The Demographic Characteristics of Pulmonary Tuberculosis Patients in Western Sudan During the Conflict of 2023-2024

Amal Khalil Yousif Mohammed; Eldisugi Hassan Mohammed Humida; Ahmed Mirghani Osman Ali; Hussain Gadelkarim Ahmed

doi:doi:10.11648/j.ejpm.20241206.11

Research Article |

| Peer-Reviewed

The Demographic Characteristics of Pulmonary Tuberculosis Patients in Western Sudan During the Conflict of 2023-2024

Amal Khalil Yousif Mohammed, Eldisugi Hassan Mohammed Humida, Ahmed Mirghani Osman Ali, Hussain Gadelkarim Ahmed^*

Published in European Journal of Preventive Medicine (Volume 12, Issue 6)

Received: 8 October 2024 Accepted: 30 October 2024 Published: 26 November 2024

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Background: Pulmonary tuberculosis (PTB) was a global health burden in low-income and fragile developing countries with poor health systems districted by war, such as Sudan. The purpose of this study was to look at the demographic characteristics of patients with pulmonary tuberculosis, such as gender, age, material status, education, occupation, and treatment delays. Methodology: We conducted a retrospective descriptive. The study included about 533 patients with pulmonary tuberculosis. The data gathering was done in August 2024. A data collection sheet was produced, and all pertinent information was acquired. Results: The results showed that 76% of 533 pulmonary tuberculosis patients were males and 24% were females, with the primary age groups being 26-35 years old (27.5%) and 18-25 years old (22%). More than 51% were from metropolitan regions, with a primary education, and 29% worked as gold miners, followed by free workers. Conclusion: PTB represents the Sudan's biggest health problem, impacted the productive and working-age population, as well as the destitute community, causing significant financial, security, and environmental issues. Direct support for the TB control program has raised community awareness regarding early detection and treatment of PTB.

Published in	European Journal of Preventive Medicine (Volume 12, Issue 6)
DOI	10.11648/j.ejpm.20241206.11
Page(s)	132-137
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Tuberculosis, Pulmonary, Mycobacterium Tuberculosis, Sudan

1. Introduction

Tuberculosis is a significant global health issue that affects both healthcare systems and communities due to several reasons, including psychological, physical, and economic aspects. According to WHO estimates from 2022, approximately 1.3 million individuals succumbed to tuberculosis. Tuberculosis is ranked as the second biggest cause of death among all infectious diseases

[1]

. In 2022, the global incidence of new tuberculosis cases reached 10.6 million, including 5.8 million males, 3.5 million females, and 1.3 million children

[2]

. Mycobacterium tuberculosis (MTB) induces pulmonary tuberculosis through the aerosolization of bacteria during patient coughing. The World Health Organization's End TB Strategy seeks to reduce worldwide TB incidence and death by 90% and 95%, respectively, by 2035. Over the past 25 years, Sudan has been afflicted by a conflict that has significantly impacted the healthcare system and overall health services, resulting in a humanitarian crisis. Currently, 7.8 million individuals are experiencing severe health issues related to both mental and physical well-being, alongside 1.6 million internally displaced persons and 1.1 million refugees, all amidst a severely diminished economic output. The WHO and the Sudan Health Observatory under the federal ministry of health identify malaria as the predominant communicable disease, followed by tuberculosis, pneumonia, and diarrheal disorders

[3]

. In Sudan, tuberculosis is the primary cause of death, accounting for 1% of total fatalities among patients admitted to healthcare facilities

[4]

. The primary aim of the study is to evaluate the burden of tuberculosis in Sudan during the 2023 conflict, specifically to ascertain the demographic characteristics of patients with pulmonary tuberculosis. To ascertain the predominant challenges associated with the war that impact the illness burden in the country.

2. Material and Methods

This retrospective descriptive study was performed in the respiratory department of El-Obeid Teaching Hospital in North Kordofan State, Sudan. The study encompassed more than 533 patients diagnosed with pulmonary tuberculosis, including complete coverage files. The data gathering was conducted in August 2024. A data collection sheet was developed, and all pertinent data was compiled. Statistical analysis: Data sets were imported into the Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, version 25), and results were generated from them.

