Modeling Survival Time to Death Among TB and HIV Co-infected Adult Patients: an Institution-Based Retrospective Cohort Study.

BACKGROUND: Tuberculosis is a serious health threat, particularly for people living with human immunodeficiency virus (HIV), and HIV-positive people are more likely than others to contract the disease. Globally, tuberculosis (TB) is one of the leading causes of death among people living with HIV. The purpose of the current study was to identify factors associated with survival rates of TB/HIV co-infected patients using survival models. METHODS: A retrospective study was conducted on TB/HIV co-infected adult patients registered and under follow-up at Tepi General Hospital (TGH) and Mizan-Tepi University Teaching Hospital (MTUTH), southwest Ethiopia. All TB/HIV co-infection patients who were registered and under follow-up from 1st January 2015 through 1st January 2020 were considered. The global Schoenfeld test was used to test the proportional hazard (PH) assumption. Various accelerated failure time (AFT) models were compared to determine the best model for the time to death of TB/HIV co-infected patients' data set. Among the most commonly used accelerated failure time models (AFT models), the study used exponential, Weibull, log-logistic, and log-lognormal AFT models. AIC and BIC were used to compare the performance of fitted models. The data were analyzed with the statistical software R. RESULTS: Of 363 TB/HIV co-infected patients followed for 60 months, 79 (21.8%) died, while the remaining 284 (78.2%) were censored. The overall median survival time was 15.6 months. The proportional hazard assumption was checked and it was violated. In comparison to other models, the lognormal AFT model performed better. The results of the multivariable lognormal AFT model showed that age, residence, substance use, educational status, clinical stages of the disease, cluster of differentiation 4 (CD4 count/mm3), functional status, cotrimoxazole prophylactic therapy use (CPT use), and INH were all found to be significant factors, while gender, illness other than TB, and disclosure of status were insignificant variables at 5% level of significance. CONCLUSION: Current study results revealed that older age, substance use, advanced WHO clinical stages of the disease (stage IV), bedridden functional status, and CD4 less than 200 count/mm3 were significantly associated with shorter survival time to death of HIV/TB co-infected patients while having advanced educational status, being from urban residence, CPT use, and INH significantly increase the survival time to death of TB/HIV co-infected patients. Patients with TB/HIV co-infection should be given special attention based on these important factors to improve their health and prolong their lives. HIV-positive patients are more likely than others to contract the TB disease. The risk of death among TB/HIV co-infected patients was found to be high. Out of all patients, 79 (21.8%) died. Accelerated failure time models are good alternatives for scenario Cox proportional hazard assumptions not met.

Determinants of exclusive breastfeeding practice among mothers in Sheka Zone, Southwest Ethiopia: A cross-sectional study.

Objectives: The objective of this study was to identify the determinants of exclusive breastfeeding (EBF) practice in Sheka zone, Ethiopia. In addition, the study aims to assess the prevalence of EBF practice in the study area. Study design: A community-based cross-sectional study design was used. Methods: A random sample of 630 mothers was selected by stratified cluster sampling using Kebele (an administrative unit) as a cluster. Data were collected using interviewer-administered questionnaires between June and July 2017. Descriptive statistics were used to assess the prevalence of EBF. A multivariable logistic regression model was used to identify determinants of EBF practice. Results: The prevalence of EBF was 76%. The prevalence of EBF decreases as the age of the infant increases: 95.3% of infants aged 1 month were exclusively breastfed, but only 45.5% of infants aged 6 months were exclusively breastfed. The determinants of EBF practice were age of the child, mother's educational level, marital status, household income, place of delivery, receiving postnatal care and place of residence. Mothers with a child aged <1 month were 34.9 times more likely to be practicing EBF than mothers with a child aged 5-6 months. Conclusions: Although the prevalence of EBF was below the World Health Organisation recommended level, the practice of EBF in the study area was good. The prevalence of EBF was shown to decrease as infant age increased. Therefore, we recommend that health workers in health centres and hospitals provide advice about EBF and the duration of EBF during postnatal care visits and infant vaccination appointments.