Objective This study aims to assess the safety and efficacy of solely using local anesthetics for cleft lip repair and/or revision in adolescent and adult patients. Design Systematic review. Setting Clinical studies describing the use of local anesthetics in cleft lip repair procedures. Patients, Participants A literature search was conducted using PubMed, Google Scholar, and Embase following the PRISMA 2025 guidelines. Inclusion criteria were studies focusing exclusively on local anesthetic techniques in adolescent or adult patients undergoing cleft lip procedures. Non-English studies, studies involving patients under the age of 10, or those undergoing cleft palate or other otolaryngological procedures were excluded. Risk of bias was addressed by using a modified Downs and Black checklist. Interventions Review of local anesthetic use alone for adult and adolescent patients undergoing cleft lip repair or revision. Main Outcomes The main studied outcomes were any reported general perioperative complications, the necessity of switching to general anesthesia, patients’ self-reported pain during the surgery, wound dehiscence, wound infection, and the need for postoperative narcotics for pain control. Results The included studies demonstrated consistent evidence supporting the sole use of local anesthesia for cleft lip repair and revision, with absence of wound dehiscence or infection. Most patients reported minimal to no pain and required no general anesthesia during the procedures. Conclusions The current literature supports the safety and efficacy of local anesthesia alone for cleft lip repair and revision procedures. This modality offers a promising approach in resource-limited countries where access to general anesthesia is often limited.

