War-associated increase in pediatric respiratory infections in Western Ukraine: a regional study from Chernivtsi Oblast (2022–2025)

War-associated increase in pediatric respiratory infections in Western Ukraine: a regional study from Chernivtsi Oblast (2022–2025) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article War-associated increase in pediatric respiratory infections in Western Ukraine: a regional study from Chernivtsi Oblast (2022–2025) Olena Koloskova, Ksenia Rudan, Nataliya Bohutska, Khrystyna Buryniuk-Hloviak, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9186042/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Acute respiratory infections remain a major cause of pediatric morbidity and hospitalization worldwide. Armed conflicts disrupt healthcare systems and living conditions, increasing the vulnerability of children to infectious diseases. Since 2022, the full-scale war in Ukraine has led to large-scale population displacement and significant pressure on regional healthcare systems. However, quantitative evidence on the impact of prolonged war on pediatric respiratory disease patterns remains limited. This is particularly important for regions hosting internally displaced populations. Here we show that the burden of pediatric respiratory infections in Chernivtsi Oblast increased substantially during 2022–2025, with a 53% rise in hospitalizations and a marked increase in disease severity. The proportion of pneumonia increased over time, accompanied by a more than twofold rise in severe and complicated cases, and strong associations with emergency care utilization. These findings indicate that pneumonia is a key driver of increased healthcare burden during wartime and that prolonged conflict contributes to more severe disease in children. Our results highlight the need for adaptive healthcare strategies and improved surveillance systems in conflict-affected regions. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research epidemiological analysis impact of war on child health pneumonia pediatric respiratory infections respiratory hospitalization internally displaced children Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 INTRODUCTION Acute respiratory infections are among the leading causes of morbidity and hospitalization in children worldwide. Their burden is particularly high in conditions associated with adverse social, environmental, and healthcare-related factors. Armed conflicts are known to substantially affect population health, especially in vulnerable groups such as children. The full-scale war in Ukraine has led to large-scale internal displacement, overcrowding in temporary settlements, chronic psycho-emotional stress, disruption of access to primary healthcare, decreased vaccination coverage, and increased antibiotic use [1]. These factors may contribute to changes in the incidence, structure, and severity of pediatric respiratory infections [2, 3]. Chernivtsi Oblast, located near the European Union border, has become a major transit and settlement region for internally displaced populations since the beginning of the war. The region has experienced a significant influx of children from active conflict areas, including Donetsk, Kharkiv, Luhansk, Zaporizhzhia, Kherson, and Mykolaiv regions. These population movements have created additional pressure on the healthcare system and may have influenced epidemiological patterns of respiratory diseases [4, 5, 6]. Despite increasing attention to the health consequences of war, there is limited systematic evidence on long-term changes in the epidemiology of pediatric respiratory infections in regions hosting displaced populations [7, 8, 9, 10]. In particular, data on hospitalization rates, disease structure, and mortality remain insufficient. The aim of this study was to conduct a retrospective epidemiological analysis of temporal changes in hospitalization, prevalence, mortality, and the structure of respiratory diseases among children in Chernivtsi Oblast during the period of the full-scale war (2022–2025). RESULTS Pediatric Respiratory Hospitalizations During the War During the first year of the full-scale war (2022) in Chernivtsi Oblast, a total of 29,739 pediatric hospitalizations were recorded, of which 27.4% were due to respiratory diseases. Across the 2022–2025 period, the total number of bed-days for children hospitalized with respiratory infections reached 60,141. Specifically, 1,040 children with community-acquired pneumonia spent 10,278 bed-days in hospital, representing 15.6% of total bed occupancy. Infants under one year accounted for 940 cases (11.5%) of respiratory hospitalizations, primarily due to acute bronchiolitis and community-acquired pneumonia. Over four years, pediatric hospitalizations due to respiratory diseases increased by 4,324 episodes, representing a 53.0% rise compared to the first year of the war (Fig. 1 ). Trends in Community-Acquired Pneumonia Severe and complicated forms of community-acquired pneumonia increased by 131.3% over the study period. The proportion of hospitalized pneumonia cases among emergency department visits grew from 76.6% in 2022 to 87.8% in 2025. The share of community-acquired pneumonia within respiratory hospitalizations also increased from 12.7% in 2022 to 19.3% in 2025, reflecting both rising prevalence and severity of disease (Fig. 2 ). Hospital Burden and Internally Displaced Children The majority of children hospitalized for respiratory infections presented with severe or complicated conditions requiring inpatient monitoring. Annual hospital visits for pediatric respiratory infections increased by 65.9% compared to pre-war levels, and hospitalizations rose by 47.1%. The average number of emergency department visits among internally displaced children (IDPs) was 1,018.25 per year, with hospitalization rates ranging from 76.6% in 2022 to 87.8% in 2025 (Fig. 3 ). Correlation Between Hospitalization Variables Correlation analysis using Pearson coefficients revealed strong positive associations between total pediatric respiratory hospitalizations (RespHosp) and pneumonia cases (r = 0.93), as well as with emergency department visits (EDvisits, r = 0.82) and hospitalizations following these visits (EDhosp, r = 0.87). Pneumonia cases alone were highly correlated with ED visits (r = 0.90) and ED hospitalizations (r = 0.94), underscoring the significant contribution of pneumonia to hospital workload. Hospitalizations of IDPs (IDPhosp) showed moderate positive correlation with total IDP visits (IDPvisits, r = 0.62) and moderate negative correlations with ED visits