Dataset Information

Incidence and predictors of mortality among adolescents on antiretroviral therapy in Amhara Region, Ethiopia: a retrospective cohort analysis.

ABSTRACT:

Objective

This study aimed to assess the incidence and predictors of mortality in adolescents receiving antiretroviral therapy (ART) in Ethiopia's Amhara Region.

Design

We conducted an institution-based retrospective follow-up study.

Settings

The study was conducted at Amhara Region's comprehensive specialised hospitals in Ethiopia.

Participants

We included 961 randomly selected medical records of adolescents receiving ART between January 2005 and June 2020.

Primary and secondary outcomes

The incidence of mortality since ART treatment initiation served as the primary outcome, and predictors of mortality served as secondary outcomes. We used Cox proportional hazard regression to examine the relationship between mortality and its predictors. Variables with p values<0.05 in the multivariable analysis were considered statistically significant mortality predictors. Adjusted HR (aHR) with 95% CI was used to measure the strength of association.

Results

More than half (n=496, 53.5%) of the adolescents living with HIV (ALHIV) were girls. The adolescent mortality rate was 1.52 (95% CI: 1.04 to 1.53) per 100 person-years throughout the follow-up period of 81 583 adolescent months. Mortality was higher for ALHIV who had not received formal education (aHR: 3.27, 95% CI: 1.36 to 7.87), had widowed parents (aHR: 1.85, CI: 95% 1.01 to 3.56) or received no social support (aHR: 2.81, 95% CI: 1.69 to 4.67). Adolescents who had opportunistic infections (OIs) at ART initiation (aHR: 1.94, 95% CI: 1.19 to 3.14), low haemoglobin (Hgb/g/l) levels (aHR: 2.17, 95% CI: 1.08 to 4.18), a bedridden functional status (aHR: 3.11, 95% CI: 1.64 to 5.72), stage IV clinical staging (aHR: 3.03, 95% CI: 1.46 to 6.30), non-disclosing status (aHR: 2.24, 95% CI:1.36 to 3.69) and CD4 count 200-350 cells/mm³ (aHR: 2.17, 95% CI: 1.08 to 4.18) also had a higher risk of death. Not receiving cotrimoxazole preventive therapy (aHR: 1.85, 95% CI: 1.07 to 3.22) and poor adherence to ART (aHR: 2.24, 95% CI: 1.27 to 3.95), compared with adherent, was associated with higher mortality risk. Changed treatment regimens were associated with lower mortality (aHR: 0.59, 95% CI: 0.35 to 0.98).

Conclusions

Our study found a lower mortality rate for adolescents with HIV than previous Ethiopian studies, but our significant mortality predictors were similar to those found in earlier studies of adults and adolescents. Our findings reveal a potential point for health service improvement in Ethiopia: incorporating monitoring of Hgb levels into patient follow-up care, supporting recommendations that clinicians emphasise managing OIs and providing counselling services to improve adherence.

SUBMITTER: Leshargie CT

PROVIDER: S-EPMC9664312 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

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Publications

Incidence and predictors of mortality among adolescents on antiretroviral therapy in Amhara Region, Ethiopia: a retrospective cohort analysis.

Leshargie Cheru Tesema CT Demant Daniel D Burrowes Sahai S Frawley Jane J

BMJ open 20221109 11

<h4>Objective</h4>This study aimed to assess the incidence and predictors of mortality in adolescents receiving antiretroviral therapy (ART) in Ethiopia's Amhara Region.<h4>Design</h4>We conducted an institution-based retrospective follow-up study.<h4>Settings</h4>The study was conducted at Amhara Region's comprehensive specialised hospitals in Ethiopia.<h4>Participants</h4>We included 961 randomly selected medical records of adolescents receiving ART between January 2005 and June 2020.<h4>Prima ...[more]

