The Effect of War and Siege on Children with Diabetes Admitted to Ayder comprehensive specialized hospital in Mekelle, Tigray, Ethiopia: A cross-sectional Study

Abstract Background The war between Tigray Regional Government in Northern Ethiopia and the Ethiopian Federal Government along with its allies followed by the accompanying siege between November 2020 and November 2022 led to the collapse of Tigray’s healthcare system. The present study compared diabetes care among children at the Ayder Comprehensive Specialized Hospital, Tigray, during the war and siege period with that of the pre-war period. Methods We employed a retrospective cross-sectional survey using data from September 2019 to August 2020 (pre-war period) and compared it with data between September 2021 to August 2022 (war & siege period). We applied descriptive statistics such as frequency and percentages and calculated Pearson’s or Spearman’s correlation analyses to assess correlations as appropriate. Results We identified 143 admitted pediatric patients (56 in the pre-war and 87 during the war & siege periods) with a mean age of 109 months in both periods. A higher proportion of diabetes admissions were accounted for by diabetic ketoacidosis (DKA) during the war & siege period (90%) compared to the pre-war period (75%). The most common precipitating factor for DKA in the pre-war period was infections (35%), while for the war & siege period, there was malnutrition (47%), infection (46%), lack of access to healthcare facilities (31%) and running out of medicines (24%). Complications such as death, renal failure, cerebral edema, and shock were more common during the war & siege periods. The case fatality rate, which occurred at 9% during the war and siege (vs 0% during pre-war) was significantly correlated with the severity of DKA, the degree of hypokalemia, the presence of complications, and admission during the war & siege period. Conclusions Our study showed the negative impact of war and siege on diabetes care in children demonstrating a high rate of DKA admissions with increased severity, complications, malnutrition, and case fatality rates. People with diabetes especially type 1 deserve great attention during such a crisis as the lack of insulin could lead to severe complications including death.