Preprints Articles

Acute Competence vs. Referral Hesitancy: The Impact of Professional Seniority on Child Epilepsy Management in an LMIC Setting - EEC 2026 (Accepted) - Athena - Greece

KURA Research Center, Sudan

Background: In low- and middle-income countries (LMICs) like Sudan, consistent adherence to International League Against Epilepsy (ILAE) protocols is critical to mitigating the morbidity of Child epilepsy. However, systemic resource constraints and variable access to specialist care often fragment standard management, making physician adherence the primary determinant of clinical outcomes.

Objective: To rigorously evaluate clinical practice adherence to standardized epilepsy protocols and quantify the impact of professional hierarchy on guideline fidelity.

Methods: A cross-sectional study was conducted with physicians, ranging from House Officers to Consultants mostly from Kassala State in Sudan. A structured instrument assessed core practice domains, including seizure classification, acute management, medication selection, and specialist referral thresholds. Data were analyzed using Mean and SD ,Chi-Square test, Pearson correlation coefficients and one-way ANOVA and Regression to determine Score and statistical significance in practice variances across professional ranks and years of experience.

Results: A total of 264 Medical Practitioners Mainly House Officers (47.9%) demonstrated strong overall alignment with ILAE guidelines (Mean Score: 4.18 ± 1.03; 83.5% adherence). However, domain stratification revealed a critical performance dichotomy, while proficiency was robust in managing acute breakthrough seizures (Mean: 4.26), it dropped significantly regarding the timing of referrals to neurologists (Mean: 3.64). One-way ANOVA confirmed highly significant disparities in clinical practice scores across professional levels (F (3, 260) = 13.90, p < .001). This finding, combined with a positive correlation between seniority and adherence (p = 0.012), establishes that early-career doctors the primary first responders are the most hesitant to refer complex cases.

Conclusion: This study exposes a significant "experience gap" in Child epilepsy care. While acute competence is widespread, referral hesitancy among the junior workforce creates a bottleneck in the care pathway. As junior staff constitute the majority of frontline providers, this disparity underscores an urgent need for algorithm-based referral checklists to standardize decision-making and bridge the gap between protocol and practice.

Keywords: Child epilepsy, ILAE guidelines, referral patterns, clinical practice, LMIC.

Unprotected on the Frontlines: The Critical HBV Immunization Gap Among Healthcare Students in Sudan. (Accepted) - 18th WCPH, Cape Town, South Africa, 2026

Hamzaelhussein Mohieldin (l) , Kamel Oshik (l), Malaz Algassim (l), Safia Al Tayeb (l), Rayyan Salah Alnoor Othman (l), Wejdan Tajelsir (l), Muzn Samir (l), Amna Alsafi (l), Omer Aljaily (l), Alhassan Ali (l), Sana Omer (l), Sami Elamin (l) (2)

(l) KURA Research Center, Sudan - (2) University of Harvard, USA

Background: Hepatitis B Virus (HBV) remains a potent occupational threat in Sudan, yet the immunological security of the future healthcare workforce is critically overlooked. In high-prevalence regions, the safety of trainees is paramount to institutional health security. This study evaluates the alarming gap in HBV protection among medical and nursing students at the University of Kassala.

Methods: A cross-sectional survey conducted in early 2025 assessed 231 medical (61.3%) and nursing (38.7%) students. Utilizing the Kobo Toolbox platform, the study analyzed vaccination history, theoretical knowledge, and specific experiences with occupational exposure and needle stick injuries.

Results: The data uncovers a dangerous disconnect between clinical responsibility and protection. Despite operating in high-risk environments, over 94% of the cohort remains immunologically vulnerable. While 18.67% initiated vaccination, effective immunity is nearly non-existent; only 5.81% completed the necessary three-dose regimen.This immunization deficit is driven by systemic failure rather than personal neglect. Students cited a profound lack of procurement guidance (21.16%) and the complete absence of institutional programs (17.84%) as primary barriers. The risk is immediate: 12.45% of students reported sustaining needle stick injuries, yet nearly half the cohort lacks knowledge of correct post-exposure prophylaxis protocols, leaving them defenseless against potential infection.
Conclusion: Current prevention strategies at the University of Kassala are insufficient. The severe disparity between occupational exposure and immunological protection constitutes an urgent safety crisis. Moving beyond theoretical awareness to institutional action is non-negotiable. Implementing a mandatory, subsidized vaccination program is an ethical imperative to secure the safety of Sudan’s next generation of healthcare providers.

