Dataset Information

Incidence and predictors of treatment failure among children on first-line antiretroviral therapy in Amhara Region Referral Hospitals, northwest Ethiopia 2018: A retrospective study.

ABSTRACT:

Background

Human 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.

Methods

An 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.

Results

A 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.

Conclusion

The 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.

SUBMITTER: Yihun BA

PROVIDER: S-EPMC6494040 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Incidence and predictors of treatment failure among children on first-line antiretroviral therapy in Amhara Region Referral Hospitals, northwest Ethiopia 2018: A retrospective study.

Yihun Birtukan Aklog BA Kibret Getiye Dejenu GD Leshargie Cheru Tesema CT

PloS one 20190501 5

<h4>Background</h4>Human 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 o ...[more]

PMID: 31042743

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Project description:BackgroundDespite remarkable progress in the reduction of death in under-five children, neonatal mortality has shown little or no concomitant reduction globally. It is also one of the most common causes of neonatal death in Ethiopia. Little is known on predictors of neonatal sepsis. Risk based screening and commencement of treatment appreciably reduces neonatal death and illness. Therefore, the main aim of this study was to identify predictors of neonatal sepsis in public referral hospitals of Northwest Ethiopia.MethodsInstitutional based unmatched case-control study was conducted among a total of 231 neonates in Debre Markos and Felege Hiwot referral hospitals from March 2018- April 2018. Neonates who fulfill the preseted criteria for sepsis were considered as cases and neonates diagnosed with other medical reasons except sepsis were controls. For each case, two consecutive controls were selected by simple random sampling method. Data were collected using structured pretested questionnaire through a face to face interview with index mothers and by reviewing neonatal record using checklist. The collected data were entered into Epi data version 3.1 and exported to STATA/ SE software version 14. Binary and multivariable logistic regression analyses were employed. Statistical significance was declared at P<0.05.ResultMultivariable logistic regression analysis showed that, duration of rupture of membrane ≥ 18hours was significantly associated with sepsis (AOR = 10.4, 95%CI = 2.3-46.5). The other independent predictors of neonatal sepsis were number of maternal antenatal care service ≤3 (AOR = 4.4, 95%CI = 1.7-11.5), meconium stained amniotic fluid (AOR = 3.9, 95%CI = 1.5-9.8), urinary tract infection during pregnancy (AOR = 10.8, 95% CI = 3.4-33.9), intranatal fever (AOR = 3.2, 95% CI = 1.1-9.5), first minute APGAR score <7 (AOR = 3.2, 95% CI = 1.3-7.7), resuscitation at birth (AOR = 5.4, 95% CI = 1.9-15.5), nasogastric tube insertion (AOR = 3.7, 95% CI = 1.4-10.2).ConclusionNeonatal invasive procedures, ANC follow up during pregnancy, different conditions during birth like meconium stained amniotic fluid, low APGAR score and resuscitation at birth were the independent predictors of neonatal sepsis.

Project description:IntroductionNowadays, the burden of colorectal cancer (CRC) has been increasing in the world, particularly in developing nations. This could be related to the poor prognosis of the disease due to late presentation at diagnosis and poor treatment outcomes. In Ethiopia, studies related to the stage of colorectal cancer at diagnosis and its determinants are limited. Therefore, the study was intended to assess advanced stage presentation and its associated factors among colorectal cancer patients in northwest Ethiopia.MethodsAn institution-based retrospective study was conducted among 367 CRC patients at two oncologic centers (the University of Gondar and Felege Hiwot comprehensive specialized hospitals) from January 1, 2017, to December 31, 2020. Data were entered into EPi-data 4.2.0.0 and transferred to STATA version 14 statistical software for analysis. Binary logistic regression was used to identify factors associated with the outcome variable. All variables with P-value < 0.2 during bi-variable analysis were considered for multivariable logistic regression. The level of statistical significance was declared at P-value <0.05.ResultsThe magnitude of advanced stage presentation of colorectal cancer was 83.1%. Being rural dwellers (Adjusted odds ratio (AOR) = 3.6; 95% CI: 1.8,7.2), not medically insured (AOR = 3.9; 95% CI: 1.9,7.8), patients delay (AOR = 6.5; 95% CI:3.2, 13.3), recurrence of the disease (AOR = 2.3; 95% CI: 1.1,4.7), and no comorbidity illness (AOR = 4.4; 95% CI: 2.1, 9.1) were predictors of advanced stage presentation of CRC.ConclusionThe current study revealed that the advanced-stage presentation of colorectal cancer patients was high. It is recommended that the community shall be aware of the signs and symptoms of the disease using different media, giving more emphasis to the rural community, expanding health insurance, and educating patients about the recurrence chance of the disease. Moreover, expansion of colorectal treatment centers and screening of colorectal cancer should be given emphasis.

