Factors affecting the survival of HIV-infected children after ART initiation in Bahir-Dar, Ethiopia

Background: The attention given to HIV-infected children in terms of providing ART had so far taken a second rank. This was because primary concern is about adults.Objectives: This study had the objectives to estimate the survival duration and identify socio-economic, demographic and clinical predictor variables that affect the survival of HIV-infected children under ART.Methods: The data used in this study were obtained from the medical records of 255 HIV-infected children under the age of 15 who received ART in Felege-Hiwot Referral Hospital, Ethiopia. The Kaplan-Meier method and log-rank test allowed for comparison of survival of patients in different categories. Identification of predictors of survival was accomplished by employing the Cox proportional hazards regression model.Results: The mean survival time was found to be 22.4 months with standard deviation of 0.7 months. Baseline hemoglobin level, WHO clinical stage and age had significant impact on the survival of children during the 30 months of follow up.Conclusion: The risk of death among HIV-infected children with lower hemoglobin level in younger age groups was higher compared to those who were older and had higher hemoglobin level; the risk was highest in stage IV which was very similar to that in stage III

Determinants of mortality among one to four years old children in Ethiopia: A study based on the 2011 EDHS data

Background: According to the UN report for the 10 years before 2011, the mortality rate for under-five children has decreased by 35% worldwide. UNICEF reported that Ethiopia reduced under-five mortality by 40% over the 15 years before 2008. From the EDHS 2011 report child mortality rate in Ethiopia went down from 50 out of 1000 deaths in 2005 to 31 out of 1000 in 2011. Despite this encouraging development the country is expected to do more to bring down child mortality rate to a lower level.Objectives: This study was done to estimate the survival of one to four years old children in Ethiopia and to identify determinants of mortality for this age group of children.Methods: The study used the 2011 Ethiopian Demographic and Health Survey data. Survival analysis was employed to analyze the data on 12,710 children.Results: The results showed that the predictors mother’s education, mother’s age, marital status, birth order(s) and place of residence had significant impact on child mortality. On the other hand sex of a child, family size, wealth index, water source and toilet facility were not found to be significant.Conclusion: A lot of effort has to be made to intensify educating females so as to alleviate their level of empowerment. The concerned government and nongovernment bodies, the media and the wider community should discourage early marriage. Due to the fact that a much larger proportion of child mortality occurred in rural areas of the country, it is necessary to avail child and mothers maternal care services infrastructure outside the urban areas

Survival of HIV-TB co-infected adult patients under ART in Ambo Referral Hospital, Ethiopia

Background: HIV infection is the greatest risk factor for acquiring TB infection and developing the disease. TB enhances HIV replication by accelerating the natural evolution of HIV infection; it is the leading cause of sickness and death of people living with HIV.Objectives: To estimate the survival of HIV/AIDS co-infected patients and to identify predictors of survival based on data obtained from Ambo referral hospital, West Shoa Zone in Oromia Regional State, Ethiopia.Methods: This retrospective study was conducted based on data collected in 501 cases of HIV-infected TB patients of age 15 years and above who started anti-TB treatment between September 1, 2006 and August 31, 2011 and followed until February 29, 2012. The Kaplan-Meier method and the log-rank test were used to compare the survival experience of different categories of patients. The Cox regression model was employed to identify predictors of mortality.Results: A total of 79 deaths occurred during the follow up period of 78.66 months. Of these 49 patients died within the first nine months after initiation of the anti-TB treatment and the remaining 30 died after finishing the treatment; the last death occurred at 67.83 months. The overall median survival of the 79 death cases was 27.7 months. The Cox regression analysis showed that initial weight, TB site (pulmonary or extra-pulmonary), WHO clinical stage, functional status and CD4 count were significant risk factors. The most important predictors associated with higher risk of death at 0.05 level of significance were: low initial weight, low CD4 count, WHO stages III and IV as well as ambulatory and bedridden physical conditions.Conclusion: A careful monitoring of the health status of patients with low initial weight, low CD4 cell count, advanced WHO stages III & IV, ambulatory and bedridden functional status is necessary to improve the survival of HIV-TB co-infected patients at initiation of and during anti-TB treatmen

Determinants of infant mortality in Ethiopia: A study based on the 2005 EDHS data

Background: According to the Ethiopian Demographic and Health Survey of 2000, the infant mortality rate in Ethiopia was estimated at 96.8 deaths per 1000 live births. Continuous follow up studies about infant mortality are vital to the development of the country. The present study is an undertaking against the background of the prevailing high rate of infant mortality based on Ethiopian Demographic and Health Survey data gathered in 2005.Objective: The main objective of this study was to determine socioeconomic, demographic and environmental factors/variables that could have impact on infant mortality in Ethiopia.Methods: The study used data from the 2005 Ethiopian Demographic and Health Survey. The Kaplan-Meier method and Cox proportional hazards regression model were employed to analyze the data.Results: The results of Kaplan-Meier estimation showed that most infant deaths occurred in the earlier months immediately after birth and then declined as the age of the infant advanced to 12 months. It was observed that about 47.9 % and 58.4% of the deaths, respectively, occurred in the first and second months of the follow up period. The Cox proportional hazards analysis identified “breast feeding status”, “mother’s age”, “mother’s level of education”, “child birth order”, “source of drinking water” and “sex of infant” as significant predictors of infant mortality.Conclusion: In order to reduce infant mortality, awareness creation efforts have to increase birth spacing, improve the level of education of mothers, encourage breastfeeding, provide access to safe water and discourage teenage pregnancy. To this effect, existing health policy guidelines related to birth have to be improved, and perhaps new ones be formulated, in order to achieve the desired outcome of reducing infant mortality

