Malnutrition Is Closely Linked to Healthcare Access and Affordability in Sudanese ESRD Patients, Influenced by Clinical and Socioeconomic Factors During Wartime
1
University of Khartoum, Faculty of Medicine, Khartoum, Sudan
2
Field Epidemiology Training Program, Republic of Sudan Federal Ministry of Health, Khartoum, Sudan
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
End-stage renal disease patients are at risk of malnutrition, leading to poor clinical outcomes. In conflict-affected settings, the risk is compounded due to disrupted health systems and financial constraints. This work examines the determinants of malnutrition and explores the role of healthcare affordability within access frameworks among haemodialysis patients in Northern Sudan.
METHODS:
This is a cross-sectional analysis previously conducted [1,2] among 141 ESRD patients receiving haemodialysis at four public centres in Northern Sudan. Nutritional status was assessed using the Subjective Global Assessment (SGA). Healthcare access was evaluated using a validated tool based on Penchansky and Thomas model. Descriptive statistics, bivariate analyses, ANCOVA, and multivariate logistic regression were performed using SPSS version 21, with statistical significance set at p < 0.05.
RESULTS:
Nearly half of the patients experienced some degree of malnutrition (mild to moderate: 44%; severe: 4.3%). Female gender (OR = 2.29, 95% CI: 1.04–5.07) and longer dialysis duration (OR = 2.95, 95% CI: 1.16–7.51) were associated with higher odds of malnutrition. Although overall healthcare access scores were moderate to high, affordability was the lowest-scoring access dimension, and higher overall access was associated with better nutritional status. After adjustment for potential confounders, malnourished patients demonstrated significantly lower affordability scores than well-nourished patients (p < 0.05). Higher income strongly predicted higher odds of healthcare access (AOR=9.997, 95%CI: 2.10-47.71; p<0.05), while health insurance did not significantly predict better access.
CONCLUSIONS:
In wartime, malnutrition among haemodialysis patients was highly prevalent and influenced by iatrogenic, economic, and healthcare access–related factors. Healthcare affordability was a key factor associated with malnutrition, even when services are nominally accessible. These findings highlight the need to move beyond service availability and address financial barriers through targeted subsidies, policies integrating nutritional services into routine care, and context-specific financing mechanisms to protect vulnerable patients and promote more equitable access.
End-stage renal disease patients are at risk of malnutrition, leading to poor clinical outcomes. In conflict-affected settings, the risk is compounded due to disrupted health systems and financial constraints. This work examines the determinants of malnutrition and explores the role of healthcare affordability within access frameworks among haemodialysis patients in Northern Sudan.
METHODS:
This is a cross-sectional analysis previously conducted [1,2] among 141 ESRD patients receiving haemodialysis at four public centres in Northern Sudan. Nutritional status was assessed using the Subjective Global Assessment (SGA). Healthcare access was evaluated using a validated tool based on Penchansky and Thomas model. Descriptive statistics, bivariate analyses, ANCOVA, and multivariate logistic regression were performed using SPSS version 21, with statistical significance set at p < 0.05.
RESULTS:
Nearly half of the patients experienced some degree of malnutrition (mild to moderate: 44%; severe: 4.3%). Female gender (OR = 2.29, 95% CI: 1.04–5.07) and longer dialysis duration (OR = 2.95, 95% CI: 1.16–7.51) were associated with higher odds of malnutrition. Although overall healthcare access scores were moderate to high, affordability was the lowest-scoring access dimension, and higher overall access was associated with better nutritional status. After adjustment for potential confounders, malnourished patients demonstrated significantly lower affordability scores than well-nourished patients (p < 0.05). Higher income strongly predicted higher odds of healthcare access (AOR=9.997, 95%CI: 2.10-47.71; p<0.05), while health insurance did not significantly predict better access.
CONCLUSIONS:
In wartime, malnutrition among haemodialysis patients was highly prevalent and influenced by iatrogenic, economic, and healthcare access–related factors. Healthcare affordability was a key factor associated with malnutrition, even when services are nominally accessible. These findings highlight the need to move beyond service availability and address financial barriers through targeted subsidies, policies integrating nutritional services into routine care, and context-specific financing mechanisms to protect vulnerable patients and promote more equitable access.
| eISSN: | 2654-1459 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
