Diagnosis of Idiopathic Granulomatous Mastitis in a Sudanese Woman.

Idiopathic granulomatous mastitis (IGM) is a relatively rare specific chronic inflammatory process of unknown etiology, that diagnostically overlaps with common breast pathologies in Sudan, namely breast cancer (BC) and tuberculous mastitis (TBM). We report the case of a 34-year-old female who presented with a 1-month history of a painful lump in the lower outer quadrant of her left breast. A tru-cut biopsy showed features of granulomatous inflammation suggestive of IGM. Four months later, she presented with similar features and fine-needle aspiration cytology (FNAC) confirmed the presence of IGM and excluded the presence of both, BC and TBM. Histology once again confirmed the diagnosis of granulomatous mastitis with no evidence of breast cancer. Grocott's Methenamine Silver, Ziehl-Neelsen stain, and polymerase chain reaction were negative and accordingly the possibility of fungal infection and TBM were excluded. To our knowledge, this is the first case report of IGM in Sudan. FNAC helped in correct diagnosis of our case and importantly, conditions such as BC and TBM were both excluded as common mimickers of IGM. Although breast biopsy is the main golden approach in the diagnosis of IGM in addition to the usefulness of adjunct ancillary microbiological techniques, still further research is needed to establish whether FNAC can be a reliable tool in the diagnosis of IGM with the common practice of this diagnostic tool in Sudan.

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.

An outbreak of cutaneous leishmaniasis among a displaced population in North Sudan: Review of cases.

BACKGROUND: Human cutaneous leishmaniasis (CL) is an endemic disease in many parts of Sudan. OBJECTIVE: To document an outbreak of CL among internally displaced people (IDP) in north Sudan. METHODS: A household survey was conducted in the rural region of New Manasir, at El Damer Locality in north Sudan during the year 2013. All villagers were screened for recent and old skin lesions in addition to other urgent medical problems. Written consent was obtained from each participant before data collection. A pretested, interviewer-administered questionnaire was used to collect the socio-demographic and clinical characteristics of participants. The diagnosis of CL was based on clinical findings and/or identification of the amastigotes on skin smears. RESULTS: Out of the 1,236 individuals enrolled in this survey, 688 were diagnosed as cases of CL, giving an infection rate of 55.7%. Children constituted 244 (35.5%) of infected cases. Majority of skin lesions were found in the Extremities 524 (76.2%). The average duration of skin lesions was 3.6 months (±1.6). CONCLUSION: This outbreak among IDPs affected a large proportion of inhabitants of the newly established villages in north Sudan. Preventive measures might have help control such outbreaks.

Ethnicity and diabetes complications in Sudanese population: The need for further genetic population testing.

BACKGROUND: The aim of the present study was to assess whether there is an association between ethnicity and the high prevalence of diabetes complications in Sudan. METHODS: This was cross-sectional hospital-based study with 316 individuals with diabetes conducted in Khartoum state, Sudan. A questionnaire was used to collect demographic information. In addition to measurements of blood pressure, lipid profile and HbA1c, weight and height measurement were also performed for calculation of body mass index. RESULTS: The study included individuals recruited from 62 tribes across Sudan. The effect of ethnicity on diabetic septic foot (DSF) was not statistically significant across different tribes (X-squared = 2.6098, df = 4, p-value = 0.6251). The effect of ethnicity on Albuminuria was also not statistically significant across different tribes recruited for this study (X-squared = 4.3787, df = 4, p-value = 0.3572). The Northern group carried a significantly higher unadjusted risk for development of retinopathy (OR = 1.8471, p-value = 0.04603). The Southern group was significantly different from the others regarding the effect of ethnicity on neuropathy, compared to the 'West' group (OR = 0.1905, p-value = 0.0345). The unadjusted effect for the Southern group was also significant (OR = 0.2933, p-value = 0.0320). CONCLUSION: There was no role of ethnicity in term of DSF and albuminuria complications. However, retinopathy likely to be seen in tribes originally from north of Sudan, while neuropathy is more likely to be found in tribes originally from the south of Sudan. Further focus genetic population testing is needed.

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.

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 smoking in Sudanese individuals with diabetes and associated complications: Population-based study.

INTRODUCTION: Smoking cigarettes and diabetes are major public health problems in Sudan. Smoking is associated with insulin resistance and can be associated with type 2 diabetes. The aim of this study was to investigate the prevalence of smoking in individuals with diabetes and associated complications. METHODOLOGY: a descriptive analytical cross-sectional study, included 315 of participants with diabetes. The data collection was performed to gather demographic information, prevalence of smoking and presence of complications. In addition to measurement of blood pressure, weight and height measurement for calculation of body mass index and biochemical tests. Statistical association at p.value of 0.05 was measured using T-test for quantitative data and Chi square test for categorical data. RESULTS: The overall prevalence of smoking was found to be 33.9%. Smoking was statistically significant associated with being male; increase in age; and being married. HbA1c and triglycerides are significantly associated with smoking (P value = 0.01 and 0.05 respectively); therefore, statistical significance was found with ischemic heart disease(IHD) as well (P value = 0.05). Hypertension, duration of diabetes, low density lipoprotein (LDL), cholesterol and body mass index (BMI) were not statistically significant with smoking. CONCLUSION: Almost third of the population with diabetes are smokers (33.9%). Smoking is statistically associated with IHD, high triglyceride and HbA1c. Therefore, smoking cessation schemes 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.

