Exploratory Analysis of Time from HIV Diagnosis to ART Start, Factors and effect on survival: A longitudinal follow up study at seven teaching hospitals in Ethiopia.

BACKGROUND: The HIV care in Ethiopia has reached 79% coverage. The timeliness of the care provided at the different levels in the course of the disease starting from knowing HIV positive status to ART initiation is not well known. This study intends to explore the timing of the care seeking, the care provision and associated factors. METHODS: This is a longitudinal follow-up study at seven university hospitals. Patients enrolled in HIV care from September 2005 to December 2013 and aged ≥14 years were studied. Different times in the cascade of HIV care were examined including the duration from date HIV diagnosed to enrollment in HIV care, duration from enrollment to eligibility for ART and time from eligibility to initiation of ART. Ordinal logistic regression was used to investigate their determinants while the effect of these periods on survival of patients was determined using cox-proportional hazards regression. RESULTS: 4159 clients were studied. Time to enrollment after HIV test decreased from 39 days in 2005 to 1 day after 2008. It took longer if baseline CD4 was higher, and eligibility for ART was assessed late. Young adults, lower baseline CD4, HIV diagnosis<2008, late enrollment, and early eligibility assessment were associated with early ART initiation. Male gender, advanced disease stage and lower baseline CD4 were consistent risk factors for mortality. CONCLUSION AND RECOMMENDATION: Time to enrollment and duration of ART eligibility assessment as well as ART initiation time after eligibility is improving. Further study is required to identify why mortality is slightly increasing after 2010.

Epidemiological analysis of tuberculosis in Ethiopia: a ten-year trend analysis.

Tuberculosis has been one the major causes of morbidity and mortality in Ethiopia for long. Accordingly, the Ethiopian Ministry of Health and its stakeholders have their unreserved and integrated efforts on this health problem. Among these efforts was the well developed HMIS for Tuberculosis programs. However, the direction to where Tuberculosis in Ethiopia is heading hasn't been well analyzed and unpackaged by epidemiologically relevant factors. The overall aim of this study was to examine the epidemiological trends of Tuberculosis in Ethiopia for the ten-year period from 2000-2009. The trends were investigated from spatial, temporal, disease type and gender perspectives. A time-series study design was applied to analyze the ten-year trends of Tuberculosis in Ethiopia. Data on ten-key indicators for the period of 2000-2009 was obtained from the Ministry of Health public documents. Five stratifying variables were used to analyze the trends in the key TB indicators. The data on the indicators have undergone five stages of analysis: Aggregation, computation, summarization, graphics and model fitting. The incidence rate of tuberculosis is increasing in Ethiopia at a rate of 5 new TB cases per 100,000 population per year. Urban agro-ecological zones have been more affected by the disease throughout the ten-year period. Extra-pulmonary rate and smear-negativity has shown a modest increment during the study period. Masculine gender was also disproportionately affected by tuberculosis during the ten-year study period. On the other hand case detection rate and treatment success rate are found to be increasing at a rate of 0.5% per year.

Epidemiological analysis of tuberculosis trends in Ethiopia: 2000-2009.

Tuberculosis has been one the major causes of morbidity and mortality in Ethiopia for long. Accordingly, the Ethiopian Ministry of Health and its stakeholders have their unreserved and integrated efforts on this health problem. Among these efforts was the well developed HMIS for tuberculosis programs. However, the direction to where tuberculosis in Ethiopia is heading hasn't been well analyzed and unpackaged by epidemiologically relevant factors. The overall aim of this study was to examine the epidemiological trends of tuberculosis in Ethiopia for the ten-year period from 2000-2009. The trends were investigated from spatial, temporal, disease type and gender perspectives. A time-series study design was applied to analyze the ten-year trends of tuberculosis in Ethiopia. Data on ten-key indicators for the period of 2000-2009 was obtained from the Ministry of Health public documents. Five stratifying variables were used to analyze the trends in the key tuberculosis indicators. The data on the indicators have undergone five stages of analysis: aggregation, computation, summarization, graphics and model fitting. The incidence rate of tuberculosis is increasing in Ethiopia at a rate of 5 new tuberculosis cases per 100.000 populations per year. Urban agro-ecological zones have been more affected by the disease throughout the ten-year period. Extra-pulmonary rate and smear-negativity has shown a modest increment during the study period. Masculine gender was also disproportionately affected by tuberculosis during the ten-year study period. On the other hand case detection rate and treatment success rate are found to be increasing at a rate of 0.5% per year.

Modeling trends of health and health related indicators in Ethiopia (1995-2008): a time-series study.

BACKGROUND: The Federal Ministry of Health of Ethiopia has been publishing Health and Health related indicators of the country annually since 1987 E.C. These indicators have been of high importance in indicating the status of health in the country in those years. However, the trends/patterns of these indicators and the factors related to the trends have not yet been investigated in a systematic manner. In addition, there were minimal efforts to develop a model for predicting future values of Health and Health related indicators based on the current trend. OBJECTIVES: The overall aim of this study was to analyze trends of and develop model for prediction of Health and Health related indicators. More specifically, it described the trends of Health and Health related indicators, identified determinants of mortality and morbidity indicators and developed model for predicting future values of MDG indicators. METHODS: This study was conducted on Health and Health related indicators of Ethiopia from the year 1987 E.C to 2000 E.C. Key indicators of Mortality and Morbidity, Health service coverage, Health systems resources, Demographic and socio-economic, and Risk factor indicators were extracted and analyzed. The trends in these indicators were established using trend analysis techniques. The determinants of the established trends were identified using ARIMA models in STATA. The trend-line equations were then used to predict future values of the indicators. RESULTS: Among the mortality indicators considered in this study, it was only Maternal Mortality Ratio that showed statistically significant decrement within the study period. The trends of Total Fertility Rate, physician per 100,000 population, skilled birth attendance and postnatal care coverage were found to have significant association with Maternal Mortality Ratio trend. There was a reversal of malaria parasite prevalence in 1999 E.C from Plasmodium Falciparum to Plasmodium Vivax. Based on the prediction from the current trend, the Millennium Development Goal target for under-five mortality rate and proportion of people having access to basic sanitation can be achieved. CONCLUSION: The current trend indicates the need to accelerate the progress of the indicators to achieve MDGs at or before 2015, particularly for Maternal Health and access to safe water supply.