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

Hiluf Ebuy Abraha; Hale Teka; Awol Yemane Legesse; Mohamedawel Mohamedniguss Ebrahim; Mache Tsadik; Girmatsion Fisseha; Bereket Berhe; Brhane Ayele; Gebrehaweria Gebrekurstos; Tesfit Gebremeskel; Tsega Gebremariam; Martha Yemane Hadush; Tigist Hagos; Abraha Gebreegziabher; Kibrom Muez; Haile Tesfay; Hagos Godefay; Afework Mulugeta

doi:10.1371/journal.pone.0299650

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

PLoS One. 2024 Mar 13;19(3):e0299650. doi: 10.1371/journal.pone.0299650. eCollection 2024.

Authors

Hiluf Ebuy Abraha^{1

2}, Hale Teka¹, Awol Yemane Legesse¹, Mohamedawel Mohamedniguss Ebrahim¹, Mache Tsadik¹, Girmatsion Fisseha¹, Bereket Berhe¹, Brhane Ayele³, Gebrehaweria Gebrekurstos⁴, Tesfit Gebremeskel¹, Tsega Gebremariam¹, Martha Yemane Hadush¹, Tigist Hagos¹, Abraha Gebreegziabher¹, Kibrom Muez¹, Haile Tesfay⁴, Hagos Godefay⁴, Afework Mulugeta¹

Affiliations

¹ College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia.
² Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America.
³ Tigray Health Research Institute, Mekelle, Tigray, Ethiopia.
⁴ Tigray Regional Health Buruea, Mekelle, Tigray, Ethiopia.

Abstract

Background: 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.

Methods: 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.

Results: 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%).

Conclusions: 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.

Copyright: © 2024 Abraha et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

MeSH terms

Acquired Immunodeficiency Syndrome*
Cause of Death
Communicable Diseases*
Ethiopia / epidemiology
Female
Humans
Maternal Death*
Pregnancy
Surveys and Questionnaires

Grants and funding

This study was funded by United Nations International Children's Emergency Fund (UNICEF) and United Nations Fund for Population Activities (UNFPA). (Grant # DK A62/ZZT07). The fund was solely for data collection purposes. The funders had no role in the study design, data collection, analysis add decision to publish of the study. AYL, HT, and HEA jointly secured funding.