A multiple-imputation-based approach to sensitivity analyses and effectiveness assessments in longitudinal clinical trials.

It is important to understand the effects of a drug as actually taken (effectiveness) and when taken as directed (efficacy). The primary objective of this investigation was to assess the statistical performance of a method referred to as placebo multiple imputation (pMI) as an estimator of effectiveness and as a worst reasonable case sensitivity analysis in assessing efficacy. The pMI method assumes the statistical behavior of placebo- and drug-treated patients after dropout is the statistical behavior of placebo-treated patients. Thus, in the effectiveness context, pMI assumes no pharmacological benefit of the drug after dropout. In the efficacy context, pMI is a specific form of a missing not at random analysis expected to yield a conservative estimate of efficacy. In a simulation study with 18 scenarios, the pMI approach generally provided unbiased estimates of effectiveness and conservative estimates of efficacy. However, the confidence interval coverage was consistently greater than the nominal coverage rate. In contrast, last and baseline observation carried forward (LOCF and BOCF) were conservative in some scenarios and anti-conservative in others with respect to efficacy and effectiveness. As expected, direct likelihood (DL) and standard multiple imputation (MI) yielded unbiased estimates of efficacy and tended to overestimate effectiveness in those scenarios where a drug effect existed. However, in scenarios with no drug effect, and therefore where the true values for both efficacy and effectiveness were zero, DL and MI yielded unbiased estimates of efficacy and effectiveness

Prevalence of bovine tuberculosis and its associated risk factors in the emerging dairy belts of regional cities in Ethiopia.

Bovine tuberculosis (BTB) has become an economically important disease in dairy herds found in and around Addis Ababa City and is emerging in regional cities like Gondar, Hawassa and Mekelle because of the establishment of dairy farms in the milk sheds of these cities. A cross-sectional study to estimate the prevalence of BTB and identify associated risk factors was conducted between February 2016 and March 2017. A total of 174 herds comprising of 2,754 dairy cattle in the cities of Gondar, Hawassa and Mekelle were tested using the Single Intradermal Comparative Cervical Tuberculin (SICCT) test. Data on herd structure, animal origin, body condition, housing condition, farm hygiene, management and biosecurity practices were collected using a pre-tested structured questionnaire. Generalized Linear Models (GLM) and Generalized Linear Mixed Models (GLMM) were used to analyze the herd and animal level risk factors, respectively. The herd prevalence was 22.4% (95% CI: 17-29%) while the animal prevalence was 5.2% (95% CI: 4-6%) at the cut-off >4 mm. The herd prevalence rose to 65.5% (95% CI: 58-72%) and the animal prevalence rose to 9% (95% CI: 8-10%) when the severe interpretation of >2 mm cut-off was applied. The mean within-herd prevalence in positive farms at the cut-off >4 mm was 22.7% (95% CI: 15-31%). At the herd level, the analysis showed that herd size, farm hygiene, feeding condition and biosecurity were significantly associated with BTB status, while new cattle introductions showed only borderline significance and that age of farm, housing condition, farmers' educational status and animal health care practice were not significant. At the animal level, the results showed that age and animal origin were identified as significant predictors for BTB positivity but sex and body condition score were not related to BTB status. Descriptive analysis revealed that herds having 'BTB history' showed slightly higher likelihood of being BTB positive compared to farms having no previous BTB exposure. In conclusion, this study showed relatively lower average prevalence in the emerging dairy regions as compared to the prevalence observed in and around Addis Ababa City, warranting for implementation of control program at this stage to reduce or possibly stop further transmission of BTB.This work was funded by the Biotechnology and Biological Sciences Research Council, the Department for International Development, the Economic & Social Research Council, the Medical Research Council, the Natural Environment Research Council and the Defence Science & Technology Laboratory, under the Zoonoses and Emerging Livestock Systems (ZELS) programme, ref: BB/L018977/1

Prevalence of bovine tuberculosis and its associated risk factors in the emerging dairy belts of regional cities in Ethiopia

Bovine tuberculosis (BTB) has become an economically important disease in dairy herds found in and around Addis Ababa City and is emerging in regional cities like Gondar, Hawassa and Mekelle because of the establishment of dairy farms in the milk sheds of these cities. A cross-sectional study to estimate the prevalence of BTB and identify associated risk factors was conducted between February 2016 and March 2017. A total of 174 herds comprising of 2,754 dairy cattle in the cities of Gondar, Hawassa and Mekelle were tested using the Single Intradermal Comparative Cervical Tuberculin (SICCT) test. Data on herd structure, animal origin, body condition, housing condition, farm hygiene, management and biosecurity practices were collected using a pre-tested structured questionnaire. Generalized Linear Models (GLM) and Generalized Linear Mixed Models (GLMM) were used to analyze the herd and animal level risk factors, respectively. The herd prevalence was 22.4% (95% CI: 17-29%) while the animal prevalence was 5.2% (95% CI: 4-6%) at the cut-off >4 mm. The herd prevalence rose to 65.5% (95% CI: 58-72%) and the animal prevalence rose to 9% (95% CI: 8-10%) when the severe interpretation of >2 mm cut-off was applied. The mean within-herd prevalence in positive farms at the cut-off >4 mm was 22.7% (95% CI: 15-31%). At the herd level, the analysis showed that herd size, farm hygiene, feeding condition and biosecurity were significantly associated with BTB status, while new cattle introductions showed only borderline significance and that age of farm, housing condition, farmers' educational status and animal health care practice were not significant. At the animal level, the results showed that age and animal origin were identified as significant predictors for BTB positivity but sex and body condition score were not related to BTB status. Descriptive analysis revealed that herds having 'BTB history' showed slightly higher likelihood of being BTB positive compared to farms having no previous BTB exposure. In conclusion, this study showed relatively lower average prevalence in the emerging dairy regions as compared to the prevalence observed in and around Addis Ababa City, warranting for implementation of control program at this stage to reduce or possibly stop further transmission of BTB

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Practice of code of ethics and associated factors among medical doctors in Addis Ababa, Ethiopia.