3. Results

This study examined 533 individuals with pulmonary tuberculosis ranging in age from two years to 90 years, with a mean age of 37.1 ± 17.44 and a mean STD of 37.1 ± 17.44. 76% of the patients were male, 34% were female, and the majority (27.5%) were between the ages of 26 and 35. About 51.9% of the patients live in metropolitan areas, with 59% married. See Table 1 and Figure 1 below.

Table 1. The study was distributed demographically based on age, residence, and marital status.

Variable	Males n=405	Females n=128	Total n=533
Age
≤ 18years	22	18	40
18-25	90	29	119
26-35	124	23	147
36-45	73	21	94
46-60	49	17	66
≥ 60	47	20	67
Residence
Urban	207	70	277
Rural	198	58	256
Marital status
Single	169	33	202
Married	230	84	314
Divorce	2	2	4
Widow	4	9	13

Table 2. Shows the study's demographic distribution based on education and occupation.

	Males N=405	Females n=128	Total N=533
Occupation
Employee	15	4	19
Farmer	48	4	52
Gold miner worker	152	1	153
Health worker	3	0	3
Job less	24	94	118
Soldier	17	0	17
Student	11	21	32
Worker	135	4	139
Education
Illiterate	100	46	146
Primary	178	49	227
Intermediate	18	5	23
Secondary	98	25	123
University	11	3	14

Download: Download full-size image

Figure 1. Shows the distribution of the study age groups based on the sex of the patients, marital status, and residence.

Download: Download full-size image

Figure 2. Displays the frequency of studies on pulmonary tuberculosis in relation to occupation and education.

Table 2 and Figure 2 show the study population's distribution by degree of education and employment. The majority of the patients (42.5%) were primary educated, with 27.4% being illiterate. Furthermore, the study subjects were divided into eight groups based on their occupation: 29% are gold miners, 22% are unemployed, and 73.4% of the unemployed are women. See Table 2 and Figure 2.

Table 3. Shows the study's demographic distribution based on the length of symptoms before treatment and the reasons for treatment delay.

	Males N=405	Females n=128	Total N=533
Duration of symptom before starting treatment
1-2mounth	119	35	154
2-6 month	122	42	164
6-12mounth	68	26	94
more than 12 months	96	25	121
Causes of delay testament
No health servers in patient area	129	22	151
No security at area of the patient	125	44	169
Financial obstacles	128	54	182
Mess diagnosis	23	8	31

Download: Download full-size image

Figure 3. Represents the study's distribution based on the length of symptoms and the delay in patient management.

The study focuses on the distribution of demographic data based on the length of symptoms prior to treatment and the reasons for treatment delay. 30.7% of patients seek medical advice between 2 and 6 months before beginning treatment. 42.2% of female patients arrived late to the health facility due to financial constraints, 28.3% of all patients received medical services late due to a lack of health servers in the patient area, and 31.7% had no security in the patient area during the Sudan war (see Table 3 and Figure 3).

4. Discussion

Tuberculosis is a worldwide health issue that affects both health systems and communities in low-income nations. Sudan, an impoverished and fragile developing nation with a deficient health system, has Eastern Sudan as an endemic region for TB and a conflict zone

[5]

. In Sudan, tuberculosis accounted for 1% of total fatalities. This study examines the demographic characteristics of pulmonary tuberculosis patients during the initial year of the Sudan war. A total of 533 patients with pulmonary tuberculosis were enrolled, of which 405 (76%) were male and 128 (24%) were female. The primary age group affected by pulmonary tuberculosis was 26-35 years, comprising 27.5% of the patients, with 153 (29%) employed as gold miners, followed by 26% in other occupations. The core demographic load of PTB consisted of young, urban, married men with a rudimentary education engaged in gold mining occupations

[6]

