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Incidence of Mortality and Its Predictors Among Adult Visceral Leishmaniasis Patients at the University of Gondar Hospital: A Retrospective Cohort Study.

ABSTRACT: Background:Visceral leishmaniasis (VL) is a neglected tropical disease, affecting the poor and productive age group of a country, resulting in a huge impact on its economic development. Even though anti-leishmanial drugs reduce the incidence of mortality among VL patients, there is still death of these patients while on treatment. In this aspect, there are limited studies in Ethiopia; therefore, this study aimed to determine the incidence of mortality and its predictors among adult VL patients at the University of Gondar Hospital. Methods:Institution-based retrospective cohort study was conducted among 586 adult visceral leishmaniasis patients who were admitted to the University of Gondar Hospital from 2013 to 2018. Data were collected from the patients' charts and registration books, and analyzed using Stata 14 software. Kaplan-Meier failure curve and Log r?ank test was used to compare the survival probability of patients with independent variables. A multivariable stratified Cox regression model was used to identify predictors of mortality among VL patients. P? 0.05 was employed to declare statistically significant factors. Adjusted hazard ratio (AHR) and 95% confidence interval (95% CI) were estimated for potential risk factors included in the multivariable model. Results:A total of 586 VL patients were included in the study. The age of patients ranged from 18 to 55 years with a median age of 27 years. The incidence of mortality was 6.6 (95% CI: 5.2-8.4) per 1000 person-days of observation. Independent predictors of mortality were presence of comorbidity (AHR=2.29 (95% CI: 1.27-4.11)), relapse VL (AHR=3.03 (95% CI: 1.25-7.35)), treatment toxicity (AHR=5.87 (95% CI: 3.30-10.44)), nasal bleeding (AHR=2.58 (95% CI: 1.48-4.51)), jaundice (AHR=2.84 (95% CI: 1.57-5.16)) and being bedridden at admission (AHR=3.26 (95% CI: 1.86-5.73)). Conclusion:The incidence of mortality among VL patients was high. Mortality was higher among VL patients with concomitant disease, relapse VL, treatment toxicity, nasal bleeding, jaundice, and those who were bedridden at admission, which implies that great care should be taken for these risky groups through strict follow-up and treatments.

SUBMITTER: Yeshaw Y

PROVIDER: S-EPMC7102893 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Incidence of Mortality and Its Predictors Among Adult Visceral Leishmaniasis Patients at the University of Gondar Hospital: A Retrospective Cohort Study.

Yeshaw Yigizie Y Tsegaye Adino Tesfahun AT Nigatu Solomon Gedlu SG

Infection and drug resistance 20200324

<h4>Background</h4>Visceral leishmaniasis (VL) is a neglected tropical disease, affecting the poor and productive age group of a country, resulting in a huge impact on its economic development. Even though anti-leishmanial drugs reduce the incidence of mortality among VL patients, there is still death of these patients while on treatment. In this aspect, there are limited studies in Ethiopia; therefore, this study aimed to determine the incidence of mortality and its predictors among adult VL pa ...[more]

PMID: 32273732

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Project description:INTRODUCTION:Loss to follow up after the initiation of antiretroviral therapy (ART) is common in Africa, particularly in Ethiopia and it is a considerable obstacle for the effectiveness of the ART program. Mortality is a competing risk of loss to follow up but it is often overlooked and there is limited evidence about the incidence and predictors of loss to follow up in the presence of competing events. OBJECTIVE:To assess the Incidence and predictors of loss to follow up among adult HIV patients on ART in University of Gondar Comprehensive Specialized Hospital between January 1, 2015, and December 31, 2018. METHODS:Institution based retrospective follow up study was conducted in University of Gondar Comprehensive Specialized Hospital. A Gray's test and cumulative incidence curve were used to compare the cumulative incidence function of loss to follow up. Bivariable and multivariable competing risk regression models were fitted to identify the predictors of lost to follow up and those variables with p-value <0.05 in the multivariable analysis was considered as significant predictors of lost to follow up. RESULT:A total of 531 adult HIV patients on ART were included in the analysis. The incidence rate of loss to follow up in this study was 10.90 (95% CI: 8.9-13.2) per 100 person years. Being age group 15-30 years (aSHR = 2.01; 95%CI;1.11-3.63), being daily laborer(aSHR = 2.60; 95%CI;1.45-4.66), not receiving cotrimoxazole preventive therapy (aSHR = 2.66; 95%CI;1.68-4.21), not receiving isoniazid preventive therapy(aSHR = 4.57; 95% CI;1.60-13.08), ambulatory functional status (aSHR = 1.61; 95% CI; 1.02-2.51) and taking AZT-3TC-NVP medication at start of ART(aSHR = 2.01; 95% CI; 1.16-3.78) were significant predictors of lost to follow up. CONCLUSION:In this study the incidence of lost to follow up was high. Young people, daily laborer, ambulatory patients and those taking AZT-3TC-NVP as well as those who did not take opportunistic prophylaxis were at higher risk of loss to follow up. Therefore, giving special attention to the high-risk groups for lost to follow up highlighted in this study could decrease the rate of LTFU.