Keywords

Hepatitis, Vaccination, Exposure, Students

War, "Takaya," and the New Epidemiology of Deprivation: Nutritional Stress and Chronic Disease in Sudan (Accepted) - 18th WCPH, Cape Town, South Africa, 2026

Fatima Ismaila (l) , Mohamed Sharf aldein (l) , Hamzaelhussien Mohieldin (l) , Mohammed Ganim (l)

(l) KURA Research Center, Sudan

Background: The conflict in Sudan has decimated food supply chains, forcing a transition from balanced nutrition to "survival diets." In response, Takaya (communal street kitchens) have emerged as the primary source of sustenance, offering monotonous, legume-heavy meals. While these kitchens prevent mass starvation, the public health consequences of this sudden nutritional shift characterized by reduced meal frequency and high plant-based purine intake remain poorly understood in the context of Non-Communicable Diseases (NCDs).

Objective: To evaluate the association between war-induced dietary patterns, specifically the meal frequency and composition provided by communal kitchens, and the exacerbation of chronic inflammatory conditions in Khartoum’s Western Nile region.

Methods: A descriptive cross-sectional study was conducted at Al Banjadeed Teaching Hospital (2023–2024). Data from 386 patients were collected using structured questionnaires focusing on socioeconomic status, food source (Takaya vs. private), meal frequency, dietary composition, and lab tests. Statistical analysis via SPSS 27 utilized chi-square tests and multiple linear regression to identify nutritional predictors of disease flares.

Results: Most participants (62.4%) were from low-income households. Severe nutritional insecurity was evident, with 47.4% restricted to a single daily meal. Dietary reliance on lentils (79.8%) and beans (54.4%) was nearly universal. A significant association was found between the Takaya-style diet (combined beans and lentils) and increased disease prevalence (p = 0.028). Notably, traditional risk factors like alcohol and gender were non-significant. Instead, the synergy of dehydration, reduced meal frequency, and legume-based monotony significantly increased the severity of inflammatory flares.

Conclusion: The Sudanese conflict has inverted the NCD paradigm, shifting inflammatory triggers from "affluence" to "deprivation." The Takaya system, while a vital humanitarian lifeline, facilitates a nutritional monotony that exacerbates metabolic imbalances. These findings underscore the urgent need for humanitarian "survival rations" to be supplemented with hydration support and micronutrients to mitigate the rising NCD burden in global conflict zones.

Keyword :

Takaya , Food Insecurity, Chronic, Diseases

Bridging the Knowledge Gap: Impact of a Community Based Health Education Intervention on Dengue Fever Awareness (Accepted) - 18th WCPH, Cape Town, South Africa, 2026

Hamzaelhussein Mohieldin (l), Al haj Ezzaaddeen (l), Abd Almoneim Mustafa (l), Sohayb Mohamed (l) , Malaz Algassim (l)

(l) KURA Research Center, Sudan

Background: Dengue fever remains a significant public health challenge in endemic regions, often exacerbated by community misconceptions regarding transmission and management. Effective health education is critical for disease prevention and safe home-based care. This audit evaluated the immediate impact of a targeted health education program on the knowledge, attitudes, and practices of residents in New Halfa Village regarding dengue fever.
Methods: A pre-test/post-test interventional study design was employed with a cohort of 42 participants from New Halfa Village. Participants completed a structured questionnaire assessing knowledge of dengue transmission, symptoms, severe signs, and medication safety before and after attending a health awareness session. Data were analyzed to measure changes in knowledge scores and specific competencies.
Results: The intervention resulted in a significant improvement in overall knowledge, with the average score rising from 5.19 (pre-education) to 8.0 (post-education) out of 9 possible points. The most critical safety improvement was observed in medication awareness: prior to education, only 31.0% of participants knew to avoid aspirin; this increased to 97.6% post-intervention. Similarly, recognition of severe hemorrhagic signs (e.g., bleeding, shock) doubled from 47.6% to 95.2%.
However, a persistent misconception regarding transmission vectors remained: despite the intervention, 61.9% of participants continued to incorrectly believe that dengue can be transmitted directly from person to person via touch . Participant satisfaction was high, with 100% recommending the session to others.
Conclusion: The health education program was highly effective in improving clinical awareness and critical safety practices, particularly regarding the avoidance of contraindicated medications like aspirin. However, deep-seated misconceptions regarding direct transmission proved resistant to standard educational methods. Future interventions in Halfa Village should employ targeted behavioral change communication strategies to distinguish between vector-borne and direct contact transmission.

