Department of Biostatistics

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    Joint modeling of onset of microvascular complications and longitudinal fasting blood sugar among type 2 diabetes patients at Ayder and Mekelle hospitals, 2025
    (Mekelle University, 2025-06-28) TETEMKE MEKONEN
    Introduction: Type 2 diabetes mellitus is a major cause of microvascular complications that impact patients' quality of life and contribute to long-term health issues. Worldwide, 18.8% of individuals with diabetes experience these complications, rising to 37.9% in Ethiopia. Fasting blood sugar levels are vital for managing Type 2 diabetes and are linked to the onset of microvascular complications; however, no studies have examined the relationship between fasting blood sugar progression and the onset of these complications in the Tigray region. Objective: To jointly model the longitudinal pattern of fasting blood sugar and the time to onset of microvascular complications among type 2 diabetes mellitus patients at Ayder and Mekelle hospitals using a joint modeling approach, January 2018 - March 2024 Methods: A retrospective longitudinal study was conducted among 447 type 2 diabetes patients at Ayder and Mekelle hospitals from May 25 to July 10, 2024. Data were collected from patients' medical records using Kobo Toolbox, with training and supervision provided to data collectors. The adequacy of the random effects assumption was assessed and proportional hazards assumptions were validated. Joint modeling of Cox-PH with random intercept and random slope was fitted. Akaike Information Criteria and Bayesian information criterion were used for model comparison. Variables were interpreted via hazard ratios and 95% confidence intervals. Result: The incidence rate of microvascular complications was 6 per 1000 person-months (95% CI: 5–7) with estimated restricted mean of 62 months. For one unit increased in longitudinal mean log (FBS), the hazard of complications was 18.92 (CI: 6.050, 54.598) times higher. For one unit increase in body mass index the hazard of complications was 6.1% more likely higher. A one-unit increase in the triglyceride level, the hazard of complications was 0.3% more likely higher. Patients on injection plus oral medications had a 2.45 times higher hazard of complications compared to those on single oral medications (AHR = 2.455, CI: 1.118, 5.302). Conclusion: fasting blood sugar trajectory, baseline fasting blood sugar, Body mass index, Triglycerides level, proteinuria, and type of medication intake were significant predictors of time to onset of microvascular complications. These findings emphasize the importance of continuous monitoring and tight control of blood glucose levels in diabetes management to prolong the onset of microvascular complications.
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    JOINT MODELING OF TIME TO DEVELOP TUBERCULOSIS AND CHANGE IN CD4 COUNT AMONG HIV PATIENTS UNDER ART IN MEKELLE, ETHIOPIA, 2024
    (Mekelle University, 2025-06-28) TEKLEBRHAN KINFE
    Background: In patients with HIV, tuberculosis remains the leading cause of mortality and morbidity. Little is known about the predictors and the median time to develop tuberculosis while considering for the effect of the variation of longitudinal CD4 cell count. Objective: To investigate the time to develop tuberculosis accounting for longitudinal CD4 cell count change and its predictors among HIV patients who are under ART follow-up at Mekelle General Hospital and Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia, 2024. Methodology: A facility-based retrospective follow-up study was conducted among 449 adult PLHIV under ART follow-up from March 2018 to May 2024. The study participant were selected via a simple random sampling. The secondary data were collected from the patients’ medical records via Kobocollect version 2021.2.4 and exported to STATA version 17.0. The final model was a joint random intercept Cox-proportional hazard model. A model with the lowest Akaike information criterion and Bayesian information criterion was selected. Results: The incidence density of TB disease was 6.77 cases/100 person-years with a restricted mean survival time of 60 months. The joint analysis provided an association parameter alpha with AHR=0.854; 95% CI(0.8-0.91), indicating that for a unit increase in the average √CD4 cell count , the hazard of TB infection decreased by 14.6%, keeping other variables constant. The study also revealed that advanced WHO clinical stage (AHR = 1.024, 95% CI: 1.017–1.033), sex (AHR= 1.62, 95% CI: 1.09,2.4), CPT intake (AHR= 0.55, 95% CI: 0.35,0.89), and adherence (AHR= 0.38, 95% CI: 0.28,0.52) were significantly associated with the time to develop tuberculosis. The random intercept model indicated that greater variation in CD4 counts at baseline contributed strongly to the hazard of tuberculosis. Conclusion and Recommendation: This research highlights that PLHIV with a decreasing trajectory of CD4 count, advanced WHO clinical stage, female sex, history of CPT intake, and poor adherence have a higher risk of tuberculosis. On the basis of these findings, it is strongly recommended that the government and relevant health actors working on TB/HIV should intensify activities that improve patient adherence and a regular CD4 cell measurement.