. Identify potential obstacles, delays, and lost opportunities in the prevention and diagnosis of tuberculosis. In developed nations characterized by a low disease burden, a primary limitation is the delayed diagnosis of bacilliferous adults who are in contact with young children. This issue is prevalent among segments of the population experiencing socioeconomic vulnerability. In underdeveloped countries with a significant disease burden, the primary challenge is monitoring children who have been in contact with bacilliferous patients

[7-9]

. Undernutrition is a significant risk factor for tuberculosis (TB), associated with an estimated 2.2 million TB cases in 2022, as reported by the World Health Organization (WHO) Global Tuberculosis Report

[10-13]

. The study by Li SJ indicated that the incidence of pulmonary tuberculosis (PTB) is elevated among the elderly, with the burden of PTB increasingly affecting the elderly, males, rural populations, and clinically diagnosed individuals. The current study indicates that over 30% of patients experience a delay of 2 to 6 months from the onset of symptoms to the initiation of treatment

[14]

. It was reported that in a low-endemic country with an inadequate health system, there was a normal delay of several months in the identification and treatment of tuberculosis

[15, 16]

. During the initial years of the Sudan war, the study revealed that 34% of patients did not commence treatment promptly due to financial barriers, while 31.7% delayed treatment initiation due to a lack of security in their location when symptoms arose. In conclusion, pulmonary tuberculosis is a significant health issue in Sudan, impacting the economically active population and impoverished communities, exacerbated by financial, security, and environmental challenges. Provided direct support for the tuberculosis control program and enhanced community awareness regarding early detection and treatment of pulmonary tuberculosis.

Abbreviations

PTB	Pulmonary Tuberculosis
TBCU	Tuberculosis Control Unit

Acknowledgments

The authors extend their gratitude to the staff of El-Obeid Teaching Hospital-TBCU for their assistance in sample collection.

Ethical Consideration

Permission was obtained from authorities in El-Obeid Teaching Hospital to get access to the notified information.

Ethical Approval

We obtained written permission from the manager of El-Obeid teaching hospital and the study's proposal has been granted approval by the Human Research Ethics Committee at MRCC. Approval Number: HREC0014/PMRCC.9/24.

Author Contributions

Amal Khalil Yousif Mohammed: Conceptual, Administration, Data collection, Analysis, Final approval

Ahmed Mirghani Osman Ali: Data collection, Analysis, Final approval

Hussain Gadelkarim Ahmed: Conceptual, Consultation, Writing, critical revision, Final Approval

Funding

The Prof. Medical Research Consultancy Center (PMRCC) funded this project. Grant Number: PMRCC/2024A8