Keywords

Dengue Fever, Education , Community

Bridging the Knowledge Gap in High-Prevalence Regions: Assessing Hepatitis B Vaccination Awareness Among Healthcare Students in Kassala State, Sudan

Hamzaelhussein Mohieldin 1 , Kamel Oshik 1, Malaz Algassim 1, Safia Al Tayeb 1, Rayyan Salah Alnoor 1, Wejdan Tajelsir 1, Muzn Samir 1, Amna Alsafi 1, Omer Aljaily 1, Alhassan Ali 1, Sana Omer 1, Sami Elamin 1, MD

KURA Research Center, Sudan - University of Harvard, USA

Background : Hepatitis B Virus (HBV) remains a significant public health challenge in Sudan, particularly in areas with documented high case rates like Kassala State. Healthcare students in these regions face an elevated risk of needle-stick injuries and occupational exposure during clinical training. This medical and nursing students to identify gaps that may contribute to infection rates in this specific geographical context. Study aimed to evaluate the level of awareness regarding HBV vaccination protocols among

Methods : A cross-sectional study was conducted involving 239 students (Medical: 66.1%; Nursing: 33.9%) studying in Sudan. Data regarding knowledge of dose requirements, immunity timelines, and vaccine accessibility were analyzed. Pearson’s Chi-Square tests (p < 0.05$) were used to correlate demographic variables with HBV knowledge levels, with a focus on preparedness for clinical practice in high-prevalence states like Kassala.

Results : Analysis of 239 respondents revealed a profound knowledge-practice gap regarding HBV protection. Despite the geographical risk in Kassala State, 48.1% of participants were unaware of the standard three-dose regimen required for seroconversion. A significant correlation was observed between academic seniority and knowledge of vaccine protection (p < 0.001), confirming that junior students enter high-risk clinical environments with critical levels of vulnerability. Furthermore, a disciplinary disparity was identified; medical students demonstrated significantly higher awareness of vaccine efficacy compared to nursing students (p < 0.001), exposing a major weakness in the nursing biosafety curriculum. Economic uncertainty remains a primary barrier, as 48.5% of students were unaware of the vaccine’s cost structure, and only 8% perceived it as a free service. Finally, only 24.7% of the cohort correctly identified the 6-month timeline for achieving full immunity, suggesting that the majority of students are practicing in high-risk wards in Eastern Sudan under a dangerous, false sense of biological security

Conclusion : In regions such as Kassala State, where HBV cases are frequently recorded, the observed knowledge-practice gap among students is a critical concern. The study underscores the urgent need for standardized, mandatory HBV vaccination and education programs before students begin clinical rotations. Strengthening occupational health policies at the university level is vital to reducing the transmission of HBV among the future healthcare workforce in Sudan’s most affected states.

Keywords

Hepatitis, Vaccination, Exposure, Students , Knowledge

‍Perception of Sudanese Mothers Toward Milk Tooth Extraction Among Children in Khartoum Hospitals (2022).

KURA Research Center, Sudan

Background: Harmful traditional practices continue to affect children, being the major causes of the prevalence of those practices in Sub Saharan Africa, and also in Sudan. One such practice, milk tooth extraction (MTE) the manual removal of un erupted primary canines is most frequently performed on children under five years old. It is the common belief that such practice can heal symptoms like diarrhea, vomiting, and fever. Though it is still there, very little contemporary evidence exists on the prevalence and perception of MTE in Sudan. This study aimed to establish the prevalence of MTE and to investigate mothers’ perceptions of this practice in Khartoum State.

Approach: The cross-sectional hospital study was carried out in seven major teaching hospitals in Khartoum state. Parents of children under five, 385 in total, were interviewed with the help of a semi-structured questionnaire, which included questions related to the socio-demographic data, awareness, attitudes, and experience of MTE. Data were analyzed using SPSS V21. Descriptive statistics and bivariate logistic regression were applied to identify the factors associated with practice.

Results:

The findings indicate that the average age of the Participants was 34.9 ± 7.5 years, and the mean age of the children was 2.1 ± 1.3 years. Among Mothers 94.3% had heard of MTE and 18.4% admitted that their children had been through the operation. Nearly 40% of mothers considered MTE as good, most of them (69.4%) pointing to family tradition, (56.1%) - diarrhea, and (37.7%) - fever. MTE was significantly associated with lower maternal education, rural origin, and older maternal age (P < 0.05). Most ‍‌‍mothers reported that the procedure was performed by using traditional unsterile sharp instruments , fortunately no major complication were reported despite the imminent danger .

Implications:

Despite‍‌‍‍‌ being a deeply cultural practice, MTE is still a medically injurious one to the children of Sudanese mothers. The findings call for the provision of healthcare education that is attuned to the culture and of community-based interventions through the level of primary healthcare. Involving campaigns to create awareness among mothers of reproductive age and healthcare workers will facilitate clearing up wrong beliefs, lowering the incidences of infant oral mutilation, and consolidating child health care systems in Sudan as well as in other comparable ‍‌‍‍‌regions.

