Frequency of Diabetic Ketoacidosis and Its Determinants Among Pediatric Diabetes Mellitus Patients in Northwest Ethiopia

BACKGROUND: Diabetic ketoacidosis (DKA) is one of the most common public health problems and is still a major child killer in sub-Saharan African countries, particularly Ethiopia. There are limited and inconclusive data in Amhara regional state; moreover, predictors for the incidence of DKA were not investigated before. Therefore, this study aimed to assess the frequency of DKA and its determinants among pediatric diabetes mellitus patients in public hospitals in northwest Ethiopia. METHODS: An institutional-based retrospective follow-up study was conducted from September 2015 to February 2018 at selected public hospitals in northwest Ethiopia. A simple random sampling method was used to select 389 study subjects. Statistical analysis was done by R-studio version 1.1.4. Akakia’s information criteria was used for model comparison and the negative binomial regression model was fitted to identify determinants for the frequency of DKA. An adjusted incidence rate ratio with 95% confidence interval was used to declare statistical significance. RESULTS: The average frequency of DKA was 1.01 per individual. The incidence rate of DKA was increased among diabetes mellitus patients with an infection (adjusted incidence rate ratio (AIRR) = 1.41, 95% CI = 1.05–2.14), heart diseases (AIRR = 4.1, 95% CI = 1.17–14.68), treatment discontinuation (AIRR = 2.91, 95% CI = 2.02–4.22), low level of sodium (AIRR = 1.88, 95% CI = 1.22–2.89) and low dose of treatment at baseline (AIRR = 0.96, 95% CI = 0.94–0.97). CONCLUSION: Having an infection, heart diseases, taking a low dose of treatment, a low sodium level, and treatment discontinuation were the factors that increase the frequency of DKA.