Abstract
BACKGROUND: People in war-affected areas are more likely to experience excess mortality with hunger. However, information on the causes of death associated with hunger is often nonexistent. The purpose of this study was to verify and investigate hunger and hunger-related deaths after the Pretoria deal in Tigray, northern Ethiopia. METHODS: A cross-sectional study was conducted in nine districts and 53 IDP sites, which were randomly selected. All households with deceased family members were included and screened for perceived causes of death between November 2, 2022, and August 30, 2023. Suspected starvation deaths were further verified by the WHO-adapted verbal autopsy questionnaire to establish cause-specific mortality. Using a standardized cause-of-death list, three physicians assigned the causes of death, and disagreements over-diagnoses were settled by consensus. The Food and Nutrition Technical Assistance guidelines were also used to quantify household hunger status. RESULTS: Verbal autopsies were conducted for 72.2% (1946/2694) of deaths. Of these deaths, 201 (7.5%) in under-five children and 1205 (44.7%) in females were recorded. Deaths increased from 8.6% in March to 16.4% in July. A total of 90.6% of deaths occurred at home. Starvation was the predominant cause of death across all ages (49.3%, n = 1329). About 94/155 (60.3%) in the IDP center and 1235/2539 (48.6%) in the community died due to starvation. Children under five had a higher risk of starvation-related deaths (OR = 1.7; 95% CI: 1.22-2.34). Females were also more likely to die by starvation than males. Large proportions of households (60.1%) had moderate or severe hunger. CONCLUSION: Starvation was the leading cause of death across all ages in the study group. This reflects an expedited humanitarian response from aid agencies to prevent more deaths. Interventions, including the return of the displaced communities to their original homes, are needed to rescue those facing moderate to severe hunger.