Introduction Even the purest motives can yield harmful outcomes. This statement rings particularly true in the arena of outreach medical volunteering, where a rising number of healthcare workers cross borders every year to offer their services. As this phenomenon grows increasingly popular, the intent to "do good" must be carefully weighed against the practicalities and potential consequences of well-intentioned actions. As we delve into these critical aspects, our aim is to promote a more ethically conscious and sustainable approach to global outreach initiatives, with a special focus on the nuanced challenges and opportunities present in low- and middle-income countries (LMICs). "Voluntourism," characterized by short-term volunteering missions often combined with vacationing, contrasts with long-term outreach medical programs (OMPs) that focus on sustainability and deeper community impact. [1,2] The latter are more likely to align with the community's needs and contribute to building local capacity rather than providing temporary relief. While driven by noble intentions, outreach medical volunteering faces a precarious ethical terrain, especially regarding the risk of perpetuating a cycle of colonialism in regions like Latin America, Africa, parts of Asia, and the Indian subcontinent, where structural inequities from historical marginalization remain deeply entrenched in today's social fabric[3]. Consequently, significant ethical concerns requiring careful consideration during planning and implementation of these initiatives are raised. Ethical challenges in medical volunteering Cultural insensitivity and language barriers A primary concern is cultural insensitivity, which often arises when volunteers' experience does not align with the demands of the onsite healthcare landscape[3,4]. Such insensitivity can diminish the effectiveness of healthcare delivery, exacerbate existing disparities, and even cause psychological distress or social disruption among both onsite and volunteering teams. Thus, it is important to acknowledge existing cultural nuances, while avoiding the imposition of foreign medical standards. While English often serves as a universal language in healthcare settings, relying solely on its use or on translators may oversimplify the complexities of linguistic and cultural barriers. Translation may help convey information, but it does not always capture subtle nuances or cultural contexts that are essential for meaningful communication. Volunteers must recognize that effective communication extends beyond language and involves understanding nonverbal cues, local idioms, and cultural norms. In addition, medical volunteers should avoid a "white savior" approach – a term that describes the tendency of individuals from more affluent or developed countries to view themselves as rescuers or heroes to those in less developed countries – recognizing that their participation, without cultural sensitivity and bilateral collaboration with onsite teams, can be harmful[3]. Instead, volunteers should be able to show genuine adaptability to diverse healthcare and social environments. All efforts, including research studies within these programs, must prioritize actual benefits to local communities, which are often neglected in planning and execution of these initiatives[3]. The importance of local perspectives Moreover, in an era where globalization, driven by social media, is fostering a more homogenized global culture, preserving local cultural identities becomes increasingly important. OMPs must be mindful of this dynamic to avoid inadvertently contributing to cultural erosion. By respecting and integrating the local perspectives into program planning and execution, volunteers can ensure that their efforts empower communities rather than overshadowing them. This involves actively involving community members in decision-making processes to ensure programs align with their needs and expectations, while maintaining transparent communication about program goals, processes, and outcomes to build trust and ensure accountability. Additionally, involving onsite providers in leadership roles within programs and providing professional development opportunities can ensure that both volunteers and onsite partners can learn from each other. True objectives vs. personal agendas Careful reflection is encouraged on the true objectives of these OMPs. Volunteers should avoid engaging in these activities merely to fulfill personal desires for self-worth, professional advancement, or social media visibility. Equally important is acknowledging that these programs, if not carefully planned and executed, risk serving the interests of the volunteers more than those of the local communities they aim to assist.[1-3,5] Patient autonomy and informed consent Furthermore, there's a significant risk of compromising patient autonomy in handling patient material and delivering perioperative information. Thus, ensuring informed consent in the patients' (or guardians') native language fosters bidirectional communication, empowering them to make informed decisions. What is more, any graphic material (photos and videos) must strictly require the patient's explicit consent. This safeguards the principle of autonomy and maintains the integrity of the programs by preventing any inadvertent exploitation or disrespect of the patients' dignity and rights[4,6]. Coordination among volunteer groups Additionally, outreach initiatives and patients often lack coordination between different groups servicing the same geographic areas, leading to competition for patient recruitment, a situation exacerbated due to varying levels of healthcare access and infrastructure. This issue becomes particularly problematic when different groups operate on the same patient within an unacceptable timeframe, often to maintain their caseloads. Such practices are not regulated and can exacerbate the risk of poor outcomes and complications. Hence, medical organizations embarking on OMPs should guarantee patient follow-up and continuity of care to ensure quality of care. Competency of volunteers Moreover, the pervasive issue of unintentional harm at both individual and systemic levels becomes apparent when well-intentioned volunteers from more affluent regions attempt medical procedures without profound expertise in their particular medical area. Such a gap often results in suboptimal outcomes, stemming from the volunteers' skills and medical expertise not aligning with the intricate demands of the setting. That being so, it's imperative for programs to ensure that volunteers possess verified clinical competence in their designated areas of care. Follow-up care and capacity building Another critical ethical dilemma in OMPs involves insufficient follow-up care, leaving patients to navigate postoperative issues without sufficient support, revealing an ethical responsibility gap. The departure of medical teams and inadequate collaboration with onsite teams exacerbate this issue, undermining the patient-perceived competence of onsite healthcare systems. This can demoralize onsite health professionals and foster a reliance cycle on external volunteers, hindering onsite healthcare capacity development and exacerbating existing inequities[4]. While there is a growing global expectation for standardized healthcare, implementing and sustaining such practices in resource-limited populations presents significant challenges. These barriers often stem from systemic inequities, resource shortages, and the reliance on intermittent external support rather than robust, locally-led solutions. Addressing this disparity requires a focus on long-term capacity building and prioritizing self-sufficiency, where volunteers play a supportive role in enhancing onsite medical infrastructure rather than dominating it. The solution lies in prioritizing sustainable onsite medical infrastructure development, ensuring that healthcare delivery aligns with local needs and capabilities, ultimately fostering a resilient and equitable system. Aligning resources with onsite needs Aligning resources with onsite healthcare needs is crucial for OMPs' economic efficiency and long-term impact. This involves optimizing financial aspects and strategically utilizing volunteers' human capital and expertise. Quality assurance guidelines for responsible outreach activities provide a structured framework for achieving these goals, thus ensuring that OMPs not only contribute to immediate healthcare benefits but also foster sustainable socio-economic development.[6,7] These guidelines mandate comprehensive planning and execution across all mission stages, emphasizing the inclusion of onsite healthcare professionals to ensure continuity of care and reinforcing long-term self-sufficiency. Additionally, they rely on the implementation of standardized processes, which are critical for maintaining consistency, safety, and accountability. This reduces variability and mitigates the risks associated with differing approaches, thus addressing medicolegal concerns by providing clear protocols for decision-making and care delivery. Cost-effectiveness When effectively implemented, OMPs have the potential to significantly benefit the communities they serve, both immediately and in the long term. For instance, in the context of cleft lip and palate surgical volunteerism, numerous initiatives worldwide have long been providing access to critical healthcare services that would otherwise remain unattainable due to resource limitations. These programs have not only demonstrated their ability to avert substantial disability-adjusted life years (DALYs) in LMICs, but have also contributed to millions of dollars in economic gains through increased productivity and reduced healthcare costs.[8-10] The role of global academic surgery Lastly, embracing global academic surgery is vital to strengthening onsite healthcare systems and fostering genuine bilateralism[3,11]. As discussed by Ellis et al, a "comprehensive" global health program should involve education and research, and should partner with at least one local institution[12]. Therefore, establishing equal bilateral academic partnerships, where volunteers and onsite providers learn together, is fundamental to shifting from mere assistance to meaningful collaboration, respecting onsite expertise. This ensures that OMPs contribute to a legacy of empowerment and sustainability, not dependency. Conclusions Overall, the role of medical volunteering in shaping healthcare systems is profound, but it must be navigated carefully to avoid undermining local capacities. Adhering to quality assurance guidelines is paramount and ensures program safety, effectiveness, and cultural sensitivity, with a central emphasis on ethical and cultural competency, as well as ensuring sustainable development. Our aim in outreach volunteering should be to complement and enhance onsite healthcare structures, rather than replace them, favoring comprehensive over fragmented care. This approach involves direct medical care and encourages onsite practitioners to collaborate directly with the team, while empowering them to build a model of continuity of care. Medical outreach initiatives have great potential to reduce disease burdens and contribute to broader economic improvements. By addressing immediate healthcare needs while promoting dignity, respect, and access to quality care, these programs contribute to a future where equitable healthcare is universal, regardless of geographic or economic barriers.

