Department of Biostatistics

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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 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.