Gebregergs Gebremedhin Berhe, Berhe Gebretsadik, Gebrehiwot Kibrom Gebreslasie, Mulugeta Afework
Department of Epidemiology, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
Department of Internal Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
Infect Drug Resist. 2024 Jul 26;17:3241-3251. doi: 10.2147/IDR.S464787. eCollection 2024.
The Tigray region of Ethiopia, which has been affected by civil war from 2020 to 2022, is facing an increase in tuberculosis in the damaged health system. Our study employed mathematical modeling to predict the incidence of tuberculosis and its trends during the war and in the post-conflict setting of Tigray, Northern Ethiopia.
We predicted the incidence of tuberculosis from 2020 to 2025 in Tigray using the SEIRD model in the context of the recent war and compared it with its counterfactual trend in the absence of war. The counterfactual trend was forecasted using an autoregressive integrated moving average (ARIMA) model for stationary time-series data. We performed rolling origin cross-validation for ARIMA and sensitivity analysis for the SEIRD model. The initial tuberculosis data and model parameters were obtained from the Institute for Health Metrics and Evaluation and the literature, respectively.
Between 2000 and 2017, the incidence of tuberculosis in Tigray decreased at an annual rate of 3.0%. Shortly before the war, the incidence of tuberculosis in the region was 178 per 100,000 people. In a counterfactual scenario where there was no war, the incidence was projected to decrease to 144.3 in 2022 and 126.3 in 2025. However, owing to the war and siege, the SEIRD-projected incidence of tuberculosis would have increased to 965.5 (95% CI: 958.5-972.7) in 2022 and 372.4 (95% CI: 367.7-376.6) in 2025. Over 800 cases of tuberculosis per 100,000 people were attributed to the war in 2022. In the postwar period, the incidence is projected to decrease by 30% by 2023.
The Tigray War reversed a two-decade decline in tuberculosis cases, causing a five-fold increase compared to the no-war scenario. Urgent interventions are needed to support tuberculosis prevention, testing, and treatment, particularly in key and vulnerable populations.
埃塞俄比亚的提格雷地区在2020年至2022年期间受到内战影响，受损的卫生系统面临结核病发病率上升的问题。我们的研究采用数学建模来预测埃塞俄比亚北部提格雷地区战争期间及冲突后环境下的结核病发病率及其趋势。
我们在近期战争背景下使用SEIRD模型预测了提格雷地区2020年至2025年的结核病发病率，并将其与没有战争情况下的反事实趋势进行比较。反事实趋势使用自回归积分移动平均（ARIMA）模型对平稳时间序列数据进行预测。我们对ARIMA进行了滚动原点交叉验证，并对SEIRD模型进行了敏感性分析。初始结核病数据和模型参数分别从健康指标与评估研究所和文献中获取。
2000年至2017年期间，提格雷地区的结核病发病率以每年3.0%的速度下降。战前不久，该地区的结核病发病率为每10万人178例。在没有战争的反事实情景中，预计发病率在2022年将降至144.3例，在2025年将降至126.3例。然而，由于战争和围困，SEIRD模型预测的结核病发病率在2022年将增至965.5例（95%置信区间：958.5 - 972.7），在2025年将增至372.4例（95%置信区间：367.7 - 376.6）。2022年每10万人中超过800例结核病病例归因于战争。在战后时期，预计到2023年发病率将下降30%。
提格雷战争扭转了结核病病例长达二十年的下降趋势，与无战争情景相比增加了五倍。需要采取紧急干预措施来支持结核病的预防、检测和治疗，特别是在重点和弱势群体中。
