235 research outputs found
Infant mortality and causes of infant deaths in rural Ethiopia: a population-based cohort of 3684 births
No full textResearch articleBACKGROUND: Ethiopia has made large-scale healthcare investments to improve child health and survival. However, there is insufficient population level data on the current estimates of infant mortality rate (IMR) in the country. The aim of this study was to measure infant mortality rate, investigate risk factors for infant deaths and identify causes of death in a rural population of northern Ethiopia. METHODS: Live births to a cohort of mothers under the Kilite Awlaelo Health and Demographic Surveillance System were followed up to their first birthday or death, between September 11, 2009 and September 10, 2013. Maternal and infant characteristics were collected at baseline and during the regular follow-up visit. Multiple-Cox regression was used to investigate risk factors for infant death. Causes of infant death were identified using physician review verbal autopsy method. RESULTS: Of the total 3684 infants followed, 174 of them died before their first birthday, yielding an IMR of 47 per 1000 live births (95 % CI: 41, 54) over the four years of follow-up. About 96 % of infants survived up to their first birthday, and 56 % of infant deaths occurred during the neonatal period. Infants born to mothers aged 15-19 years old had higher risk of death (HR = 2.68, 95 % CI: 1. 74, 4.87) than those born to 25-29 years old. Infants of mothers who attained a secondary school and above had 56 % lower risk of death (HR = 0.44, 95 % CI: 0.24, 0.81) compared to those whose mothers did not attend formal education. Sepsis, prematurity and asphyxia and acute lower respiratory tract infections were the commonest causes of death. CONCLUSION: The IMR for the four-year period was lower than the national and regional estimates. Our findings suggest the need to improve the newborn care, and empower teenagers to delay teenage pregnancy and attain higher levels of education.Berhe Weldearegawi, Yohannes Adama Melaku, Semaw Ferede Abera, Yemane Ashebir, Fisaha Haile, Afework Mulugeta, Frehiwot Eshetu and Mark Spig
Causes of death among females-investigating beyond maternal causes: a community-based longitudinal study
No full textBACKGROUND: In developing countries, investigating mortality levels and causes of death among all age female population despite the childhood and maternal related deaths is important to design appropriate and tailored interventions and to improve survival of female residents. METHODS: Under Kilite-Awlealo Health and Demographic Surveillance System, we investigated mortality rates and causes of death in a cohort of female population from 1st of January 2010 to 31st of December 2012. At the baseline, 33,688 females were involved for the prospective follow-up study. Households under the study were updated every six months by fulltime surveillance data collectors to identify vital events, including deaths. Verbal Autopsy (VA) data were collected by separate trained data collectors for all identified deaths in the surveillance site. Trained physicians assigned underlining causes of death using the 10th edition of International Classification of Diseases (ICD). We assessed overall, age- and cause-specific mortality rates per 1000 person-years. Causes of death among all deceased females and by age groups were ranked based on cause specific mortality rates. Analysis was performed using Stata Version 11.1. RESULTS: During the follow-up period, 105,793.9 person-years of observation were generated, and 398 female deaths were recorded. This gave an overall mortality rate of 3.76 (95% confidence interval (CI): 3.41, 4.15) per 1,000 person-years. The top three broad causes of death were infectious and parasitic diseases (1.40 deaths per 1000 person-years), non-communicable diseases (0.98 deaths per 1000 person-years) and external causes (0.36 per 1000 person-years). Most deaths among reproductive age female were caused by Human Deficiency Virus/Acquired Immune Deficiency Virus (HIV/AIDS) and tuberculosis (0.14 per 1000 person-years for each cause). Pregnancy and childbirth related causes were responsible for few deaths among women of reproductive age--3 out of 73 deaths (4.1%) or 5.34 deaths per 1,000 person-years. CONCLUSIONS: Communicable diseases are continued to be the leading causes of death among all age females. HIV/AIDS and tuberculosis were major causes of death among women of reproductive age. Together with existing efforts to prevent pregnancy and childbirth related deaths, public health and curative interventions on other causes, particularly on HIV/AIDS and tuberculosis, should be strengthened.Yohannes Adama Melaku, Berhe Weldearegawi, Alemseged Aregay, Fisaha Haile Tesfay, Loko Abreha, Semaw Ferede Abera and Afework Mulugeta Bezabi
Causes of death among adults in northern Ethiopia: evidence from verbal autopsy data in health and demographic surveillance system