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    Joint Modeling of Longitudinal Blood Pressure and Time to Complications Among Hypertensive Patients: A Retrospective Cohort Study in Mekelle, Ethiopia, 2018-2024
    (Mekelle University, 2025-06-28) MISHO MLAW
    Introduction: Hypertension is one of the 21st century emerging major public health problem, which is a strong risk factor for myocardial infraction, heart failure, ischemic or hemorrhagic stroke, chronic kidney disease, and eye disorder. Despite its significance, limited studies have investigated the association between longitudinal blood pressure measurements and the time to development of complications among hypertensive patients. Objectives: To determine the predictors, association between longitudinal blood pressure measurements and time to develop complications among hypertensive patients in ACSH and Mekelle General Hospital, Tigray, Ethiopia, 2018-2024. Methodology: A retrospective cohort study among 403 adult hypertensive patients with no complications from the beginning of follow up in Ayder Comprehensive Specialized Referral Hospital and Mekelle General Hospital from January 2018 to March 2024 was included. Data from patient’s medical record was collected using Kobo toolbox and exported to Stata version 17 and R 4.4.3 for data management and analysis. A bivariate mixed-effects model, Cox proportional hazards model, and a multivariate joint model linking longitudinal and survival sub-models through shared random effects were fitted. The final interpretation was done by hazard ratio. Result: A multivariate joint modeling analysis was the best fitted model based on the minimum Akaike Information Criterion value with an estimated value of the association parameters of 10.4 (p < 0.001) and 4.9 (p = 0.040), supporting the association between systolic and diastolic blood pressure with time to event was statistically significant. The multivariate joint modeling analysis showed that patients with family history of cardiovascular diseases (Hazard Ratio = 4.31), patient with Diabetes mellitus comorbidity (Hazard Ratio = 3.86), patient who take multiple treatment regimens have higher chance of developing hypertension related complications. Both Systolic and Diastolic blood pressure measurements were found to be critical predictors of hypertension complications. Conclusion and Recommendation - This study highlights the importance of effective blood pressure management and the need for targeted interventions that account for family history, clinical comorbidities, and treatment regimens to reduce the risk of complications in hypertensive patients.
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    TIME TO END STAGE OF RENAL DISEASE ASSOCIATED WITH SERUM CREATININE AMONG ADULT CHRONIC KIDNEY PATIENTS IN AYDER COMPREHENSIVE SPECIALIZED HOSPITAL: JOINT AND COPULA MODELING
    (Mekelle University, 2024-12-20) MENGSTU SURAFEL TEKULU
    Background- Chronic kidney disease (CKD) is a global public health issue and around 13.4% of people had CKD. Out of these, 14.5 million people have end stage of renal disease (ESRD) and 7.083 million needed renal replacement therapy. Paired kidney shared the same gene and comes from the same person. In Ethiopia, the incidence of CKD is estimated to be 21.71%. The war between Ethiopia federal and Tigray government leads to 70–80% of health facility dysfunctional. Objective The main objective was to determine time to ESRD associated with longitudinal serum creatinine, joint time to right and left kidney failure among adult CKD patients, and determinant factors in Ayder Comprehensive Specialized Hospital from 2019 to 2024. Methods - A retrospective cohort study conducted among 408 adult CKD patients in Ayder Comprehensive Specialized Hospital from 2019 to 2024. CKD patients without ESRD at the start of follow-up included in the study and data collected from medical card. Pretest, supervision and training used to assess data completeness. Joint and Copula Cox-proportional hazard model (CoxPH) used. Archimedean Copula model fitted to predict joint time to fail both kidney and interpretation done using hazard ratio (HR) and 95% confidence interval (C.I). Result- In the joint Cox-PH model variables with HR and 95% C.I interpreted. A unit increased in hemoglobin level the hazard of ESRD decreased by 11 %, HR= 0.89(0.7865,0.9935). A unit increased in urea the hazard of ESRD increased by HR =1.01(1.0065,1.0135) times, as estimate glomerular filtration rate increased, hazard of ESRD decreased by 2%, HR= 0.98(0.9621,0.9978). As longitudinal serum creatinine increased, hazard of ESRD increased by HR= 4.31(3.5760,5.0641) and being hepatitis, hazard of ESRD increased by HR= 2.61(1.8936,3.3264) times. In the Copula model, 86% of time to ESRD due to dependency of right and left kidney. Conclusion and Recommendation - The variables hemoglobin level and glomerular filtration rate value had a negative association, whereas urea level, longitudinal serum creatinine value and hepatitis had a significant positive effect on time to ESRD at the 5% level of significance. These factors increase the incidence of ESRD among CKD. To decrease the progression, health professional should provide early screening of chronic disease and strictly follow for laboratorial abnormality, every patient should follow appropriately for medical service and life style modification to prevent for chronic disease.