PMID: 36351711

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Project description:IntroductionTuberculosis (TB) continues to be a significant public health issue, particularly in low-income and middle-income countries. Globally, the End TB Strategy targets an 80% reduction in TB incidence by 2030. Despite this strategy, there remains limited evidence on the incidence of TB among HIV-infected children after the test-and-treat strategies in Amhara Region. Hence, this study aimed to assess the incidence of TB and its predictors among children on antiretroviral therapy (ART) in Amhara Region, which is the second largest region in Ethiopia and located in the northwestern, northeastern and north-central parts of Ethiopia.MethodsA multicentre institution-based retrospective follow-up study was conducted on 421 HIV-infected children receiving ART from July 2014 to March 2022. The study participants were selected using simple random technique. National antiretroviral intake and follow-up forms were used to gather data through the KoBo Toolbox. Stata V.17 was used for data analysis. The Kaplan-Meier curve was applied to estimate failure time, and the log-rank test was employed to compare groups of predictors. To identify TB predictors, Gompertz regression models, both bivariable and multivariable, were constructed. Ultimately, a 95% CI adjusted HR (AHR) was calculated, and variables with a p value less than 0.05 were considered statistically significant.ResultsA total of 421 children with a record completeness rate of 97.9% were analysed in the study. The TB incidence rate in children on ART was 2.16 (95% CI 1.52, 3.05) per 100 child-year observations. Anaemia at baseline (AHR: 3.83; 95% CI 1.46, 10.04), never taking TB preventive treatment (TPT) (AHR: 3.78; 95% CI 1.44, 9.94), wasting (AHR: 2.53; 95% CI 1.19, 5.38) and not initiating ART within 7 days (AHR: 2.35; 95% CI 1.15, 4.78) were significant predictors of TB in children.ConclusionThe incidence of TB in children on ART was relatively high. HIV-positive children presenting with anaemia, those who never took TPT, wasted children and those with late initiation of ART were prone to the occurrence of TB. Therefore, prioritising anaemia treatment, TB preventive therapy, nutritional counselling and timely initiation of ART are essential to curb the TB burden.

Project description:BackgroundEvidence shows that earlier access to Antiretroviral Therapy (ART) helps to increase the survival of children by delaying the progression to advanced stages of HIV-related diseases. However, the effect of testing and treatment strategies on mortality among children receiving ART has remained a limited study in Ethiopia. This study aimed to assess the incidence of mortality and its predictors among HIV-infected children receiving ART in Amhara Region Specialized Hospitals, after the test and treat strategy.MethodsA multicenter facility-based retrospective follow-up study was conducted on 475 HIV-infected children receiving ART at Amhara Region Comprehensive Specialized Hospitals from June 10, 2014, to February 28, 2022. A simple random sampling technique was used to select the study participants. Data were collected using national antiretroviral intake and follow-up forms via the KoBo Toolbox. Data analysis was done using STATA version 17. Descriptive analyses were summarized using the Kaplan-Meier curve, and a log-rank test was used to estimate and compare. Both bivariable and multivariable Weibull regression model were fitted to identify predictors of mortality. Finally, an adjusted hazard ratio with 95% CI was computed, and variables having a p-value < 0.05 were considered as statistically significant predictors of mortality.ResultsAmong the 461 (97.1%) records included in the final analysis [42], 9.11% of the individuals died within the follow-up period. In this study, the overall mortality rate was found to be 2.53 per 100 child-year observations (95% Confidence Interval (CI): 1.87, 3.43). HIV-infected children presenting with opportunistic infections (OIs) other than tuberculosis infection (adjusted hazard ratio (AHR): 3.81, 95% CI: 1.66, 8.72), tuberculosis (AHR: 7.14, 95% CI: 2.86, 17.79), wasting (AHR: 2.83, 95% CI: 1.44, 5.56), and advanced disease staging (AHR: 4.02, 95% CI: 1.84, 8.78) were at higher risk of mortality.ConclusionIn this study, the mortality rate was high after the test-and-treat strategy. HIV-infected children presenting with OIs, advanced disease staging, and wasting were at higher risk of mortality. Therefore, to increase the survival rate for HIV-positive children, clinicians should place a strong emphasis on early screening, controlling OIs, and optimizing nutritional supplements.

