AbstractThe armed conflict in Tigray, which spanned from November 2020 to November 2022, along with the accompanying siege, led to the near-total collapse of Tigray’s healthcare system. Type 1 Diabetes Mellitus, the most common chronic condition in children, requires significant lifestyle adjustments, including daily insulin injections, regular glucose monitoring, and dietary modifications; all of which are severely impacted by war and siege.

2020年11月至2022年11月，提格雷发生武装冲突，伴随着围困，导致提格雷的医疗体系几乎完全崩溃。1型糖尿病是儿童最常见的慢性病，需要进行重大的生活方式调整，包括每日胰岛素注射，定期血糖监测和饮食调整；所有这些都受到战争和围困的严重影响。

This study compared Type 1 diabetes care for children at the Ayder Comprehensive Specialized Hospital, Tigray, during the conflict and siege period with that of the pre-war period. We conducted a retrospective cross-sectional survey, analyzing data from September 2019 to August 2020 (pre-war period) and comparing it with data from September 2021 to August 2022 (war and siege period).

这项研究比较了艾德综合专科医院Tigray在冲突和围困期间与战前时期对儿童的1型糖尿病护理。我们进行了一项回顾性横断面调查，分析了2019年9月至2020年8月（战前时期）的数据，并将其与2021年9月至2022年8月（战争和围攻时期）的数据进行了比较。

Descriptive statistics, including frequencies and percentages, were employed, and Pearson’s or Spearman’s correlation analyses were used to evaluate correlations where appropriate. We identified 143 pediatric patients admitted (56 during the pre-war period and 87 during the war and siege period), with a mean age of 109 months in both periods.

采用描述性统计，包括频率和百分比，并在适当的情况下使用Pearson或Spearman的相关分析来评估相关性。我们确定了143名入院的儿科患者（战前56名，战争和围攻期间87名），两个时期的平均年龄均为109个月。

During the war and siege, a higher proportion of diabetes admissions were due to diabetic ketoacidosis (DKA) (90%) compared to the pre-war period (75%). In the pre-war period, the most common trigger for DKA was infections (35%), while in the war and siege period, it shifted to malnutrition (47%), infections (46%), lack of access to healthcare facilities (31%), and running out of medicines (24%).

在战争和围攻期间，与战前（75%）相比，糖尿病酮症酸中毒（DKA）（90%）导致糖尿病入院的比例更高。在战前时期，DKA最常见的触发因素是感染（35%），而在战争和围攻期间，它转变为营养不良（47%），感染（46%），缺乏医疗保健设施（31%）和药品耗尽（24%）。

Complications such as death, renal failure, cerebral edema, and shock were more prevalent during the war and siege periods. The case fatality rate was significantly higher during the war and siege (9%) compared to the pre.

。战争和围攻期间的病死率（9%）明显高于战前。

IntroductionThe war which started in November 2020 between the Tigray regional government in northern Ethiopia on one side and the Ethiopian federal government and its allies, on the other side led to the near total collapse of the Tigray region’s health care system once touted as one of the best performing in the country1,2,3.

引言2020年11月，埃塞俄比亚北部蒂格雷地区政府与埃塞俄比亚联邦政府及其盟友之间爆发战争，导致蒂格雷地区医疗保健系统几乎完全崩溃，该系统曾被吹捧为该国表现最佳的医疗保健系统之一1,2,3。

In addition, a complete siege was also imposed on Tigray by the Ethiopian federal government and its allies until the formal signing of the cessation of hostilities by both sides in November 20224. Tigray’s health facilities were looted, damaged, and vandalized resulting in only 3.6% of all health facilities being fully functional during the war and siege5,6,7.According to a WHO report, only 3% of Tigray’s health facilities remained fully functional due to the two-year blockade and destruction.

