Determinants of Time-to-Death of Chronic Lymphocytic Leukemia Patients at Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia.

Background: Leukemia is a group of cancers that usually begin in the bone marrow and results in a large number of abnormal white blood cells. Chronic Lymphocytic Leukemia is the most prevalent leukemia in Western countries, with an estimated incidence rate of less than 1 to 5.5 per 100 000 people, and average age at diagnosis of 64 to 72 years. It is more common in men among Chronic Lymphocytic Leukemia patients in Ethiopia's hospitals at Felege Hiwot Referal Hospital. Methods: A retrospective cohort research design was employed to acquire critical information from patients' medical records in order to achieve the study's purpose. The study comprised the medical records of 312 Chronic Lymphocytic Leukemia who were followed from January 1, 2018 to December 31, 2020. A Cox proportional hazard model was used to determine the risk factors for time to death in Chronic Lymphocytic Leukemia patients. Results: Accordingly the Cox proportional hazard model, age (Hazard Ratio = 11.36; P < .001), sex of male (Hazard Ratio = 1.04; P = .004), married status (Hazard Ratio = 0.03; P = .003), medium stages of Chronic Lymphocytic Leukemia (Hazard Ratio = 1.29; P = .024), high stages of Chronic Lymphocytic Leukemia (Hazard Ratio = 1.99; P < .001), presence of anemia (Hazard Ratio =0.09; P = .005), platelets (Hazard Ratio = 2.11; P = .007), hemoglobin (Hazard Ratio = 0.02; P < .001), lymphocytes (Hazard Ratio = 0.29; P = .006), red blood cell (Hazard Ratio = 0.02; P < .001), which patients with Chronic Lymphocytic Leukemia had a significant relationship with time to death. Conclusions: Age, sex, Chronic Lymphocytic Leukemia stage, anemia, platelets, hemoglobin, lymphocytes, and red blood cells were all statistically significant determinants in the time to death of Chronic Lymphocytic Leukemia patients, according to the data. As a result, healthcare providers should pay particular attention to and emphasize the identified characteristics, as well as provide frequent counseling on how to enhance the health of Chronic Lymphocytic Leukemia patients.

Determinants of Low Birth Weight Among Newborns at Debre Tabor Referral Hospital, Northwest Ethiopia: A Cross-Sectional Study.

Introduction: Low birth weight is one of the important predictors of perinatal survival, infant morbidity, and mortality, as well as the risk of developmental disabilities and diseases in the future. Objectives: The study aimed to identify the associated factors of low birth weight among newborns at Debre Tabor referral hospital, Northwest Ethiopia. Methods: A hospital-based cross-sectional study was conducted from January 1, 2021 to October 30, 2021 at Debre Tabor Referral Hospital. A total sample of 420 newborn birth records was considered. The binary logistic regression model was used to assess the associated factors of low birth weight. The results are presented as crude odds ratios and adjusted odds ratios (AOR) together with their corresponding 95% confidence intervals. Results: In this study, 422 participants were included. Rural residence (AOR = 2.01; 95%CI 1.10-3.69), married marital status (AOR = 0.82; 95%CI 0.78-0.86), formal education (AOR = 0.79; 95%CI 0.67-0.92), smoking during pregnancy (AOR = 1.19; 95%CI 1.07-1.33), attended antenatal care (ANC) visits (AOR = 0.57; 95%CI 0.35-0.91), diabetes during pregnancy (AOR = 4.34; 95%CI 3.50-5.39), iron supplementation (AOR = 0.23; 95%CI 0.20-0.25), and maternal history of anemia (AOR = 5.87; 95%CI 2.67-12.89) were significantly associated with low birth weight of newborns. Conclusion: This finding showed that residence, marital status, educational status, smoking during pregnancy, ANC visit, diabetes during pregnancy, iron supplementation, and mother's history of anemia were significantly associated with low birth weight. Therefore, policy makers and public health experts/practitioners should plan smoking preventive public health promotion campaigns. Furthermore, it is important that all health professionals properly manage the possible cause of LBW during pregnancy.

Determinants of exclusive breastfeeding practices among mothers in Ethiopia.