Project description:BackgroundChronic kidney disease (CKD) is the severest form of kidney disease characterized by poor filtration. The magnitude of chronic kidney disease is trending upward in the last few years linked with the rapidly escalating cases of non-communicable chronic diseases, particularly diabetes mellitus. However, little is known about when this problem may occur, the incidence as well as predictors of chronic kidney disease among type-II diabetes mellitus patients. Thus, this study was conducted to determine the incidence, time to the occurrence, and predictors of chronic kidney disease in type-II diabetic patients attending the Amhara region referral hospitals, Ethiopia.MethodsA retrospective follow-up study was conducted involving 415 participants with type-II diabetes mellitus that enrolled in the chronic follow-up from 2012 to 2017. Multivariable shared Frailty Weibull (Gamma) survival model was employed considering the hospitals as a clustering variable. Model fitness was checked by both the Akaike information criteria (AIC) and log-likelihood. Factors having a p-value of ≤0.2 in the bi-variable analysis were considered to enter the multivariable model. Variables that had a p-value of <0.05 with its corresponding 95% confidence level were deemed to be significant predictors of chronic kidney disease.ResultsThe overall cumulative incidence of chronic kidney disease was 10.8% [95%; CI: 7.7-14.0%] with a median occurrence time of 5 years. The annual incidence rate was 193/10,000 [95%; CI: 144.28-258.78]. Having cardiovascular disease/s [AHR = 3.82; 95%CI: 1.4470-10.1023] and hypercholesterolemia [AHR = 3.31; 95% CI: 1.3323-8.2703] were predictors of chronic kidney disease.ConclusionOne out of every ten diabetic patients experienced chronic kidney disease. The median time to develop chronic kidney disease was five years. Hypercholesterolemia and cardiovascular diseases have escalated the hazard of developing CKD. Thus, health promotion and education of diabetic patients to optimize cholesterol levels and prevent cardiovascular disease is recommended to limit the occurrence of this life-threatening disease.

Project description:IntroductionSleep plays an essential role in every individual's life since it contributes greatly to their well-being and health. Poor sleep quality is one of the most common consequences of hypertension (HTN), which is a leading public health problem. In Ethiopia, it is the main health concern among hypertension patients. Thus, in the study area, there is limited information regarding the investigation of sleep quality among hypertension patients. Therefore, this study aimed to assess sleep quality and associated factors among adult hypertensive patients attending a chronic follow up care clinic in northwest Amhara regional state referral hospitals, Northwest Ethiopia.MethodsAn institution-based cross-sectional study was conducted among adult HTN patients from March 15/2021 to May 15/2021 in Northwest Amhara Regional State Referral Hospitals. A systematic random sampling method was used to select the study participants. A face-to-face interviewer-administered questionnaire with chart review was used. The Pittsburgh Sleep Quality Index (PSQI) for assessing sleep quality was used in this study. A binary logistic regression was used to see the association between dependent and independent variables. Variables having a p-value < 0.05 with a 95% CI were considered statistically significant in the multivariable logistic regression analysis.ResultsIn this study, 563 hypertensive patients were included, with a response rate of 96.9%. The overall prevalence of poor sleep quality was 37.7% (95% CI: 33.4%-41.6%). Female gender (AOR = 2.55, 95% CI: 1.55-4.18), age ≥ 65 years (AOR = 4.07, 95% CI: 2.07-7.97), overweight (BMI) ≥ 25 kg/m2 (AOR = 1.68, 95% CI: 1.06-2.65), WHO stage II hypertension (AOR = 1.78, 95% CI:1.01-3.12), poor physical activity (AOR = 2.39, 95% CI:1.41-4.05), participants who had depression (AOR = 2.03,95% CI:1.24-3.34) and participants who had anxiety (AOR = 1.89, 95% CI: 1.16-3.03) were factors associated with poor sleep quality.ConclusionsIn this study, more than one-third of the study participants had poor sleep quality. Female gender, age ≥ 65 years, overweight (BMI) ≥ 25 kg/m2, stage II hypertension, physical inactivity, depression, and anxiety were all associated with poor sleep quality. Managing depression and anxiety disorders, encouraging physical activity, and providing health education about weight loss are all necessary for HTN patients.