。蒂格雷的卫生设施遭到抢劫、破坏和破坏，导致在战争和围困期间，只有3.6%的卫生设施能够完全发挥作用5,6,7。根据世卫组织的报告，由于两年的封锁和破坏，只有3%的蒂格雷卫生设施仍然能够完全发挥作用。

The conflict and siege led to the suspension of immunization services, an increase in infectious disease outbreaks, decreased treatment for communicable and non-communicable diseases (NCDs) such as HIV and diabetes mellitus, and worsening food insecurity and malnutrition, which in turn increased complications and mortality8.

冲突和围困导致免疫服务中断，传染病疫情增加，艾滋病毒和糖尿病等传染性和非传染性疾病（NCDs）的治疗减少，粮食不安全和营养不良恶化，进而增加并发症和死亡率8。

Coupled with the siege, patients with chronic conditions were among those who suffered the most. A study by Abraha et al. conducted in 46 health facilities in Tigray reported a more than 50% reduction in hypertension follow-up visits, resulting in a rise in acute and chronic complications and mortality9.

再加上围攻，慢性病患者是受影响最大的患者之一。Abraha等人在Tigray的46家卫生机构进行的一项研究报告称，高血压随访减少了50%以上，导致急性和慢性并发症和死亡率上升9。

Another recent study by Gebrehiwet et al. highlighted critical disruptions in healthcare services and high rates of loss to follow-up among NCD patients, potentially leading to increased morbidity and mortality10.Diabetic care was one of the most compromised services due to the prolonged interruption of insulin supplies, leading to acu.

Gebrehiwet等人最近的另一项研究强调，非传染性疾病患者的医疗服务严重中断，随访率高，可能导致发病率和死亡率增加10。由于胰岛素供应的长期中断，糖尿病护理是最受损害的服务之一，导致acu。

“As one of two doctors responsible for the management of people with diabetes at Ayder Hospital, I would like to highlight the plight of people with diabetes, particularly with type 1, who are now at serious risk of death due to lack of insulin.”

“作为艾德医院负责糖尿病患者管理的两位医生之一，我想强调糖尿病患者的困境，特别是1型糖尿病患者，他们现在由于缺乏胰岛素而面临严重的死亡风险。”

However, such personal appeals should be supported by data documenting the impact of the war and siege on patients with diabetes compared to the pre-war & siege period in Tigray. This study aims to do just that by focusing on children with diabetes at Ayder Comprehensive Specialized Hospital, Mekelle as a case study.

然而，这种个人呼吁应该得到数据的支持，这些数据记录了战争和围攻对糖尿病患者的影响，与战前和围攻期间相比。这项研究旨在通过将梅克尔艾德综合专科医院的糖尿病儿童作为案例研究来做到这一点。

The findings from the study will contribute to better understanding of the impact of war on diabetes care and assist in rebuilding of the diabetic care infrastructure in Tigray.MethodsStudy design, population, and settingWe conducted a retrospective cross-sectional survey comparing data from two distinct periods: September 1, 2019, to August 30, 2020 (pre-war period) and September 1, 2021, to August 30, 2022 (war and siege period) at Ayder Comprehensive Specialized Hospital (ACSH).

这项研究的结果将有助于更好地了解战争对糖尿病护理的影响，并有助于重建蒂格雷的糖尿病护理基础设施。方法研究设计，人口和环境我们进行了一项回顾性横断面调查，比较了两个不同时期的数据：2019年9月1日至2020年8月30日（战前时期）和2021年9月1日至2022年8月30日（战争和围攻时期）艾德综合专科医院（ACSH）。

Data extraction was done in November 2022. ACSH, Tigray’s flagship healthcare institution located in Mekelle, was established in 2008. Before the onset of the war, ACSH was serving as the tertiary referral centre to more than 8 million populations in the catchment areas of Tigray, and parts of neighbouring regional states in Ethiopia such as Afar, and Amhara.

数据提取于2022年11月完成。ACSH是Tigray位于Mekelle的旗舰医疗保健机构，成立于2008年。在战争爆发之前，ACSH是提格雷集水区以及埃塞俄比亚阿法尔和阿姆哈拉等部分邻国800多万人口的三级转诊中心。

During the war and siege, the hospital was partially functioning with very limited resources and serving parts of Tigray only. Prior to the war, child health care was one of the major departments serving both inpatient and outpatient departments with a total of 162 beds, and six wards and was staffed up with more than 20 specialists and 5 subspecialists.