No full textBACKGROUND: In countries where registration of vital events is lacking and the proportion of people who die at home without medical care is high, verbal autopsy is used to determine and estimate causes of death. METHODS: We conducted 723 verbal autopsy interviews of adult (15 years of age and above) deaths from September 2009 to January 2013. Trained physicians interpreted the collected verbal autopsy data, and assigned causes of death according to the international classification of diseases (ICD-10). We did analysis of specific as well as broad causes of death (i.e. non-communicable diseases, communicable diseases and external causes of death) by sex and age using Stata version 11.1. We performed logistic regression to identify socio-demographic predictors using odds ratio with 95% confidence interval and a p-value of 0.05. FINDINGS: Tuberculosis, cerebrovascular diseases and accidental falls were leading specific causes of death accounting for 15.9%, 7.3% and 3.9% of all deaths. Two hundred sixty three (36.4% [95% CI: 32.9, 39.9]), 252 (34.9% [95% CI: 31.4, 38.4]) and 89 (12.3% [95% CI: 10.1, 14.9]) deaths were due to non-communicable, communicable diseases, and external causes, respectively. Females had 1.5 times (AOR = 1.53 [95% CI: 1.10, 2.15]) higher odds of dying due to communicable diseases than males. The odds of dying due to external causes were 4 times higher among 15-49 years of age (AOR = 4.02 [95% CI: 2.25, 7.18]) compared to older ages. Males also had 1.7 times (AOR = 1.70 [95% CI: 1.01, 2.85]) higher odds of dying due to external causes than females. CONCLUSION: Tuberculosis, cerebrovascular diseases and accidental falls were the top three causes of death among adults. Efforts to prevent tuberculosis and cerebrovascular diseases related deaths should be improved and safety efforts to reduce accidents should also receive attention.Yohannes Adama Melaku, Berhe Weldearegawi Sahle, Fisaha Haile Tesfay, Afework Mulugeta Bezabih, Alemseged Aregay, Semaw Ferede Abera, Loko Abreha, Gordon Alexander Zell
Epidemiology and social determinants of chronic diseases attributed adult mortality and its influence on maternal and young child nutrition in Tigray, 2009-2015: evidence from Kilte Awlaelo- Health and Demographic Surveillance Site
No full textIn Ethiopia, the burden of disease related to communicable diseases has recently decreased significantly, while morbidity and mortality due to non-communicable diseases (NCDs) have increased. At the same, maternal and child malnutrition remained a major public health problem of Ethiopia. In developing countries, where health insurance is largely unavailable, individual medical conditions can also affect the overall and nutritional well-being of household members. In particular, the occurrence of disease and adult mortality in households can affect the nutritional well-being of the most vulnerable household members, especially lactating mothers and their young children. If the diseases are of chronic nature, which usually are costly and adult household members die from it in the long-term, this can be devastating for the family.
The aim of this Ph.D. project was to investigate the epidemiology and social determinants of NCDs-attributed adult mortality, and to examine the association of chronic diseases attributed adult mortality with undernutrition of lactating mothers and their young children in rural population of Kilte Awlaelo-Health and Demographic Surveillance Site (KA-HDSS), Eastern Zone of Tigray, Ethiopia.
During the data analysis, causes of death in adults were classified into chronic and non-chronic causes. The category of adult mortality due to chronic diseases refers to all causes that may be characterized by a long duration of illness. This group includes all deaths caused by NCDs and chronic communicable diseases such as tuberculosis and HIV/AIDS.
The thesis has three articles, all published in peer-reviewed journals. The first article reports findings on the epidemiology and social-determinants of adult mortality caused by NCDs among 45,982 adult residents of KA-HDSS using population-based longitudinal data collected from 2009 to 2015. The second article tested whether the burden of undernutrition was higher among lactating mothers who were living in households with adult mortality from chronic diseases than among lactating mothers living in households with no adult mortality from chronic diseases. The third article examined whether there was an association between undernutrition of children and adult mortality from chronic diseases. Both longitudinal and cross-sectional data were used in the second and third articles. To our knowledge, this study showed for the first time that adult mortality caused by NCDs varied according household members’ relationship to their household head: extended family and non-family members of the household head had higher hazard of mortality compared to the household heads. In addition, this work can be considered as the first study from a low-income setting to examine whether mortality of an adult household member from chronic diseases is associated with undernutrition of lactating mothers and their young children.
The results of the first study indicate a double mortality burden from both communicable diseases and NCDs in the study population. Between 2009 and 2015, the leading causes of NCDs-attributed adult mortality were cardiovascular diseases, cancer and renal failure. Compared to heads of households, extended family and non-family co-residents had an increased hazard of mortality from NCDs. Literacy and younger age were protective factors against adult mortality caused by NCDs. However, the protective role of literacy against adult mortality from NCDs decreased with increasing age.