and ED hospitalizations (r from − 0.46 to -0.57), reflecting a gradual decline in the proportion of IDPs among total visits and hospitalizations over time. Overall, these analyses suggest that general trends in healthcare burden during the 2022–2025 war period were primarily driven by overall respiratory hospitalizations and pneumonia, whereas IDP-related variables exerted more localized effects (Fig. 4 ). Given the limited number of annual observations, the correlation analysis was considered exploratory and intended to identify potential relationships between epidemiological indicators rather than to establish causal associations. Regional Distribution of Hospitalized Internally Displaced Children Children from Donetsk, Kharkiv, and Mykolaiv regions accounted for the largest numbers of hospitalizations, while fewer cases originated from Luhansk, Zaporizhzhia, and Kherson regions. The overall number of visits to the emergency department of Chernivtsi Regional Children’s Clinical Hospital by internally displaced children was distributed across regions as follows ( https://datawrapper.dwcdn.net/PBu18/3/ ): Donetsk (746 children), Kharkiv (541), Kyiv (861), Mykolaiv (206), Kherson (275), Zaporizhzhia (253), and Luhansk (119) regions (Fig. 5 .). These numbers reflect pronounced regional variations in the impact of the conflict and internal displacement on pediatric healthcare utilization. These regional differences highlight the differential impact of displacement on pediatric hospital care within Chernivtsi Oblast. Pediatric Respiratory Mortality Over the four-year study period, 49 children aged 0–18 years died, with infants under one year accounting for 75.5% of deaths. The mortality rate due to respiratory diseases in pediatric patients was 14.3%. DISCUSSION This study provides a comprehensive assessment of hospitalizations of children with respiratory diseases in the Chernivtsi Oblast during the first four years of the full-scale war (2022–2025). The results indicate a significant increase both in the number and severity of hospitalizations. In 2022, the share of hospitalizations due to respiratory diseases among all pediatric admissions was 27.4%, rising by 53.0% to 32.4% in 2025 [11]. Notably, the number of severe and complicated cases of community-acquired pneumonia increased by 131.3% over the four-year period [11], with the average share of pneumonia among respiratory hospitalizations rising from 12.7% in 2022 to 19.3% in 2025 [12, 13]. Our data confirm that internally displaced children (IDCs) significantly impacted hospital workload. The average annual number of IDC visits to the emergency department of OKNP “Chernivtsi Regional Children’s Clinical Hospital” was 1,018.25, with the share of hospitalizations ranging from 76.6% in 2022 to 87.8% in 2025 [14, 15]. Most hospitalizations involved children from Donetsk, Kharkiv, Mykolaiv, Kherson, Zaporizhzhia, and Luhansk regions, highlighting regional differences in the effects of the war and migration on healthcare [16]. Correlation analysis revealed a strong positive relationship between the total number of pediatric hospitalizations for respiratory infections and cases of pneumonia (r = 0.93), as well as emergency department visits (EDvisits r = 0.82; EDhosp r = 0.87). IDC hospitalization indicators showed moderate positive correlations among themselves (r = 0.62) and moderate negative correlations with other indicators (r from − 0.46 to -0.57), indicating a gradual decrease in the proportion of IDCs among overall hospitalizations in later years of the war [17]. Over the four-year war period in the Chernivtsi Oblast, 49 children aged 0–18 years died, with 75.5% of deaths occurring in infants under one year of age. Mortality from respiratory diseases among all deceased children was 14.3%, consistent with UNHCR estimates for refugee children (14.0–20.0%) [18]. Comparison with international data confirms the consistency of the findings: among 47,851 refugee children in Romania, interstitial pneumonia was observed in 23.0% of cases, and severe acute respiratory distress in 19.0%, reflecting the significant impact of war on child health in border regions [19]. Experience from Syria also indicates a high burden of respiratory pathology among internally displaced children – 29.0% of respiratory disease cases, with chronic respiratory conditions in 14.0% of patients [20]. This study demonstrates that the war not only increased the incidence and severity of pediatric respiratory infections but also substantially increased the burden on the healthcare system, especially in inpatient settings. However, prolonged residence of IDCs in the rear regions was associated with stabilization of the frequency of visits and more rational hospitalization, suggesting adaptive processes and partial improvement of children’s mental health [21, 22]. Thus, these findings expand the understanding of pediatric respiratory infection epidemiology during wartime, emphasize the importance of considering IDC status and regional factors in healthcare planning, and provide a basis for developing prevention strategies and optimizing treatment of children in crisis conditions [23]. Limitations A limitation of the present study is the relatively small number of time points used for correlation analysis, which may influence the stability of correlation estimates. Therefore, these findings should be interpreted cautiously and confirmed in studies with longer observation periods. METHODS Study Design and Population The study was conducted as a retrospective observational regional analysis using data from the Chernivtsi Oblast (Ukraine) during the period of the full-scale Russian-Ukrainian war (2022–2025). The study population included both local children and internally displaced persons (IDPs) from eastern regions affected by the ongoing conflict. According to these data, as of 1 March 2026, a total of 19,104 children aged 0 to 18 years were officially registered as and granted the status of “internally displaced persons” in the Chernivtsi Oblast. Hospitalization data were obtained from regional health records, and cases were classified according to the primary respiratory diagnosis, including pneumonia, bronchiolitis, and bronchial asthma. Children were stratified by age groups, with particular attention to those under one year of age. Data Collection and Processing Data on hospital admissions, age, and region of origin were collected in Microsoft Excel (Windows 11) for initial organization and cleaning. Descriptive statistics and inferential analyses were performed using Statistica 13.5 (TIBCO