在战争和围攻期间，该医院部分运作，资源非常有限，仅为提格雷的部分地区提供服务。战前，儿童保健是住院部和门诊部的主要部门之一，共有162张病床，6个病房，配备了20多名专家和5名专科医生。

Although Ayder Comprehensive Specialized Hospital was a teaching hospital for both under and post-graduates before the war, but during the war and siege it was serving as a teaching institution for limited postgraduate programs only.Sampling and eligibility criteriaWe includ.

虽然艾德综合专科医院在战前是一家面向未成年人和研究生的教学医院，但在战争和围攻期间，它只是一家面向有限研究生课程的教学机构。我们包括抽样和资格标准。

1.

1.

Mild DKA: - The patient has no signs of dehydration, oriented, alert but fatigued.

轻度DKA：-患者没有脱水迹象，定向，警觉但疲劳。

2.

2.

Moderate DKA: - The patient has some dehydration, Kussmaul respirations; oriented but sleepy; arousable.

中度DKA：-患者有一些脱水，Kussmaul呼吸；定向但困倦；唤醒。

3.

3.

Severe DKA: - The patient has severe dehydration to shock, Kussmaul or depressed respirations; sleepy to depressed sensorium to coma.

严重DKA：-患者因休克，Kussmaul或呼吸抑制而严重脱水；昏昏欲睡到感觉迟钝再到昏迷。

Hypokalemia was defined as serum potassium level of less than 3.5 mmol/L and farther categorized as mild when the serum potassium level is 3 to 3.4 mmol/L, moderate when the serum potassium level is 2.5 to 3 mmol/L, and severe when the serum potassium level is less than 2.5 mmol/L.19,20.Data extraction was performed using a checklist developed in ODK software.

低钾血症定义为血清钾水平低于3.5 mmol/L，当血清钾水平为3至3.4 mmol/L时进一步分类为轻度，当血清钾水平为2.5至3 mmol/L时为中度，当血清钾水平低于2.5 mmol/L.19,20时为严重。使用ODK软件中开发的检查表进行数据提取。

Two pediatric residents were trained to collect the data from medical charts, and the principal investigator reviewed the completeness of the data daily.Data analysisThe extracted data were exported to Excel and then imported into SPSS for analysis. Descriptive statistics were used to assess frequencies, percentages, ratios, and measures of dispersion.

。数据分析将提取的数据导出到Excel，然后导入SPSS进行分析。描述性统计用于评估频率，百分比，比率和离散度。

Categorical data were compared using Pearson’s Chi-square test or Fisher’s exact test. Correlations were assessed using Pearson’s or Spearman’s correlation analyses, as appropriate. A p-value of < 0.05 was considered statistically significant.ResultsSociodemographic characteristicsA total of 143 children with diabetes were admitted to Ayder Comprehensive Specialized Hospital (ACSH) across two-time intervals: pre-war and during the war and siege.

使用Pearson卡方检验或Fisher精确检验比较分类数据。酌情使用Pearson或Spearman的相关分析评估相关性。p值<0.05被认为具有统计学意义。结果社会人口学特征共有143名糖尿病儿童在两个时间间隔内被送入艾德综合专科医院（ACSH）：战前和战争期间以及围攻期间。

All patient records from these admissions were included in the analysis. Of these 143 patients, 56 were admitted during the pre-war period, and 87 during the war and siege period. The mean age of the patients was approximately 109 months in both periods. Detailed demographic characteristics of the study participants are presented (Table 1).Clinical presentation and complicationsTable 1 also presents the detailed clinical and nutritional characteristics of children admitted for diabetes.