Next, we assessed the level of undernutrition among the lactating mothers and examined its association with household-level occurrence of adult mortality from chronic diseases by controlling the effect of a wide range of epi-demographic and agro-ecological variables. Nearly two-fifths (38%; 95% CI: 36.1, 40.1%) of the mothers were undernourished. We found an increased risk of maternal undernutrition for lactating mothers who were living in households which experienced adult mortality from chronic diseases. In addition, maternal undernutrition was strongly associated with recent history of household-level morbidity, poor health-seeking practice, lack of diverse food crops, and a low index score for housing and environmental factors.
In the third article, we determined the burden of undernutrition among children of complementary feeding age (6 to 23 months) and its factors within the context of nutrition-specific and -sensitive drivers of young child undernutrition. Here, mortality from chronic diseases were constructed as a nutrition-specific factor. We found high prevalence of wasting (13.7%; 95% CI: 12.1, 15.5%) and inadequate child dietary diversity (81.3%; 95%CI: 79.2, 83.1%). Adult mortality history from chronic diseases was not associated with young child undernutrition and child dietary diversity. However, child undernutrition was strongly associated with recent history of household-level morbidity, maternal undernutrition, low child dietary diversity, poverty, larger family size, insecure employment of household heads, and living in highland areas. Poor household wealth status and lack of diverse food crops production, particularly in highland areas, were also strongly associated with lower child dietary diversity.
Overall, this thesis has shown that an epidemiological transition is ongoing in the surveillance population. Population-based intervention measures are recommended that aim to reduce NCD-related adult mortality by targeting the leading causes of death and focusing on vulnerable population subgroups, such as the extended family and nonfamily household members. In this study, there was no association between the occurrence of chronic diseases attributed adult mortality and young child undernutrition. However, adult mortality from chronic diseases was associated with maternal undernutrition. Our findings appear to call for multi-sectoral interventions, mainly by the agriculture, nutrition and health sectors, to promote nutritional well-being of lactating mothers and their dyads in the long-term.In Äthiopien ist die Krankheitslast im Zusammenhang mit übertragbaren Erkrankungen zuletzt deutlich zurückgegangen, während die Morbidität und Mortalität aufgrund nicht übertragbarer Krankheiten (NCDs) angestiegen ist. Gleichzeitig blieb die Unterernährung von Müttern und Kindern weiterhin ein großes Problem der öffentlichen Gesundheit in Äthiopien. In Entwicklungsländern, in denen es größtenteils keine Krankenversicherung gibt, können individuelle Erkrankungen auch das allgemeine Wohlbefinden und das Ernährungswohl der Haushaltsmitglieder beeinträchtigen. So kann das Auftreten von Krankheiten und die Erwachsenensterblichkeit in Haushalten insbesondere das Ernährungswohl der am stärksten gefährdeten Haushaltsmitglieder beeinträchtigen – vor allem stillende Mütter und ihre kleinen Kinder. Wenn es sich um chronische Erkrankungen handelt, die meist hohe Kosten verursachen und erwachsene Haushaltsmitglieder langfristig daran versterben, kann dies für den Familienverband bedrohlich werden.
Das Ziel dieses Ph.D. Projekts war es, die Epidemiologie und die sozialen Determinanten der durch nichtübertragbare Krankheiten verursachten Erwachsenensterblichkeit zu untersuchen und den Zusammenhang zur Unterernährung stillender Mütter und ihrer Kinder in der ländlichen Bevölkerung von Kilte Awlaelo – der Gesundheits- und demografischen Überwachungsstelle (KA-HDSS) in der Ostzone von Tigray, Äthiopien - zu untersuchen.
Während der Datenauswertung wurden die Todesursachen bei Erwachsenen in chronische und nichtchronische Ursachen eingeteilt. Die Kategorie der Erwachsenensterblichkeit aufgrund chronischer Todesursachen bezieht sich auf alle Ursachen, die durch eine lange Krankheitsdauer gekennzeichnet sein können. Diese Gruppe umfasst alle Todesfälle, die durch nichtübertragbare Krankheiten und chronisch übertragbare Krankheiten wie Tuberkulose und HIV/AIDS verursacht werden.
