Prevalence and associated factors of diabetic ketoacidosis among children with diabetes mellitus at a tertiary hospital in Southern Ethiopia: a 10-year retrospective study

Diabetic ketoacidosis (DKA) is a potentially life-threatening acute complication of type 1 diabetes mellitus and remains a common cause of recurrent hospital admissions among children. Despite being an important contributor to pediatric morbidity and mortality, evidence regarding the prevalence and associated factors of DKA among children in Southern Ethiopia, particularly in the study area, is limited. Therefore, this study aimed to assess the prevalence and associated factors of DKA among children aged 6 months to 14 years with diabetes who attended follow-up care or were admitted to Wolaita Sodo University Comprehensive Specialized Hospital between November 15, 2015, and November 14, 2025. An institution-based retrospective cross-sectional study was conducted using medical records from November 15, 2015, to November 14, 2025. A census sampling technique was employed. All eligible children aged 6 months to 14 years with diabetes were included in the study. DKA was diagnosed using a modified protocol adapted from ISPAD and other international guidelines for resource-limited settings. A structured checklist was used to extract socio-demographic and clinical data. Binary logistic regression analysis was employed to identify factors associated with DKA. A p- value < 0.05 in final model was considered statistically significant. The overall prevalence of DKA was 42.0% (95% CI: 36.6%–47.5%). Among the 139 children who developed DKA, 38 (27.3%) had mild DKA, 88 (63.3%) had moderate DKA, and 13 (9.4%) had severe DKA. Children aged 10–14 years (AOR = 9.24; 95% CI: 4.04–21.11), those residing in rural areas (AOR = 2.38; 95% CI: 1.43–3.79), those with a previous history of DKA (AOR = 2.52; 95% CI: 1.21–5.27), and newly diagnosed patients with type 1 diabetes mellitus (AOR = 5.11; 95% CI: 2.65–9.84) were significantly associated with DKA. More than one-third of children with diabetes developed DKA. Age 10–14 years, rural residence, previous history of DKA, and newly diagnosed type 1 diabetes mellitus were significantly associated with DKA. Therefore, healthcare providers may give particular attention to adolescents, children from rural areas, those with a previous history of DKA, and those with newly diagnosed diabetes. Not applicable.