BACKGROUND: Exclusive breastfeeding (EBF) is the most cost-effective intervention to reduce infant morbidity and mortality worldwide. It is crucial since human milk contains nutrients, living cells, and defensive factors which enable infants to have better immunity, physical and mental development. Therefore, this study aimed at identifying the predictors of exclusive breastfeeding practices among mothers in Ethiopia using Ethiopian Demographic and Health Survey (EDHS) 2016 data. METHODS: EDHS 2016 data were used for the analysis. A total of 1,066 mothers were included in the analysis. The binary logistic regression model was used to identify the determinants of EBF practice among mothers. The result presented using adjusted odd ratio (AOR) with a 95% confidence interval. RESULTS: The prevalence of EBF was 58% of infants under age 6 months. Mothers age 25-34 (AOR = 1.74; 95% CI 1.31-2.32), child age 4-5 months (AOR = 0.74; 95% CI 0.66-0.84), married marital status (AOR = 1.26; 95% CI 1.06-1.50), mothers attained secondary education or higher (AOR = 2.00; 95% CI 1.54-2.58), husband attained secondary education or higher (AOR = 1.70; 1.39-2.13), richer wealth index (AOR = 0.35; 95% CI 0.18-0.69), accessed to the media (AOR = 1.77; 95% CI 1.38-2.27), number of living children 3-4 (AOR = 0.49; 95% CI 0.25-0.95), health facility (AOR = 1.87; 95% CI 1.09-3.20), rural residence (AOR = 0.66; 95% CI 0.49-0.89) and mothers living in Afar (AOR = 100.2; 95% CI 15.68-640.61), Somali (AOR = 52.65; 95% CI 8.48-326.77), SNNPR (AOR = 6.94; 95% CI 1.05-45.79), Harari (AOR = 61.94; 95% CI 9.75-393.44), Addis Ababa (AOR = 13.07; 95% CI 2.06-82.99), and Dire Dawa (AOR = 28.91; 95% CI 4.38-190.86) were associated with EBF practice. CONCLUSIONS: The practice of exclusive breastfeeding remains low in Ethiopia. Therefore, the stakeholders should be taken into consideration those determinant factors identified in this study in policies and programmes to increase EBF practice among mothers. Moreover, designing and implementing specific strategies to enhance the rate of exclusive breastfeeding practices through community-based education is recommended.

Reason and Associated Factors for Nonuse of Contraceptives Among Ethiopian Rural Married Women: A Multilevel Mixed Effect Analysis.

Introduction: Contraception has a clear impact on the health of women and families in developing countries. This study aims to identify multilevel determinants of nonuse of modern contraceptives among Ethiopian rural married women in their productive age group. Method: The study relied on data from the 2016 Ethiopian Demographic and Health Surveys. A multilevel logistic regression model was used for analysis. Result: In rural areas, nonuse of modern contraceptives is surprising high (81.7%), primarily due to fear of side effects (12.89%) and breastfeeding (8.2%). Among women aged 35 to 49 years (adjusted odds ratio [AOR] = 0.66; 95% confidence interval [CI]: 0.540.81), husbands with secondary and above education levels (AOR = 0.83; 95% CI: 0.7-1), those in the high wealth index (AOR = 0.61; 95% CI: 0.51-0.72), and those who have had 1 to 2 children in the past 5 years (AOR = 0.28; 95% CI: 0.24-0.33), there was a lower chance of not using contraception. Muslims are less likely to want to use modern contraceptives (AOR = 1.2; 95% CI: 0.96-1.4). Women living in Afar (AOR = 20.9; 95% CI: 9.6-44.7), Oromia (AOR = 1.5; 95% CI: 1.01-2.3), Somali (AOR = 71.1; 95% CI: 24.1-209.2), Gambela (AOR = 2.3; 95% CI: 1.4-3.9), Harari (AOR = 4.4; 95% CI: 2.24-8.72), and Dire Dawa (AOR = 3.2; 95% CI: 1.5-6.9), regional states, were less likely to want to use modern contraceptives as compared to those in Tigray. Conclusion: Family planning interventions should target younger women, women living in rural areas, the poor, and Muslim women. In order to maximize the effectiveness of family planning promotion policies, it's important to address the reasons for nonuse of contraceptives identified in each region and contextual differences regarding women of reproductive age.