Project description:BackgroundWith expanding access to pediatric antiretroviral therapy, several patients in the developing world were switched to the second-line regimen, and some require third-line medications. A delay in a second-line switch is associated with an increased risk of mortality and other undesired therapeutic outcomes, drives up program costs, and challenges the pediatric antiretroviral therapy service. Nevertheless, there remain limited and often conflicting estimates on second-line antiretroviral therapy use during childhood, especially in resource-limited settings like Ethiopia. Thus, this study intended to determine the incidence and predictors of switching to second-line antiretroviral therapy among children.MethodsA retrospective cohort study was conducted by reviewing records of 424 randomly selected children on first-line antiretroviral therapy from January 2014 to December 2018 at public hospitals in the Central and Southern Zones of Tigray, Northern Ethiopia. Data were collected using extraction tool; entered into Epi-data; cleaned, and analyzed by STATA version-14. Kaplan-Meier curve, log-rank test, and life table were used for data description and adjusted hazard ratios and p-value for analysis by Cox proportional hazard regression. Variables at a P-value of ≤0.20 in the bi-variable analysis were taken to multivariable analysis. Finally, statistical significance was declared at a P-value of ≤0.05.Results and conclusionAnalysis was conducted on 424 charts with a total person-time observation of 11686.1 child-months and an incidence switch rate of 5.6 (95%CI: 4.36-7.09) per 1000 child-month-observations. Being orphan [AHR = 2.36; 95%CI: 1.10-5.07], suboptimal adherence [AHR = 2.10; 95% CI: 1.12-3.92], drug toxicity [AHR = 7.05; 95% CI: 3.61-13.75], advanced latest clinical stage [AHR = 2.75; 95%CI: 1.05-7.15], and tuberculosis co-infection at baseline [AHR = 3.08; 95%CI: 1.26-7.51] were significantly associated with switch to second-line antiretroviral therapy regimen. Moreover, a long duration of follow-up [AHR = 0.75; 95% CI: 0.71-0.81] was associated with decreased risk of switching. Hence, it is better to prioritize strengthening the focused evaluation of tuberculosis co-infection and treatment failure with continuous adherence monitoring. Further research is also needed to evaluate the effect of drug resistance.

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:ObjectiveThis study aimed to assess the incidence and predictors of mortality in adolescents receiving antiretroviral therapy (ART) in Ethiopia's Amhara Region.DesignWe conducted an institution-based retrospective follow-up study.SettingsThe study was conducted at Amhara Region's comprehensive specialised hospitals in Ethiopia.ParticipantsWe included 961 randomly selected medical records of adolescents receiving ART between January 2005 and June 2020.Primary and secondary outcomesThe 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.ResultsMore 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).ConclusionsOur 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.

