Health-related quality of life inequalities among patients with T2D in armed-conflict affected populations in Tigray, Northern Ethiopia

Abstract

War causes tragic loss of life, destruction, and long-lasting quality-of-life distress in armed-conflict-affected populations. After conflict emerged between the federal government of Ethiopia and the Tigray regional government, the destruction of healthcare facilities and the blockage of humanitarian services were evident, resulting in the interruption of treatment services. The study aimed to assess the associations between war-related crises and health-related quality of life (HRQoL) among type 2 diabetic (T2D) patients. A multicenter observational study was conducted at selected public hospitals ( n = 5) in Tigray, Northern Ethiopia. A questionnaire comprising an EQ-5D-5 L-based HRQoL measurement tool, patient socio-demographic characteristics, war exposure, and clinical conditions was administered. Data related to the war period were collected retrospectively, whereas postwar data were gathered on a prospective basis. Binary and multivariable logistic regressions were performed to identify predictors associated with low HRQoL. Eighty hundred forty-six war survivors participated in this study. The largest subgroup of participants was in the age range of 55–64 years, and the majority of participants were highly exposed to war ( n = 428, 50.6%), with a significant number affected by psychological trauma. Half of the participants ( n = 423, 50.0%) were displaced from their homes. The mean EQ-5D-5 L index score and EQ VAS score were 0.45 and 58.05 during the war and 0.79 and 73.41 after the war, respectively. Long treatment duration and physical damage caused by the war were among the predictors associated with a lower HRQoL during and after the war. Anxiety/depression and pain/discomfort were among the dimensions that significantly affected patients’ HRQoL. A significant difference was found in T2D patients’ HRQoL during and after the war. Most factors, including physical damage caused by the war, negatively affected the HRQoL of patients with T2D. A tailored approach is needed for appropriate diabetic care during and after war.