Clefts of the lip and/or palate can result in significant morbidity as well as economic and psychosocial distress for patients and families. Global Smile Foundation is a non-profit organization committed to providing comprehensive cleft care to patients with cleft of the lip/palate around the world. Primary cleft lip and primary cleft palate repairs performed by the Global Smile Foundation in the last decade were reviewed. Averted disability-adjusted life years were estimated and assessed for their economic value. A total of 15,310 disability-adjusted life years were averted. The financial gain was estimated between $78,323,624 and $152,906,604, with an average financial benefit of $48,021 to $93,750 per patient.

Background Since COVID-19 was declared a worldwide pandemic by the World Health Organization (WHO) in March of 2020, foundation-based cleft outreach programs to Low- and Middle-Income Countries (LMICs) were halted considering global public health challenges, scarcity of capacity and resources, and travel restrictions. This led to an increase in the backlog of untreated patients with cleft lip and/or palate, with new challenges to providing comprehensive care in those regions. Resumption of international outreach programs requires an updated course of action to incorporate necessary safety measures in the face of the ongoing pandemic. In this manuscript, the authors outline safety protocols, guidelines, and recommendations implemented in Global Smile Foundation's (GSF) most recent outreach trip to Beirut, Lebanon. Methods COVID-19 safety protocols for outreach cleft care and an Action Response Plan were developed by the GSF team based on the published literature and recommendations from leading international organizations. Results GSF conducted a 1-week surgical outreach program in Beirut, Lebanon, performing 13 primary cleft lip repairs, 7 cleft palate repairs, and 1 alveolar bone grafting procedure. Safety protocols were implemented at all stages of the outreach program, including patient preselection and education, hospital admission and screening, intraoperative care, and postoperative monitoring and follow-up. Conclusions Organizing outreach programs in the setting of infectious diseases outbreaks should prioritize the safety and welfare of patients and team members within the program's local community. The COVID-19 protocols and guidelines described may represent a reproducible framework for planning future similar outreach initiatives in high-risk conditions.

