Bayesian Approach to Zero-Inflated Bivariate Ordered Probit Regression Model, with an Application to Tobacco Use

This paper presents a Bayesian analysis of bivariate ordered probit regression model with excess of zeros. Specifically, in the context of joint modeling of two ordered outcomes, we develop zero-inflated bivariate ordered probit model and carry out estimation using Markov Chain Monte Carlo techniques. Using household tobacco survey data with substantial proportion of zeros, we analyze the socioeconomic determinants of individual problem of smoking and chewing tobacco. In our illustration, we find strong evidence that accounting for excess zeros provides good fit to the data. The example shows that the use of a model that ignores zero-inflation masks differential effects of covariates on nonusers and users

Knowledge, attitude and practice of progestin-only emergency contraceptives among female students of Jimma Teachers Training College, Jimma, Ethiopia

Background: Emergency contraception (EC) is the safest strategy for prevention of unintended pregnancy following unsafe sex provided that users have sufficient knowledge & awareness of EC. Objective: The main objective of this study was to assess the knowledge, attitude, and practice of progestin-only emergency contraceptives. Methods: Retrospective cross-sectional study was conducted from February 16 to April 18, 2017, among students of Jimma teacher’s training college. Chi-square test was run to identify the association between variables. Variables with the critical value P<0.05 at CI of 95% were considered as statistically significant.Results: A total of 270 female students were involved in the study; of which 53.70% of them had knowledge about ECs. A significant association was found between knowledge on ECs & age distribution (p<0.001) and also the sexual activity of the participants (p=0.013).More than half of the respondents agreed that widespread use of ECs would increase the prevalence of HIV/ AIDS and other sexually transmitted diseases (STIs). Of the total study participants, 121 (44.81%) have used ECs and the utilization practice has a significant association with age distribution (p<0.001 and religion of the study participants (p=0.002).   Conclusion: Generally, nearly half of the study participants had knowledge about ECs and used EC at least once in their lifetime. Most of the students agreed that relying on EC pills and its accessibility would promote the spread of HIV/AIDS and STIs.  Funding: The study was conducted with the financial support of Jimma UniversityKeywords: Knowledge, emergency contraceptives, attitude, practic

Prevalence, Reasons, and Perceived Effects of Khat Chewing Among Students of a College in Gondar Town, Northwestern Ethiopia: A Cross‑sectional Study

Background: The estimate of the number of people chewing Khat globally ranges from 5 to 10 million people. Its use may result in a variety of effects due to the different compounds in it with effects on the gastro‑intestinal system and nervous system being the principal ones. Aim: To assess the prevalence, factors, and effects of Khat chewing among students of a college in Gondar town, northwestern Ethiopia. Subjects and Methods: An institution‑based cross‑sectional study was conducted from 15th to 20th of April 2009 on a total sample of 424 students who were selected using stratified random sampling technique. Data were collected by three of the principal investigators using a structured pretested data collection instrument and analyzed by Epi Info version 3.5.2. Results: The lifetime and current prevalence of Khat chewing among the respondents were 42% (168/400) and 32.5% (130/400), respectively. Sex (P < 0.01), religion (P < 0.001), and income (P < 0.01) showed statistically significant variation in Khat chewing. The commonest frequency of Khat chewing was once a day 33.1% (43/130) while alcohol (40.8% [53/130]) and cigarette (40.0% [52/130]) were the mostly used substances with Khat. More than half of the chewers (53.85% [70/130]) reported spending 1–4 h for one Khat chewing ceremony. Financially majority of the chewers reported spending up to 10 Ethiopian Birr (ETB) (1.13 United States Dollar) on Khat ( 54.6% [71/130]) and other substances (64.6% [84/130]). Nearly two‑thirds (62.3% [81/130]) of the chewers mentioned seeking concentration during study as their main reason for chewing. Among chewers, 83.1% (108/130) reported they faced problem associated to sleep disturbance, 82.3% (107/130) loss of appetite, and 80.8% (105/130) constipation. Conclusion: The prevalence of Khat chewing was fairly high among the students and the majority among them used other substances together with Khat. Spending of a significant amount of money and facing health problems were reported to be consequences of the habit. The college should take steps to make students aware of the ills of Khat chewing and associated habits.Keywords: College, Effects, Gondar, Khat, Prevalence, Reason

Measuring Hidden Support for Physical Intimate Partner Violence: A List Randomization Experiment in South-Central Ethiopia

Understanding how and why physical intimate partner violence (IPV) persists in high-risk communities has proven difficult. As IPV is both sensitive and illegal, people may be inclined to misreport their views and experiences. By embedding a list randomization experiment (LRE), which increases respondent privacy, in a survey of 809 adult Arsi Oromo men and women in rural south-central Ethiopia, we test the reliability of direct questioning survey methods (e.g., used in the Demographic and Health Surveys) for measuring attitudes that underpin the acceptability of IPV. Participants were randomly assigned versions of the survey in which they were asked either directly or indirectly about the acceptability of wife-beating. By comparing responses across these surveys, we identify the extent to which views are being misreported using direct questioning methods, as well as identifying the "true" predictors of continued support for wife-beating. Indirect questioning reveals that almost one third of the sample believe that wife-beating is acceptable. Adults (particularly men) who are less educated (50% endorsement). These individuals, however, are also more inclined to hide their approval when asked directly by an interviewer. That we find high but underreported support for wife-beating among some members of the community demonstrates a clear need to encourage a more open dialogue, to prevent violence toward women remaining undetected and thus unchanged. This finding also raises questions about the accuracy of traditional direct questioning for capturing information on IPV attitudes and norms. Of relevance to policy, we find that wife-beating is entirely absent only among adults with higher levels of education, living in households where decision making is shared between couples.Wellcome Trust Seed AwardMinisterio de Educación, Cultura y Deport

