Understanding Hypertension Prevalence among Starving Young Adults in Conflict-Affected Sudan

ABSTRACT


INTRODUCTION
Hypertension (high blood pressure) is a common medical condition found in any population (Fuchs & Whelton, 2020).It poses an alarming health challenge worldwide, while being prevalent across (Squires & Gaur, 2020) (Ahmed et al., 2022).This study reflects a convergence of factors such as economic instability, environmental stress and nutritional deficiencies culminating in a heightened susceptibility within starving young adults (male and female) in three of the most affected states of Sudan.While hypertension is associated with affluent societies but understanding the prevalence of hypertension in context with starvation, underscores a nuance between nutrition, health and socioeconomic dynamics (Chaturvedi et al., 2023).It can shed light to explore public health concerns and formulate policies for the mitigation of hypertension morbidity and mortality in resource constricted settings.

METHODOLOGY Study Sites and Subjects
The research was conducted in refugee/ residential displacement camps located in the three most conflictaffected states of Sudan: Al Jazirah, Central Darfur, and Khartoum.Additionally, a functional hospital from each region was used to run clinical test for detection of hypertension.The distribution of participants across the study sites was as follows: Al Jazirah (n=270), Central Darfur (n=200), and Khartoum (n=250), totaling a sample size of 720 individuals.The demographic composition of the sample reflected a gender distribution of 43% male and 57% female participants.The study span was of one year and four months, commenced in January 2022 and concluded in June 2023.
The selected regions were characterized by destroyed infrastructure and a lack of basic necessities, contributing to the challenging living conditions experienced by the inhabitants of the displacement camps.The research aimed to encompass a diverse population, encompassing individuals from various age groups, sexes, and occupations.The participants' age range was divided into six categories: 20-24, 25-30, 31-35, 36-40, 41-45, and 45-50 years, ensuring representation across different stages of adulthood.This approach facilitated a comprehensive examination of the prevalence of hypertension among individuals residing in displacement camps across Sudan, capturing the nuances of age, gender, and occupational diversity within the study population.

Measurement of Blood Pressure
Standardized protocols for measurement of bold pressure was used in both sitting and standing positions, to target potential variations associated with postural changes with a resting period of 15 minutes in between, for the restoration of their cardiovascular response (Mol et al., 2020).Additionally, participants were not allowed to take tea, coffee or cigarettes during measurement to abstain from potential confounding effects.The measurements were taken under shade from the right arm, positioned at heart level, using correctly calibrated mercury sphygmomanometer and stethoscope to ensure accuracy and consistency across assessments.Changes in systolic and diastolic blood pressure levels were monitored longitudinally to examine trends and variations over time.Moreover, continuous monitoring of blood pressure was conducted over a 24-hour period using a portable Am.J. Med. Sci. Innov. 3(2) 59-66, 2024 Ambulatory Blood Pressure Monitoring (ABPM) device, allowing for a comprehensive assessment of blood pressure patterns and fluctuations throughout the day and night (Huang et al., 2021).Additionally, collaboration with local workers and expertise facilitated this measurement procedure.

Laboratory Tests
Further, relevant various psychological parameters to the objectives of study were evaluated using laboratory tests.Assessment of Electrolytes Imbalances; by measuring serum electrolytes, sodium and potassium levels, and metabolic parameters; including glucose, lipid profile, inflammation markers were assessed and then to evaluate kidney's health and function, blood urea nitrogen (BUN) and serum creatinine levels were measured.These assessments were done to elucidate potential associations with hypertension in the context of food deprivation and starvation (Allen & Saunders, 2023;Funayama et al., 2021).

Clinical Examination
A comprehensive clinical examination was conducted to identify malnutrition signs and cardiovascular health status of a patient.While Physical examinations identified indicators of malnutrition, including muscle wasting, loss of subcutaneous fat, and dry, scaly skin.Further an assessment of cardiovascular status involved examination of peripheral pulses, jugular venous pressure, and heart murmurs, enabled a thorough evaluation of cardiovascular health.

