Importance: The war in Tigray, Ethiopia, has disrupted the health care system of the region. However, its association with health care services disruption for chronic diseases has not been well documented. Objective: To assess the association of the war with the utilization of health care services for patients with chronic diseases. Design, Setting, and Participants: Of 135 primary health care facilities, a registry-based cross-sectional study was conducted on 44 rural and semiurban facilities of Tigray. Data on health services utilization were extracted for patients with tuberculosis, HIV, diabetes, hypertension, and psychiatric disorders in the prewar period (September 1, to October 31, 2020) and during the first phase of the war period (November 4, 2020, to June 30, 2021). Main Outcomes and Measures: Records on the number of follow-up, laboratory tests, and patients undergoing treatment of the aforementioned chronic diseases were counted during the prewar and war periods. Results: Of 4645 records of patients with chronic diseases undergoing treatment during the prewar period, 998 records (21%) indicated having treatment during the war period. Compared with the prewar period, 59 of 180 individuals (33%, 95% CI, 26%-40%) had tuberculosis, 522 of 2211 (24%, 95% CI, 22%-26%) had HIV, 228 of 1195 (19%, 95% CI, 17%-21%) had hypertension, 123 of 632 (20%, 95% CI, 16%-22%) had psychiatric disorders, and 66 of 427 (15%, 95% CI, 12%-18%) had type 2 diabetes records, which revealed continued treatment during the war period. Of 174 records of patients with type 1 diabetes in the prewar period, at 2 to 3 months into the war, the numbers dropped to 10 with 94% decline compared with prewar observations. Conclusions and Relevance: This study found that the war in Tigray has resulted in critical health care service disruption and high loss to follow-up for patients with chronic disease, likely leading to increased morbidity and mortality. Local, national, and global policymakers must understand the extent and impact of the service disruption and urge their efforts toward restoration of those services. © 2023 American Medical Association. All rights reserved.

Abstract

anti human immunodeficiency virus agent, antiretroviral therapy, Article, chronic disease, controlled study, cross-sectional study, Ethiopia, follow up, health care facility, health care utilization, human, Human immunodeficiency virus infection, hypertension, insulin dependent diabetes mellitus, laboratory, laboratory test, major clinical study, mental disease, non insulin dependent diabetes mellitus, primary health care, rural area, tuberculosis, urban area, war, facilities and services utilization, patient attitude, Chronic Disease, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Facilities and Services Utilization, HIV Infections, Humans, Hypertension, Patient Acceptance of Health Care

Significance Statement:

War and Health Care Services Utilization for Chronic Diseases in Rural and Semiurban Areas of Tigray, Ethiopia

Gebrehiwet T.G., Abebe H.T., Woldemichael A., Gebresilassie K., Tsadik M., Asgedom A.A., Fisseha G., Berhane K., Gebreyesus A., Alemayoh Y., Gebresilassie M., Godefay H., Gesesew H.A., Tesfaye S., Siraj E.S., Aregawi M.W., Mulugeta A.

The war in Tigray, Ethiopia, has severely disrupted health care services, particularly for chronic diseases. This study found that during the war period, only 21% of patients with chronic diseases had continued treatment, a significant drop from the prewar period. This disruption is likely leading to increased morbidity and mortality, highlighting the urgent need for local, national, and global policymakers to understand the extent of the service disruption and work towards its restoration.

JAMA Network Open

2023

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