Project description:BackgroundHuman immunodeficiency virus (HIV) infection is a major public health concern globally, especially in sub-Saharan African countries. Even though determining the incidence of treatment failure and its predictor is a crucial step to reduce the problem, there is limited information indicating the incidence and predictors of treatment failure among children in Ethiopia. Therefore, this study was conducted to assess the incidence and predictors of treatment failure among children on first-line antiretroviral therapy (ART) in Amhara Region referral hospitals, Northwest Ethiopia.MethodsAn institution-based retrospective follow-up study was conducted from January 30, 2011, to January 30, 2018. A total of 402 children on first-line antiretroviral therapy were selected with a simple random sampling method in Amhara Region Referral Hospitals, Northwest Ethiopia. Data were extracted by reviewing patients' ART intake and follow-up forms using pretested and structured checklists. The collected data were entered into Epidata Version 4.2 and analysis was done using STATA Version 13. Bivariable and multivariable Cox proportional hazards regression models were fitted to identify predictors of treatment failure.ResultsA total of 402 records of children on antiretroviral therapy (ART) were reviewed and treatment failures rate within the follow-up period were 12.19% (95% CI: 8.5, 15.88). This study also found that the overall incidence density rate was 3.77% per 100 person-years observation. Virologic failure accounts 48.98% followed by immunologic (28.57%) and mixed failures (22.44%). Poor ART adherence (AHR: 4.6, 95%CI: 1.61, 13.20), drug regimens, AZT-3TC-NVP (AHR: 5.2, 95%CI: 1.9, 14.26), and AZT-3TC-EFV (AHR: 6.26, 95% CI: 1.88, 20.87), Children whose both parent were died (AHR: 2.8, 95%CI: 1.07, 7.37) and world health organization (WHO) clinical stage-4 (AHR: 2.95, 95%CI: 1.04, 8.366) were found to be predictors for treatment failure among children.ConclusionThe proportion of treatment failure among children on first-line ART in Amhara Region referral hospitals, Northwest Ethiopia was found to be high. Nearly half of the children experienced Virologic failure. Poor ART adherence, children whose parents`died without parents, WHO clinical stage-4 at baseline and type of regimen patients took were found to be predictors of first-line ART treatment failure. Therefore, expanding access to routine viral load, CD4 and clinical monitoring is mandatory to detect and early intervene of treatment failures' to improve outcomes for children on ART. Patient caregivers or parents should strictly support children on medication adherence. Training to health professionals should be given time-based on revised guidelines, and follow up of treatment outcome should be monitored nationally to take the appropriate intervention.

Project description:BackgroundNeonatal mortality poses a significant public health challenge in sub-Saharan Africa, with congenital heart disease emerging as the leading cause of morbidity and mortality among neonates, especially in countries like Ethiopia. Despite efforts to reduce neonatal mortality rates, Ethiopia continues to experience an increased mortality rate, particularly among neonates with congenital heart disease. This study aims to investigate the incidence and predictors of mortality in this vulnerable population within Ethiopia.MethodA retrospective cohort study was conducted at an institution, involving 583 randomly selected neonates diagnosed with congenital heart disease. In the current study, the dependent variable was survival status. Data entry utilized EpiData data version 4.6, and analysis was performed using STATA version 16. Probability of death was compared using the log-rank test and Kaplan-Meier failure curve. Significant predictors were identified using bivariable and multivariate Cox regression. Model fitness and proportional hazard assumptions were evaluated using the Cox-Snell graph and Global test, respectively. Associations were assessed by adjusted hazard ratios with 95% confidence intervals.ResultsThe study participants were followed for 4844 days. The mortality rate was 9.9%. The incidence density was 11.9 per 1000 person-days of observation. Neonatal sepsis (AHR: 2.24; 95% CI [1.18-4.23]), cyanotic congenital heart disease (AHR: 3.49; 95% CI [1.93-6.28]), home delivery (AHR: 1.9; 95% CI [1.06-3.6]), maternal history of gestational diabetes mellitus (AHR: 1.94; 95% CI [1.04-3.61]), and having additional congenital malformations (AHR: 2.49; 95% CI [1.33-4.67]) were significant predictors for neonatal mortality.Conclusion and recommendationThe incidence density of mortality was high compared to studies conducted in developed countries. Neonatal sepsis, type of congenital heart disease, place of delivery, maternal history of gestational diabetes mellitus, and having an additional congenital malformation were significant predictors of mortality among neonates with congenital heart disease. Therefore, healthcare providers should pay special attention to patients with identified predictors. Furthermore, the Federal Ministry of Health, stakeholders, and policymakers should collaborate to address this issue.