OBJECTIVEA protruded premaxilla has always been challenging to care for by cleft care professionals. This study aims to fortify the use of a single-stage premaxillary setback, with posterior vomerine ostectomy and primary cheiloplasty to achieve proper care for patients with bilateral cleft lip and palate (BCLP) and protruded premaxilla.DESIGNLongitudinal retrospective analysis.SETTINGTwenty-three outreach programs to four countries (Ecuador, Lebanon, Peru, and El-Salvador) between 2016-2022.PATIENTS/PARTICIPANTSSixty-five patients between the ages of 3 months and 6 years and 5 months, with BCLP and severely protruded premaxilla underwent premaxillary setback via posterior vomerine ostectomy and primary cheiloplasty. Patients with diagnosed syndromes and inaccessible vomer bone due to fused palates were excluded from the study.INTERVENTIONSPremaxillary setback with posterior vomerine ostectomy, bilateral gingivoperiosteoplasties (GPP), and primary cheiloplasty.MAIN OUTCOME MEASURE(S)Postoperative complications and aesthetic outcomes.RESULTSThe mean age at surgery was 13.17 ± 14.1 months, with an average follow-up time of 26 ± 17 months. Patients underwent their procedures in Ecuador (72%), Peru (9%), Lebanon (8%) and El-Salvador (1%). The majority of patients were aged 1 year or less (66.7%) and were males (58.5%). All patients were operated on successfully and had good aesthetic outcomes. Only one patient developed partial necrosis.CONCLUSIONPatients with BCLP and severe premaxillary protrusion have always carried immense social, psychological, and financial burdens, especially in outreach settings. Our described single-stage technique has proven to be safe and effective with good aesthetic results. Further follow-up after primary repair should be done to document and ensure proper facial growth and normal nasolabial maturation.

Objective Describe the first hybrid global simulation-based comprehensive cleft care workshop, evaluate impact on participants, and compare experiences based on in-person versus virtual attendance.Design Cross-sectional survey-based evaluation.Setting International comprehensive cleft care workshop.Participants Total of 489 participants.Interventions Three-day simulation-based hybrid comprehensive cleft care workshop.Main Outcome Measures Participant demographic data, perceived barriers and interventions needed for global comprehensive cleft care delivery, participant workshop satisfaction, and perceived short-term impact on practice stratified by in-person versus virtual attendance.Results The workshop included 489 participants from 5 continents. The response rate was 39.9%. Participants perceived financial factors (30.3%) the most significant barrier and improvement in training (39.8%) as the most important intervention to overcome barriers facing cleft care delivery in low to middle-income countries. All participants reported a high level of satisfaction with the workshop and a strong positive perceived short-term impact on their practice. Importantly, while this was true for both in-person and virtual attendees, in-person attendees reported a significantly higher satisfaction with the workshop (28.63 +/- 3.08 vs 27.63 +/- 3.93; P = .04) and perceived impact on their clinical practice (22.37 +/- 3.42 vs 21.02 +/- 3.45 P = .01).Conclusion Hybrid simulation-based educational comprehensive cleft care workshops are overall well received by participants and have a positive perceived impact on their clinical practices. In-person attendance is associated with significantly higher satisfaction and perceived impact on practice. Considering that financial and health constraints may limit live meeting attendance, future efforts will focus on making in-person and virtual attendance more comparable.