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    PREDICTORS AND TIME TO PNEUMONIA DEVELOPMENT IN MECHANICALLY VENTILATED ADULT PATIENTS IN THE ICU AT AYDER COMPREHENSIVE SPECIALIZED HOSPITAL, MEKELLE, TIGRAY 2024
    (Mekelle University, 2024-10-20) Masresha Gebru
    Introduction: Ventilator-Associated Pneumonia (VAP) is the second most common nosocomial infection in the intensive care unit (ICU). Researchers have conducted limited studies, and identifying the factors linked to the development of VAP is crucial for implementing preventive measures. Objective: To determine predictors and time to pneumonia development in mechanically ventilated adult patients in the intensive care unit at Ayder Comprehensive Specialized Hospital, Mekelle, Tigray 2024. Methods and Materials: A retrospective cohort study design was employed. All patients admitted to the adult intensive care unit and under mechanical ventilation from January 1, 2018, to December 31, 2020, were recruited consecutively. Data was collected using ODK and exported to STATA 17 for analysis. Log-rank test and multivariable lognormal regression were fitted to identify time to pneumonia development predictors. An adjusted hazard ratio with a 95% confidence interval was used to measure the association. The lognormal model best fits the data based on goodness-of-fit criteria, including the Akaike Information Criterion and Bayesian Information Criterion. The assumptions of survival times were checked using graphical methods. Models with and without interaction terms were compared, and the final model was selected based on the best fit to the data. Result: Data from 203 patient folders were analyzed, with a median follow-up of 6 days. The overall occurrence of pneumonia among adult patients in the ICU under mechanical ventilation was 61.08%, with an incidence rate of 15.3 cases per 813 person-days. The duration of mechanical ventilation for late pneumonia (AHR=1.32, 95% CI: 1.13, 1.55), cause of admission to intensive care unit due to respiratory disease (AHR=0.72, 95% CI: 0.53, 0.93), primary indication for intubation for patient with trauma (AHR=0.72, 95% CI: 0.53, 0.98), Sex of patient female patients (AHR=0.85, 95% CI 0.73, 0.98) were significantly associated with VAP in the adult ICU patients. Conclusions and Recommendation: The study highlights high pneumonia incidence in mechanically ventilated patients, emphasizing prioritizing resources allocation for those who are under mechanical ventilation to minimize the incidence of pneumonia.