Software Inc., Palo Alto, CA, USA) and RStudio version 2023.06.1 + 524 (R version 4.3.1; https://www.r-project.org/ ) for statistical calculations, correlation analyses, and visualization of trends over time. Statistical Analysis Continuous variables were summarized using means and standard deviations or medians and interquartile ranges, as appropriate. Categorical variables were expressed as counts and percentages. Comparative analyses between groups were conducted using chi-square tests or Fisher’s exact tests for categorical variables and t-tests or Mann–Whitney U tests for continuous variables. Correlation analyses were performed using Pearson or Spearman coefficients, depending on data distribution. Adjusted odds ratios (aOR) were calculated to assess the effect of displacement status on hospitalization risk, controlling for age and primary diagnosis. Statistical significance was set at p < 0.05. Data Visualization Figures illustrating trends in hospitalizations, age distribution, and regional origin were generated in RStudio. A geographical map showing the distribution of hospitalized IDPs from different regions was created using Datawrapper ( https://app.datawrapper.de/ ). All figures were formatted for clarity according to Scientific Reports standards. Ethical Considerations This study was conducted as a retrospective observational regional analysis of pediatric hospitalizations in the Chernivtsi Oblast (Ukraine) during the full-scale Russian-Ukrainian war (2022–2025). The study protocol was reviewed and approved by the Ethics Committee of the Bukovinian State Medical University (protocol #4, 18.12.2025). All procedures were performed in accordance with relevant institutional and national guidelines, as well as the principles of the Declaration of Helsinki, ensuring the protection of patient confidentiality. Informed consent Due to the retrospective nature of the study and the use of anonymized, aggregated data derived from hospital records and publicly available statistics, the requirement for obtaining informed consent was waived by the Ethics Committee of the Bukovinian State Medical University. Declarations AUTHOR CONTRIBUTIONS O.K.designed the study and drafted the manuscript. K.R. prepared all figures. N.B. collected and verified statistical data. K.B-H. performed data analysis. O.V. and K.V. assisted with data collection, literature review, and manuscript editing. All authors reviewed and approved the final manuscript. Data availability statement The datasets generated and analyzed during the current study are not publicly available due to patient confidentiality but are available from the corresponding author on reasonable request. Additional Information (including a Competing Interests Statement) Correspondence and requests for materials should be addressed to K.R. [email protected] Competing Interests: The authors declare no competing interests. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Ethical Approval: The study was approved by the Ethics Committee of Bukovinian State Medical University (protocol #4 18.12.2025) and was conducted in accordance with relevant guidelines and regulations. References Armitage, R. War in Ukraine: The impacts on child health. Br. J. Gen. Pract. 72, 272–273 (2022). Pluta, M. et al. Ukrainian war refugee children with particularly severe viral infections: A case series report. Pediatr. Infect. Dis. J. 43, e30–e36 (2024). https://doi.org/10.1097/INF.0000000000004162 Lavie, M., Maymon, D., Diamant, N. et al. Respiratory syncytial virus bronchiolitis among refugees and asylum seekers from war-torn countries. Pediatr. Pulmonol. 56, 2888–2892 (2021). https://doi.org/10.1002/ppul.25562 Page, B., Irving, D., Amalberti, R. & Vincent, C. Health services under pressure: A scoping review and development of a taxonomy of adaptive strategies. BMJ Qual. Saf. 33, 738–747 (2024). Yoon, J. G. et al. Clinical characteristics and disease burden of respiratory syncytial virus infection among hospitalized adults. Sci. Rep. 10, 12106 (2020). https://doi.org/10.1038/s41598-020-69017-8 Chen, Z. et al. Contribution of respiratory syncytial virus to burden of lower respiratory tract infections: A global analysis of 204 countries and territories, 1990–2021. Trop. Med. Infect. Dis. 10, 223 (2025). https://doi.org/10.3390/tropicalmed10080223 de Alencar Rodrigues, J. A. R. et al. Ukraine: War, bullets, and bombs—Millions of children and adolescents are in danger. Child Abuse Negl. 128, 105622 (2022). Awuah, W. A. et al. Vulnerable in silence: Paediatric health in the Ukrainian crisis. Ann. Med. Surg. 82, 104369 (2022). Murray, C. J. et al. Armed conflict as a public health problem. BMJ 324, 346–349 (2002). Cantor, D. et al. Understanding the health needs of internally displaced persons: A scoping review. J. Migr. Health 4, 100071 (2021). https://doi.org/10.1016/j.jmh.2021.100071 Becker, G. et al. Acute appendicitis in children during war conflict: Results from a multicenter study. J. Clin. Med. 14, 4615 (2025). https://doi.org/10.3390/jcm14134615 Terkawi, A. S. et al. Child and adolescent health in northwestern Syria: Findings from healthy-Syria 2017 study. Avicenna J. Med. 9, 94–106 (2019). Dida, G. O. et al. Factors predisposing women and children to indoor air pollution in rural villages, Western Kenya. Arch. Public Health 80, 46 (2022). https://doi.org/10.1186/s13690-022-00791-9 Alhaffar, M. H. D. B. A. & Janos, S. Public health consequences after ten years of the Syrian crisis: A literature review. Glob. Health 17, 111 (2021). https://doi.org/10.1186/s12992-021-00762-9 van Berlaer, G. et al. Diagnoses, infections and injuries in Northern Syrian children during the civil war: A cross-sectional study. PLoS One 12, e0182770 (2017). https://doi.org/10.1371/journal.pone.0182770 Omer, A. T. et al. Child health in war crisis: Barriers to healthcare utilization among internally displaced Sudanese caregivers 2024–2025. BMC Public Health 25, 3376 (2025). https://doi.org/10.1186/s12889-025-24627-7 M. S. & Vaithilingan, S. Childhood pneumonia in low- and middle-income countries: A systematic review. Cureus 16, e57636 (2024). https://doi.org/10.7759/cureus.57636 Hershey, C. L. et al. Incidence and risk factors for malaria, pneumonia and diarrhea in children under 5 in UNHCR refugee camps: A retrospective study. Confl. Health 5, 24 (2011). https://doi.org/10.1186/1752-1505-5-24 Tătăranu, E. et al. Emergency care for refugee patients at Suceava Hospital, Romania: Challenges and insights from the first year of the Russian-Ukrainian conflict. Healthcare 13, 138 (2025). https://doi.org/10.3390/healthcare13020138 Basha, L. et al. Impact of the Syrian conflict and forced displacement on respiratory health. BMJ Open Respir. Res. 10, e001636 (2023). https://doi.org/10.1136/bmjresp-2023-001636 Khosravi, M. Mental health needs in war-affected refugee children: Barriers, gaps, and strategies for effective care. Child Adolesc. Psychiatry Ment. Health 18, 146 (2024). https://doi.org/10.1186/s13034-024-00840-x Metersky, K. et al. Psycho-social stressors experienced by young war refugees in developed countries: A scoping review. Can. J. Nurs. Res. 56, 350–362 (2024). https://doi.org/10.1177/08445621241263459 Lewtak, K. et al. What do hospital admission data reveal about the health needs of Ukrainian child refugees in Poland? Eur. J. Public Health 35 (Suppl. 