The ongoing conflict and siege in Tigray, Ethiopia have had a devastating impact on the region’s healthcare system, particularly for children with ketoacidosis’>diabetic ketoacidosis (DKA) during the conflict, rising from 75% to 90%. DKA cases also became more severe, with higher rates of life-threatening complications like cerebral edema, renal failure, and shock.
Malnutrition emerged as a major issue, with the proportion of children with moderate to severe malnutrition more than doubling from 25% to 62% during the war and siege. This was largely due to the lack of access to adequate food and healthcare services, as the conflict disrupted the region’s supply chains and destroyed medical facilities.
The study also revealed a stark increase in mortality, with the DKA-related death rate surging from 0% to 9% during the conflict. Factors like the severity of DKA, degree of hypokalemia, and the presence of complications were all strongly associated with these tragic outcomes.
These findings underscore the urgent need for the international community to prioritize the healthcare needs of children with type 1 diabetes during humanitarian crises. As the authors emphasize, the lack of insulin and other essential resources can lead to devastating consequences, including severe complications and loss of life. Rebuilding the diabetes care infrastructure in Tigray will be crucial to prevent such devastating impacts in the future.
Main Content:
The Collapse of Tigray’s Healthcare System
The armed conflict that erupted in Tigray, Ethiopia in November 2020 and the subsequent siege imposed by the Ethiopian federal government and its allies have had a catastrophic impact on the region’s healthcare system. According to a report by the World Health Organization, only 3% of Tigray’s health facilities remained fully functional during the two-year blockade and destruction.
This near-total collapse of the healthcare infrastructure had severe consequences for patients with chronic conditions, including children with type 1 diabetes. Type 1 diabetes, the most common chronic disease in children, requires a highly specialized and consistent regimen of daily insulin injections, regular glucose monitoring, and dietary modifications. However, the prolonged interruption of insulin supplies and the disruption of essential medical services made it nearly impossible for young patients to manage their condition effectively.
Alarming Trends in Diabetic Care and Outcomes
The researchers at Ayder Comprehensive Specialized Hospital in Mekelle, Tigray, set out to document the impact of the war and siege on children with diabetes. By comparing data from the pre-war period (September 2019 to August 2020) and the conflict period (September 2021 to August 2022), they uncovered a deeply concerning trend.
During the war and siege, the proportion of children admitted with diabetic ketoacidosis (DKA) – a life-threatening complication of diabetes – increased significantly, from 75% to 90%. Moreover, the severity of these DKA cases also worsened, with higher rates of severe complications, such as cerebral edema (from 0% to 11%), renal failure, and shock.
The study also found a dramatic rise in malnutrition among the young diabetic patients, with the proportion of those with moderate to severe malnutrition more than doubling from 25% to 62%. This alarming trend was largely attributed to the lack of access to adequate food and healthcare services during the conflict.
Tragic Consequences: Soaring Mortality Rates
Perhaps the most devastating finding of the study was the sharp increase in mortality rates among children with diabetes during the war and siege. The DKA-related death rate surged from 0% in the pre-war period to 9% during the conflict.
The researchers identified several factors that were strongly associated with these tragic outcomes, including the severity of DKA, the degree of hypokalemia (low potassium levels), and the presence of life-threatening complications. Sadly, all seven of the diabetic patients who died during the war and siege had developed DKA, leading to multi-organ failure or respiratory failure.
The Urgent Need for Targeted Interventions
The findings from this study underscore the critical importance of prioritizing the healthcare needs of children with type 1 diabetes during humanitarian crises. As the authors emphasize, the lack of access to insulin and other essential medical supplies can have devastating consequences, leading to severe complications and even loss of life.
Rebuilding the diabetic care infrastructure in Tigray will be crucial to prevent such tragic outcomes in the future. This will require a concerted effort from the international community, governments, and humanitarian organizations to ensure a steady supply of insulin, medical equipment, and essential resources, as well as the restoration of functional healthcare facilities.
Additionally, the study highlights the need for targeted interventions to address the issue of malnutrition among children with diabetes during conflicts and sieges. Ensuring access to appropriate food and nutrition will be essential for maintaining stable blood sugar levels and preventing further complications.
Lessons for the Global Community
The experiences of children with diabetes in Tigray serve as a sobering reminder of the devastating impact that war and siege can have on vulnerable populations. As the authors note, similar challenges in managing diabetes have been reported in other conflict zones, such as Yemen, Syria, and Iraq.
These findings underscore the urgent need for the global community to prioritize the healthcare needs of people with chronic conditions, especially children, during humanitarian crises. By investing in the resilience of healthcare systems and ensuring the uninterrupted supply of essential medical resources, we can work to prevent such devastating consequences in the future.
As the Tigray conflict and its aftermath continue to unfold, the lessons learned from this study will be crucial in guiding the rebuilding of the region’s diabetic care infrastructure and informing the response to similar crises around the world.
Author credit: This article is based on research by Atsede Gebrekidan, Hansa Haftu, Berhane Yohannes Hailu, Dawit Zenebe, Migbnesh Gebremedhin, Hiluf Ebuy Abraha, Abadi Luel, Hailay Abrha Gesesew, Elias S. Siraj.
For More Related Articles Click Here
