Maternal mortality during war time in Tigray, Ethiopia: A community-based study.

This study seeks to examine the impact of war on maternal mortality following an exacerbation in the dynamics of inequality in maternal health caused by the continuing conflict. Community-based cross-sectional study. Tigray region of Northern Ethiopia, between November 2020 and May 2022. This study surveyed a total of 189 087 households from six of the seven zones of Tigray in 121 tabiyas from 31 districts selected. A multistage cluster sampling technique was used to select the districts and tabiyas. The study was conducted in two phases. In the first phase, reproductive-age deaths that occurred during the study period were screened. In the second phase, verbal autopsies were conducted at the screened households. Maternal mortality ratio level and cause-specific mortality. The results of the study showed that the maternal mortality ratio was 840 (95% CI 739-914) per 100 000 live births. Haemorrhage, 107 (42.8%), pregnancy-induced hypertension, 21 (8.4%), and accidents, 14 (5.6%), were the main causes of mortality. Additionally, 203 (81.2%) of the mothers died outside of a health facility. This study has shown a higher maternal mortality ratio following the dynamics of the Tigray war, as compared with the pre-war level of 186/100 000. Furthermore, potentially many of the pregnancy-related deaths could have been prevented with access to preventive and emergency services. Given the destruction and looting of many facilities, the restoration and improvement of the Tigray health system must take precedence.

Legesse AY ，Teka Tseghay H ，Abraha HE ，Fisseha G ，Ebrahim MM ，Tsadik M ，Berhe B ，Gebrekurstos G ，Ayele B ，Gebremeskel T ，Gebremariam T ，Hadush MY ，Hagos T ，Gebreziabiher A ，Muez K ，Mulugeta A ，Tesfay H ，Godefay H ... -  《-》

Under-five mortality during the war in Tigray: A community-based study.

Abreha BB ，Fisseha G ，Tsadik M ，Legesse AY ，Teka H ，Abraha HE ，Hadush MY ，Gebrekurstos G ，Ayele B ，Hailu AG ，Tsegay H ，Ebrahim MM ，Godefay H ，Gebremariam T ，Hagos T ，Muoze K ，Mulugeta A ，Gebremeskel T ... -  《Conflict and Health》

Causes of death among women of reproductive age during the war in Tigray, Ethiopia.

In 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. This 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. A 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%). The 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.

Abraha HE ，Teka H ，Legesse AY ，Ebrahim MM ，Tsadik M ，Fisseha G ，Berhe B ，Ayele B ，Gebrekurstos G ，Gebremeskel T ，Gebremariam T ，Hadush MY ，Hagos T ，Gebreegziabher A ，Muez K ，Tesfay H ，Godefay H ，Mulugeta A ... -  《PLoS One》

Neonatal mortality during the war in Tigray: a cross-sectional community-based study.

Neonatal mortality is among the key national and international indicators of health services. The global Sustainable Development Goal target for neonatal mortality is fewer than 12 deaths per 1000 livebirths, by 2030. Neonatal mortality estimates in the 2019 Ethiopian Demographic Health Survey found 25·7 deaths per 1000 livebirths. Subnational surveys specific to Tigray, Ethiopia, reported a neonatal mortality lifetime prevalence of 7·13 deaths. Another government report from the Tigray region estimated a neonatal mortality rate of ten deaths per 1000 livebirths in 2020. Despite the numerous interventions in Ethiopia's Tigray region to achieve the Sustainable Development Goals, the war has disrupted most health services, but the effect on neonatal mortality is unknown. Thus, this study aimed to investigate the magnitude and causes of neonatal mortality during the war in Tigray. A cross-sectional community-based study was conducted in Tigray to evaluate neonatal mortality that occurred from Nov 4, 2020, to May 30, 2022. Among the 31 districts, 121 tabias were selected using computer-generated random sampling, and 189 087 households were visited. We adopted a validated WHO 2022 verbal autopsy tool, and data were collected using an interviewer-administrated Open Data Kit. In the absence of the mother, other respondents to the verbal autopsy interview were household members aged 18 years and older who provided care during the final illness that led to death. 29 761 livebirths were recorded during the screening of 189 087 households. Verbal autopsy was administered for 1158 households with neonatal deaths. 317 neonates were stillborn, and 841 neonatal deaths were recorded with the WHO 2022 verbal autopsy tool from Nov 4, 2020, to May 30, 2022, in 31 districts. The neonatal mortality rate was 28·2 deaths per 1000 livebirths. 476 (57%) of the 841 neonatal deaths occurred at home and 296 (35%) in health facilities. A high rate of neonatal deaths was reported in rural districts (80% [673 of 841]) compared with urban districts (20% [168 of 841]), and 663 (79%) deaths occurred during the early neonatal period, in the first week of life (0-6 days). The leading causes of neonatal death were asphyxia (35% [291 of 834]), prematurity (30% [247 of 834]), and infection (12% [104 of 834]). Asphyxia (37% [246 of 663]) and infection (28% [50 of 178]) were the leading causes of death for early and late neonatal period deaths, respectively. Neonatal mortality in Tigray is high due to preventable causes. An urgent response is needed to prevent the high number of neonatal deaths associated with the depleted health resources and services resulting from the war, and to achieve the Sustainable Development Goal on neonatal mortality. UNICEF and United Nations Fund for Population Activities. For the Tigrigna translation of the abstract see Supplementary Materials section.

Tsadik M ，Legesse AY ，Teka H ，Abraha HE ，Fisseha G ，Ebrahim MM ，Berhe B ，Hadush MY ，Gebrekurstos G ，Ayele B ，Tsegay H ，Gebremeskel T ，Gebremariam T ，Hagos T ，Gebreegziabher A ，Muoze K ，Mulugeta A ，Gebregziabher M ，Godefay H ... -  《Lancet Global Health》

Understanding maternal mortality from top-down and bottom-up perspectives: Case of Tigray Region, Ethiopia.

Godefay H ，Byass P ，Kinsman J ，Mulugeta A ... -  《-》