Data Availability Statement

Data regarding this study available from the corresponding author.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Goyal R, Parakh A. Post-tuberculosis Sequelae in Children. Indian J Pediatr. 2024; 91(8): 817-822. https://doi.org/10.1007/s12098-023-04912-2
[2]	WHO. Tuberculosis 7 November 2023. Accessed on 2024. Available at: https://www.who.int/news-room/fact-sheets/detail/tuberculosis
[3]	Republic of the. Sudan FM of H. Annual Health Statistical Report. 2021.
[4]	Badawi MM, SalahEldin MA, Idris AB, Idris EB, Mohamed SG. Tuberculosis in Sudan: systematic review and meta-analysis. BMC Pulm Med. 2024 Jan 23; 24(1): 51. https://doi.org/10.1186/s12890-024-02865-6
[5]	Abdallah TM, Ali AA. Epidemiology of tuberculosis in Eastern Sudan. Asian Pac J Trop Biomed. 2012; 2(12): 999-1001. https://doi.org/10.1016/S2221-1691(13)60013-1
[6]	Li SJ, Li YF, Song WM, Zhang QY, Liu SQ, Xu TT, An QQ, Liu JY, Li HC. Population aging and trends of pulmonary tuberculosis incidence in the elderly. BMC Infect Dis. 2021 Mar 25; 21(1): 302. https://doi.org/10.1186/s12879-021-05994-z
[7]	Russo DO, Jimenez ALL, Diniz LMO, Cardoso CA, Romanelli RMC. Missed opportunities in the prevention and diagnosis of pediatric tuberculosis: a scoping review. J Pediatr (Rio J). 2024 Jul-Aug; 100(4): 343-349. https://doi.org/10.1016/j.jped.2023.10.009
[8]	Shanmuga Priya K, et al. “Advancements in Artificial Intelligence for the Diagnosis of Multidrug Resistance and Extensively Drug-Resistant Tuberculosis: A Comprehensive Review.” Cureus vol. 16,5 e60280. 14 May. 2024, https://doi.org/10.7759/cureus.60280
[9]	Feiterna-Sperling, Cornelia et al. “Pilot study to identify missed opportunities for prevention of childhood tuberculosis.” European journal of pediatrics vol. 181,9(2022): 3299-3307. https://doi.org/10.1007/s00431-022-04537-1
[10]	Franco JV, Bongaerts B, Metzendorf MI, Risso A, Guo Y, Peña Silva L, Boeckmann M, Schlesinger S, Damen JA, Richter B, Baddeley A, Bastard M, Carlqvist A, Garcia-Casal MN, Hemmingsen B, Mavhunga F, Manne-Goehler J, Viney K. Undernutrition as a risk factor for tuberculosis disease. Cochrane Database Syst Rev. 2024 Jun 11; 6(6): CD015890. https://doi.org/10.1002/14651858
[11]	Ekeng, Bassey et al. “The Spectrum of Pathogens Associated with Infections in African Children with Severe Acute Malnutrition: A Scoping Review.” Tropical medicine and infectious disease vol. 9,10 230. 6 Oct. 2024, https://doi.org/10.3390/tropicalmed9100230
[12]	Franco JV, Bongaerts B, Metzendorf MI, Risso A, Guo Y, Peña Silva L, Boeckmann M, Schlesinger S, Damen JA, Richter B, Baddeley A, Bastard M, Carlqvist A, Garcia-Casal MN, Hemmingsen B, Mavhunga F, Manne-Goehler J, Viney K. Diabetes as a risk factor for tuberculosis disease. Cochrane Database Syst Rev. 2024 Aug 23; 8(8): CD016013. https://doi.org/10.1002/14651858.CD016013.pub2
[13]	Naidoo K, Perumal R, Ngema SL, Shunmugam L, Somboro AM. Rapid Diagnosis of Drug-Resistant Tuberculosis-Opportunities and Challenges. Pathogens. 2023 Dec 27; 13(1): 27. https://doi.org/10.3390/pathogens13010027
[14]	Leutscher P, Madsen G, Erlandsen M, Veirum J, Ladefoged K, Thomsen V, Wejse C, Hilberg O. Demographic and clinical characteristics in relation to patient and health system delays in a tuberculosis low-incidence country. Scand J Infect Dis. 2012 Jan; 44(1): 29-36. https://doi.org/10.3109/00365548.2011.608081
[15]	Singh V. Tuberculosis treatment-shortening. Drug Discov Today. 2024 May; 29(5): 103955. https://doi.org/10.1016/j.drudis.2024.103955
[16]	Gautam S, Shrestha N, Mahato S. Diabetes among tuberculosis patients and its impact on tuberculosis treatment in South Asia: a systematic review and meta-analysis. Sci Rep. 2021 Jan 22; 11(1): 2113. https://doi.org/10.1038/s41598-021-81057-2

Cite This Article

Plain Text BibTeX RIS

APA Style

Mohammed, A. K. Y., Humida, E. H. M., Ali, A. M. O., Ahmed, H. G. (2024). The Demographic Characteristics of Pulmonary Tuberculosis Patients in Western Sudan During the Conflict of 2023-2024. European Journal of Preventive Medicine, 12(6), 132-137. https://doi.org/10.11648/j.ejpm.20241206.11

Copy | Download

ACS Style

Mohammed, A. K. Y.; Humida, E. H. M.; Ali, A. M. O.; Ahmed, H. G. The Demographic Characteristics of Pulmonary Tuberculosis Patients in Western Sudan During the Conflict of 2023-2024. Eur. J. Prev. Med. 2024, 12(6), 132-137. doi: 10.11648/j.ejpm.20241206.11