Project description:BackgroundIn Ethiopia, the trend of neonatal mortality showed slow pace of reduction from 2000-2016 compared to the reduction in infant and under-five mortality over the same period. This study aimed at unpacking the trends of admission, specific causes and rate of neonatal mortality as well as predictors of neonatal mortality at a general hospital in Somali region of Ethiopia.MethodsA hospital based retrospective cohort study was conducted from 25th of May 2017to 10th of June, 2017. All the new-borns admitted in the neonatal Intensive Care Unit of the hospital were reviewed over three years period (Aug2014-May2017). Data were cleaned and exported to SPSS version 20 and both descriptive and analytical analysis were executed. The level of significance was set at P<0.05. Binary logistic regression was used to produce summary of statistics including crude and adjusted odds ratio and 95% confidence intervals.ResultsThis study reviewed a total of 792 new-borns below the age of 28 days admitted in the NICU of Karamara hospital over a period of three years (August, 2014 to May, 2017). The mean birth weight was 2733 ± 740 g and neonates with normal birth weight stood at 64%. Seven hundred forty seven new-borns (94.3%) were discharged alive while 45 (5.7%) new-borns died in the course of hospitalization making a Neonatal Mortality Rate (NMR) of 5.7% (57 per 1000 live births), and 96 percent of these deaths were early neonatal deaths that occurred in the first one week of life (i.e. <7 days).After all variables which had an association with neonatal mortality (P <0.05) were entered in to a multivariate logistic model to control the effect of confounders: prematurity (AOR = 0.492(0.253, 0.957), P = 0.037) and average length of stay below two days (AOR = 0.418(0.186, 0.936), P = 0.034) were independently associated with neonatal mortality showing protective effect.ConclusionThe causes of neonatal death reported in this study are preventable, the neonatal mortality rate is high compared to the national and regional figures. Prematurity and shorter length of stay in the NICU of less than two days showed independent association with neonatal mortality. This calls for more work along the continuum of care, improving the quality of care, early transfer of sick neonates to the NICU along with scaling up establishment of the NICUs in other hospitals of the region.

Project description:BackgroundAcquired Immunodeficiency Syndrome (AIDS) is one of the most fatal infectious diseases in the world, especially in Sub-Saharan Africa, including Ethiopia. Even though Antiretroviral therapy (ART) significantly decreases mortality overall, death rates are still highest especially in the first year of ART initiation.ObjectiveTo assess the incidence and predictors of mortality within the first year of ART initiation among adults on ART at Debre-Markos Referral Hospital, Northwest Ethiopia.MethodsA retrospective follow-up study was conducted among 514 newly enrolled adults to ART from 2014 to 2018 at Debre-Markos Referral Hospital. Patients' chart number was selected from the computer using a simple random sampling technique. Data were entered into EPI- INFO 7.2.2.6 and analyzed using Stata 14.0. The mortality rate within the first year was computed and described using frequency tables. Both bivariable and multivariable Cox-proportional hazard models were fitted to show predictors of early mortality.ResultsOut of 494 patient records included in the analysis, a total of 54 deaths were recorded within one year follow-up period. The overall mortality rate within 398.37 person years (PY) was 13.56 deaths/100 PY with the higher rate observed within the first three months. After adjustment, rural residence (Adjusted Hazard Ratio (AHR) = 1.97; 95% CI: 1.05-3.71), ≥ 6 months pre-ART duration (AHR = 2.17; 95% CI: 1.24-3.79), ambulatory or bedridden functional status at enrolment (AHR = 2.18; 95% CI: 1.01-4.74), and didn't take Cotrimoxazole preventive therapy (CPT) during follow-up (AHR = 1.88; 95% CI: 1.04-3.41) were associated with early mortality of adults on ART.ConclusionMortality within the first year of ART initiation was high and rural residence, longer pre-Art duration, ambulatory or bedridden functional status and didn't take CPT during follow-up were found to be independent predictors. Hence, giving special attention for patients from rural area and provision of CPT is crucial to reduce mortality.