Project description:ObjectivesIt has been reported that maintaining a normal body temperature among surgical patients can reduce the length of hospitalisation by up to 40%, decrease the risk of surgical site infection by 64% and reduce mortality by fourfold. Nurses are primarily responsible for preventing the occurrence of hypothermia among surgical patients. This study assessed nurses' knowledge and practices with respect to perioperative hypothermia prevention in Northwest Ethiopia, and investigated the factors associated with good knowledge and practice.DesignCross-sectional study.SettingNorthwest Amhara Regional State Referral Hospitals, Northwest Ethiopia, 25 March-20 May 2021.Participants413 nurses working in the perioperative units of five referral hospitals.Outcome measuresPerioperative hypothermia prevention knowledge and practice among nurses.ResultsNearly three-fifths (59.1%; 95% CI: 54.7% to 63.7%) of respondents had good knowledge and about half (50.4%; 95% CI: 45.5% to 55.0%) had good practice with respect to perioperative hypothermia prevention. Factors associated with nurses' knowledge of prevention of perioperative hypothermia included male sex (adjusted OR (AOR): 1.61, 95% CI: 1.02 to 2.53), having a bachelor's degree (AOR: 2.50, 95% CI: 1.25 to 5.00), having a master's degree (AOR: 4.39, 95% CI: 1.45 to 13.20) and training participation (AOR: 3.68, 95% CI: 2.14 to 6.33). Factors associated with nurses' practice of prevention of perioperative hypothermia included working in recovery (AOR: 2.87, 95% CI: 1.08 to 7.58) and intensive care units (AOR: 2.39, 95% CI: 1.09 to 5.22), training participation (AOR: 2.64, 95% CI: 1.53 to 4.57), being satisfied with their job (AOR: 2.15, 95% CI: 1.34 to 3.43) and having good knowledge (AOR: 2.64, 95% CI: 1.63 to 4.27).ConclusionNurses' knowledge and practice of the prevention of perioperative hypothermia were inadequate. Hospital managers need to design and strengthen training programmes and work to enhance job satisfaction.

Project description:BackgroundEven though pregnancy does not affect HIV infection progression, HIV affects the pregnancy outcome. Maternal HIV infection has many untoward effects which include low birth weight which is the major cause of neonatal, infant, and under-five mortality. However, there is controversy and limited information about the effect of HIV status on birth weight around the world including Ethiopia. Therefore, this study aimed to compare the prevalence of LBW and their associated factors among HIV+ and HIV- mothers delivered in Northwest Amhara region referral hospitals.MethodA comparative crossectional study was conducted from September 2016 to September 2019. A simple random sampling technique was used to select 474 participants. Data were collected from the mothers' chart by using a data extraction sheet and then entered into Epi-data and exported into SPSS for analysis. Independent variables with p-values < 0.2 in the bivariable analysis were entered into multivariable logistic regression models with backward logistic regressions method to control confounders and identify the factor.ResultThe overall prevalence of LBW was 13.9% (95% CI:10.8%-17.1%). The prevalence was higher among HIV+ 17.7% (95% CI:14.1%-22.8%) than HIV- mothers 10.1% (95% CI:6.3%-13.8%). CD4 count < 200 cells/mm3 [AOR 3.2, 95%CI (1.05, 9.84)] and between 200-350 cells/mm3 [2.81, 95% CI (1,08, 7.28)], Mothers with MUAC <23 cm [AOR 3.39, 95% CI (1.41, 8.18)] and gestational age <37 weeks [AOR 7.34, 95% CI (3.02,17.80)] were significantly associated with LBW in HIV+ mothers. While, rural residence [AOR 3.93,95% CI (1.356,11.40)], PROM during current pregnancy [AOR 4.96, 95% CI (2.55, 15.83)] and gestational age <37 week [AOR 8.21, 95% CI (2.60, 25.89)] were significantly associated with LBW in HIV negative mothers.ConclusionThe prevalence of LBW was significantly higher among HIV+ mothers as compared to HIV-mothers and this study suggests to emphasize nutritional supplementation of HIV positive mothers, needs to focus on nutritional counseling during ANC/PMTCT follow up and encourage HIV positive mothers to delay their pregnancy until their immune status improve.

Dataset Information

Incidence and predictors of treatment failure among children on first-line antiretroviral therapy in Amhara Region Referral Hospitals, northwest Ethiopia 2018: A retrospective study.

Background

Methods

Results

Conclusion

Publications

Incidence and predictors of treatment failure among children on first-line antiretroviral therapy in Amhara Region Referral Hospitals, northwest Ethiopia 2018: A retrospective study.

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