Healthcare Ethics Literacy in Pre-Conflict Sudan: A Multi- Disciplinary Institutional Baseline Study from a Tertiary Hospital (2013–2014)

Abstract Background Sudan established its Sudan Medical Council (SMC) in 1964 and promulgated a national Code of Medical Ethics in 1969 — predating bioethical institutionalisation in many high-income countries. Yet the operational ethics literacy of its frontline clinical workforce had never been empirically characterised. This study reports the first pre-conflict, multi-disciplinary institutional baseline assessment of healthcare ethics knowledge and attitudes from Sudan's premier tertiary referral centre. Methods A descriptive cross-sectional institutional audit was conducted at Soba University Hospital, Khartoum, Sudan (Protocol No. FAMS-REC-2013/042; December 2013 — March 2014; 12 weeks; STROBE-compliant). Total enumeration of 100 frontline clinical providers was achieved (response rate: 100%). A bilingual (Arabic/English) structured questionnaire with open-ended knowledge verification was administered. Composite knowledge adequacy was defined as verified ≥ 3/4 correct domain responses (≥ 75% threshold). Fisher's Exact tests, Prevalence Ratios (PR) with 95% confidence intervals, and Cramér's V effect sizes were computed using SPSS v20. Results Despite universal (100%) undergraduate ethics curriculum exposure, 66% demonstrated inadequate overall ethics knowledge (95% CI: 55.8–75.2%), constituting a 66-percentage-point knowledge-curriculum paradox. Domain deficits: 67% unaware of four bioethical principles, 59% unaware of the SMC national ethics code, 57% lacking applied health ethics knowledge. Attitudinally, 86% affirmed informed consent as essential and 92% endorsed infection control compliance, yet 68% acknowledged resource-driven ethical compromise daily — documenting structural professional dissonance. No significant associations were detected between knowledge adequacy and any stratifier (professional category, educational qualification, CPD exposure, international experience, or marital status; all Fisher's p > 0.05; all Cramér's V ≤ 0.15), confirming a systemic rather than cadre-specific deficit. Conclusion A profound knowledge-attitude paradox characterises healthcare ethics literacy at this Sudanese tertiary centre. The universal knowledge deficit across all professional and educational strata confirms a systemic curriculum failure. As the only available pre-conflict multi-disciplinary bioethics institutional baseline from Sudan's premier tertiary centre, this dataset provides an essential reference for post-conflict health system reconstruction.