HbA1c levels. The equation to compute the calculated HbA1c also incorporated the fasting blood glucose (FBG) level and was as follows: HbA1c  = 2.6 + 0.03 × FBG (mg/dl). RESULT: We enrolled 290 patients with type 2 DM in this study. Of these, 204 (70.3%) were females and the mean (SD) age was 54.9 (12.8) years. The mean (SD) diabetes duration was 6.8 (5.5) years. There were 211 (72.8%) patients using oral hypoglycaemic agents, 62 (21.4%) were using insulin and 17 (5.9%) were using both insulin and oral hypoglycaemic agents. There was a borderline difference between the mean (SD) calculated and measured HbA1c levels (p = 0.054). There was a significant correlation between the calculated and measured HbA1c (r = 0.595, p < 0.001). However, there was no agreement between the calculated and measured HbA1c . The bias ±SD (limits of agreement) for calculated versus measured HbA1c was -1.008 ± 2.02% (-5.05, 2.032). CONCLUSION: Despite the presence of a significant correlation between the calculated and measured HbA1c , the calculated level has shown an unacceptable agreement with the measured HbA1c .

High Mortality Rate in Adult COVID-19 Inpatients in Eastern Sudan: A Retrospective Study.

AIM: The current pandemic of coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory coronavirus syndrome 2 (SARS-CoV-2). It is a global public health concern that has resulted in the rapid growth in the number of infected patients with significant mortality rates. Hence, we conducted a retrospective study in Gadarif Hospital to evaluate the presenting manifestations, mortality rate, and the risk factors associated with mortality in hospitalized patients. METHODS: A retrospective study was conducted at Gadarif Hospital in Eastern Sudan. Medical files of the patients admitted during the period between April and July 2020 were reviewed. All the files of the adult patients (aged 18 or above), of both sexes, who had a confirmed COVID-19-positive status via laboratory testing using PCR and who were admitted during this period were reviewed. The data extracted included patients' demographics and initial clinical presentation, symptoms, signs, and the laboratory and radiographic findings. The data were analyzed using SPSS v22. RESULTS: Eighty-eight patients were admitted with COVID-19. The median (interquartile) age was 62 (55.00-70.00) years old, and 72 (81.8%) of them were males. Most patients (75%) experienced a one-week duration of symptoms. A fever (87.5%), cough (80.68%), and shortness of breath (77.27%) were the most common presenting symptoms. Following a clinical assessment, both the systolic and diastolic blood pressure were found to be normal in most patients, at 92.05% and 89.77%, respectively. An oxygen saturation of less than 90% was seen in 71.59% of patients. The general mortality rate was 37.5% and most deaths occurred during the first 24 h of admission (21/33 [63.64%]). There was no significant difference in the death rate between females and males (5/16 [31.3%] vs 28/72 [38.9%], P = 0.776). There was no significant difference in the body mass index, tobacco use, or education level between the patients who died and those who survived. A logistic regression showed that being older (AOR = 1.05, 95% CI = [1.01, 1.10]) and having a lower PO2 level (AOR = 1.11, 95% CI = [1.04, 1.16]) were associated with mortality. CONCLUSION: The general mortality rate was 37.5%, and the risk factors that could predict increased mortality in hospitalized COVID-19 positive cases included old age and a lower PO2 level.

Prevalence and factors associated with overweight and central obesity among adults in the Eastern Sudan.

BACKGROUND: A global epidemic of obesity has been documented, particularly among African countries. While central obesity and overweight have been reported for many countries, very limited information exists about the prevalence of these health problems in Sudan, and these data are nonexistent for Eastern Sudan. The present study aimed to determine the prevalence of obesity and central obesity, as well as the factors associated with both, among adults in Gadarif, Eastern Sudan. METHODS: A cross-sectional study was conducted in Gadarif, Eastern Sudan, during the period of January through May 2018. Sociodemographic and health characteristics data were collected through a questionnaire. Body mass index (BMI) and waist circumference (WC) were measured using the standard methods. Both descriptive and inferential statics were applied to analyze the data. RESULTS: A total of 594 adults participated in the study; 70.4% of them were female. The mean (standard deviation) age was 44.98 (16.64) years. Of the 594 enrolled participants, 33.7%, 7.4%, 26.8%, and 32.2% were normal weight, underweight, overweight, and obese, respectively. The prevalence of central obesity was (67.8%). Approximately, one-third of the participants (29.29%) were obese and had central obesity. In the multinomial regression, being married was the main risk factor associated with overweight, and older age, female sex, being married and hypertension were significantly associated with obesity. In the binary regression, the main risk factors associated with central obesity were female sex and being married. CONCLUSION: The prevalence rates of both obesity and central obesity among the study participants were high. Older age and hypertension were only associated with obesity. Obesity and central obesity were significantly associated with female sex and being married. This study provided valuable baseline information to develop appropriate strategies for the prevention and control of obesity in Eastern Sudan.