Postnatal Care Utilization Coverage and its Associated Factors Among Mothers in South Gondar Zone, Northwest Ethiopia: A Cross-Sectional Study.

Background: Postnatal care (PNC) is critical for both the mother and the infant to treat delivery complications and provide the mother with important information on caring for herself and her baby. However, only 17% of women and 13% of newborns in Ethiopia received a postnatal checkup within the first two days of birth. This figure is significantly lower than the least developed countries. This study aimed to assess the coverage and associated factors of PNC service utilization in South Gondar Zone, Northwest Ethiopia. Method: A community-based cross-sectional study was conducted from September 2020 to May 2021. The data were gathered using an interviewer-administered structured questionnaire. A total of 434 women who gave birth within 2 years of the study were included in the analysis. Bivariable and multivariable logistic regression model was used to identify factors associated with PNC service utilization. Result: The prevalence of women who used PNC services was 36.4%. The study showed that antenatal care visit, husbands who have a secondary education, women with a secondary education, daily laborer women, husbands working for the government or non-profit sector, delivered in a health institution, nearby hospitals, travel by car to the nearest health facility were positively associated with PNC utilization. While, not having a cell phone, rural women and not having road access to a health facility, have not been receiving counseling were negatively associated with PNC utilization. Conclusion: The coverage of PNC service utilization in the study area was extremely low. Therefore, government and health care departments should pay special attention to uneducated women, women in rural areas, and women who are unemployed, are not exposed to mass media, and do not have access to transportation to improve PNC service utilization. Furthermore, programs educating mothers on the benefits of antenatal checkups and safer places of childbirth should be considered to increase PNC service utilization.

Bayesian Shared Frailty Models for Time to First Birth of Married Women in Ethiopia: Using EDHS 2016.

Introduction: The primary effect of the fertility process is the birth of the first child. The ages at which women establish marital union and give their first birth depend on and result in varying demographic features. This research demonstrates how to examine the effect of numerous factors on married women's delay to first birth in Ethiopia using Bayesian parametric models with gamma shared frailty distribution. Methods: This study analyzed data from the 2016 EDHS on factors related to the time of married women to first birth. A sample of 8810 married women from all parts of Ethiopia participated in the study. The Akaike information criterion (AIC) and Bayesian information criterion (BIC) were used to compare several parametric models with gamma shared frailty distributions to find the best model (BIC). Finally, when the prior data was taken into account, the chosen model was proven to be accurate (Bayesian approach). Results: The median survival time for the first birth after marriage is 24 years (95% CI; 23.4, 25.3). The result shows that the place of residence, the access to media, the level of education of the mother, the education level of the husband, the use of the head of the contraceptives, and the sex of the household are statistically associated with the time to first birth of married women. The Weibull-gamma shared frailty model under the Bayesian approach was found to be the best model that fit the time to first birth data in this study. The result also showed that there is heterogeneity between regions of married women. Conclusion: To slow the increase in the Ethiopian population, families must be taught how to use contraception, and rural populations must be educated on the necessity of increasing the length of the first birth gap rather than encouraging early marriage. In general, attempts to reduce fertility by raising the age of the first marriage must consider the social and cultural settings in which marriage takes place. On the other hand, the campaign against early marriage should focus on the sociocultural, physiological, and psychological effects, as well as the reduction of reproduction.

Multilevel log linear model to estimate the risk factors associated with infant mortality in Ethiopia: further analysis of 2016 EDHS.