Musculoskeletal (MSK) injuries are the most common and debilitating work-related injuries among healthcare providers. These injuries often occur due to a lack of awareness and insufficient guidance during the early years of medical training. Recognizing the need to address this issue, the Comprehensive Cleft Care Workshop (CCCW) has taken steps to integrate an ergonomics session into its curriculum. The goal of this initiative is to enhance awareness on ergonomics, improve the integration of ergonomics into daily routine, and ultimately reduce the occurrence of MSK injuries among healthcare professionals.

BACKGROUND:In countries which lack robust health care systems, congenital conditions such as cleft lip and/or palate deformities are often untreated in certain individuals. Many volunteer organizations have stepped in to fill this gap but certain factors, such as continuity of care, are yet to be studied for these clinics.METHODS:This is a retrospective cohort study of 167 pediatric patients with cleft lip and/or palate residing in El Salvador treated by a nongovernmental organizations between 2011 and 2020. This data was used in univariate and multivariable models to associate particular patient factors to their likelihood of following up to their annual clinic visits.RESULTS:Each 1-year increase in duration of follow-up was associated with a 27% decrease in the odds of attending a visit. In addition, 33.7% of cleft lip and 49.7% of cleft palate/cleft lip and palate patients returned at least once. Males had 36% higher odds of attending a return visit compared with females but this difference was not statistically significant. Time spent travelling to the clinic had no effect on follow-up rates.CONCLUSION:Nongovernmental organizations utilizing a diagonal care model should consider using more strategies to maximize continuity of care by increasing communication with patients and emphasizing the need of following up during clinic visits. Continued and increased collaboration with the local team is also of great importance.

Background/Purpose: Health care systems worldwide have suffered tremendous consequences due to the COVID-19 pandemic. Low- and middle-income countries (LMICs), that already had unmet surgical needs prior to the pandemic, have been especially affected. Although surgical outreach programs provide temporary increases in workforce and resources in LMICs, these programs were severely impacted by the pandemic due to precipitous travel bans, flight changes, and cancellations of unprecedented magnitude. Global Smile Foundation (GSF) volunteers have provided interdisciplinary cleft care through surgical outreach programs for over 3 decades, with the success of these programs heavily relying on volunteers and their continued willingness to provide global care. GSF has had to promptly acclimate to surging challenges. Moreover, little has been discussed regarding the impact of the pandemic on LMICs. This study is the first to assess how the pandemic might affect surgical outreach programs providing care in LMICs. Methods/Description: ERB approval was obtained to collect data from study subjects. Inclusion criteria comprised of individuals who have participated in at least one global surgical outreach program with GSF and had a current email address in the organization's database. The total number of study subjects was 403. There were no exclusion criteria. The data were collected in the form of a 6-question survey that gathered responses in the form of multiple-choice, checkbox, and free-text answers. Results: The survey received 223 responses, corresponding to a 55% response rate. Although most volunteers (64%) plan on joining future GSF outreach programs, 31% remain unsure of their future commitment. Volunteers' main concerns to join future outreach programs were worries of COVID-19 infection (85%) and mandatory quarantine in their home-country post-trip (69%) and in the host country (60%). A lot of uncertainty remains regarding safety to resume outreach programs. Many volunteers would not consider traveling until a vaccine is available (30%). Additionally, 70% of respondents report current travel restrictions implemented by their institution, with 78% of these respondents disclosing that no time frame has yet been determined to resume traveling. Conclusions: This study shows that, while the COVID-19 pandemic does not completely dissuade GSF volunteers from their commitment to providing cleft care in LMICs, a lot of uncertainty remains regarding upcoming surgical outreach programs. One would therefore worry that the existing burden of disease highlighted by the 2015 Lancet Commission on Global Surgery will only increase.