4), ckaf161.350 (2025). https://doi.org/10.1093/eurpub/ckaf161.350 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 11 May, 2026 Reviewers agreed at journal 04 May, 2026 Reviewers invited by journal 22 Apr, 2026 Editor assigned by journal 20 Apr, 2026 Editor invited by journal 14 Apr, 2026 Submission checks completed at journal 09 Apr, 2026 First submitted to journal 09 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9186042","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":628975952,"identity":"213bc2c4-3daf-492b-90c5-c9cbd8a66ed9","order_by":0,"name":"Olena Koloskova","email":"","orcid":"","institution":"Bukovinian State Medical University","correspondingAuthor":false,"prefix":"","firstName":"Olena","middleName":"","lastName":"Koloskova","suffix":""},{"id":628975953,"identity":"e4266334-254f-460e-b489-e877aa80ede4","order_by":1,"name":"Ksenia Rudan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYJCCA1CS8QGQ4uEjRQuzAUgLGyl2sUmAaIJaDI73Hjzwg+FeYt/xs8cqv+bYybAxMD98dAOPFsmecwkHexiKE2eeyUu7LbstGegwNmPjHDxa+CVyDA7wMCQkbjiQY3ZbchszUAsPmzQ+LWzybwwO/gFpOf/GrFhyWz1hLfwSPAaHwbbcyDFj/LjtMGEtkj05BodlDBKMZ954YyzNuO04DxszAb8YHD9j/PFNRYJs3/kcw48/t1Xb87M3P3yMTwtUI4Ri5gGTBJUjAcYfpKgeBaNgFIyCEQMAm1RIGx/6fEgAAAAASUVORK5CYII=","orcid":"","institution":"Bukovinian State Medical University","correspondingAuthor":true,"prefix":"","firstName":"Ksenia","middleName":"","lastName":"Rudan","suffix":""},{"id":628975954,"identity":"ec3f973a-4abe-471c-8a2f-0fb7310eaf08","order_by":2,"name":"Nataliya Bohutska","email":"","orcid":"","institution":"Bukovinian State Medical University","correspondingAuthor":false,"prefix":"","firstName":"Nataliya","middleName":"","lastName":"Bohutska","suffix":""},{"id":628975955,"identity":"19cb9bab-c99b-42d1-b364-f3fe9772c464","order_by":3,"name":"Khrystyna Buryniuk-Hloviak","email":"","orcid":"","institution":"Bukovinian State Medical University","correspondingAuthor":false,"prefix":"","firstName":"Khrystyna","middleName":"","lastName":"Buryniuk-Hloviak","suffix":""},{"id":628975956,"identity":"3a409247-b857-4878-9341-49dc7ee74fd4","order_by":4,"name":"Olena Vlasova","email":"","orcid":"","institution":"Bukovinian State Medical University","correspondingAuthor":false,"prefix":"","firstName":"Olena","middleName":"","lastName":"Vlasova","suffix":""},{"id":628975957,"identity":"65005536-c9e9-47dc-bdca-01b3c0a13d67","order_by":5,"name":"Kateryna Vlasova","email":"","orcid":"","institution":"Bukovinian State Medical University","correspondingAuthor":false,"prefix":"","firstName":"Kateryna","middleName":"","lastName":"Vlasova","suffix":""}],"badges":[],"createdAt":"2026-03-21 13:23:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9186042/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9186042/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108401679,"identity":"b5c37a57-79e9-46f4-8600-002f9ffe97cd","added_by":"auto","created_at":"2026-05-04 09:06:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":111763,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTemporal trends in pediatric respiratory hospitalizations (2022–2025).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRespiratory hospitalizations increased from 8,163 cases in 2022 to 12,487 cases in 2025.\u003c/p\u003e","description":"","filename":"Fig.1.png","url":"https://assets-eu.researchsquare.com/files/rs-9186042/v1/6ec9f425f157fc4a634fce07.png"},{"id":108401680,"identity":"a3876d6f-1fdb-4328-8545-57071f842ded","added_by":"auto","created_at":"2026-05-04 09:06:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":107039,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePneumonia among respiratory hospitalizations.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnnual proportion of pneumonia cases among pediatric respiratory hospitalizations.\u003c/p\u003e\n\u003cp\u003eThe proportion of pneumonia increased steadily from 12.7% in 2022 to 19.3% in 2025, suggesting a growing contribution of severe and complicated respiratory infections to overall hospitalizations.\u003c/p\u003e","description":"","filename":"Fig.2.png","url":"https://assets-eu.researchsquare.com/files/rs-9186042/v1/e4190d5174e1a4b37754e82f.png"},{"id":108401683,"identity":"84e759f3-6b82-4b22-aecb-51c045cc1051","added_by":"auto","created_at":"2026-05-04 09:06:40","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":134715,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEmergency visits and hospitalizations among internally displaced children (IDPs).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnnual number of emergency department visits and hospitalizations among internally displaced children.\u003c/p\u003e\n\u003cp\u003eIDP-related emergency visits decreased from 1,197 cases in 2022 to 852 cases in 2025, while hospitalizations decreased from 917 to 748 cases. These findings indicate a reduction in the relative contribution of IDPs to pediatric healthcare utilization over time.\u003c/p\u003e","description":"","filename":"Fig.3.png","url":"https://assets-eu.researchsquare.com/files/rs-9186042/v1/dcc1d1e3294a51df6c0113fd.png"},{"id":108492917,"identity":"b8813e5f-2284-4bed-80f4-3a501528df8b","added_by":"auto","created_at":"2026-05-05 09:58:58","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":155663,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCorrelation of epidemiological indicators for pediatric respiratory infections and IDP visits.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrelation matrix showing pairwise associations between respiratory hospitalizations (RespHosp), pneumonia cases (Pneumonia), emergency department visits (EDvisits), hospitalizations through the emergency department (EDhosp), IDP-related visits (IDPvisits), IDP-related hospitalizations (IDPhosp), and hospitalization rate (HospRate).