BACKGROUND: Infant mortality is defined as the death of a child at any time after birth and before the child's first birthday. Sub-Saharan Africa has the highest infant and child mortality rate in the world. Infant and child mortality rates are higher in Ethiopia. A study was carried out to estimate the risk factors that affect infant mortality in Ethiopia. METHOD: The EDHS- 2016 data set was used for this study. A total of 10,547 mothers from 11 regions were included in the study's findings. To estimate the risk factors associated with infant mortality in Ethiopia, several count models (Poisson, Negative Binomial, Zero-Infated Poisson, Zero-Infated Negative Binomial, Hurdle Poisson, and Hurdle Negative Binomial) were considered. RESULT: The average number of infant deaths was 0.526, with a variance of 0.994, indicating over-dispersion. The highest mean number of infant death occurred in Somali (0.69) and the lowest in Addis Ababa (0.089). Among the multilevel log linear models, the ZINB regression model with deviance (17,868.74), AIC (17,938.74), and BIC (1892.97) are chosen as the best model for estimating the risk factors affecting infant mortality in Ethiopia. However, the results of a multilevel ZINB model with a random intercept and slope model revealed that residence, mother's age, household size, mother's age at first birth, breast feeding, child weight, contraceptive use, birth order, wealth index, father education level, and birth interval are associated with infant mortality in Ethiopia. CONCLUSION: Infant deaths remains high and infant deaths per mother differ across regions. An optimal fit was found to the data based on a multilevel ZINB model. We suggest fitting the ZINB model to count data with excess zeros originating from unknown sources such as infant mortality.

Factors Associated With Community Based Health Insurance Healthcare Service Utilization of Households in South Gondar Zone, Amhara, Ethiopia. A Community-Based Cross-Sectional Study.

In Ethiopia, community-based health insurance was implemented to promote equitable access to sustainable quality health care and increase financial protection. The purpose of this study was to identify factors associated with community-based Health Insurance, Health Care Service Utilization of Households in the South Gondar Zone. A community-based cross-sectional study was employed. Data were collected among 619 randomly selected households in the south Gondar zone. Chi-square and binary logistic regression analyses with a P-Value of less than .05 were used to determine the association. Out of the total households, 511(82.6%) were using the CBHI scheme for health care service utilization. Residence, marital status, education level, occupation status, family size, presence of under-five children in the household, presence of elders in the households, nearest health institution, presence of chronic illness in the household's, time taken to reach health institution, an attitude of a household were the determinant factors of community-based health insurance scheme health care service utilization of households. It is recommended that the local, regional and national governments, policymakers on optimal actions, NGOs, and other supporting organizations shall improve or scale-up the scheme by providing awareness to the community based on these significant factors and the attitude of households.

Time to Death and Its Determinant Factors Among Patients With Chronic Heart Failure in Northwest Ethiopia: A Retrospective Study at Selected Referral Hospitals.

Background: Heart failure (HF) is a major health problem that affects patients and healthcare systems worldwide. It is the leading cause of morbidity and death and negatively impacts the quality of life, healthcare costs, and longevity. However, the causes of death were not well defined. This study aimed to identify the determinants of death among patients with HF in the Amhara Region, Northwest Ethiopia. Methods: A multicenter retrospective cohort study was conducted on 285 patients in the age group 15 years or older under follow-up from 1 January 2015 to 31 December 2019. Descriptive analyses were summarized using the Kaplan-Meier survival curve and the log-rank test. Then, the Cox-proportional hazard regression model was employed to estimate the hazard of death up to 5 years after they were admitted to the HF department to follow up on their treatment. Results: Out of 285 patients with HF, 93(32.6%) of the respondents were dying within 5 years of follow-up. Anemia was the common comorbid disease (30.5%), and valvular heart disease was the most common etiology (33.7%) of chronic heart failure in this study. This study showed a significant mortality difference between hospitals. HF patients with hypertension [adjusted hazard ratio (AHR): 3.5076, 95% confidence interval (CI): 1.43, 8.60], anemia (AHR: 2.85, 95% 1.61, 5.03), pneumonia (AHR: 2.02, 95% 1.20, 3.39), chronic kidney disease (2.23, CI: 1.31, 3.77), and diabetes mellitus (AHR: 2.42, 95% CI: 1.43, 4.09) were at a higher risk of death. Moreover, patients with symptoms listed in the New York Heart Association Class (III and IV), Ischemic Heart Disease and unknown etiologies, men (AHR: 2.76, 95%:1.59, 4.78), and those with a high pulse rate (AHR: 1.02, 95%:1.00, 1.04) were at a higher risk of death. Conclusion: There was a mortality difference between hospitals. This study has revealed that HF patients with anemia, diabetes mellitus, pneumonia, hypertension, chronic kidney disease, HF etiologies, severe New York Heart Association Class (III and IV), men, and high pulse rate were the main factors associated with death. Health professionals could give more attention to patients whose pulse rate is high, men, and a patient who had comorbidities in the ward.

