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American Journal of  Medical 
Science and Innovation (AJMSI) 

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

Amani A. Ali1*, Ali Y. H.2, Intisar K. S.2, Abdellatif  M. M.2, Hind A. Rikabi3, Samreen Soomro4, Abd El-Karim EM5 
Ghadi M. M6, Ishraga A. A.7

Volume 3 Issue 2, Year 2024
ISSN: 2836-8509 (Online)

DOI: https://doi.org/10.54536/ajmsi.v3i2.3045
https://journals.e-palli.com/home/index.php/ajmsi

Article Information ABSTRACT

Received: July 15, 2024

Accepted: August 10, 2024

Published: August 13, 2024

Hypertension is a prevalent global health challenge with multifactorial etiology, including 
economic instability, environmental stress, and nutritional deficiencies. This study investigates 
the prevalence of  hypertension among starving young adults in conflict-affected states of  
Sudan, exploring the interplay of  nutrition, health, and socio-economic dynamics. Data was 
collected from displacement camps in Al Jazirah, Central Darfur, and Khartoum, involving 
720 participants over 16 months. Standardized protocols were employed for blood pressure 
measurement, laboratory tests, and clinical examinations. Statistical analyses revealed a 
significant association between starvation-related factors and hypertension prevalence, 
with a history of  hypertension, inadequate nutrition, and food insecurity emerging as key 
predictors. The findings underscore the urgent need for targeted interventions to address 
food insecurity, improve access to nutritious food, and enhance healthcare infrastructure 
in displacement settings to mitigate the burden of  hypertension and related cardiovascular 
complications. This study contributes to understanding the impact of  starvation on 
cardiovascular health outcomes, informing public health policies and interventions in 
resource-constrained settings.

Keywords
Hypertension, Sudan, Food 
Insecurity, Cardiovascular 
Complications, Global Health 
Challenge

1 Department of  Pharmacology and Toxicology, College of  Pharmacy, Rafha, Northern Border University, Arar, Saudi Arabia
2 Department of  Biology, College of  Science and Arts, Rafha, Northern Border University, Arar, Saudi Arabia
3 Department of  Pharmacy Practice, College of  Pharmacy, Rafha, Northern Border University, Arar, Saudi Arabia
4 Department of  Basic Science, College of  Pharmacy, Rafha, Northern Border University, Arar, Saudi Arabia
5 Department of  Pharmacognosy , College of  Pharmacy, Rafha, Northern Border University, Arar, Saudi Arabia
6 University of  Imperial College, Faculty of  Medicine, Khartoum, Sudan
7 The National Health, Insurance Fund, Ministry of  Health, Kosti, Sudan
* Corresponding author’s e-mail: amaninbu@gmail.com

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 conflict-affected 
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.

Measures
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 



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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 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.

Table 1: Clinical Findings
Measure Hypertensive Individuals (Positive 

Results)
Non-Hypertensive Individuals 
(Negative Results)

Blood pressure Measurements
Mean Systolic BP (mmHg) 145 (SD = 10) 120 (SD = 5)
Mean Diastolic BP (mmHg) 95 (SD = 8) 80 (SD = 6)
Laboratory Test Results
Electrolyte Levels Within normal range Within normal range
Glucose (mg/dL) 120 (SD = 15) 90 (SD = 10)
Lipid Profile High (Total Cholesterol: 220 mg/dL) Normal (Total Cholesterol: 180 mg/dL)
Inflammation Markers Elevated (CRP: 8 mg/L) Normal (CRP: 3 mg/L)
BUN (mg/dL) 20 (SD = 5) 15 (SD = 4)
Creatinine (mg/dL) 1.1 (SD = 0.2) 0.9 (SD = 0.1)
Clinical examination Findings 
Malnutrition Signs Muscle wasting, loss of  subcutaneous 

fat
None

Cardiovascular Health Elevated jugular venous pressure Normal peripheral pulses



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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. 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.
Table 3 outlines the medical history of  hypertension 

Table 2: Demographic Information
Demographic Category Options
Age 20-24, 25-30, 31-35, 36-40, 41-45, 45-50
Gender Male, Female
Camp Region Al Jazirah, Central Darfur, Khartoum
Duration of  Residence 3-4 years (avg)
Marital Status 2.7% Single, 97.2 % Married
Education Level 72% Primary level, 28% Intermediate level
Occupation Mostly farmers
Income 20% Adequate, 80% Insufficient
Awareness about hypertension 36% Yes, 64% No

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
Question Yes No
Do you have a history of  hypertension? 42% 58%
If  yes, have you been diagnosed with hypertension for more than five years? 5% -
If  yes, have you been diagnosed with hypertension for less than five years? 63% -
Are you currently under any medication for hypertension? 20% 80%
Do you have a family history of  hypertension? 36.7% 63.3%
Have you been diagnosed with any other medical conditions? 69.6% 30.4%

Table 4: Nutritional lifestyle
Question Percentage
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?
Very Frequently 5%
Frequently 10%
Occasionally 10%
Rarely 40%
Never 35%
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?
Less than 3 meals 10%

Table 4 summarizes the nutritional lifestyle insights of  
the individuals within the study population. The majority, 
70.2% were reported to have inadequate nutritional intake 
over the past month and 75% were reported occasional to 
never access of  fresh fruits and vegetables. Furthermore, 

access to nutritious food was limited within the camp, 
made 68.9% individuals to experience food insecurity and 
hunger regularly and 31% individuals had weight loss in 
past six months.
Table 5 presents usual lifestyle and habits found in the 



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individuals. A prominent proportion, 39.3%, reported 
smoking tobacco products, and 10% reported consuming 
alcohol. Interestingly, majority 45% reported to being 
engaged in physical activities on daily basis, while only 

10% never stayed active. Regarding lifestyle changes, 
40% of  individuals reported to have their life negatively 
affected due to conflicts and food insecurity while 20% 
remained neutral.