\u003c/p\u003e\n\u003cp\u003eStrong positive correlations were observed between respiratory hospitalizations and pneumonia (r = 0.93), as well as between hospitalizations and emergency department indicators. Pneumonia was also strongly correlated with emergency visits and hospitalizations. In contrast, IDP-related indicators demonstrated weaker or negative correlations with overall healthcare utilization metrics. The hospitalization rate showed relatively weak correlations with other variables.\u003c/p\u003e","description":"","filename":"Fig.4.png","url":"https://assets-eu.researchsquare.com/files/rs-9186042/v1/a87e1255e586e47f60193a4f.png"},{"id":108401682,"identity":"af00b3f8-a87f-4283-a520-4f4ff5bed60b","added_by":"auto","created_at":"2026-05-04 09:06:40","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":539174,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGeographic distribution of internally displaced pediatric patients hospitalized in Chernivtsi by region of origin (2022–2025).\u003c/strong\u003e\u003cbr\u003e\n\u0026nbsp;The map (https://datawrapper.dwcdn.net/PBu18/3/) illustrates the number of hospitalized children originating from different regions of Ukraine during the study period. Regions with no registered cases are indicated by zero values.\u003c/p\u003e","description":"","filename":"Fig.5.png","url":"https://assets-eu.researchsquare.com/files/rs-9186042/v1/c99a4b1f55c9a00b8ade2733.png"},{"id":108495401,"identity":"089eaad4-2ba5-48b1-b511-36bc870e0c62","added_by":"auto","created_at":"2026-05-05 10:09:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1159605,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9186042/v1/4468b852-ccd9-437e-b9d3-dd7ba7d1f3d8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"War-associated increase in pediatric respiratory infections in Western Ukraine: a regional study from Chernivtsi Oblast (2022–2025)","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAcute respiratory infections are among the leading causes of morbidity and hospitalization in children worldwide. Their burden is particularly high in conditions associated with adverse social, environmental, and healthcare-related factors.\u003c/p\u003e \u003cp\u003eArmed conflicts are known to substantially affect population health, especially in vulnerable groups such as children. The full-scale war in Ukraine has led to large-scale internal displacement, overcrowding in temporary settlements, chronic psycho-emotional stress, disruption of access to primary healthcare, decreased vaccination coverage, and increased antibiotic use [1]. These factors may contribute to changes in the incidence, structure, and severity of pediatric respiratory infections [2, 3].\u003c/p\u003e \u003cp\u003eChernivtsi Oblast, located near the European Union border, has become a major transit and settlement region for internally displaced populations since the beginning of the war. The region has experienced a significant influx of children from active conflict areas, including Donetsk, Kharkiv, Luhansk, Zaporizhzhia, Kherson, and Mykolaiv regions. These population movements have created additional pressure on the healthcare system and may have influenced epidemiological patterns of respiratory diseases [4, 5, 6].\u003c/p\u003e \u003cp\u003eDespite increasing attention to the health consequences of war, there is limited systematic evidence on long-term changes in the epidemiology of pediatric respiratory infections in regions hosting displaced populations [7, 8, 9, 10]. In particular, data on hospitalization rates, disease structure, and mortality remain insufficient.\u003c/p\u003e \u003cp\u003eThe aim of this study was to conduct a retrospective epidemiological analysis of temporal changes in hospitalization, prevalence, mortality, and the structure of respiratory diseases among children in Chernivtsi Oblast during the period of the full-scale war (2022\u0026ndash;2025).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePediatric Respiratory Hospitalizations During the War\u003c/h2\u003e \u003cp\u003eDuring the first year of the full-scale war (2022) in Chernivtsi Oblast, a total of 29,739 pediatric hospitalizations were recorded, of which 27.4% were due to respiratory diseases. Across the 2022\u0026ndash;2025 period, the total number of bed-days for children hospitalized with respiratory infections reached 60,141. Specifically, 1,040 children with community-acquired pneumonia spent 10,278 bed-days in hospital, representing 15.6% of total bed occupancy. Infants under one year accounted for 940 cases (11.5%) of respiratory hospitalizations, primarily due to acute bronchiolitis and community-acquired pneumonia. Over four years, pediatric hospitalizations due to respiratory diseases increased by 4,324 episodes, representing a 53.0% rise compared to the first year of the war (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTrends in Community-Acquired Pneumonia\u003c/h3\u003e\n\u003cp\u003eSevere and complicated forms of community-acquired pneumonia increased by 131.3% over the study period. The proportion of hospitalized pneumonia cases among emergency department visits grew from 76.6% in 2022 to 87.8% in 2025. The share of community-acquired pneumonia within respiratory hospitalizations also increased from 12.7% in 2022 to 19.3% in 2025, reflecting both rising prevalence and severity of disease (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eHospital Burden and Internally Displaced Children\u003c/h3\u003e\n\u003cp\u003eThe majority of children hospitalized for respiratory infections presented with severe or complicated conditions requiring inpatient monitoring. Annual hospital visits for pediatric respiratory infections increased by 65.9% compared to pre-war levels, and hospitalizations rose by 47.1%. The average number of emergency department visits among internally displaced children (IDPs) was 1,018.25 per year, with hospitalization rates ranging from 76.6% in 2022 to 87.8% in 2025 (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eCorrelation Between Hospitalization Variables\u003c/h3\u003e\n\u003cp\u003eCorrelation analysis using Pearson coefficients revealed strong positive associations between total pediatric respiratory hospitalizations (RespHosp) and pneumonia cases (r\u0026thinsp;=\u0026thinsp;0.93), as well as with emergency department visits (EDvisits, r\u0026thinsp;=\u0026thinsp;0.82) and hospitalizations following these visits (EDhosp, r\u0026thinsp;=\u0026thinsp;0.87). Pneumonia cases alone were highly correlated with ED visits (r\u0026thinsp;=\u0026thinsp;0.90) and ED hospitalizations (r\u0026thinsp;=\u0026thinsp;0.94), underscoring the significant contribution of pneumonia to hospital workload. Hospitalizations of IDPs (IDPhosp) showed moderate positive correlation with total IDP visits (IDPvisits, r\u0026thinsp;=\u0026thinsp;0.62) and moderate negative correlations with ED visits and ED hospitalizations (r from \u0026minus;\u0026thinsp;0.46 to -0.57), reflecting a gradual decline in the proportion of IDPs among total visits and hospitalizations over time. Overall, these analyses suggest that general trends in healthcare burden during the 2022\u0026ndash;2025 war period were primarily driven by overall respiratory hospitalizations and pneumonia, whereas IDP-related variables exerted more localized effects (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e Given the limited number of annual observations, the correlation analysis was considered exploratory and intended to identify potential relationships between epidemiological indicators rather than to establish causal associations.