Determinants of fertility in rural Ethiopia: the case of Butajira Demographic Surveillance System (DSS)

<p>Abstract</p> <p>Background</p> <p>Fertility is high in rural Ethiopia. Women in the reproductive age group differed in various characteristics including access to food and encounter to drought which requisite the assessment of determinants of fertility.</p> <p>Methods</p> <p>Reproductive age women were recruited from a DSS, the Butajira DSS database. A DHS maternity history questionnaire was administered on 9996 participants. Data quality was assured besides ethical clearance. Poisson regression crude and adjusted Incidence Rate Ratio with 95 Confidence Interval were used to identify determinants of fertility.</p> <p>Results</p> <p>Delayed marriage, higher education, smaller family, absence of child death experience and living in food-secured households were associated with small number of children. Fertility was significantly higher among women with no child sex preference. However, migration status of women was not statistically significant.</p> <p>Conclusions</p> <p>Policy makers should focus on hoisting women secondary school enrollment and age at first marriage. The community should also be made aware on the negative impact of fertility on household economy, environmental degradation and the country's socio-economic development at large.</p

Genetic Risk Score to Identify Risk of Venous Thromboembolism in Patients With Cardiometabolic Disease

BACKGROUND –: Venous thromboembolism (VTE) is a major cause of cardiovascular morbidity and mortality with a known genetic contribution. We tested the performance of a genetic risk score (GRS) for its ability to predict VTE in three cohorts of patients with cardiometabolic disease. METHODS –: We included patients from the FOURIER, PEGASUS-TIMI 54, and SAVOR-TIMI 53 trials (history of atherosclerosis, myocardial infarction, and diabetes, respectively) who consented for genetic testing and were not on baseline anticoagulation. We calculated a VTE GRS based on 297 SNPs with established genome-wide significance. Patients were divided into tertiles of genetic risk. Cox proportional hazards models were used to calculate hazard ratios for VTE across genetic risk groups. The polygenic risk score was compared to available clinical risk factors (age, obesity, smoking, history of heart failure, diabetes) and common monogenic mutations. RESULTS –: A total of 29,663 patients were included in the analysis with a median follow-up of 2.4 years, of whom 174 had a VTE event. There was a significantly increased gradient of risk across VTE genetic risk tertiles (p-trend <0.0001). After adjustment for clinical risk factors, patients in the intermediate and high genetic risk groups had a 1.88-fold (95% CI 1.23–2.89, p=0.004) and 2.70-fold (95% CI 1.81–4.06, p<0.0001) higher risk of VTE compared to patients with low genetic risk. In a continuous model adjusted for clinical risk factors, each standard deviation increase in the GRS was associated with a 47% (95% CI 29–68) increased risk of VTE (p<0.0001). CONCLUSIONS –: In a broad spectrum of patients with cardiometabolic disease, a polygenic risk score is a strong, independent predictor of VTE after accounting for available clinical risk factors, identifying 1/3 of patients who have a risk of VTE comparable to that seen with established monogenic thrombophilia

Association between culture and the preference for, and perceptions of, 11 routes of medicine administration: A survey in 21 countries and regions

Medicines can be taken by various routes of administration. These can impact the effects and perceptions of medicines. The literature about individuals' preferences for and perceptions of the different routes of administration is sparse, but indicates a potential influence of culture. Our aim was to determine: (i) any association between one's culture and one's preferred route of medicine administration and (ii) individual perceptions of pain, efficacy, speed of action and acceptability when medicines are swallowed or placed in the mouth, under the tongue, in the nose, eye, ear, lungs, rectum, vagina, on the skin, or areinjected. A cross-sectional, questionnaire-based survey of adults was conducted in 21 countries and regions of the world, namely, Tunisia, Ghana, Nigeria, Turkey, Ethiopia, Lebanon, Malta, Brazil, Great Britain, United States, India, Serbia, Romania, Portugal, France, Netherlands, Japan, South Korea, Hong Kong, mainland China and Estonia, using the Inglehart–Welzel cultural map to ensure coverage across all cultures. Participants scored the pain/discomfort, efficacy, speed of onset and acceptability of the different routes of medicine administration and stated their preferred route. Demographic information was collected. A total of 4435 participants took part in the survey. Overall, the oral route was the most preferred route, followed by injection, while the rectal route was the least preferred. While the oral route was the most preferred in all cultures, the percentage of participants selecting this route varied, from 98% in Protestant Europe to 50% in the African-Islamic culture. A multinomial logistic regression model revealed a number of predictors for the preferred route. Injections were favoured in the Baltic, South Asia, Latin America and African-Islamic cultures while dermal administration was favoured in Catholic Europe, Baltic and Latin America cultures. A marked association was found between culture and the preference for, and perceptions of the different routes by which medicines are taken. This applied to even the least favoured routes (vaginal and rectal). Only women were asked about the vaginal route, and our data shows that the vaginal route was slightly more popular than the rectal one