Prevalence and risk factors associated with rural women's protected against tetanus in East Africa: Evidence from demographic and health surveys of ten East African countries.

BACKGROUND: Tetanus is a deadly bacterial infection caused by Clostridium tetani wound contamination characterized muscular spasms and autonomic nervous system dysfunction. Maternal and neonatal tetanus occurs under improper hygiene practices during childbirth. Globally, an estimated 3.3 million newborn deaths occur every year, and about 9,000 babies die every day in the first 28 days of life. This study sought to identify risk factors associated with the immunization of rural women against tetanus in rural areas in ten East African countries. METHOD: The data used in this study were taken from the Demographic and Health Survey (DHS) of ten East African countries (Ethiopia, Burundi, Comoros, Zimbabwe, Kenya, Malawi, Ruanda, Tanzania, Uganda and, Zambia). Multivariable binary logistic regression is used to determine the risk factors associated with tetanus-protected women in east Africa. RESULTS: The weighted total samples of 73735 rural women were included in the analysis. The combined prevalence of tetanus immunization among protected rural women in ten East African countries was 50.4%. Those women with age of 24-34 (AOR = 0.778; 95%CI: 0.702-0.861), higher educational level (AOR = 4.010; 95%CI: 2.10-5.670), rich women (AOR = 3.097;95%CI: 2.680-3.583), mass media coverage (AOR = 1.143; 95%CI: 1.030-1.269), having above three antenatal care follow up (AOR = 1.550; 95% CI: 1.424-1.687), big problem of distance to health facility (AOR = 0.676; CI: 0.482-0.978) and place of delivery health facility (AOR = 1.103; 95% CI: 1.005-1.210) had a significant effect on women's protected from tetanus. CONCLUSION: The coverage of tetanus immunization in East Africa was very low. Public health programs target rural mothers who are uneducated, poor households, longer distances from health facilities, mothers who have the problem of media exposure, and mothers who have not used maternal health care services to promote TT immunization.

Determinants of Organic Fertilizers Utilization Among Smallholder Farmers in South Gondar Zone, Ethiopia.

BACKGROUND: Adoption of organic fertilization is low among farmers in rural areas of Ethiopia, affecting yields and general food security in the region. This study aimed to identify the determinants of the utilization of organic fertilizers among smallholder farmers in the South Gondar Zone, Amhara National Regional State (ANRS), Northwest Ethiopia. METHODS: A community-based cross-sectional study was used among smallholder farmers in the South Gondar Zone, ANRS, Northwest Ethiopia. Primary data were collected from 420 sample respondents using multistage sampling with a combination of both simple random and cluster sampling techniques. The binary logistic regression model was used to assess the use of organic fertilizers among smallholder farmers in the South Gondar Zone. The results are presented as adjusted odds ratios (AOR) together with their corresponding 95% confidence intervals. RESULTS: head of household age (AOR = 1.099, 95% CI 1.018-1.187), married marital status (AOR = 10.506, 95% CI 1.355-81.427), literate head of household (AOR = 3.323, 95% CI 1.571-7.029), number of laborers (AOR = 1.442, 95% CI 1.060-1.962), farming experience (AOR = 1.132, 95% CI 1.041-1.232), farm size (AOR = 1.063, 95% CI 1.008-1.121), and number of livestock (AOR = 1.368, 95% CI 1.115-1.677) were positively associated with the utilization of organic fertilizer while single marital status (AOR = 0.062, 95% CI 0.004-0.851), cost of laborer (AOR = 0.965, 95% CI 0.951-0.978), household income (AOR = 0.880, 95% CI 0.824-0.939), medium soil fertility (AOR = 0.039, 95% CI 0.007-0.229), fertile soil (AOR = 0.020, 95% CI 0.003-0.120), and home to farm distance (AOR = 0.219, 95% CI 0.067-0.717) were negatively associated with the utilization of organic fertilizer. CONCLUSIONS: This finding showed that multiple variables have an effect to determining the use of organic fertilizer by smallholder farmers. Therefore, the finding is important to adopt programs to encourage the use of organic fertilizer, implement policies in an attempt to adapt the use of organic fertilizer among the South Gondar Zone, and critically consider these factors. Furthermore, extension workers should focus on raising awareness about the importance of organic fertilizers to encourage or expand their use among smallholder farmers.