Project description:BackgroundBreast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in over 100 countries. In March 2021, the World Health Organization called on the global community to decrease mortality by 2.5% per year. Despite the high burden of the disease, the survival status and the predictors for mortality are not yet fully determined in many countries in Sub-Saharan Africa, including Ethiopia. Here, we report the survival status and predictors of mortality among breast cancer patients in South Ethiopia as crucial baseline data to be used for the design and monitoring of interventions to improve early detection, diagnosis, and treatment capacity.MethodsA hospital-based retrospective cohort study was conducted among 302 female breast cancer patients diagnosed from 2013 to 2018 by reviewing their medical records and telephone interviews. The median survival time was estimated using the Kaplan-Meier survival analysis method. A log-rank test was used to compare the observed differences in survival time among different groups. The Cox proportional hazards regression model was used to identify predictors of mortality. Results are presented using the crude and adjusted as hazard ratios along with their corresponding 95% confidence intervals. Sensitivity analysis was performed with the assumption that loss to follow-up patients might die 3 months after the last hospital visit.ResultsThe study participants were followed for a total of 4,685.62 person-months. The median survival time was 50.81 months, which declined to 30.57 months in the worst-case analysis. About 83.4% of patients had advanced-stage disease at presentation. The overall survival probability of patients at two and three years was 73.2% and 63.0% respectively. Independent predictors of mortality were: patients residing in rural areas (adjusted hazard ratio = 2.71, 95% CI: 1.44, 5.09), travel time to a health facility ≥7 hours (adjusted hazard ratio = 3.42, 95% CI: 1.05, 11.10), those who presented within 7-23 months after the onset of symptoms (adjusted hazard ratio = 2.63, 95% CI: 1.22, 5.64), those who presented more than 23 months after the onset of symptoms (adjusted hazard ratio = 2.37, 95% CI: 1.00, 5.59), advanced stage at presentation (adjusted hazard ratio = 3.01, 95% CI: 1.05, 8.59), and patients who never received chemotherapy (adjusted hazard ratio = 6.69, 95% CI: 2.20, 20.30).ConclusionBeyond three years after diagnosis, patients from southern Ethiopia had a survival rate of less than 60% despite treatment at a tertiary health facility. It is imperative to improve the early detection, diagnosis, and treatment capacities for breast cancer patients to prevent premature death in these women.

Project description:Birth asphyxia is one of the leading causes of early neonatal mortality, which causes an estimated 900,000 deaths annually. Therefore, assessing the survival status and predictors of mortality among asphyxiated neonates will be highly helpful to policymakers in designing, implementing, and evaluating programs to achieve the sustainable development goal of reducing neonatal mortality as low as 12/1,000 live births by 2030. A facility-based retrospective cohort study was conducted among 378 asphyxiated neonates admitted to the NICU of Dessie Comprehensive Specialized Hospital from January, 2017 -December, 2019. The data were collected from eligible records by using a structured data extraction tool from March 30 -April 21, 2020. The data were cleaned manually and entered into Epi-data version 7.1.2.0, and STATA version 16 was used for the analysis. Bivariate and Multivariate Cox proportional hazard regression analysis were performed, and significant predictors were identified using 95% confidence interval and p-value <0.05. A total of 378 neonates were followed for 2298 neonatal days, ranging from 1 to 28 days. The mortality incidence rate was 5.3/100 person-days-of observation (95% CI: 4.41, 6.29), and 32% (95% CI: 27.6%, 36.8%) of the study subjects died. Admission weight (AHR: 1.72; 95% CI: 1.09, 2.72), seizure (AHR: 1.52; 95% CI: 1.02, 2.27), neonates who received resuscitation (AHR: 2.11; 95% CI: 1.18, 3.80), and stage of asphyxia (moderate (AHR: 3.50; 95% CI: 1.55, 8.36), and severe (AHR: 11.55; 95% CI: 4.73, 28.25)) were significant predictors of neonatal mortality among asphyxiated neonates. The magnitude of neonatal mortality among asphyxiated neonates in the study area was high. Admission weight, seizure, resuscitation, and stage of asphyxia were significant predictors of mortality among neonates with asphyxia. Therefore, special attention should be given to asphyxiated neonates with low admission weight and those who had seizure. Additionally, the timing, quality, and effectiveness of resuscitation might need further assessment and evaluation.

Dataset Information

Incidence and predictors of mortality among adolescents on antiretroviral therapy in Amhara Region, Ethiopia: a retrospective cohort analysis.

Objective

Design

Settings

Participants

Primary and secondary outcomes

Results

Conclusions

Publications

Incidence and predictors of mortality among adolescents on antiretroviral therapy in Amhara Region, Ethiopia: a retrospective cohort analysis.

Similar Datasets

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