Copy | Download

AMA Style

Mohammed AKY, Humida EHM, Ali AMO, Ahmed HG. The Demographic Characteristics of Pulmonary Tuberculosis Patients in Western Sudan During the Conflict of 2023-2024. Eur J Prev Med. 2024;12(6):132-137. doi: 10.11648/j.ejpm.20241206.11

Copy | Download

@article{10.11648/j.ejpm.20241206.11,
  author = {Amal Khalil Yousif Mohammed and Eldisugi Hassan Mohammed Humida and Ahmed Mirghani Osman Ali and Hussain Gadelkarim Ahmed},
  title = {The Demographic Characteristics of Pulmonary Tuberculosis Patients in Western Sudan During the Conflict of 2023-2024
},
  journal = {European Journal of Preventive Medicine},
  volume = {12},
  number = {6},
  pages = {132-137},
  doi = {10.11648/j.ejpm.20241206.11},
  url = {https://doi.org/10.11648/j.ejpm.20241206.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejpm.20241206.11},
  abstract = {Background: Pulmonary tuberculosis (PTB) was a global health burden in low-income and fragile developing countries with poor health systems districted by war, such as Sudan. The purpose of this study was to look at the demographic characteristics of patients with pulmonary tuberculosis, such as gender, age, material status, education, occupation, and treatment delays. Methodology: We conducted a retrospective descriptive. The study included about 533 patients with pulmonary tuberculosis. The data gathering was done in August 2024. A data collection sheet was produced, and all pertinent information was acquired. Results: The results showed that 76% of 533 pulmonary tuberculosis patients were males and 24% were females, with the primary age groups being 26-35 years old (27.5%) and 18-25 years old (22%). More than 51% were from metropolitan regions, with a primary education, and 29% worked as gold miners, followed by free workers. Conclusion: PTB represents the Sudan's biggest health problem, impacted the productive and working-age population, as well as the destitute community, causing significant financial, security, and environmental issues. Direct support for the TB control program has raised community awareness regarding early detection and treatment of PTB.
},
 year = {2024}
}

Copy | Download

TY - JOUR
T1 - The Demographic Characteristics of Pulmonary Tuberculosis Patients in Western Sudan During the Conflict of 2023-2024

AU - Amal Khalil Yousif Mohammed
AU - Eldisugi Hassan Mohammed Humida
AU - Ahmed Mirghani Osman Ali
AU - Hussain Gadelkarim Ahmed
Y1 - 2024/11/26
PY - 2024
N1 - https://doi.org/10.11648/j.ejpm.20241206.11
DO - 10.11648/j.ejpm.20241206.11
T2 - European Journal of Preventive Medicine
JF - European Journal of Preventive Medicine
JO - European Journal of Preventive Medicine
SP - 132
EP - 137
PB - Science Publishing Group
SN - 2330-8230
UR - https://doi.org/10.11648/j.ejpm.20241206.11
AB - Background: Pulmonary tuberculosis (PTB) was a global health burden in low-income and fragile developing countries with poor health systems districted by war, such as Sudan. The purpose of this study was to look at the demographic characteristics of patients with pulmonary tuberculosis, such as gender, age, material status, education, occupation, and treatment delays. Methodology: We conducted a retrospective descriptive. The study included about 533 patients with pulmonary tuberculosis. The data gathering was done in August 2024. A data collection sheet was produced, and all pertinent information was acquired. Results: The results showed that 76% of 533 pulmonary tuberculosis patients were males and 24% were females, with the primary age groups being 26-35 years old (27.5%) and 18-25 years old (22%). More than 51% were from metropolitan regions, with a primary education, and 29% worked as gold miners, followed by free workers. Conclusion: PTB represents the Sudan's biggest health problem, impacted the productive and working-age population, as well as the destitute community, causing significant financial, security, and environmental issues. Direct support for the TB control program has raised community awareness regarding early detection and treatment of PTB.