Project description:BackgroundAnemia is a major public health problem worldwide which accounts 24.8% of the population. Subsequently, anemia is a leading killer of people living with human immunodeficiency virus and many of these deaths occur in developing countries including Ethiopia. Cross sectional studies have done on anemia and human immunodeficiency virus. However, there is limited study on incidence of anemia and its predictors among adults on HIV care, especially no survival study has been conducted in the study area.ObjectiveTo assess incidence and predictors of anemia among adults on Human immunodeficiency virus care.MethodsAn institution-based retrospective cohort study was conducted among 434 adults on HIV care from January 1st 2015 to December 30th 2019 at Debre Tabor Referral Hospital. A computer-generated simple random sampling technique was employed to select the study participants. Ethical clearance was obtained from the Institutional Review Board of Bahir Dar University, and also, we got implied consent to review charts from the concerned bodies in the hospital. Data were entered using Epi-data version 3.1 and analyzed by using STATA version 14.0. A Kaplan Meier survival curve was utilized to estimate anemia free survival time. Bivariable and Multivariable Cox proportional hazards model were fitted to identify predictors of anemia.ResultsThe overall incidence density rate of anemia was 6.27 (95% CI: 0.051, 0.077) per 100 person years. Clinical stage III/IV (AHR = 1.04; 95% CI = 1.02, 1.06), Body Mass Index less than 18.5 kg/m2 (AHR = 3.11; 95% CI = 1.56, 6.22), serum creatinine greater than 1.1 IU/L(AHR = 2.07; 95% CI = 1.12, 3.81) and fair/poor level of adherence(AHR = 1.05; 95% CI = 1.03, 1.07) were statistically significant predictors of anemia while increased anti-retroviral treatment duration (AHR = 0.98; 95% CI = 0.97, 0.99) decrease the risk of anemia at 95% confidence level.ConclusionThe overall incidence density rate of anemia was high. Patients with clinical stage III/IV, body mass index < 18.5 kg/m2, serum creatinine greater than 1.1 IU/L and fair/poor level of adherence were significant predictors of anemia while increased antiretroviral treatment duration had decreased the risk of anemia.RecommendationEven if the overall incidence rate of anemia was lower as compared to previous studies in Ethiopia, still the incidence of anemia was high. So, prevention measures should be taken beside with HIV care especially within 6-months ART initiation.

Project description:IntroductionCorneal transplantation is the only treatment option for corneal blindness to restore sight. However, there is a disproportionate imbalance between the demand and supply of corneal tissue in Ethiopia. This is because accessing corneal tissue is reliant on people who are willing to donate corneas after death.ObjectiveThis study aimed to assess the proportion of willingness to donate cornea and associated factors among adult patients attending at University of Gondar comprehensive and specialized hospital.MethodInstitutional based cross-sectional study was conducted from July 13 to July 28, 2020, through a face-to-face interview. A total of 451 samples were selected using systematic random sampling. The data were entered into Epidemiological information version 7 and exported to statistical package for social science version 20 for formal analysis. Variables with a P-value of < 0.20 in a bi-variable logistic regression were entered into the multivariable logistic regression and those variables with a p-value of < 0.05 were taken as statistically significant. The strength of association was shown using the odds ratio with a 95% confidence interval.ResultA total of 408 adults participated in this study with a response rate of 90% and the proportion of willingness to donate cornea was 179(43.90%). Participants who had a religious belief in Christianity (AOR = 3.23 (95% CI: 1.09-9.57)) and good knowledge about corneal donation (AOR = 5.45(95%CI: 2.69-11.18)) were positively associated with the willingness of corneal donation. On the other side, the age group above 43 years (AOR = 0.31(95% CI: 0.11-0.89) was negatively associated with the willingness of corneal donation.ConclusionThe proportion of willingness to donate cornea 43.9% among participants attending Gondar University Comprehensive and Specialized Hospital. Age group greater than 43 years, religion of Christianity and good knowledge were associated with the willingness of corneal donation.

Dataset Information

Incidence of Mortality and Its Predictors Among Adult Visceral Leishmaniasis Patients at the University of Gondar Hospital: A Retrospective Cohort Study.

Publications

Incidence of Mortality and Its Predictors Among Adult Visceral Leishmaniasis Patients at the University of Gondar Hospital: A Retrospective Cohort Study.

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