MALNUTRITION AMONG PATIENTS WITH END-STAGE RENAL DISEASE IN WAR 2024: THE ROLE OF HEALTHCARE ACCESS, DIALYSIS, GENDER, AND ECONOMIC DISPARITIES

 

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MALNUTRITION AMONG PATIENTS WITH END-STAGE RENAL DISEASE IN WAR 2024: THE ROLE OF HEALTHCARE ACCESS, DIALYSIS, GENDER, AND ECONOMIC DISPARITIES

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Suodad
Elhassan
Suodad Elhassan suodad@gmail.com University of Khartoum Faculty of Medicine Khartoum Sudan *
Iyas A. A. Abdelhadi iyas.ahmed98@gmail.com University of Khartoum Faculty of Medicine Khartoum Sudan -
Nashwa N. S. Mohamed nshwanjmeldeen@gmail.com University of Khartoum Faculty of Medicine Khartoum Sudan -
Aliaa M. A. Mohammed alyaalkani706@gmail.com University of Khartoum Faculty of Medicine Khartoum Sudan -
Waad A. O. Mohammed waadabdelelah102@gmail.com University of Khartoum Faculty of Medicine Khartoum Sudan -
Hiba H. M. Abdalla hbhhsnalbsyr@gmail.com University of Khartoum Faculty of Medicine Khartoum Sudan -
Amna Khairy amnakh22@hotmail.com Republic of Sudan Federal Ministry of Health Field Epidemiology Training Program Khartoum Sudan -
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End-stage renal disease patients on haemodialysis are at risk of malnutrition, leading to poor clinical outcomes. This multifaceted issue is expected to be worsened by the ongoing war in Sudan, which has caused massive internal displacement and disrupted healthcare provision for ESRD patients. This study aimed to identify the prevalence and key contributing factors of malnutrition among haemodialysis patients in Northern Sudan.

This cross-sectional study was conducted across four out of 12 public haemodialysis centres in Northern Sudan, recruiting 141 patients via cluster sampling. Data on socioeconomic status and clinical profiles were collected through interviews and record reviews. Nutritional status was comprehensively assessed using the Subjective Global Assessment (SGA), and healthcare access was evaluated using a validated scale based on the Penchansky and Thomas model. Data analysis included descriptive statistics, bivariate tests, and multivariable logistic regression to identify predictors of malnutrition.

Figure 1. Malnutrition in Relation to Dialysis Duration among Patients with ESRD, n=141Most of the patients were males (68.1%), and the mean age was 52 ± 14.5 years. The study found a high prevalence of malnutrition, affecting 48.3% of patients (44.0% mildly to moderately malnourished and 4.3% severely malnourished). Multivariable analysis identified two significant independent predictors: female gender (Adjusted Odds Ratio, AOR = 2.29, 95% CI: 1.04–5.07) and haemodialysis duration exceeding five years (AOR = 2.95, 95% CI: 1.16–7.51). Furthermore, a higher level of healthcare access was significantly associated with a lower rate of malnutrition (p<0.05). Lower income, urban residence, hypertension, and cardiopathy were linked to worse nutritional scores. A heavy burden of gastrointestinal symptoms was observed, with 77.3% reporting symptoms interfering with oral intake.

The study reveals a high prevalence of malnutrition in haemodialysis patients, significantly linked to clinical factors like prolonged dialysis, female gender, and healthcare access, as well as profound socioeconomic disparities exacerbated by conflict. The findings highlight the iatrogenic role of long-term dialysis and call for an integrated, multidisciplinary healthcare approach. We recommend protocols that enforce regular nutritional monitoring, symptom management, and policies that address the critical socioeconomic barriers to food security and healthcare.

Kewords