Fertility Level and Its Determinants Among Women of Reproductive Age Group Before and After the War in Tigray: A Community-Based Cross-Sectional Study

연구목적: 이 연구는 에티오피아 티그라이 지역 여성의 전쟁 전후 가임 수준 변화를 조사하고, 이에 영향을 미치는 주요 요인을 파악하기 위해 수행되었다. 연구의 중요성: 전쟁의 다차원적 인구학적 영향을 이해하는 것은 중요하다. 특히, 티그라이 지역의 정치적 불안정과 건강 시스템 붕괴가 출산율에 미친 영향을 규명하는 최초의 시도이다. 연구방법론: 2023년 11월부터 2024년 3월까지 티그라이 지역의 3개 행정 구역에서 커뮤니티 기반 단면 연구를 수행하였다. 총 935명의 여성 참가자를 대상으로 다단계 층화 표본추출법을 사용하여 데이터를 수집하였고, Stata 14 버전을 활용하여 기술 통계 및 포아송 회귀 분석을 실시하였다. 연구결과: 티그라이 지역의 평균 출산율은 4.6으로, 도시에서는 6.4, 농촌에서는 4.2로 나타났다. 여성의 나이와 첫 결혼 나이가 출산율에 유의미한 영향을 미쳤으며, 전쟁 후 출산율이 증가하였다. 결론 및 시사점: 연구 결과, 전쟁 후 출산율이 증가하였기에, 여성과 출생아의 건강을 보호하고 인구 역학적 안정성을 확보하는 것이 필요함을 알 수 있었다.

Purpose: Fertility rate, defined as the average number of children born during an individual's reproductive years, remains a global public health concern. Over the past 4 years, Ethiopia's political landscape, particularly in the Tigray, has changed, given the devastating war in the region. These hostilities severely damaged the region's health system. While war has multi-dimensional consequences on population dynamics, it remains unclear if fertility in the region was affected. Originality: This study aimed to understand the fertility status before or after the war in Tigray which is the first of its kind. Methodology: A community-based cross-sectional study was conducted between November 2023 and March 2024 in three administrative zones of the Tigray region, including 935 study participants. A stratified multistage sampling method was employed, and data were collected via structured interviews using the Open Data Kit and analyzed using Stata version 14. Poisson regression was used to examine fertility as the outcome variable. The ethical approval was obtained from the Institutional Review Board of Mekelle University’s College of Health Sciences. Result: The survey showed that the average fertility rate of the region was 4.6 (urban, 6.4; rural, 4.2). Fertility was higher among women aged 35-49 years, and in those age at first marriage ≥26. Conclusions and Implication: Post-war fertility showed an increase compared to the pre-war fertility. Women’s age and age at first marriage were significant fertility determinants. It is essential to implement socially appropriate, universally accessible services to reduce fertility and establish regulations to protect the health and well-being of reproductive-age group women by delaying marriage.