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.

Generalized anxiety disorder among mothers attending perinatal services during COVID-19 pandemic: using ordinal logistic regression model.

Background: Generalized anxiety disorder is characterized by excessive and uncontrollable worry about a variety of events. It is critical to ensure a pregnant mother's mental health in order to reduce pregnancy and birth-related problems. The major goal of current study was to identify the factors associated with generalized anxiety disorder among mothers attending perinatal services in the study area during COVID-19 using ordinal logistic regression. Methods: The institution-based cross-sectional study was conducted from July 10th, 2020 to August 10th, 2020 at Kembata Tembaro zone, Southern Ethiopia. The current study included 423 mothers. The GAD-7 scale was used to assess the anxiety level among mothers. An Ordered logit model was used to identify the determinants of GAD. Brant test of the parallel line was utilized to check proportionality assumption. The statistical significance was determined using an adjusted proportional odd ratio with a 95%CI, and a p-value <5%. STATA software version 14 was used to analyze statistical data. Results: Of all 423 mothers attending perinatal service during COVID-19; 134(31.7%), 171(40.4%), 85(20.1%), and 33 (7.8%) had non/minimal to severe generalized anxiety disorder respectively. The results of multivariable proportional odds model (POM) showed that the variables town residents [aPOR = 1.827; 95% CI:1.233-2.708], having alcohol habit [aPOR = 3.437, 95% CI = 1.397-8.454], having occupation [aPOR = 0.509, 95% CI: 0.303-0.857], being health care worker [aPOR = 0.117, 95% CI = 0.044-0.311], having chronic illness [aPOR = 7.685, 95% CI = 3.045-19.39], having family history of anxiety/mood disorder [aPOR = 7.839, 95% CI = 2.656-23.12], fear of contracting COVID-19 [aPOR = 1.704, 95% CI = 1.152-2.521], having moderate social support [aPOR = 0.648, 95% CI = 0.425-0.989], having strong social support [aPOR = 0.495, 95% CI = 0.272-0.901] were significantly associated with generalized anxiety disorder at 5% level of significance. Conclusion: Current findings concluded that the prevalence of GAD among mothers attending perinatal service during COVID-19 was high. The covariates like being town resident, lower-income status, occupation status, having a chronic illness, having a positive family history of anxiety or mood disorder, perceived social support, and fear of the COVID-19 were significantly associated with generalized anxiety disorder among mothers. Mothers who visit perinatal services should be given special consideration to improve health care services and ensure their mental health.

Multilevel analysis of factors associated with utilization of institutional delivery in Ethiopia.

BACKGROUND: The maternal mortality rate in poor nations remains unacceptably high. The purpose of this study was to identify factors associated with institutional delivery usage. METHODS: The data came from the Ethiopian mini demographic and health survey, which was conducted in 2019. This study comprised 3978 women of reproductive age who had given birth within the previous 5 years. To uncover significantly linked parameters associated with institutional delivery, we used a multilevel logistic regression model. Statistical significance was declared at p < 0.05, and we assessed the strength of association using adjusted odds ratios with 95% confidence intervals. RESULTS: More than half of the women (53.67%) among 3978 women with last birth had their babies delivered in a health facility. In the multilevel logistic regression analysis, women in age group 45-49 (AOR = 2.43, 95% CI: 1.280, 4.591), primary educational level (AOR = 2.21, 95% CI: 1.864, 2.625, secondary and above education level (AOR = 6.37, 95% CI: 4.600, 8.837), being Muslim (AOR = 2.57, 95% CI: 1.245, 2.166), women who visited ANC service four up to seven times (AOR = 2.75, 95% CI: 2.175, 3.473), women visited ANC service eight times and above (AOR = 3.295% CI: 1.685, 6.050), women who reside in middle wealth index (AOR = 1.57, 95% CI: 1.273, 1.950), and rich wealth index (AOR = 3.43, 95% CI: 2.782, 4.225) were more likely to give birth at health institution compared to their counterparts. Furthermore, women being in rural area (AOR = 0.34, 95% CI:- 0.283, 0.474) and protestant women (AOR = 0.1.57, 95% CI: 0.479, 0.852) were less likely to deliver at health institution. CONCLUSIONS: Ethiopia still has a low level of institutionalized delivery. Institutional delivery in Ethiopia should be improved through context-specific and personalized programs, such as educating women and enhancing access to ANC services.

Prevalence and Determinants of Contraceptive Utilization among Women in the Reproductive Age Group in Ethiopia.

