Additional file 1 of Child health services and armed conflict in Tigray, North Ethiopia: a community-based study

Supplementary Material

Characteristics of deceased women of reproductive age in Tigray, Northern Ethiopia, 2020–2022 (n = 832).

Characteristics of deceased women of reproductive age in Tigray, Northern Ethiopia, 2020–2022 (n = 832).</p

S1 Dataset -

BackgroundIn resource-limited countries with weak healthcare systems, women of reproductive age are particularly vulnerable during times of conflict. In Tigray, Ethiopia, where a war broke out on 04 November 2020, there is a lack of information on causes of death (CoD) among women of reproductive age. This study aims to determine the underlying CoD among women of reproductive age during the armed conflict in Tigray.MethodsThis community-based survey was carried out in six Tigray zones, excluding the western zone for security reasons. We used a multistage stratified cluster sampling method to select the smallest administrative unit known as Tabiya. Data were collected using a standardized 2022 WHO Verbal Autopsy (VA) tool. The collected data were analyzed using the InterVA model using R analytic software. The study reported both group-based and cause-specific mortality fractions.ResultsA total of 189,087 households were screened and 832 deaths were identified among women of reproductive age. The Global Burden of Disease classification showed that infectious and maternal disorders were the leading CoD, accounting for 42.9% of all deaths. External causes contributed to 26.4% of fatalities, where assault accounted for 13.2% of the deaths. Maternal deaths made up 30.0% of the overall mortality rate. HIV/AIDS was the primary CoD, responsible for 13.2% of all deaths and 54.0% of infectious causes. Other significant causes included obstetric hemorrhage (11.7%) and other and unspecified cardiac disease (6.6%).ConclusionsThe high proportion of infectious diseases related CoD, including HIV/AIDS, as well as the occurrence of uncommon external CoD among women, such as assault, and a high proportion of maternal deaths are likely the result of the impact of war in the region. This highlights the urgent need for targeted interventions to address these issues and prioritize sexual and reproductive health as well as maternal health in Tigray.</div

Cause-specific mortality fraction (CSMF) among women of reproductive age death in Tigray, Northern Ethiopia, 2020–2022 (n = 832).

A) Overall CSMF, B) CSMF of communicable and maternal diseases group, C) CSMF of non-communicable diseases group, D) CSMF of external causes or injuries. Note that the survey weighting we used may not directly impact the assignment of causes to individual deaths. This applies specifically when using the verbal autopsy tool.</p

Group-based category for each district, among women of reproductive age death in Tigray, Northern Ethiopia, 2020–2022 (n = 832).

Group I: Communicable, maternal, and nutritional disorders, Group II: Non-communicable diseases, and Group III: External causes (Injuries). This classification is presented based on the proportion of primary CoD not CSMF. The percentage in this figure is not a survey-weighted percent. (DOCX)</p

The three broad causes of death categories and subcategories among women of reproductive age death in Tigray, Northern Ethiopia, 2020–2022 (n = 832).

The three broad causes of death categories and subcategories among women of reproductive age death in Tigray, Northern Ethiopia, 2020–2022 (n = 832).</p

Sampling frame for the study.

BackgroundIn resource-limited countries with weak healthcare systems, women of reproductive age are particularly vulnerable during times of conflict. In Tigray, Ethiopia, where a war broke out on 04 November 2020, there is a lack of information on causes of death (CoD) among women of reproductive age. This study aims to determine the underlying CoD among women of reproductive age during the armed conflict in Tigray.MethodsThis community-based survey was carried out in six Tigray zones, excluding the western zone for security reasons. We used a multistage stratified cluster sampling method to select the smallest administrative unit known as Tabiya. Data were collected using a standardized 2022 WHO Verbal Autopsy (VA) tool. The collected data were analyzed using the InterVA model using R analytic software. The study reported both group-based and cause-specific mortality fractions.ResultsA total of 189,087 households were screened and 832 deaths were identified among women of reproductive age. The Global Burden of Disease classification showed that infectious and maternal disorders were the leading CoD, accounting for 42.9% of all deaths. External causes contributed to 26.4% of fatalities, where assault accounted for 13.2% of the deaths. Maternal deaths made up 30.0% of the overall mortality rate. HIV/AIDS was the primary CoD, responsible for 13.2% of all deaths and 54.0% of infectious causes. Other significant causes included obstetric hemorrhage (11.7%) and other and unspecified cardiac disease (6.6%).ConclusionsThe high proportion of infectious diseases related CoD, including HIV/AIDS, as well as the occurrence of uncommon external CoD among women, such as assault, and a high proportion of maternal deaths are likely the result of the impact of war in the region. This highlights the urgent need for targeted interventions to address these issues and prioritize sexual and reproductive health as well as maternal health in Tigray.</div

Group-based Cause-Specific Mortality Fraction (CSMF) versus age group among women of reproductive age death in Tigray, Northern Ethiopia, 2020–2022 (n = 832).

Group I: Communicable, maternal, and nutritional disorders, Group II: Non-communicable diseases, and Group III: External causes (Injuries). Note that the survey weighting we used may not directly impact the assignment of causes to individual deaths. This applies specifically when using the verbal autopsy tool.</p

List of all causes of death among women of reproductive age death in Tigray, Northern Ethiopia, 2020–2022 (n = 832).

List of all causes of death among women of reproductive age death in Tigray, Northern Ethiopia, 2020–2022 (n = 832).</p