Impact of remote learning on posture and musculoskeletal health among Sudanese medical students during the 2023–2024 conflict: a cross-sectional study

Abstract

Background: The 2023 armed conflict in Sudan disrupted higher education and forced a sudden shift to remote learning. This transition altered students’ physical habits, posture, and daily routines, potentially increasing the risk of musculoskeletal disorders (MSDs). Evidence regarding the musculoskeletal impact of such disruption among medical students in conflict-affected contexts remains scarce. Objective: To assess the prevalence, patterns, and predictors of musculoskeletal symptoms among Sudanese medical students engaged in remote learning during the 2023–2024 conflict. Method: We conducted a cross-sectional study between May and August 2024 among 421 medical students who were engaged in remote learning during the conflict across more than 15 Sudanese universities. Participants completed a validated online questionnaire adapted from a Greek study.Data collected included demographics, remote learning habits, posture, and musculoskeletal complaints. Paired data were analyzed using McNemar's chi-squared test and paired t-tests, while group comparisons were conducted using the Kruskal–Wallis test and Pearson’s chi-square test. Results are reported with 95% confidence intervals (CI). Results: Participants’ mean age was 22.3 ± 2.3 years; 71% were female. Physical inactivity increased from 25% (95% CI [21%, 30%]) before the conflict to 45% (95% CI [41%, 50%]) during it (p < 0.001). Daily musculoskeletal pain prevalence rose from 23% (95% CI [19%, 27%]) to 32% (95% CI [27%, 37%]) (p < 0.001), and mean pain intensity increased from 3.4 ± 2.0 (95% CI [3.2, 3.6]) to 4.4 ± 2.2 (95% CI [4.2, 4.6]). Prolonged screen exposure (>6 hours/day) was significantly associated with higher pain frequency (P-value = 0.020). Conclusions: MSDs were highly prevalent among Sudanese medical students during conflict-related remote learning. Female gender, poor ergonomic posture, and extended screen time were major associated factors. The findings emphasize the need for ergonomic awareness programs, structured physical activity, and improved learning setups in conflict and low-resource settings.