INTRODUCTION: Despite the huge advantages of family planning programs, contraception use in Ethiopia remains low. Determining the magnitude and associated factors of contraceptive utilization helps to take action for further improvement. Therefore, this study aimed to assess the prevalence and identify determinants of using contraceptives among women of reproductive age in Ethiopia. METHODS: The 2019 Ethiopian Mini Demographic and Health Survey 2019 (EMDHS 2019) dataset was utilized in this population-based investigation. In the current study, 8885 reproductive-age women were included. Binary logistic regression analysis was employed to examine significant factors associated with the utilization of contraceptive methods. The analysis was done using SPSS software version 20. RESULTS: The prevalence of contraceptive utilization amongst women's reproductive age in Ethiopia was 37.6%. Of all contraceptive users, a large number of women, 57.0%, used injectable kinds of contraceptives followed by implants (24.3%). Participants aged 20-29 (AOR = 2.32, 95%CI: 1.79-3.01) and aged 30-39 years (AOR = 3.12, 95%CI: 2.58-3.78); from Addis Ababa (AOR = 3.27, 95%CI:2.42-4.43), Dire Dawa (AOR = 2.96, 95%CI:2.28-3.84), and urban residence (AOR = 2.49, 95%CI:2.13-2.91); who had secondary education level 1.391(AOR = 1.14-1.70), diploma and above (AOR = 1.39, 95%CI:1.12-1.72); being in rich wealth index (AOR = 1.260, 95%CI:1.06-1.50); having five or more children (AOR = 1.37, 95%CI:1.17-1.61); and who had knowledge about contraceptives (AOR = 1.88, 95%CI:1.42-2.48) and being married (AOR = 5.82, 95%CI: 4.60-7.36) had higher odds of utilizing contraceptives, while women aged 40-49 years (AOR = 0.93, 95%CI: 0.89-0.96) and from residential region of Oromia (AOR = 0.516, 95%CI: 0.40-0.67), Somalia (AOR = 0.48, 95%CI: 0.38-0.62) and Benishangul (AOR = 0.53, 95%CI: 0.40-0.70) had lower odds of using contraception. CONCLUSIONS: The study concluded that the use of contraceptives remained very low (found below the national target) in Ethiopia. Factors like age, educational level, number of children, and region of the women, religion, wealth index, and marital status are determinant factors associated with contraceptive use among reproductive-age women in Ethiopia. For a more successful intervention approach that encourages the use of contraceptive methods, these variables should be considered.

Determinants of acute respiratory infection among under-five children in rural Ethiopia.

INTRODUCTION: In low- and middle-income nations, acute respiratory infection (ARI) is the primary cause of morbidity and mortality. According to some studies, Ethiopia has a higher prevalence of childhood acute respiratory infection, ranging from 16 to 33.5%. The goal of this study was to determine the risk factors for acute respiratory infection in children under the age of five in rural Ethiopia. METHODS: A cross-sectional study involving 7911 children under the age of five from rural Ethiopia was carried out from January 18 to June 27, 2016. A two stage cluster sampling technique was used recruit study subjects and SPSS version 20 was used to extract and analyze data. A binary logistic regression model was used to identify factors associated with a childhood acute respiratory infection. The multivariable logistic regression analysis includes variables with a p-value less than 0.2 during the bivariate logistic regression analysis. Adjusted odds ratios were used as measures of effect with a 95% confidence interval (CI) and variables with a p-value less than 0.05 were considered as significantly associated with an acute respiratory infection. RESULTS: The total ARI prevalence rate among 7911 under-five children from rural Ethiopia was 7.8%, according to the findings of the study. The highest prevalence of ARI was found in Oromia (12.8%), followed by Tigray (12.7%), with the lowest frequency found in Benishangul Gumuz (2.4%). A multivariable logistic regression model revealed that child from Poor household (AOR = 2.170, 95% CI: 1.631-2.887), mother's no education (AOR = 2.050,95% CI: 1.017-4.133), mother's Primary education (AOR = 2.387, 95% CI:1.176-4.845), child had not received vitamin A (AOR = 1.926, 95% CI:1.578-2.351), child had no diarrhea (AOR = 0.257, 95% CI: 0.210-0.314), mothers not working (AOR = 0.773, 95% CI:0.630-0.948), not stunted (AOR = 0.663, 95% CI: 0.552-0.796), and not improved water source (AOR = 1.715, 95% CI: 1.395-2.109). Similarly, among under-five children, the age of the child, the month of data collection, anemia status, and the province were all substantially linked to ARI. CONCLUSIONS: Childhood ARI morbidity is a serious health challenge in rural Ethiopia, according to this study, with demographic, socioeconomic, nutritional, health, and environmental factors all having a role. As a result, regional governments, healthcare staff, and concerned groups should place a priority on reducing ARI, and attempts to solve the issue should take these variables into account.