\u003c/p\u003e\n\u003ch3\u003eRegional Distribution of Hospitalized Internally Displaced Children\u003c/h3\u003e\n\u003cp\u003eChildren from Donetsk, Kharkiv, and Mykolaiv regions accounted for the largest numbers of hospitalizations, while fewer cases originated from Luhansk, Zaporizhzhia, and Kherson regions. The overall number of visits to the emergency department of Chernivtsi Regional Children\u0026rsquo;s Clinical Hospital by internally displaced children was distributed across regions as follows (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://datawrapper.dwcdn.net/PBu18/3/\u003c/span\u003e\u003cspan address=\"https://datawrapper.dwcdn.net/PBu18/3/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e): Donetsk (746 children), Kharkiv (541), Kyiv (861), Mykolaiv (206), Kherson (275), Zaporizhzhia (253), and Luhansk (119) regions (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.). These numbers reflect pronounced regional variations in the impact of the conflict and internal displacement on pediatric healthcare utilization. These regional differences highlight the differential impact of displacement on pediatric hospital care within Chernivtsi Oblast.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePediatric Respiratory Mortality\u003c/h2\u003e \u003cp\u003eOver the four-year study period, 49 children aged 0\u0026ndash;18 years died, with infants under one year accounting for 75.5% of deaths. The mortality rate due to respiratory diseases in pediatric patients was 14.3%.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study provides a comprehensive assessment of hospitalizations of children with respiratory diseases in the Chernivtsi Oblast during the first four years of the full-scale war (2022\u0026ndash;2025). The results indicate a significant increase both in the number and severity of hospitalizations. In 2022, the share of hospitalizations due to respiratory diseases among all pediatric admissions was 27.4%, rising by 53.0% to 32.4% in 2025 [11]. Notably, the number of severe and complicated cases of community-acquired pneumonia increased by 131.3% over the four-year period [11], with the average share of pneumonia among respiratory hospitalizations rising from 12.7% in 2022 to 19.3% in 2025 [12, 13].\u003c/p\u003e \u003cp\u003eOur data confirm that internally displaced children (IDCs) significantly impacted hospital workload. The average annual number of IDC visits to the emergency department of OKNP \u0026ldquo;Chernivtsi Regional Children\u0026rsquo;s Clinical Hospital\u0026rdquo; was 1,018.25, with the share of hospitalizations ranging from 76.6% in 2022 to 87.8% in 2025 [14, 15]. Most hospitalizations involved children from Donetsk, Kharkiv, Mykolaiv, Kherson, Zaporizhzhia, and Luhansk regions, highlighting regional differences in the effects of the war and migration on healthcare [16].\u003c/p\u003e \u003cp\u003eCorrelation analysis revealed a strong positive relationship between the total number of pediatric hospitalizations for respiratory infections and cases of pneumonia (r\u0026thinsp;=\u0026thinsp;0.93), as well as emergency department visits (EDvisits r\u0026thinsp;=\u0026thinsp;0.82; EDhosp r\u0026thinsp;=\u0026thinsp;0.87). IDC hospitalization indicators showed moderate positive correlations among themselves (r\u0026thinsp;=\u0026thinsp;0.62) and moderate negative correlations with other indicators (r from \u0026minus;\u0026thinsp;0.46 to -0.57), indicating a gradual decrease in the proportion of IDCs among overall hospitalizations in later years of the war [17].\u003c/p\u003e \u003cp\u003eOver the four-year war period in the Chernivtsi Oblast, 49 children aged 0\u0026ndash;18 years died, with 75.5% of deaths occurring in infants under one year of age. Mortality from respiratory diseases among all deceased children was 14.3%, consistent with UNHCR estimates for refugee children (14.0\u0026ndash;20.0%) [18].\u003c/p\u003e \u003cp\u003eComparison with international data confirms the consistency of the findings: among 47,851 refugee children in Romania, interstitial pneumonia was observed in 23.0% of cases, and severe acute respiratory distress in 19.0%, reflecting the significant impact of war on child health in border regions [19]. Experience from Syria also indicates a high burden of respiratory pathology among internally displaced children \u0026ndash; 29.0% of respiratory disease cases, with chronic respiratory conditions in 14.0% of patients [20].\u003c/p\u003e \u003cp\u003eThis study demonstrates that the war not only increased the incidence and severity of pediatric respiratory infections but also substantially increased the burden on the healthcare system, especially in inpatient settings. However, prolonged residence of IDCs in the rear regions was associated with stabilization of the frequency of visits and more rational hospitalization, suggesting adaptive processes and partial improvement of children\u0026rsquo;s mental health [21, 22].\u003c/p\u003e \u003cp\u003eThus, these findings expand the understanding of pediatric respiratory infection epidemiology during wartime, emphasize the importance of considering IDC status and regional factors in healthcare planning, and provide a basis for developing prevention strategies and optimizing treatment of children in crisis conditions [23].\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eA limitation of the present study is the relatively small number of time points used for correlation analysis, which may influence the stability of correlation estimates. Therefore, these findings should be interpreted cautiously and confirmed in studies with longer observation periods.