Survival analysis of patients under chronic HIV-care and antiretroviral treatment at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Background: Health care planning depends upon good knowledge of prevalence that requires a clear understanding of survival patterns of patients who receive medication, treatment and care. Survival analysis can bring to light the effect that some demographic, social, medical and clinical characteristics have on the mortality rate of HIV-patients.Objectives: The objective of this research undertaking was to estimate mortality rate and identify predictors that have significant impact on the survival status of a sample of patients who received antiretroviral treatment and care in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.Methods: The data for this research were collected during the follow-up time from 2005 to 2008. Out of a population of HIV-patients who were taking antiretroviral therapy in the hospital in that period, data on 1,000 patients were used for this study. The study subjects were people in the age range from 15 to 75 years. The Kaplan-Meier Method was employed to estimate mortality; the Cox Proportional Hazards Regression Method was used to identify determinants of mortality.Results: After initiation of the antiretroviral treatment, HIV-positive patients lived for an average of 5.65 years (CI: 3.69-7.61 years); the median survival age was found to be 3.98 years (CI: 2.98-4.97 years). The number of medications, baseline functional status, CD4 count, antiretroviral treatment, age, gender and weight impact the survival experience of the patients.Conclusions: Antiretroviral therapy treatment reduced death among AIDS patients by 50 percent. Providing treatment at health facilities outside big towns and in the country should be given due attention. Similar studies in the future need to consider predictors in addition to those considered in this study. [Ethiop. J. Health Dev. 2012;26(1):22-29

Survival analysis of HIV-infected patients under antiretroviral treatment at the Armed Forces General Teaching Hospital, Addis Ababa, Ethiopia

Background: The introduction of ART dramatically improved the survival and health quality of HIV-infected patients in the industrialized world; and the survival benefit of ART has been well studied too. However, in resource-poor settings, where such treatment was started only recently, limited data exist on treatment results. Since the military across most countries of the world had been identified as one of the eight vulnerable and most-at-risk sub-populations to HIV/AIDS, it is worthwhile undertaking studies in the area.Objectives: The objectives of this study were to estimate mortality rate and to identify survival predictors of patients taking ART based on data obtained from Armed Forces Teaching and General Hospital in Addis Ababa, Ethiopia.Methods: The records of 734 patients enrolled in the Armed Forces General Teaching Hospital in Addis Ababa between September 2003 and August 2007 were reviewed, and a retrospective cohort study conducted. The KaplanMeier method and log-rank test were used to compare the survival experience of different categories of patients. The proportional hazards Cox regression model was employed to identify predictors of mortality.Results: Of the 734 included in the current study, 86 (11.7%) died during the first 12 months. Of these 28 (32.6%) deaths occurred within the first three months after initiation of ART; another 15 died in the following three months of follow up; that is to say a total of 43 (50%) deaths occurred within six months. In the last six months 43 patients died; that makes the remaining 50% of the total. The most important predictors of mortality at 0.05 level of significance were low CD4 cell count at baseline, employment status, functional status, WHO clinical stages III and IV, TB coinfection, and opportunistic infections.Conclusion: Based on the finding of the study it can be concluded that a careful monitoring of patients with low CD4 cell count, advanced WHO stages, history of opportunistic infections, ambulatory and bedridden functional status, coinfection with TB and being employed/unemployed must be undertaken in order to improve the survival of AIDS patients

Risk factors of neonatal mortality in Ethiopia

Background: An understanding of risk factors related to neonatal mortality is important to guide the development of focused and evidence-based health interventions to reduce neonatal deaths.Objective: This study aimed to identify risk factors of neonatal mortality in Ethiopia.Methods: The data source for the study was the 2011 Ethiopian Demographic and Health Survey. The survival information of a total of 8,651 live-born neonates born five years before the survey was examined. Stratified Cox-proportional hazards model was employed to identify risk factors associated with neonatal deaths.Results: About 71% of the neonatal deaths occurred within the first week after birth and, the cumulative death rate reached 79% in the second week. The estimated hazard ratios of mortality were higher for twins or multiple births (HR=3.73, 95% CI: 2.81-4.94), first order birth (HR=1.68, 95% CI: 1.25-2.24), male sex (HR=1.26, 95% CI: 1.06-1.50), birth interval shorter than 24 months (HR=1.63, 95% CI:1.31-2.03), very small and vary large size neonates born to mothers younger than 20 years of age and above 34 years (HR=1.38, 95% CI:1.05-1.82) and (HR=1.32, 95% CI 0.06-2.80), respectively, and neonates whose mothers had a history of pregnancy complications (HR=1.73, 95% CI: 1.27-2.24) compared to their respective counterparts. The risk of dying was lower for neonates whose mothers attended antenatal visits (HR=0.72, 95% CI: 0.59-0.89) and neonates put to breast immediately upon birth (HR=0.83, 95% CI: 0.59-0.99).Conclusion: Public health interventions directed at reducing neonatal death should address the demographic factors mentioned above and maternal healt

Softly shrunk and partially shrunk rank-reduced estimation of the regression coefficients

partially shrunk estimators, softly shrunk estimators, softly shrunk rank-reduced estimators,

Improved estimators of common variance of p-populations when Kurtosis is known

Hessian, Kurtosis, Mean-squared error, Non-singular matrix, Pooled sample variance, Positive definite matrix, Relative efficiency,