Chahine, Elsa M. MD; Annan, Beyhan MPH; Ramly, Elie P. MD; Hamdan, Usama S. MD, FICS Author Information

Introduction: The authors analyzed the insights of participants and faculty members of Global Smile Foundation's Comprehensive Cleft Care Workshops concerning the barriers and interventions to multidisciplinary cleft care delivery, after stratification based on demographic and geographic factors. Methods: During 2 simulation-based Comprehensive Cleft Care Workshops organized by Global Smile Foundation, participants and faculty members filled a survey. Surveys included demographic and geographic data and investigated the most relevant barrier to multidisciplinary cleft care and the most significant intervention to deliver comprehensive cleft care in outreach settings, as perceived by participants. Results: The total response rate was 57.8%. Respondents reported that the greatest barrier to comprehensive cleft care was financial, and the most relevant intervention to deliver multidisciplinary cleft care was building multidisciplinary teams. Stratification by age, gender, and geographical area showed no statistical difference in reporting that the greatest barrier to cleft care was financial. However, lack of multidisciplinary teams was the most important barrier according to respondents with less than 5 years of experience ( P = 0.03). Stratification by gender, years in practice, specialty, and geographical area showed no statistical difference, with building multidisciplinary teams reported as the most significant intervention. However, increased training was reported as the main intervention to cleft care for those aged less than 30 years old ( P = 0.04). Conclusions: Our study delivers an assessment for barriers facing multidisciplinary cleft care delivery and interventions required to improve cleft care delivery. The authors are hoping that stratification by demographic and geographic factors will help them delineate community-specific road maps to refine cleft care delivery.

cause of UVFI and among these, thyroidectomy is the most common surgery to post the nerve at risk. Other than iatrogenic injury, non-laryngeal malignancies such as lymphoma, esophageal and lung cancer as a group is also among prevalent causes of UVFI. Intubation may result immobility of vocal cord either due to mechanical cause such as in cricoarytenoid joint dislocation or neural injury which leads to vocal fold paresis or paralysis. The pathophysiology of RLN injuries secondary to intubation has been extensively investigated by many authors. In the cadaveric dissection study, the recurrent laryngeal nerve (RLN) is most vulnerable at approximately 6 to 8 mm below the posterior-third of the true vocal fold, whereby the injury can be directly from endotracheal tube (ETT) placement or by the inflated ETT balloon. At this critical anatomical area, the nerve fibers to thyroarytenoid and lateral cricoarytenoid muscles are at most at risk as the course lies above the cricoid cartilage. In comparison to nerve fibers to posterior cricoarytenoid and interarytenoid muscles that lies lateral to cricoid cartilage, they are protected from the inflated cuff pressure. Axonal ischemia is the proposed pathophysiology of the RLN injury. It will results in severe axonal injury if the intubation lasted for more than 6 hours, which subsequently causing nerve conduction failure leading to vocal fold immobility. Although theoretically can happen, bilateral RLN axonal ischemia secondary to both side of pressure exerted from the cuffed ETT balloon, resulting in bilateral vocal fold palsy is a real unfortunate to occur especially in a non-neck setting surgery, which some time may require tracheostomy to open up the airway. We have reported one patient post thyroidectomy having bilateral vocal fold palsy after extubation. The RLNs were functionally intact throughout the continuous neuromonitoring intra-operatively. The condition fully recovered after three-month, with one-week course of oral steroid at the initial part of treatment. We postulated the fatigability of the nerves after repeated stimulation was the underlying cause of the bilateral transient palsy. The left side of vocal fold injury is more common to be reported to be associated with intubation. The postulation is the fact that most clinicians are right handed and thus more tendency to injure the left side of the larynx when introducing the ETT. Second reason is the preference of securing the ETT to right side of the patient‘s mouth which then impose more pressure to the left side of the vocal fold and trachea. The longer course of RLN on left side also imposed a risk for compression injury over the tracheoesophageal groove. This laterality is the same from the surgical point of view whereby the longer course of the left RLN has make it more susceptible to injury from iatrogenic or sequel of a lesion etiologies. RLN palsy commonly presents with hoarseness with variable degree of dysphagia and aspiration symptoms. Regardless of the cause, diminishing of the mucosal sensation and degree of glottal gap carries risk of aspiration with subsequent increase risk of morbidity and mortality from aspiration pneumonia. Each patient is unique as the capability of re-innervation of the larynx is different among individuals. However, it is suggested that any patient who is suspected to have a new onset UVFI is referred to an otorhinolaryngologist for further assessment of the larynx and for immediate intervention of UVFI to reduce the morbidity and mortality mentioned above.