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e "},{"header":"METHODS","content":"\u003ch2\u003eStudy Design and Population\u003c/h2\u003e\u003cp\u003eThe study was conducted as a retrospective observational regional analysis using data from the Chernivtsi Oblast (Ukraine) during the period of the full-scale Russian-Ukrainian war (2022–2025). The study population included both local children and internally displaced persons (IDPs) from eastern regions affected by the ongoing conflict. According to these data, as of 1 March 2026, a total of 19,104 children aged 0 to 18 years were officially registered as and granted the status of “internally displaced persons” in the Chernivtsi Oblast. Hospitalization data were obtained from regional health records, and cases were classified according to the primary respiratory diagnosis, including pneumonia, bronchiolitis, and bronchial asthma. Children were stratified by age groups, with particular attention to those under one year of age.\u003c/p\u003e\u003ch2\u003eData Collection and Processing\u003c/h2\u003e\u003cp\u003eData on hospital admissions, age, and region of origin were collected in Microsoft Excel (Windows 11) for initial organization and cleaning. Descriptive statistics and inferential analyses were performed using Statistica 13.5 (TIBCO Software Inc., Palo Alto, CA, USA) and RStudio version 2023.06.1 + 524 (R version 4.3.1; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.r-project.org/\u003c/span\u003e\u003cspan class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e ) for statistical calculations, correlation analyses, and visualization of trends over time.\u003c/p\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eContinuous variables were summarized using means and standard deviations or medians and interquartile ranges, as appropriate. Categorical variables were expressed as counts and percentages. Comparative analyses between groups were conducted using chi-square tests or Fisher’s exact tests for categorical variables and t-tests or Mann–Whitney U tests for continuous variables. Correlation analyses were performed using Pearson or Spearman coefficients, depending on data distribution. Adjusted odds ratios (aOR) were calculated to assess the effect of displacement status on hospitalization risk, controlling for age and primary diagnosis. Statistical significance was set at p \u0026lt; 0.05.\u003c/p\u003e\u003ch2\u003eData Visualization\u003c/h2\u003e\u003cp\u003eFigures illustrating trends in hospitalizations, age distribution, and regional origin were generated in RStudio. A geographical map showing the distribution of hospitalized IDPs from different regions was created using Datawrapper (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://app.datawrapper.de/\u003c/span\u003e\u003cspan class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). All figures were formatted for clarity according to Scientific Reports standards.\u003c/p\u003e\u003ch2\u003eEthical Considerations\u003c/h2\u003e\u003cp\u003eThis study was conducted as a retrospective observational regional analysis of pediatric hospitalizations in the Chernivtsi Oblast (Ukraine) during the full-scale Russian-Ukrainian war (2022–2025). The study protocol was reviewed and approved by the Ethics Committee of the Bukovinian State Medical University (protocol #4, 18.12.2025). All procedures were performed in accordance with relevant institutional and national guidelines, as well as the principles of the Declaration of Helsinki, ensuring the protection of patient confidentiality.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the retrospective nature of the study and the use of anonymized, aggregated data derived from hospital records and publicly available statistics, the requirement for obtaining informed consent was waived by the Ethics Committee of the Bukovinian State Medical University.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eO.K.designed the study and drafted the manuscript. K.R. prepared all figures. N.B. collected and verified statistical data. K.B-H. performed data analysis. O.V. and K.V. assisted with data collection, literature review, and manuscript editing. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to patient confidentiality but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional Information (including a Competing Interests Statement)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrespondence and requests for materials\u003c/strong\u003e should be addressed to K.R. [email protected]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u003c/strong\u003e The study was approved by the Ethics Committee of Bukovinian State Medical University (protocol #4 18.12.2025) and was conducted in accordance with relevant guidelines and regulations.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eArmitage, R. War in Ukraine: The impacts on child health. Br. J. Gen. Pract. 72, 272\u0026ndash;273 (2022). \u003c/li\u003e\n\u003cli\u003ePluta, M. et al. Ukrainian war refugee children with particularly severe viral infections: A case series report. Pediatr. Infect. Dis. J. 43, e30\u0026ndash;e36 (2024). https://doi.org/10.1097/INF.0000000000004162 \u003c/li\u003e\n\u003cli\u003eLavie, M., Maymon, D., Diamant, N. et al. Respiratory syncytial virus bronchiolitis among refugees and asylum seekers from war-torn countries. Pediatr. Pulmonol. 56, 2888\u0026ndash;2892 (2021). https://doi.org/10.1002/ppul.25562 \u003c/li\u003e\n\u003cli\u003ePage, B., Irving, D., Amalberti, R. \u0026amp; Vincent, C. Health services under pressure: A scoping review and development of a taxonomy of adaptive strategies. BMJ Qual. Saf. 33, 738\u0026ndash;747 (2024). \u003c/li\u003e\n\u003cli\u003eYoon, J. G. et al. Clinical characteristics and disease burden of respiratory syncytial virus infection among hospitalized adults. Sci. Rep. 10, 12106 (2020). https://doi.org/10.1038/s41598-020-69017-8 \u003c/li\u003e\n\u003cli\u003eChen, Z. et al. Contribution of respiratory syncytial virus to burden of lower respiratory tract infections: A global analysis of 204 countries and territories, 1990\u0026ndash;2021. Trop. Med. Infect. Dis. 10, 223 (2025). https://doi.org/10.3390/tropicalmed10080223 \u003c/li\u003e\n\u003cli\u003ede Alencar Rodrigues, J. A. R. et al. Ukraine: War, bullets, and bombs\u0026mdash;Millions of children and adolescents are in danger. Child Abuse Negl. 128, 105622 (2022). \u003c/li\u003e\n\u003cli\u003eAwuah, W. A. et al. Vulnerable in silence: Paediatric health in the Ukrainian crisis. Ann. Med. Surg. 82, 104369 (2022). \u003c/li\u003e\n\u003cli\u003eMurray, C. J. et al. Armed conflict as a public health problem. BMJ 324, 346\u0026ndash;349 (2002). \u003c/li\u003e\n\u003cli\u003eCantor, D. et al. Understanding the health needs of internally displaced persons: A scoping review. J. Migr. Health 4, 100071 (2021). https://doi.org/10.1016/j.jmh.2021.100071 \u003c/li\u003e\n\u003cli\u003eBecker, G. et al. Acute appendicitis in children during war conflict: Results from a multicenter study. J. Clin. Med. 14, 4615 (2025). https://doi.org/10.3390/jcm14134615 \u003c/li\u003e\n\u003cli\u003eTerkawi, A. S. et al. Child and adolescent health in northwestern Syria: Findings from healthy-Syria 2017 study. Avicenna J. Med. 9, 94\u0026ndash;106 (2019). \u003c/li\u003e\n\u003cli\u003eDida, G. O. et al. Factors predisposing women and children to indoor air pollution in rural villages, Western Kenya. Arch. Public Health 80, 46 (2022). https://doi.org/10.1186/s13690-022-00791-9 \u003c/li\u003e\n\u003cli\u003eAlhaffar, M. H. D. B. A. \u0026amp; Janos, S. Public health consequences after ten years of the Syrian crisis: A literature review. Glob. Health 17, 111 (2021). https://doi.org/10.1186/s12992-021-00762-9 \u003c/li\u003e\n\u003cli\u003evan Berlaer, G. et al. Diagnoses, infections and injuries in Northern Syrian children during the civil war: A cross-sectional study. PLoS One 12, e0182770 (2017). https://doi.org/10.1371/journal.pone.0182770 \u003c/li\u003e\n\u003cli\u003eOmer, A. T. et al. Child health in war crisis: Barriers to healthcare utilization among internally displaced Sudanese caregivers 2024\u0026ndash;2025. BMC Public Health 25, 3376 (2025). https://doi.org/10.1186/s12889-025-24627-7 \u003c/li\u003e\n\u003cli\u003eM. S. \u0026amp; Vaithilingan, S. Childhood pneumonia in low- and middle-income countries: A systematic review. Cureus 16, e57636 (2024). https://doi.org/10.7759/cureus.57636 \u003c/li\u003e\n\u003cli\u003eHershey, C. L. et al. Incidence and risk factors for malaria, pneumonia and diarrhea in children under 5 in UNHCR refugee camps: A retrospective study. Confl. Health 5, 24 (2011). https://doi.org/10.1186/1752-1505-5-24 \u003c/li\u003e\n\u003cli\u003eTătăranu, E. et al. Emergency care for refugee patients at Suceava Hospital, Romania: Challenges and insights from the first year of the Russian-Ukrainian conflict. Healthcare 13, 138 (2025). https://doi.org/10.3390/healthcare13020138 \u003c/li\u003e\n\u003cli\u003eBasha, L. et al. Impact of the Syrian conflict and forced displacement on respiratory health. BMJ Open Respir. Res. 10, e001636 (2023). https://doi.org/10.1136/bmjresp-2023-001636 \u003c/li\u003e\n\u003cli\u003eKhosravi, M. Mental health needs in war-affected refugee children: Barriers, gaps, and strategies for effective care. Child Adolesc. Psychiatry Ment. Health 18, 146 (2024). https://doi.org/10.1186/s13034-024-00840-x \u003c/li\u003e\n\u003cli\u003eMetersky, K. et al. Psycho-social stressors experienced by young war refugees in developed countries: A scoping review. Can. J. Nurs. Res. 56, 350\u0026ndash;362 (2024). https://doi.org/10.1177/08445621241263459 \u003c/li\u003e\n\u003cli\u003eLewtak, K. et al. What do hospital admission data reveal about the health needs of Ukrainian child refugees in Poland? Eur. J. Public Health 35 (Suppl. 4), ckaf161.350 (2025). https://doi.org/10.1093/eurpub/ckaf161.350\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"epidemiological analysis, impact of war on child health, pneumonia, pediatric respiratory infections, respiratory hospitalization, internally displaced children","lastPublishedDoi":"10.21203/rs.3.rs-9186042/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9186042/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAcute respiratory infections remain a major cause of pediatric morbidity and hospitalization worldwide. Armed conflicts disrupt healthcare systems and living conditions, increasing the vulnerability of children to infectious diseases. Since 2022, the full-scale war in Ukraine has led to large-scale population displacement and significant pressure on regional healthcare systems. However, quantitative evidence on the impact of prolonged war on pediatric respiratory disease patterns remains limited. This is particularly important for regions hosting internally displaced populations. Here we show that the burden of pediatric respiratory infections in Chernivtsi Oblast increased substantially during 2022\u0026ndash;2025, with a 53% rise in hospitalizations and a marked increase in disease severity. The proportion of pneumonia increased over time, accompanied by a more than twofold rise in severe and complicated cases, and strong associations with emergency care utilization. These findings indicate that pneumonia is a key driver of increased healthcare burden during wartime and that prolonged conflict contributes to more severe disease in children. Our results highlight the need for adaptive healthcare strategies and improved surveillance systems in conflict-affected regions.\u003c/p\u003e","manuscriptTitle":"War-associated increase in pediatric respiratory infections in Western Ukraine: a regional study from Chernivtsi Oblast (2022–2025)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-04 09:06:36","doi":"10.21203/rs.3.rs-9186042/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-11T08:46:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"103366522178002146192419259176445671146","date":"2026-05-04T07:06:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-22T06:14:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-20T08:06:03+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-14T17:13:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-09T07:42:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-04-09T07:07:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"18bb8a6e-1c6c-46de-a1d5-0a0b33be595e","owner":[],"postedDate":"May 4th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-11T08:46:07+00:00","index":61,"fulltext":""},{"type":"reviewerAgreed","content":"103366522178002146192419259176445671146","date":"2026-05-04T07:06:50+00:00","index":58,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":66947915,"name":"Health sciences/Diseases"},{"id":66947916,"name":"Health sciences/Health care"},{"id":66947917,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-05-04T09:06:36+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-04 09:06:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9186042","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9186042","identity":"rs-9186042","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}