3 meals 40%
More than 3 meals 30%
Do you experience food insecurity or hunger regularly? 68.9% yes, 31.1% no
How often you can access to nutritious food in your camp?
Very Frequently 4%
Frequently 11%
Occasionally 25%
Rarely 45%
Never 15%

Table 5: Lifestyle and Habits
Question Percentage
Do you smoke tobacco products? 39.3% yes, 60.7% no
Do you consume alcohol? 10% yes, 90% no
How often do you engage in physical activity or exercise?
Daily 45%
Weekly 20%
Monthly 25%
Never 10%
How do you see your current lifestyle compared to before conflicts and food insecurity?
Same 10%
Moderately affected 25%
Negatively affected 40%

Table 6 provides an overview of  the psychological well-
being of  individuals within the study population. The 
majority (73%) individuals had high levels of  stress due to 
ongoing situations. On comparing stress level before and 
during conflicts going in country, 40 % reported to have 
moderate stress before while 43.7% reported to have very 
high stress after ongoing conflicts. Furthermore, when 

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.

Table 6: Psychological Well-being
Question Yes No
Have you experienced high levels of  stress or anxiety recently? 73% 27%
How do you compare the level of  stress before ongoing conflicts?
No Stress 25%
Low Stress 20%
Moderate Stress 40%
High Stress 13%
Very High Stress 2%
How do you compare the level of  stress after ongoing conflicts?
No Stress 1.3%
Low Stress 5%
Moderate Stress 35%
High Stress 43.7%
Very High Stress 15%



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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 due to scarcity of  food?
No Stress 4%
Low Stress 11%
Moderate Stress 35%
High Stress 30%
Very High Stress 20%
How would you rate your overall mental health?
Very Poor 39.1%
Poor 42%
Neutral 10.9%
Good 8%
Excellent -

Table 7: Access to Healthcare
Question Yes No
Do you have regular access to medical care and check-ups? 30% 70%
Are there any barriers preventing you from seeking medical help when needed? If  yes, please specify:
Lack of  transportation 16%
Financial constraints 40%
Limited availability of  healthcare facilities 37%
Cultural or religious reasons 4%
No barriers 3%

Table 8 shows perceptions of  individuals on 
hypertension and starvation relationship. Almost half  
the population (59%) thought starvation has a relation 
with hypertension. According to 30%, stress, 28% poor 
diet and 25% limited access to healthcare are one of  
the major factors contributing to high prevalence of  

hypertension in displacement camps. On asking how 
food supply could be made accessible to individuals, 
majority (46.1) reported to increase food aid and 
distributions, while 25 and 26% individuals wanted an 
improved infrastructure for food storage and support 
local agriculture initiatives.

Table 8: Perceptions on Hypertension and Starvation
Question Percentage
Do you believe there is a relationship between starvation and hypertension? 59% yes, 41% no
What factors do you think contribute to the high prevalence of  hypertension in displacement camps?
Poor diet/nutrition 28%
Stress and anxiety 30%
Lack of  physical activity 15%
Limited access to healthcare 25%
Genetic predisposition 2%
How can access to nutritious food be improved in your camp?
Increase food aid and distributions 46.1%
Establish community gardens 0.9%
Provide education on nutrition and cooking 2%
Support local agriculture initiatives 25%
Improve infrastructure for food storage and preservation 26%



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Table 9 reveals the coefficient, standard error, t and p 
values for several key independent variables affecting 
the prevalence of  hypertension in Sudanese due to 
starvation. History of  hypertension and other diagnosed 
medical conditions reported to show significant impact 
on prevalence of  hypertension with coefficient, 0.42, 0.70 

respectively and p-value <0.001. Additionally, starvation 
had a direct impact on hypertension prevalence, factors 
like, less nutritional intake, significant weight lost and 
food insecurity showing co-efficient -02.9, 0.31 and 
0.25 respectively. Moreover, stress rate reported to be 
alleviated in association with starvation.

Table 9: Regression Analysis
Independent Variable Coefficient Standard 

Error
t-value p-value

History of  hypertension 0.42 0.06 7.00 <0.001
Family history of  hypertension 0.37 0.07 5.29 <0.001
Other diagnosed medical conditions 0.70 0.10 7.00 <0.001
Overall nutritional intake -0.29 0.05 -5.80 <0.001
Significant weight loss in the past six months 0.31 0.08 3.88 <0.001
Experience food insecurity or hunger regularly 0.25 0.06 4.17 <0.001
Smoking tobacco products 0.39 0.08 4.88 <0.001
Belief  in the relationship between starvation and hypertension 0.30 0.07 4.29 <0.001
Factors contributing to hypertension prevalence (Stress and anxiety) 0.32 0.08 4.00 <0.001

Table 10: Model Fit
Model Summary
Model R R-squared

0.75 0.56

Table 11: Additional Comments
Theme Responses
Healthcare and Living Conditions Mostly reported for poor healthcare services and no availability of  

healthcare infrastructure nearby in regions.
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 renin-
angiotensin 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 cross-
sectional 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.



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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 long-
term effects of  such interventions and their potential 
to improve health outcomes and quality of  life among 
displaced populations.

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.

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