这些入院的所有患者记录都包括在分析中。在这143名患者中，56名在战前期间入院，87名在战争和围攻期间入院。两个时期患者的平均年龄约为109个月。给出了研究参与者的详细人口统计学特征（表1）。临床表现和并发症稳定1还介绍了因糖尿病入院的儿童的详细临床和营养特征。

The proportion of newly diagnosed diabetes patients was similar across both periods, with 47% during the pre-war period and 45% during the w.

两个时期新诊断的糖尿病患者比例相似，战前为47%，w时期为45%。

Data availability

数据可用性

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

。

AbbreviationsACSH:

缩写ACSH：

Ayder comprehensive specialized hospital

艾德综合专科医院

DM:

DM公司：

diabetes mellitus

糖尿病

DKA:

DKA：

diabetic ketoacidosis

糖尿病酮症酸中毒

MAM:

妈妈：

moderate acute malnutrition

中度急性营养不良

SAM:

山姆：

severe acute malnutrition

严重急性营养不良

T1DM:

T1DM：

type one diabetes mellitus

1型糖尿病

RBS:

苏格兰皇家银行：

Random blood sugar

随机血糖

IRB:

IRB：

Institutional Review Board

机构审查委员会

MU:

MU公司：

Mekelle University

梅克尔大学

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Download referencesAcknowledgementsThe authors would like to acknowledge the data collectors who extracted the data.Author informationAuthor notesHailay Abrha Gesesew and Elias S. Siraj contributed equally to this work.Authors and AffiliationsDepartment of Pediatrics College of Health Science, Mekelle University, Tigray, EthiopiaAtsede Gebrekidan, Hansa Haftu & Abadi LuelDepartment of Pharmacy, College of Health Science, Mekelle University, Tigray, EthiopiaBerhane Yohannes HailuDepartment of Public Health, College of Health Science, Mekelle University, Tigray, EthiopiaDawit ZenebeDepartment of Internal Medicine, College of Health Science, Mekelle University, Tigray, EthiopiaMigbnesh GebremedhinCollege of Health Science, Ayder Comprehensive Specialized Hospital, Quality Management Office, Tigray, EthiopiaHiluf Ebuy AbrahaResearch Centre for Public Health, Equity, and Human Flourishing, Torrens University Australia, Adelaide, SA, 5000, AustraliaHailay Abrha GesesewTigray Health Research Institute, Mekelle, Tigray, EthiopiaHailay Abrha GesesewDivision of Endocrine and Metabolic Disorders, Eastern Virginia Medical School, Norfolk, VA, 23510, USAElias S.

下载参考文献致谢作者要感谢提取数据的数据收集器。作者信息作者notesHailay Abrha Gesesew和Elias S.Siraj对这项工作做出了同样的贡献。作者和所属机构梅凯勒大学健康科学儿科系，蒂格雷，埃塞俄比亚塞德·格布雷基丹，汉莎·哈夫图和阿巴迪·卢尔药学系，梅凯勒大学健康科学学院，蒂格雷，埃塞俄比亚约哈纳·海卢德公共卫生系，梅凯勒大学健康科学学院，蒂格雷，埃塞俄比亚泽尼比布雷梅德欣健康科学学院，艾德综合专科医院，质量管理办公室，蒂格雷，埃塞俄比亚希鲁夫Ebuy AbrahaResearch公共卫生，公平和人类繁荣中心，澳大利亚托伦斯大学，阿德莱德，SA，5000，澳大利亚海莱Abrha Geseswtigray健康研究所，Mekelle，Tigray，埃塞俄比亚海莱Abrha GesesewDivision内分泌和代谢紊乱，东弗吉尼亚医学院，弗吉尼亚州诺福克，23510，USAElias S。

SirajAuthorsAtsede GebrekidanView author publicationsYou can also search for this author in.