Kantar, Rami S. MD, MPH; Chahine, Elsa M. MD; Alfonso, Allyson R. BS, BA; Nader, Marie K. MD; Annan, Beyhan MPH, MD; Haddad, Anthony G. MD; Hamdan, Usama S. MDAuthor Information

INTRODUCTION:We analyzed the perceptions of participants and faculty members in simulation-based comprehensive cleft care workshops regarding comprehensive cleft care delivery in developing countries.METHODS:Data were collected from participants and faculty members in 2 simulation-based comprehensive cleft care workshops organized by Global Smile Foundation. We collected demographic data and surveyed what they believed was the most significant barrier to comprehensive cleft care delivery and the most important intervention to deliver comprehensive cleft care in developing countries. We also compared participant and faculty responses.RESULTS:The total number of participants and faculty members was 313 from 44 countries. The response rate was 57.8%. The majority reported that the most significant barrier facing the delivery of comprehensive cleft care in developing countries was financial (35.0%), followed by the absence of multidisciplinary cleft teams (30.8%). The majority reported that the most important intervention to deliver comprehensive cleft care was creating multidisciplinary cleft teams (32.2%), followed by providing cleft training (22.6%). We found no significant differences in what participants and faculty perceived as the greatest barrier to comprehensive cleft care delivery (P = 0.46), or most important intervention to deliver comprehensive cleft care in developing countries (P = 0.38).CONCLUSIONS:Our study provides an appraisal of barriers facing comprehensive cleft care delivery and interventions required to overcome these barriers in developing countries. Future studies will be critical to validate or refute our findings, as well as determine country-specific roadmaps for delivering comprehensive cleft care to those who need it the most.

Background: Evidence from the developed world associates higher prevalence of hypertension with lower socioeconomic status (SES). However, patterns of association are not as clear in Africa and other developing countries, with varying levels of socioeconomic development and epidemiological transition. Using wealth and education as indicators, we investigated association between SES and hypertension among older adult women in Sudan and examined whether urbanicity mediates the relationship. Methods: The sample included women aged 50 years and over participating in the nationally representative population-based second Sudan Health Household Survey (SHHS) conducted in 2010. Principal components analysis was used to assign each household with a wealth score based on assets owned. The score was categorized into quintiles from lowest (poorest) to highest (richest). Findings: The sample included a total of 5218 women, median and mean age 55 and 59 years, respectively, with the majority not have any schooling (81.6%). The overall prevalence of reported hypertension was found to be 10.5%. After adjustment for age, marital status, work status and urban/rural location, better wealth and higher education were independently and positively associated with hypertension prevalence rates. However, when stratified by urbanicity, the relationship between wealth and hypertension lost its significance for women in urban areas but maintained it in rural areas, increasing significantly and consistently with each increase in quintile index (adjusted odds ratio, aOR1 = 1.95 95% CI = 1.08–3.52; aOR2 = 5.25, 95% CI = 3.01–9.15; aOR3 = 8.27, 95% CI = 4.78–14.3; and aOR4 = and 11.4, 95% CI = 6.45–20.0; respectively). By contrast, education played a greater role in increasing the odds of hypertension among women in urban locations but not in rural locations (aOR = 2.14, 95% CI = 1.25–7.90 vs. aOR = 0.79, 95% CI = 0.27–2.30, respectively). Conclusions: Our findings of a socioeconomic gradient in the prevalence of hypertension among women, mediated by urbanization, call for targeted interventions from early stages of economic development in Sudan and similar settings of transitioning countries.