Unexpected Malignancy in Youth: Incidental Gallbladder Adenocarcinoma Arising from a Gallbladder Polyp; A Case Report of a 29-Year-Old Female

Hamzaelhussein Mohieldin 1 , Mohammed Ganim 1, Mohammed Bokhari 1, Asmaa Mohamed 1, Mohammed Fouad 1, Elnazeir Mohamed 1, Elnoor Malik 1, Alhassan Hamid 1, Ibrahim Mohammed 1, MD

1 KURA Research Center , Sudan

Background: Gallbladder adenocarcinoma (GBC) is an uncommon but highly aggressive malignancy that predominantly affects older adults. Its occurrence in young patients is exceptionally rare, often resulting in delayed diagnosis due to a low clinical suspicion. We report an unusual case of incidental gallbladder adenocarcinoma arising from a gallbladder polyp in a 29-year-old female.

Case Presentation: A 29-year-old woman presented with a one-month history of severe right hypochondrial and epigastric pain radiating to the right shoulder and back, aggravated by fatty meals and associated with nausea, vomiting, and chills. Constitutional symptoms included mild weight loss, anorexia, and altered bowel habits. Physical examination revealed right upper quadrant tenderness with a positive Murphy sign. Laboratory investigations were largely unremarkable except for mild thrombocytosis. Radiological assessment demonstrated a distended gallbladder with a polypoid lesion and irregular wall thickening. The patient underwent elective open cholecystectomy. Histopathological examination unexpectedly revealed a moderately differentiated invasive adenocarcinoma confined to the muscular layer (pT1bNxMx), with negative surgical margins and no lymph vascular or perineural invasion.

Conclusion: This case highlights the potential for gallbladder carcinoma to occur in young adults despite the absence of typical risk factors or classical malignant features. It emphasizes the importance of maintaining clinical vigilance when evaluating gallbladder polyps, regardless of patient age, and supports comprehensive histopathological assessment and consideration of underlying genetic predispositions in early-onset disease. Early recognition remains essential for optimizing oncological outcomes.

Keywords:

Gallbladder adenocarcinoma, Gallbladder polyp, Incidental gallbladder cancer, Young adult, Cholecystectomy, Case report.

The Gendered Burden of War: Epidemiological Shifting of Metabolic Disease Linked to Food Deprivation form Men to Women in Khartoum (2023–2024)

Fatima Ismail 1, Mohamed Sharf aldein 1, Hamzaelhussien Mohieldin 1, Mohammed Ganim 1

1 KURA Research Center , Sudan

Background : Armed conflict in Sudan has induced a catastrophic collapse of food systems and economic stability. While metabolic disorders are historically associated with specific gender and lifestyle profiles, the extreme physiological stress of the 2023–2024 conflict has altered these traditional patterns. This study investigates the "disease shifting" phenomenon, where a condition traditionally prevalent in men has become dominant among women under conditions of acute food and water deprivation.

Methods : A descriptive cross sectional study was conducted at patient that come to hospital Al Banjadeed Teaching Hospital, Khartoum, between 2023 and 2024. A total of 386 patients clinically with gout were included. Data were collected using structured interviewer-administered questionnaires on socio demographics, dietary intake, alcohol consumption, and comorbidities. Statistical analyses were performed using SPSS 27, including Chi-square tests , and Kruskal–Wallis H and Multiple Linear Regression

Results : The analysis reveals a profound demographic inversion and severe nutritional crisis driven by the conflict. Out of 386 surveyed patients, the sample was predominantly female (66.8%), marking a significant departure from traditional clinical patterns for this condition. This shift is deeply rooted in the near-total collapse of food security, as evidenced by 99.5% of the population being unable to maintain a standard three-meal-a-day diet. Specifically, 47.4% of respondents are now restricted to a single meal daily, while 52.1% survive on two, leaving a negligible 0.5% with adequate food access. These deprivation levels are a direct consequence of widespread economic exhaustion, with 62.4% of participants reporting "Low" economic status and only 5.7% maintaining "High" status. Furthermore, the very low prevalence of alcohol consumption (6.5%) confirms that this clinical shift is not the result of traditional lifestyle factors, but is instead a physiological response to the extreme stress and food scarcity characterizing the war in Khartoum.

Conclusion : This study documents a significant "disease shift," where women have become the primary demographic for a metabolic condition previously considered a "disease of men." This shift is directly attributed to the severe food deprivation and economic vulnerability characterizing the Khartoum conflict. These findings necessitate a gender-sensitive approach to humanitarian medical aid, prioritizing nutritional support for women to mitigate this emerging health crisis.