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    ROUTINE HEALTH INFORMATION UTILIZATION AND ASSOCIATED FACTORS AMONG HEALTHCARE PROFESSIONALS IN MEKELLE AND ENDERTA, TIGRAY, ETHIOPIA, 2024: A MULTILEVEL ANALYSIS
    (Mekelle University, 2024-10-20) Hailemariam Atsbeha
    Background: A routine health information system comprises data collected at regular intervals. Utilization of timely, accurate, and relevant health information facilitates decision-making for effective interventions, services, and policies and it can prevent and reduce major healthcare problems in the healthcare system. Though health information is a building block for the health system, there is limited evidence about the culture of using routine health information for decision-making in Ethiopia, particularly in Tigray. Thus, this study aimed to assess the utilization of routine health information and its associated multilevel factors among healthcare professionals in Tigray, Mekelle zone, and Enderta District public health facilities and tried to make possible recommendations based on the findings. So, understanding the level of RHI utilization will be important for healthcare providers, policymakers, and program managers to improve the overall effectiveness and efficiency of the healthcare system in the region. Objective: -The general objective of the study was to assess routine health information utilization and associated factors for routine health information in Tigray region; Mekelle Zone and Enderta District public health facilities. Method: - A facility-based cross-sectional study was conducted from Feb 2024 to March 2024 in 23 public health facilities of Mekelle zone and Enderta District, Tigray Ethiopia. A simple random sampling method was used to recruit 422 participants. Data were entered and analyzed using STATA 17 software. Percentage and frequency were used to summarize categorical variables. Bivariate analysis and multivariable analysis were done to identify significant factors. Variable with a p-value <0.05 was used to identify variables significantly associated with the utilization of Routine Health Information. Results: The study found that 59.7% of the healthcare professionals had a good level of RHI utilization. The multilevel analysis revealed that data recording habit (AOR = 7.1, 95% CI: 3.1, 16), computer skills (AOR = 4.4, 95% CI: 2.2,9.1), data analysis skills (AOR = 10.1, 95% CI: 5.5, 20.), availability of standard guidelines (AOR = 7.1, 95% CI:2.4, 20), regular feedback (AOR =2.9, 95% CI: 1.04, 8.2) and the presence of a functional performance monitoring team (AOR = 7.8, 95% CI:2.6, 22), were significantly positively associated with routine health information utilization. Conclusion: - This study concluded that nearly 60% of the healthcare professionals in Mekelle zone and Enderta woreda public health facilities had good routine health information utilization. Basic computer skills, data analysis skills, data recording habit, availability of standard guidelines, regular feedback, and the presence of a functional performance monitoring team were factors significantly associated with routine health information utilization. This study recommends enhancing healthcare professionals’ computer skills, and data analysis skills, establishing a performance monitoring team, availing standard guidelines, and providing regular feedback.
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    PREDICTORS OF TIME TO RECOVERY FROM MODERATE ACUTE MALNUTRITION AMONG 6-59 MONTHS OLD CHILDREN IN INTERNALLY DISPLACED PERSONS SITES, NORTHWEST TIGRAY, ETHIOPIA, 2024, A RETROSPECTIVE FOLLOW UP
    (Mekelle University, 2024-10-20) EFREM SHUSHAY BERHE
    Background: Moderate acute malnutrition is one of the acute malnutrition categories diagnosed with an anthropometric measurement of weight for height [-3, -2) Z-score standard deviation or/and mid upper arm circumference (12.5-11.5] cm and the child should be with-out nutritional edema. Despite the existence of targeted supplementary feeding programs, the prevalence of moderate acute malnutrition was seriously high (15.1%) and the studies conducted previously used an out dated criteria to assess their recovery status from moderate acute malnutrition. Objective: The aim of this study was to determine the recovery time and its predictors among 6- 59 Months old children with moderate acute malnutrition enrolled to targeted supplementary feeding program in internally displaced persons sites of Northwest Tigray, Ethiopia, 2024. Methods: An institutional based retrospective cohort study was conducted among 452 children with moderate acute malnutrition selected using lottery method of simple random sampling with proportional allocation of the study participants to the selected fourteen sites. Data was collected using kobo tool box and imported to Stata version 17. Variables with p-value <0.25 at the restricted mean survival time uni-variable analysis, with 95% confidence interval were considered as important variables. The recovery status of the children was measured using mid upper arm circumference with measurement of >= 12.5 cm for two consecutive visits. Result: About 244 (53.08%) were female and 265(58.6%) with an age category of 24-59 months old. The overall restricted mean survival time was 15.16 weeks and recovery rate 68.36% with a truncation time of 16 weeks. Admission mid upper arm circumference category with restricted mean survival time difference of 5.47 (95% CI 3.53:8.48), ready to use supplementary food sharing status 2.07 (95% CI 1.39:3.08), and follow up status 0.57 (95% CI 0.42:0.76) were Significant predictors of time to recovery from moderate acute under nutrition. Conclusion: The study found an overall restricted mean survival time of 15.16 weeks and a recovery rate was below the minimum acceptable international standard. Recommendation: Strategies that enhance early detection should be implemented to get the child with moderate acute malnutrition at early stage. Tracking lost to follow-ups are critical, alongside counseling caregivers to treat food as medicine.