VL - 12
IS - 6
ER -

Copy | Download

Author Information

Amal Khalil Yousif Mohammed

Department of Medicine, Faculty of Medicine, University of Kordofan, El-Obeid, Sudan;Aldaman International Hospital, El-Obeid, Sudan
Eldisugi Hassan Mohammed Humida

Department of Medicine, Faculty of Medicine, University of Kordofan, El-Obeid, Sudan;EL-Obeid Teaching Hospital, El-Obeid, Sudan;EL-Obeid International Hospital – Director of Cardiac Catheterization Laboratory, El-Obeid, Sudan
Ahmed Mirghani Osman Ali

General Practician El-Obeid International Hospital (Aldaman), NK, El-Obeid, Sudan
Hussain Gadelkarim Ahmed

Medical Research Consultancy Center, NK, El-Obeid, Sudan;Department of Histopathology and Cytology, FMLS, University of Khartoum, Khartoum, Sudan

Contact Email

Download PDF

Plain Text BibTeX RIS

APA Style

Mohammed, A. K. Y., Humida, E. H. M., Ali, A. M. O., Ahmed, H. G. (2024). The Demographic Characteristics of Pulmonary Tuberculosis Patients in Western Sudan During the Conflict of 2023-2024. European Journal of Preventive Medicine, 12(6), 132-137. https://doi.org/10.11648/j.ejpm.20241206.11

Copy | Download

ACS Style

Mohammed, A. K. Y.; Humida, E. H. M.; Ali, A. M. O.; Ahmed, H. G. The Demographic Characteristics of Pulmonary Tuberculosis Patients in Western Sudan During the Conflict of 2023-2024. Eur. J. Prev. Med. 2024, 12(6), 132-137. doi: 10.11648/j.ejpm.20241206.11

Copy | Download

AMA Style

Mohammed AKY, Humida EHM, Ali AMO, Ahmed HG. The Demographic Characteristics of Pulmonary Tuberculosis Patients in Western Sudan During the Conflict of 2023-2024. Eur J Prev Med. 2024;12(6):132-137. doi: 10.11648/j.ejpm.20241206.11

Copy | Download

@article{10.11648/j.ejpm.20241206.11,
  author = {Amal Khalil Yousif Mohammed and Eldisugi Hassan Mohammed Humida and Ahmed Mirghani Osman Ali and Hussain Gadelkarim Ahmed},
  title = {The Demographic Characteristics of Pulmonary Tuberculosis Patients in Western Sudan During the Conflict of 2023-2024
},
  journal = {European Journal of Preventive Medicine},
  volume = {12},
  number = {6},
  pages = {132-137},
  doi = {10.11648/j.ejpm.20241206.11},
  url = {https://doi.org/10.11648/j.ejpm.20241206.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejpm.20241206.11},
  abstract = {Background: Pulmonary tuberculosis (PTB) was a global health burden in low-income and fragile developing countries with poor health systems districted by war, such as Sudan. The purpose of this study was to look at the demographic characteristics of patients with pulmonary tuberculosis, such as gender, age, material status, education, occupation, and treatment delays. Methodology: We conducted a retrospective descriptive. The study included about 533 patients with pulmonary tuberculosis. The data gathering was done in August 2024. A data collection sheet was produced, and all pertinent information was acquired. Results: The results showed that 76% of 533 pulmonary tuberculosis patients were males and 24% were females, with the primary age groups being 26-35 years old (27.5%) and 18-25 years old (22%). More than 51% were from metropolitan regions, with a primary education, and 29% worked as gold miners, followed by free workers. Conclusion: PTB represents the Sudan's biggest health problem, impacted the productive and working-age population, as well as the destitute community, causing significant financial, security, and environmental issues. Direct support for the TB control program has raised community awareness regarding early detection and treatment of PTB.
},
 year = {2024}
}

Copy | Download

TY - JOUR
T1 - The Demographic Characteristics of Pulmonary Tuberculosis Patients in Western Sudan During the Conflict of 2023-2024

VL - 12
IS - 6
ER -

Copy | Download