INTRODUCTION:In the health sector, questions are being raised about the possible threats to the accepted principles of ethics such as autonomy, beneficence, non malfeasance and justice in the delivery of health care. There is limited information in Ethiopia regarding to practice of code of ethics among medical doctors. Hence, this study aimed to assess practice of code of ethics and associated factors among medical doctors working in governmental and private hospitals in Addis Ababa, Ethiopia. METHODS:Institution based cross sectional quantitative study triangulated with qualitative study was conducted among 500 medical doctors working in governmental and private hospitals and three key informants from Federal Ministry of Health, Ethiopian Food, Medicine and Healthcare Administration and Control Authority and Ethiopian Medical Association in Addis Ababa from May 8, 2017 to June 30, 2017. Data were collected using pretested self-administered structured questionnaire and semi-structured questionnaire. Binary Logistic Regression and Content Analysis methods were used for the quantitative and qualitative data analysis respectively. RESULTS:The study showed that only 152 (30.4%) of medical doctors had good practice of code of ethics. The odds of having good practice of code of ethics among medical doctors in the age group of 25-29 years were 2.749 times the odds of those in the age group of 30-34 years (AOR = 2.749, 95% CI: 1.483, 5.096), medical doctors working in governmental hospitals were 65.4% less likely to have good practice of code of ethics compared to those working in private hospitals (AOR = 0.346, 95% CI: 0.184, 0.652), knowledgeable medical doctors were 83.5% more likely to have good practice of code of ethics compared to those who were not knowledgeable about code of ethics (AOR = 1.835, 95% CI: 0.999, 3.368), and the odds of having good practice of code of ethics among medical doctors with favourable attitude were 7.404 times the odds of those with unfavourable attitude towards code of ethics (AOR = 7.404, 95% CI: 4.254, 12.887). Furthermore lack of motivation, unfavorable working environment, working at various health facilities simultaneously, public awareness, taking courses on medical ethics, lack of unethical conduct reporting and complaint handling system, incompetence of medical doctors, and weak collaboration among key stakeholders were identified as determinants of practice of code of ethics. CONCLUSIONS:Only 30.4% of medical doctors had good practice of code of ethics. This indicates that practice of code of ethics among medical doctors in Addis Ababa is poor. The factors associated with practice of code of ethics were age, type of hospital, knowledge, attitude, lack of motivation, unfavorable working environment, working at various health facilities simultaneously, public awareness, medical ethics course, lack of unethical conduct reporting and compliant handling system, incompetence of medical doctors and weak collaboration among key stakeholders. Hence, awareness creation and attitudinal change on code of ethics by continuous training, implementation of integrated medical ethics course, enforcement of code of ethics and continuing professional development (CPD) implementation are important

Prognosis of colorectal cancer in Tikur Anbessa Specialized Hospital, the only oncology center in Ethiopia.

IntroductionColorectal cancer is the third most commonly diagnosed cancer in males and the second in females worldwide. According to the Addis Ababa cancer registry, it is the first in male and fourth in female in Ethiopia. However, there have not been studies on prognostic factors and survival of colorectal cancer. Hence, this study aimed to estimate survival time and identify prognostic factors.MethodsIn this institution based retrospective study, medical records review of 422 colorectal cancer patients and telephone interview was used as sources of data. Survival time was estimated using Kaplan-Meier estimator. Prognostic factors were identified using the multivariable Cox regression model.ResultsPatients diagnosed with rectal cancer had 76% (HR: 1.761, 95% CI: 1.173-2.644) increased risk of dying compared to colon cancer patients. Node positive patients were 3.146 (95% CI: 1.626-6.078) times likely to die compared to node-negative and metastatic cancer were 4.221 (95% CI: 2.788-6.392) times likely to die compared to non-metastatic patients. Receiving adjuvant therapy reduced the risk of death by 36.1% (HR: 0.639 (95% CI: 0.418-0.977)) compared to patients who had an only surgical resection. The median survival time was 39 months and the overall five years survival rate was 33%.ConclusionsThe overall survival rate was low and a majority of the patients were young at presentation. Patient's survival is largely influenced by the advanced cancer stage at presentation and delays in the administration of adjuvant therapy. Receiving adjuvant therapy was among the good prognostic factors

Socio-demographic characteristics of medical doctors in Addis Ababa, 2017 (n = 500).

<p>Socio-demographic characteristics of medical doctors in Addis Ababa, 2017 (n = 500).</p

Responses for practice related questions on of code of ethics among medical doctors in Addis Ababa, 2017 (n = 500).

<p>Responses for practice related questions on of code of ethics among medical doctors in Addis Ababa, 2017 (n = 500).</p

Institutional factors for practice of code of ethics among medical doctors in Addis Ababa, 2017 (n = 500).

<p>Institutional factors for practice of code of ethics among medical doctors in Addis Ababa, 2017 (n = 500).</p