A Comparison of Adherence and CD4 Cell Count with Respect to Virologic Failure Among HIV-Infected Adults Under Combination Antiretroviral Therapy (cART) at Felege Hiwot Teaching and Specialized Hospital, Bahir Dar, Ethiopia.

BACKGROUND: Medication adherence plays a significant in the success of combination antiretroviral therapy (cART). Therefore, the current investigation was conducted with the objective of comparing adherence and CD4 cell count with respect to virologic failure among HIV-infected adults under cART. METHODS: A retrospective study design was conducted on 792 randomly selected HIV-infected adult patients who initiated first-line cART enrolled in the first 10 months of 2012 and followed up to August 2018 by using a simple random sampling technique based on their identification number. RESULTS: The main outcome for the current investigation was the virologic failure which was decreased with successive visits. The area under the receiver operating characteristic curve for adherence and CD4 cell count change were 0.68 and 0.63 with χ 2 = 21.2; p-value <0.001 for the 12-month assessment. Similarly, these areas for the 36th and 60th month assessments were 0.71 and 0.66, with χ 2 = 23.2; p-value <0.001, and 0.73 and 0.71 with χ 2 = 24.3; p-value <0.001 for adherence and CD4 cell count, respectively. CONCLUSION: Pill count adherence was more accurate compared to CD4 cell count change for assessing virologic responses. Therefore, because of its easy access, simple use, cost-effectiveness, and accuracy, the adherence to cART was in favor of CD4 cell count change for monitoring the healthcare quality of HIV-infected patients.

Risk Factors of White Blood Cell Progression Among Patients With Chronic Lymphocytic Leukemia at Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia.

BACKGROUND: Leukemia is a type of cancers that start in the bone marrow and produce a serious number of abnormal white blood cells. Bleeding and bruising problems, fatigue, fever, and an increased risk of infection are among symptoms of the disease. The main objective of this study is to identify the determinant of the progression rate of white blood cells among patients with chronic lymphocytic leukemia at Felege Hiwot Referral Hospital (FHRH), Bahir Dar, Ethiopia. METHODS: A retrospective study design was conducted on 312 patients with chronic lymphocytic leukemia at FHRH, Bahir Dar, Ethiopia under treatment from 1 January 2017 to 31 December 2019. A linear mixed-effects model was considered for the progression of the white blood cell data. RESULTS: The estimated coefficient of the fixed effect intercept was 84.68, indicating that the average white blood cell (WBC) count of the patients was 84.68 at baseline time by excluding all covariates in the model (P-value <.001). Male sex (ß = 2.92, 95% confidence interval [CI] 0.58, 0.5.25), age (ß = .17, 95% CI 0.08, 0.28), widowed/divorced marital status (ß = 3.30, 95% CI 0.03, 6.57), medium chronic lymphocytic leukemia (CLL) stage (ß = -4.34, 95% CI -6.57, -2.68), high CLL stage (ß = -2.76, 95% CI -4.86, -0.67), hemoglobin (ß = .15, 95% CI 0.07, 0.22), platelet (ß = .09, 95% CI 0.02, 0.17), lymphocytes (ß = .16, 95% CI 0.03, 0.29), red blood cell (RBC) (ß = .17, 95% CI 0.09, 0.25), and follow-up time (ß = .27, 95% CI 0.19, 0.36) were significantly associated with the average WBC count of chronic lymphocytic leukemia patients. CONCLUSIONS: The finding showed that age, sex, lymphocytic, stage of chronic lymphocytic leukemia, marital status, platelet, hemoglobin, RBC, and follow-up time were significantly associated with the average WBC count of chronic lymphocytic leukemia patients. Therefore, health care providers should give due attention and prioritize those identified factors and give frequent counseling about improving the health of chronic lymphocytic leukemia patients.

