Background: Hypertension is the leading risk factor for death and disability globally. Its prevalence is increasing worldwide especially in low and middle income countries. It is considered a silent killer because it has no specific symptoms and thus can go unnoticed for many years, only presenting for the first time with serious complications. The situation of undiagnosed hypertension in Sudan has not been fully investigated before. Objective: To determine the prevalence of undiagnosed hypertension in the rural communities of River Nile State (RNS), Sudan and to assess the associated risk factors. Methods: A cross-sectional community-based study, in which 1099 volunteer adult participants from the rural communities in RNS, not known to be hypertensive, were included. Blood pressure was measured as well as anthropometric measurements. The WHO stepwise approach for non-communicable diseases surveillance was used for data collection. A p value below 0.05 was considered statistically significant. Results: There were 461 males (41.9%) and 683 females (58.1%). The male to female ratio was 1:1.4. The age range was 18-90 years, with a mean age of 39.6 (STD ± 15.9). The prevalence of undiagnosed hypertension was 38.2%, with a prevalence of 36.7% among males and 39.3% among females. There were significant associations between undiagnosed hypertension and increasing age, obesity, illiteracy and diabetes mellitus (p50.05). Conclusion: This study uncovers a hidden epidemic of a silent killer in the rural communities of RNS. Urgent interventions are required to address this serious health epidemic.

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Undiagnosed diabetes constitutes a challenge for health providers, especially in rural areas. The aim of this study was to determine the prevalence of undiagnosed diabetes mellitus and glucose intolerance among adults in rural communities in River Nile State, north Sudan. In a cross-sectional community-based study, blood glucose, anthropometric, demographic and clinical history data were obtained from 1111 individuals from 35 villages. The prevalence of undiagnosed diabetes was 2.6% (29 individuals); glucose intolerance was detected in 1.3% (14 individuals). Classic symptoms (polydipsia, polyuria and weight loss) were present in around half of the participants but were not more prevalent in those with diabetes. Lower educational level, increasing age, hypertension and unexplained weight loss were significant risk factors for diabetes. Other variables (obesity, sex, occupation, alcohol consumption and cigarette smoking) were not significant risk factors. There is a low prevalence of undiagnosed diabetes and glucose intolerance in the rural population of River Nile State.

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