1. Study design:
Observational descriptive (Comparative Cross-sectional) institutional based study design.
2. Study area:
The study was conducted in the Medical Campus of University of Khartoum located in Al Qasr Avenue, Khartoum, Sudan. It was established in the year 1924 where it was previously known as Kitchener Medical School.
The Medical Campus is made up of 3 faculties (Medicine, Dentistry and Pharmacy) and 14 Academic departments taking more than 300 students annually. It accommodates 3,174 medical students in total. 1998 studying Medicine, 514 Pharmacy and 662 Dentistry.
3. Study population:
Name: Students at the University of Khartoum, Medical campus, studying either Medicine, Dentistry or Pharmacy.
age: 20-24.
Inclusion criteria: undergraduate Medical students studying Medicine, Dentistry or Pharmacy of age 20-24, who gave informed written consent.
Exclusion criteria: Ages <20 and >24 who study in universities other than University of Khartoum, or who study there yet are enrolled in facilities other than the faculties of Medicine, Pharmacy and Dentistry and/or who did not give an informed written consent.
4. Sampling
4.1. Sample size
288 students based on 25% prevalence and 95% confidence interval using the equation
![](data:image/png;base64,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)
n= sample size
z= standard normal deviation
p=proportion of students with EDs= 25%
e=gross margin error=0.05.
4.2. Sampling technique
Stratified simple random sampling.
The total number of students within each faculty was obtained from previous records and divided into three strata on the basis of their faculties. Participants of ages 20-24 were then chosen Randomly:
Strata
|
Total population
|
Number of participants
|
Faculty of Dentistry
|
662
|
62
|
Faculty of Pharmacy
|
514
|
49
|
Faculty of Medicine
|
1998
|
188
|
The number of participants 299 was reached suggesting a response rate of 100%.
5. Data Collection
5.1. Tools:
Three pretested, structured, self-administered questionnaires with closed-ended questions were used:-
1. The Eating Attitudes Test 26-item which is a standardised self-report measure of Symptoms and concerns characteristic to EDs that was developed by D. Garner in 1987. Options for each question were given a score from 0 to 3 (Always=3, Often= 2, Sometimes=1, Rarely= 0, Never= 0). Individual scores were then added and a score of 20 or more suggested a high risk for development of EDs. The BMI was also calculated using the formula (body weight/height (m) 2). A BMI of less than 18.5 for females was considered underweight, higher than 18.5 but less than 24.9 was considered normal and more than 24.9 overweight. As for males, less than 19.6 was considered underweight, a BMI lying within the range 19.6-24.9. A value higher than 24.9 was also considered overweight. There was also a second section with five behavioural questions whose aim was to find out the necessity of seeking professional medical help.
2. To find the correlation between it and Child abuse and neglect the CATQ (Child Trauma Questionnaire) was used, developed by Bernstein and Fink. Its main focus was covering three aspects; sexual abuse, emotional abuse and physical abuse, but emotional and physical neglect were covered as well. Questions on each form of abuse were scored according to Likart's scaling system (SA=5, A=4, N=3, D=2, SD=1) and the total was calculated and compared to its cut-off scores (physical ≥10; emotional ≥13; sexual ≥8) and neglect (physical ≥10; emotional ≥15). Childhood maltreatment in general was described as a score which lies above the 50th percentile of the distribution (=>40), this was done as there was no official cut-point for the total score.
3. Self-esteem was assessed using a scale developed by Rosenberg in the year 1965, publically known as the Rosenberg Self-Esteem scale. It was a ten-item Likert scale (SA=5, A=4, N=3, D=2, SD=1) and high scores indicated high self-esteem and vice versa.
5.2. Method of data collection:
The questionnaire was created using an online Google form on the 1st of January 2021 and sent to participants selected randomly (through WhatsApp and Telegram applications) within the three faculties of Medicine, Pharmacy and Dentistry. No pilot test was performed as constituents of the questionnaire were pre-designed well-known scales.
After the results were submitted and the required sample size reached on the 20th of January, the scores for each section were calculated using each component's scoring system and was investigated for the presence of any correlation.
6. Variables:
6.1 Independent variables: Age, Gender, Faculty, Academic Year, Body Mass Index, Eating Disorder
6.2 Dependent variables: Low Self Esteem, Physical Abuse, Sexual Abuse, Emotional Abuse, Physical Neglect, Emotional Neglect Childhood maltreatment
7. Data analysis:
Data from the online Google form was transferred into a Microsoft Excel database and analyzed using Statistical Package for Social Science (SPSS) ® version No. 23 software.
Descriptive statistics were used to compute means, and standard deviations for numerical variables. Frequencies were calculated for nominal and ordinal variables. Appropriate tests for significance were carried out and a significance was denoted when p<0.05 All the results were presented in the form of graphs and tables.