Prevalence and associated factors of hypertension among adults in Gadarif in eastern Sudan: a community-based study.

BACKGROUND: Hypertension is becoming an increasingly common health issue worldwide, especially in countries in Sub-Saharan Africa. Hypertension is the leading risk factor for premature death and disability worldwide, and it is the leading risk factor for mortality from cardiovascular diseases worldwide. The data on hypertension in Sudan that has been published is limited. We conducted this study to assess the prevalence of hypertension and its associated risk factors. METHODS: A multistage sampling survey was conducted in Gadarif, Eastern Sudan, from January to May 2018 to investigate the prevalence of hypertension and associated factors in adults in Eastern Sudan. The World Health Organization (WHO) three-level stepwise approach questionnaire was used to gather sociodemographic characteristics (age, sex, height, weight marital status, education level, smoking habit, alcohol consumption habit, and family history of hypertension). Hypertension was defined as the presence of an average blood pressure of ≥140/90 mmHg or the reported use of anti-hypertensive medications for high blood pressure. RESULTS: A total of 600 participants (mean age: 44.9 years) were enrolled in this study. Four hundred twenty-two (70.3%) participants were women, and 196 (32.7%) participants were obese. Of the 600 enrolled participants, 245 (40.8%) individuals had hypertension, 44 (7.3%) had been previously diagnosed with hypertension, and 201 (33.5%) were newly diagnosed with hypertension. A logistic regression analysis showed no significant associations across the education level, marital status, overweight and hypertension factors. However, an older age (adjusted OR = 3.20, 95% CI = 2.28-4.51, P < 0.001) and obesity (adjusted OR = 2.41, 95% CI = 1.57-3.69, P < 0.001) were associated with the presence of hypertension. CONCLUSION: There is a high rate of hypertension in Eastern Sudan, especially among older and obese individuals. Preventive measures, such as dietary measures, should be implemented.

Validation of the wrist blood pressure measuring device Omron RS6 (HEM-6221-E) among obese Sudanese patients according to the European Society of Hypertension International Protocol Revision 2010.

Background: Electronic devices for measuring blood pressure (BP) need to go through independent clinical validation as recommended by different authorities, both in general and specific populations. The aim of this study was to assess the validity of the Omron RS6 (HEM-6221-E) wrist oscillometric devices in obese Sudanese patients. Methods: Of 90 obese individuals invited for recruitment, 33 were included in the study, and had their BP at the level of the wrist measured using Omron RS6 and standard mercury sphygmomanometer. Two observations were made and the mean was taken. BP differences between the two methods for the 33 participants were classified into three categories (≤5, ≤10, and ≤15 mmHg), according to the European Society of Hypertension-International Protocol revision 2010 (ESH-IP2) criteria. This was then used to assess the validity of the tested Omron RS6 device. Results: Participants had a mean age of 56.97 years (standard deviation (SD), 8.75; range, 36-79). Average systolic blood pressure (SBP) was 146.21 mmHg (SD, 23.07; range, 107-182), and average diastolic blood pressure (DBP) was 93.82 mmHg (SD, 16.06; range, 67-128). There was a good agreement between the two observations using the OMRON RS6 and the standard sphygmomanometer: -4 to + 3 mmHg for SBP and -4 to +4 mmHg for DBP, with the mean difference of 1.73±1.11 mmHg for SBP and 1.49±1.02 mmHg for DBP. Conclusion: Thus, the Omron RS6 (HEM-6221-E) is a valid and suitable measure of BP according to ESH-IP2.

Cytotoxic T-lymphocyte antigen-4 +49A/G polymorphisms in Sudanese adults with type 1 diabetes and latent autoimmune diabetes.