SirajAuthorsAtsede GebrekidanView作者出版物您也可以在中搜索此作者。

PubMed Google ScholarHansa HaftuView author publicationsYou can also search for this author in

PubMed Google ScholarHansa HaftuView作者出版物您也可以在

PubMed Google ScholarBerhane Yohannes HailuView author publicationsYou can also search for this author in

PubMed Google ScholarDawit ZenebeView author publicationsYou can also search for this author in

PubMed Google ScholarDawit ZenebeView作者出版物您也可以在

PubMed Google ScholarMigbnesh GebremedhinView author publicationsYou can also search for this author in

PubMed Google ScholarMigbnesh GebremedhinView作者出版物您也可以在

PubMed Google ScholarHiluf Ebuy AbrahaView author publicationsYou can also search for this author in

PubMed Google ScholarHiluf Ebuy AbrahaView作者出版物您也可以在

PubMed Google ScholarAbadi LuelView author publicationsYou can also search for this author in

PubMed Google ScholarAbadi LuelView作者出版物您也可以在

PubMed Google ScholarHailay Abrha GesesewView author publicationsYou can also search for this author in

PubMed Google ScholarHailay Abrha GesesewView作者出版物您也可以在

PubMed Google ScholarElias S. SirajView author publicationsYou can also search for this author in

PubMed Google ScholarElias S.SirajView作者出版物您也可以在

PubMed Google ScholarContributionsAG and HH contributed to the conception and drafting of writing the manuscript. BY, HAG, ESS, DZ, MG, HEA and AL participated in the analysis, critical review, and edition of the manuscript. HAG and ESS contributed equally. All authors approved the final version of the manuscript.Corresponding authorCorrespondence to.

PubMed谷歌学术贡献SAG和HH为撰写手稿的构思和起草做出了贡献。BY，HAG，ESS，DZ，MG，HEA和AL参与了手稿的分析，批判性审查和编辑。HAG和ESS的贡献相同。所有作者都批准了稿件的最终版本。对应作者对应。

Atsede Gebrekidan.Ethics declarations

Atsede Gebrekidan。伦理声明

Competing interests

相互竞争的利益

The authors declare no competing interests.

作者声明没有利益冲突。

Ethical consideration

伦理考量

Ethical clearance was obtained from the Institutional Review Board (IRB) of the College of Health Sciences of Mekelle University with IRB number MU-IRB2015/2022. Permission from Ayder Comprehensive Specialized Hospital clinical director offices and a support letter from the chief clinical director were obtained before the commencement of the study.

道德审查是从梅克尔大学健康科学学院的机构审查委员会（IRB）获得的，IRB编号为MU-IRB2015/2022。在研究开始之前，获得了艾德综合专科医院临床主任办公室的许可和首席临床主任的支持信。

Due to the retrospective nature of the study, Institutional Review Board (IRB) of the College of Health Sciences of Mekelle University waived the need of obtaining informed consent.”.

由于该研究具有回顾性，梅克尔大学健康科学学院的机构审查委员会（IRB）放弃了获得知情同意的需要。”。

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You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

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Reprints and permissionsAbout this articleCite this articleGebrekidan, A., Haftu, H., Hailu, B.Y. et al. The effect of war and siege on children with diabetes admitted to ayder comprehensive specialized hospital in mekelle, tigray, ethiopia: a cross-sectional study.

转载和许可本文引用本文Gebrekidan，A.，Haftu，H.，Hailu，B.Y。等人。战争和围攻对埃塞俄比亚提格雷梅克尔艾德综合专科医院收治的糖尿病儿童的影响：一项横断面研究。

Sci Rep 14, 25007 (2024). https://doi.org/10.1038/s41598-024-76516-5Download citationReceived: 02 May 2024Accepted: 14 October 2024Published: 23 October 2024DOI: https://doi.org/10.1038/s41598-024-76516-5Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

Sci Rep 142507（2024）。https://doi.org/10.1038/s41598-024-76516-5Download引文接收日期：2024年5月2日接受日期：2024年10月14日发布日期：2024年10月23日OI：https://doi.org/10.1038/s41598-024-76516-5Share本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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KeywordsDiabetic KetoacidosisChildrenConflictWarSiegeTigray

关键词糖尿病酮症酸中毒儿童冲突心血管造影