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.

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.

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.

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 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 of diabetic foot ulceration and associated risk factors: an old and still major public health problem in Khartoum, Sudan?

BACKGROUND: Diabetic foot ulceration (DFU) is a major health problem across the globe. The objective of this study is to determine the prevalence of DFU and its associated risk factors in Sudanese individuals with diabetes. METHODS: Three hundred and ten individuals with type 2 diabetes, who have been on treatment for DM for at least 1 year and volunteered to participate, were enrolled in this study. Participants were interviewed using standardized pretested questionnaire to record medical history, socio-demographic, life style characteristics and presence of DFU. RESULTS: The prevalence of DFU was found to be 18.1% in this cohort (95% CI: 13.78-22.34%). Among different metabolic variants like hypertension, albuminuria, retinopathy, neuropathy, HbA1c, cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL) and triglyceride, only duration of diabetes was significantly associated with DFU (P<0.0018) as shown by logistic regression statistical analysis. Even after adjusting for all other potential risk factors, living with diabetes for more than 10 years is associated with an increase in the diabetic foot probability by 3.16 folds (95% CI: 052-10.48 folds increase), P=0.006. The adjusted effect for living with diabetes for more than 20 years on the diabetic foot complication probability is an increase by 1.73 folds (95% CI: 0.39-4.37 folds increase), P=0.005. However, living with diabetes for more than 5 years had a non-significant adjusted effect on diabetic foot probability. CONCLUSIONS: Prevalence of diabetic foot ulcer was 18.1% and the risk of development of diabetic foot ulcer is increased with duration of diabetes more than 10 years.

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 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.

Obesity among Sudanese adults with diabetes: a population-based survey.

BACKGROUND: The aim of this study was to determine the prevalence of obesity among Sudanese individuals with diabetes. METHODS: Demographic and clinical data from 1,337 individuals with type 2 diabetes were collected using a pretested, standardized, interviewer administered questionnaire. Subjects were recruited from three states namely Khartoum, Northern and River Nile States. Anthropometric measurements including body weight, height and waist circumference were determined using standardized techniques and calibrated equipment. RESULTS: Total of 1,337 subjects with type 2 diabetes from Khartoum and North of Sudan were enrolled in this study and completed the questionnaires; the results showed that prevalence of obesity among individuals with diabetes was found to be 24.5%, with a higher rate of obesity in females than males (29.2% versus 18.1%). The prevalence of central obesity was also higher in women (43.6%) than men (21.8%). The prevalence of overweight was 39.9%. The overall prevalence of overweight and obesity was 64.4%. Obesity was associated with age, sex and blood pressure. While central obesity was associated with an increase in age, female sex and hypertension. Logistic regression analysis showed that female sex and hypertension are absolute risk factors for both obesity and central obesity. CONCLUSIONS: The prevalence of obesity was 24.5% and overweight was 39.9% among Sudanese individuals with diabetes and more among women than men. Obesity and central obesity were significantly associated with female sex and hypertension.

Frequency of diabetic retinopathy and associated risk factors in Khartoum, Sudan: population based study.

AIM: To assess the frequency and associated risk factors of diabetic retinopathy among Sudanese individuals with diabetes attending Makka Eye complex in Khartoum, Sudan. METHODS: The cross sectional hospital based study recruited 316 individuals with diabetes from Makkah Eye Complex Retina Clinic. Standard questionnaire was used to collect demographic data, medical history and life style characteristics. Blood samples were taken to measure HbA1c and lipid profile. Fundus and slit lamp examination were performed for screening of diabetic retinopathy. RESULTS: Among 316 participants, 187 (59.2%) were males and 129 (40.8%) were females. The mean age of participants was 58.7±10.5y. The overall frequency of retinopathy was 261 (82.6%). The percentages of the total participants with proliferative diabetic retinopathy (PDR) were 126 (39.9%) and non-proliferative diabetic retinopathy (NPDR) were 135 (42.7%). Importantly, duration of diabetes mellitus (DM) (72.2% of more than 10y), being on oral hypoglycaemic drugs (versus insulin), and hypertension were all significant risk factors for diabetic retinopathy (P=0.00, 0.01 and 0.00 respectively). Complications of diabetes like diabetic foot (17.7%), history of amputation (6.7%) and clinically significant macular edema (CSME) (47.4%) of the eyes were all significant risk factors (P<0.05). Logistic regression analysis showed that duration of diabetes, hypertension and CSME were found to be absolute risk factors (P=0.007, 0.003 and 0.000 respectively). Duration of DM of more than 10y have more than double risk (OR=2.8), while having hypertension triples the risk of retinopathy (OR=3.1). CONCLUSION: High rates of diabetic retinopathy are noted among individuals with diabetes attending Makkah Eye hospital in capital Khartoum. Urgent strategies are needed to monitor and treat hypertension and optimize diabetes control in individuals with diabetes. More investment in diabetes services is urgently needed.