Data Collection
A comprehensive questionnaire survey was conducted, aiming to find various factors associated with hypertension prevalence and its correlates.The survey delved in to medical history, nutritional status, lifestyle habits, psychological well-being and most importantly access to food.Other questionnaires were utilized to assess time period and quality and quantity of food being available to participants living in displacement camps.Standardized data collection procedures were used to maintain consistent and reliable results.It played an instrumental role in finding complex interplay of contributing factors and starvation on cardiovascular health, prevailing hypertension.

Data Analysis
The collected data was analyzed using Statistical Package for the Social Sciences (SPSS) software.Both questionnaire and qualitative data were subjected to descriptive and inferential analyses to identify patterns, themes, relationships, and associations relevant to the prevalence of hypertension in Sudan, especially when starvation is also prevailing and food security is at risk.

RESULTS AND DISCUSSIONS
Table 1 shows a comprehensive comparison between hypertensive and non-hypertensive individuals.Hypertensive individuals showed elevated blood pressure levels, with prominently higher mean systolic and diastolic blood pressures than non-hypertensive individuals.Moreover, laboratory tests revealed abnormalities in glucose, lipid profile, inflammation markers and normal electrolyte levels reflect metabolic adaptation in hypertensive individuals due to prolonged fasting or inadequate nutrition.Clinical examination results highlighted the compromised cardiovascular health and malnutrition signs in hypertensive individuals than in non-hypertensive individuals.Thus, overall clinical report indirectly proves starvation impact on prevalence of hypertension in study population.The majority of the data was collected from Khartoum, followed by Central Darfur and Al Jazirah (displacement camps).The average duration of residence was 3-4 years.Mostly (97.2%) were married and primarily (72%) were educated on primary level with common occupation of being farmers.However, significant proportion of population experience insufficient income.Furthermore, awareness about hypertension reported to be low, only 36% of the sample size was aware of this medical condition.This summarizes the trends of the population, reflecting potential factors influencing hypertensive prevalence.asked to compare the level of stress due to scarcity of food, 20% reported to have high stress followed by 30% having high and 35% having moderate stress, and only 4% individuals reported no stress.Additionally, almost everyone rated their mental health to be poor, 39.1% reported it to be very poor while only 8% considered their mental health to be good.

Symptoms of Hypertension in Adults
Yes, many adults complained for dizziness, fatigue and headaches being common.Some have mentioned chest pain and noticed increased stress levels.

Symptoms of Hypertension in Children
Yes, some children seem unusually tired and irritable and complains for headaches and nose bleeding was reported.

DISCUSSION
The results align with several studies published in recent years examining the effects of malnutrition on blood pressure and cardiovascular outcomes.A 2019 meta-analysis of 11 observational studies involving over 230,000 participants found that dietary factors like (Bossola et al., 2020).Physiologically, prolonged malnutrition has been shown to trigger systemic low-grade inflammation and impairments in vascular and endothelial function (Balderas-Peña et al., 2023).It also disrupts the reninangiotensin system, increasing aldosterone levels and sodium retention leading to elevated blood pressure over time (Poulsen & Fenton, 2019).
Notably, research has found the relationship between malnutrition and hypertension to be bidirectional.A longitudinal cohort study of over 4000 adults in rural China found that hypertension at baseline increased the risk of developing malnutrition by 30-40% over 5 years of follow up (Zhao et al., 2023)This reinforces the potential for a vicious cycle in contexts of prolonged lack of access to food.
The demographic details bear similarities to a crosssectional study in Syrian refugee camps in Jordan which also reported high rates of food insecurity, micronutrient deficiencies, chronic diseases and related risk factors like hypertension among displaced populations (KYU).
The clinical findings presented in Table 1 provide compelling evidence of the impact of starvation on cardiovascular health.Hypertensive individuals exhibited significantly higher blood pressure levels, abnormalities in glucose and lipid profiles, and signs of inflammation compared to non-hypertensive individuals.Moreover, clinical examination results revealed compromised cardiovascular health and malnutrition signs among hypertensive individuals, further corroborating the detrimental effects of starvation on hypertension prevalence.
The results of the regression analysis (Table 9) highlight the significant association between starvation-related factors and hypertension prevalence, even after controlling for other relevant variables.History of hypertension, family history of hypertension, inadequate nutritional intake, significant weight loss, and food insecurity emerged as significant predictors of hypertension prevalence, underscoring the multifactorial nature of this relationship.
In conclusion, this study provides compelling evidence of the detrimental impact of starvation on the prevalence of hypertension among Sudanese individuals residing in displacement camps.The findings underscore the urgent need for targeted interventions aimed at addressing food insecurity, improving access to nutritious food, and enhancing healthcare infrastructure in displacement settings to mitigate the burden of hypertension and related cardiovascular complications within vulnerable populations.