Determinants of desire for more children among women in Ethiopia.

BACKGROUND: Desire for more children has an impact on couple's fertility behaviors. It can be a precursor of actual fertility performance. However, the desire for more children is declining over time in Ethiopia. Therefore, this study aimed to identifying the determinants of the desire for more children among women in Ethiopia. METHODS: The 2016 Ethiopian Demographic and Health Survey data were used for the analysis. The sample consisted of 15,683 women. The binary logistic regression model was used to assess the determinants of desire for more children among women in Ethiopia. The results are presented as crude odds ratios (COR) and adjusted odds ratios (AOR) together with their corresponding 95% confidence intervals. RESULTS: No education (having no formal education) (AOR = 1.85, 95% CI 1.61-2.13), attained primary education (AOR = 1.62, 95% CI 1.43-1.83), age at first marriage 10-19 years (AOR = 1.80, 95% CI 1.27-2.54), Orthodox religion (AOR = 1.48, 95% CI 1.01-2.19), Catholic religion (AOR = 2.15, 95% CI 1.17-3.97), Muslim religion (AOR = 1.70, 95% CI 1.15-2.50), living in Amhara (AOR = 1.45, 95% CI 1.18-1.78), Oromia (AOR = 2.10, 95% CI 1.73-2.54), Benishangul (AOR = 1.17, 95% CI 1.01-1.45), SNNPR (AOR = 1.30, 95% CI 1.05-1.60), Gambela (AOR = 1.25, 95% CI 1.02-1.57), Harari (AOR = 2.24, 95% CI 1.82-2.76), ideal number of children four or fewer (AOR = 0.47, 95% CI 0.42-0.53), number of living children four or fewer (AOR = 2.12, 95% CI 1.90-2.37), and not use of contraceptives (AOR = 1.51, 95% CI 1.35-1.68) were associated with a higher desire for more children. CONCLUSION: This finding showed that the age of women, educational level, age at first marriage, religion, region, occupation, ideal number of children, number of living children, and use of contraceptives were significant determinants of desire for more children. Therefore, it is important to adopt programs to encourage the desire for more children, implement policies in an attempt to increase the total fertility rate in Ethiopia ought to critically consider these factors. Moreover, continuous education and knowledge on reproductive health will help for better fertility behaviour for the women.

Determinants of Intraocular Pressure and Time to Blindness for Glaucoma Patients at Felege Hiwot Referral Hospital, Bahir Bar, Ethiopia: A Comparison of Separate and Joint Models.

BACKGROUND: Due to the substantial increase in the number of glaucoma cases within the next several decades, glaucoma is a significant public health issue. The main objective of this study was to investigate the determinant factors of intraocular pressure and time to blindness of glaucoma patients under treatment at Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia. METHODS: A retrospective study design was conducted on 328 randomly selected glaucoma patients using simple random sampling based on the identification number of patients in an ophthalmology clinic at the hospital under the follow-up period from January 2014 to December 2018. A linear mixed effects model for intraocular pressure data, a semi-parametric survival model for the time-to-blindness data and joint modeling of the 2 responses were used for data analysis. However, the primary outcome was survival time of glaucoma patients. RESULTS: The comparison of joint and separate models revealed that joint model was more adequate and efficient inferences because of its smaller standard errors in parameter estimations. This was also approved using AIC, BIC, and based on a significant likelihood ratio test as well. The estimated association parameter (α) in the joint model was .0160 and statistically significant (P-value = .0349). This indicated that there was strong evidence for positive association between the effects of intraocular pressure and the risk of blindness. The result indicated that the higher value of intraocular pressure was associated with the higher risk of blindness. Age, hypertension, type of medication, cup-disk ratio significantly affects both average intraocular pressure and survival time of glaucoma patients (P-value < .05). CONCLUSION: The predictors; age, hypertension, type of medication, and cup-disk ratio were significantly associated with the 2 responses of glaucoma patients. Health professionals give more attention to patients who have blood pressure and cup-disk ratio greater than 0.7 during the follow-up time to reduce the risk of blindness of glaucoma patients.