OBJECTIVES: This study was conducted to assess the association of T-lymphocyte-associated protein 4 (CTLA-4 +49A/G) variant with Latent autoimmune diabetes in adults (LADA) in Eastern Sudan. The study included 24 LADA, 240 patients with type 1 diabetes mellitus (T1DM), and 240 healthy controls. Genotyping for CTLA-4 +49A/G was done by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). RESULTS: Genotypes distribution of CTLA-4 in controls was in accordance with the HWE (P > 0.05). The frequency of mutation (both homozygous and heterozygous) of CTLA-4 +49A/G (AG + GG) was significantly higher in LADA compared with T1DM and the controls [19 (79.1%) vs. 100 (41.7%) vs. 78 (32.5%), P < 0.001]. It was significantly higher when LADA was compared with T1DM [19 (79.1%) vs. 100 (41.7%), P = 0.018, OR = 3.21, 95% CI 1.16-8.89] and when LADA was compared with the controls [19 (79.1%) vs. 78 (32.5%), P = 0.001, OR = 4.49, 95% CI 1.62-12.42]. The rate of heterozygous mutation of the CTLA-4 +49A/G (AG) was significantly higher in LADA compared with T1DM and the controls [16 (66.7%) vs. 85 (35.4%) vs. 70 (29.2%), P < 0.001]. It was significantly higher when LADA was compared with T1DM [16 (66.7%) vs. 85 (35.4%), P = 0.002, OR = 3.64, 95% CI 1.49-8.87] and when LADA was compared with the controls [16 (66.6%) vs. 85 (35.4%), P = 0.001, OR = 4.85, 95% CI 1.98-11.86].

Prevalence, risk factors, and glycaemic control of type 2 diabetes mellitus in eastern Sudan: a community-based study.

BACKGROUND: Diabetes mellitus (DM) constitutes a global health threat and burden, especially in developing countries. We conducted a cross-sectional study in Gadarif in eastern Sudan to evaluate the prevalence and glycaemic control of patients with type 2 diabetes mellitus (T2DM). METHODS: We performed a cross-sectional community-based study. Data on blood glucose levels, and anthropometric, demographic and clinical history data were obtained. RESULTS: Six hundred Sudanese adults with a mean (SD) age of 44.9 (16.5) years were enrolled. More than two-thirds (70.3%) of the study participants were women. The prevalence of T2DM, newly diagnosed T2DM and uncontrolled T2DM was 20.8%, 10.0% and 80.0%, respectively. Logistic regression analysis showed no significant association between education, marital status, body mass index, waist circumference and DM. However older age (AOR = 4.88, 95% CI = 3.09-7.70) and a family history of DM (AOR = 2.58, 95% CI = 1.59-4.20) were associated with T2DM. CONCLUSION: The prevalence of T2DM is high among the Sudanese population, especially in older people and those with a family history of DM. The high prevalence of uncontrolled DM in this setting is another hidden burden.

Assessment of glycemic control in type 2 diabetes in the Eastern Sudan.

OBJECTIVES: A cross-sectional study was conducted in Gadarif, eastern Sudan to assess glycaemic control among adult patients with type 2 diabetes in eastern Sudan. Poor glycaemic control was defined as HbA1c level of ≥ 7.0%. Questionnaire was used to gathered sociodemographic and clinical characteristics. RESULTS: A total of 339 patients (69.9% were women) were enrolled in the study. The mean age of the participants was 54.8 (12.8) years. Approximately more than two-thirds (n = 243, 71.7%) of the participants were using oral glucose control agents. A round one-fifth (22.1%) of the participants were using insulin and only 6.2% of them were using both insulin and oral glucose control agents. The rate of poor glycemic control was 71.9%. In logistic regression analyses, duration of diabetes, medications used, and the triglycerides were not associated with poor glycemic control. However, being unmarried (OR = 3.64, 95% CI 1.21-10.90), adding sugar to the drinks (OR = 1.84, 95% CI 1.11-3.05, P = 0.017) and high cholesterol level (OR = 1.01, 95% CI 1.01-1.02.) were associated with poor glycemic control. In summary the rate of uncontrolled type 2 diabetes mellitus was considerably high especially among being unmarried patients and patients who were adding sugar to the drinks.