CONCLUSION
In conclusion, the findings of this study elucidate the significant impact of starvation on the prevalence of hypertension among Sudanese individuals residing in displacement camps.The high prevalence of hypertension, coupled with the demographic characteristics and clinical findings, underscores the urgent need for targeted interventions to address food insecurity and malnutrition in these vulnerable populations.The bidirectional relationship between malnutrition and hypertension emphasizes the complex interplay of physiological and socioeconomic factors contributing to cardiovascular health outcomes in displacement settings.The regression analysis highlights the importance of addressing starvation-related factors, such as inadequate nutritional intake, food insecurity, and significant weight loss, in mitigating the burden of hypertension within this population.Moreover, the association between hypertension and other diagnosed medical conditions underscores the need for integrated healthcare approaches to address both cardiovascular and other health issues among displaced individuals.Overall, this study's findings underscore the pressing need for multi-sectoral interventions aimed at improving access to nutritious food, enhancing healthcare infrastructure, and addressing socio-economic disparities in displacement settings.By addressing the root causes of food insecurity and malnutrition, we can effectively reduce the prevalence of hypertension and mitigate the associated cardiovascular complications among vulnerable populations in Sudan and similar contexts globally.This study contributes to the growing body of evidence on the impact of starvation on cardiovascular health outcomes.It underscores the importance of prioritizing nutrition and healthcare interventions in humanitarian response efforts.Further research is warranted to explore the longterm effects of such interventions and their potential to improve health outcomes and quality of life among displaced populations.

Ethical Approval
Informed consent was obtained from participants.

LIMITATIONS
Limitations of this study include reliance on self-report and the sample size may not fully represent the diverse population of Sudan.Moreover, ongoing conflicts in country restricted smooth data collection.

Table 1 : Clinical Findings Measure Hypertensive Individuals (Positive Results) Non-Hypertensive Individuals (Negative Results) Blood pressure Measurements
Table 2 provides a brief overview of the demographic information in the study of population.It included mainly young adults having age from 20-50 years old.While females being major part of study than males.

Table 2 :
Demographic Information

Table 3
outlines the medical history of hypertension in individuals of the study population.A prominent proportion of 42% of population had hypertension history, 63% being recently diagnosed while only 5% were diagnosed for more than 5 years.However, only a minority, 20% of the hypertensive patients going under medication.Additionally, 36.7% had a family history of this condition and 69.6% reported to be diagnosed with other medical conditions too.

Table 3 :
Medical History

Table 4 :
Nutritional lifestyleQuestionPercentage How would you describe your overall nutritional intake in the past month?29.8% adequate, 70.2% inadequate How often do you have access to fresh fruits and vegetables?

Table 5
Have you experienced significant weight loss in the past six months?31% yes, 69% no On average, how many meals do you consume per day?

Table 5 :
Lifestyle and Habits

Table 6 :
Psychological Well-being

Table 7
reveals individuals' accessibility to healthcare.Prominent proportion (70%) individuals stayed deprived of having regular medical care and check-ups, mostly due to financial constraints, following limited availability of healthcare facilities and transportation.While 4% did not had access due to religious and cultural reasons and 3% considered no barriers exist.How do you compare the level of stress after ongoing conflicts?

Table 7 :
Access to Healthcare

Table 8 :
Perceptions on Hypertension and Starvation

Table 10 :
Model Fit

Table 11 :
Additional Comments