Die Dissertation umfasst drei Artikel, die alle in peer-reviewten Fachzeitschriften veröffentlicht wurden. Der erste Artikel berichtet über Erkenntnisse zur Epidemiologie und den sozialen Determinanten der durch nichtübertragbare Krankheiten verursachten Erwachsenensterblichkeit bei 45.982 erwachsenen Einwohnern von KA-HDSS unter Verwendung bevölkerungsbasierter Längsschnittdaten, die von 2009 bis 2015 gesammelt wurden. Im zweiten Artikel wurde untersucht, ob die Prävalenz von Unterernährung bei stillenden Müttern, die in Haushalten leben, in denen eine durch chronische Krankheiten verursachte Erwachsenensterblichkeit auftrat, höher war als bei Müttern, in deren Haushalten keine Erwachsenensterblichkeit durch chronische Krankheiten erhoben wurde. Im dritten Artikel wurde der Frage nachgegangen, ob es einen Zusammenhang gab zwischen der Unterernährung von Kleinkindern und der durch chronische Krankheiten verursachten Erwachsenensterblichkeit. Im zweiten und dritten Artikel wurden sowohl Längsschnitt- als auch Querschnittsdaten verwendet. Unseres Wissens nach hat diese Studie zum ersten Mal gezeigt, dass die durch nichtübertragbare Krankheiten verursachte Sterblichkeit je nach Beziehung der Haushaltsmitglieder zu ihrem Haushaltsvorstand variiert: Erweiterte Familienangehörige und Nicht-Familienmitglieder hatten im Vergleich zum Haushaltsvorstand selbst ein höheres Sterberisiko. Darüber hinaus kann diese Arbeit als die erste Studie aus einem Umfeld mit niedrigem Einkommen betrachtet werden, in der untersucht wurde, ob die Sterblichkeit erwachsener Haushaltsmitglieder aufgrund chronischer Krankheiten mit der Unterernährung stillender Mütter und ihrer jungen Kinder zusammenhängt.
Die Ergebnisse der ersten Studie weisen auf eine doppelte Sterblichkeitsbelastung sowohl durch übertragbare Krankheiten als auch durch nicht übertragbare Krankheiten in der Untersuchungspopulation hin. Zwischen 2009 und 2015 waren Herz-Kreislauf-Erkrankungen, Krebs und Nierenversagen die häufigsten durch nichtübertragbare Krankheiten verursachten Todesfälle bei Erwachsenen. Im Vergleich zum Haushaltsvorstand hatten Großfamilien- und familienfremde Mitbewohner ein erhöhtes Risiko, an NCDs zu sterben. Alphabetisierung und jüngeres Alter waren schützende Faktoren gegen die durch nichtübertragbare Krankheiten verursachte Mortalität. Allerdings nimmt die schützende Rolle der Alphabetisierung bei der Erwachsenensterblichkeit aufgrund nichtübertragbarer Krankheiten mit zunehmendem Alter ab.
Als nächstes analysierten wir den Grad der Unterernährung bei stillenden Müttern und untersuchten den Zusammenhang zwischen mütterlicher Unterernährung und Sterblichkeit auf Haushaltsebene aufgrund chronischer Todesursachen bei Erwachsenen, indem wir ein breites Spektrum epidemiografischer und agrarökologischer Variablen anwandten. Knapp zwei Fünftel (38 %; 95 %-KI: 36,1, 40,1 %) der Mütter waren unterernährt. Wir fanden ein erhöhtes Risiko für mütterliche Unterernährung bei stillenden Frauen, die in Haushalten lebten, in denen es in der Vergangenheit zu einer Erwachsenensterblichkeit aufgrund chronischer Krankheiten kam. Darüber hinaus war die Unterernährung der Mütter stark mit der Morbidität auf Haushaltsebene in der jüngeren Vergangenheit, unzureichender Inanspruchnahme von Gesundheitsdiensten, Mangel an Zugang zu vielfältigen Nahrungsmittelpflanzen und einem niedrigen Indexwert für Wohnverhältnisse und Umweltfaktoren verbunden.
Im dritten Artikel haben wir die Belastung durch Unterernährung bei Kindern im Beikostalter (6 bis 23 Monate) und ihre Faktoren im Kontext ernährungsspezifischer und ernährungssensibler Indikatoren ermittelt. Dabei wurde die Erwachsenensterblichkeit aufgrund chronischer Todesursachen als ernährungsspezifischer Faktor konstruiert. Wir fanden eine hohe Prävalenz von Auszehrung (13,7 %; 95 % CI: 12,1, 15,5 %) und eine unzureichende Ernährungsvielfalt bei Kindern (81,3 %; 95 %CI: 79,2, 83,1 %). Die Sterblichkeit aufgrund chronischer Todesursachen war nicht mit der Unterernährung und der mangelhaften Ernährungsvielfalt für Kinder assoziiert. Die Unterernährung von Kindern war jedoch stark mit der Morbidität auf Haushaltsebene in der jüngeren Vergangenheit, Unterernährung der eigenen Mutter, geringer Ernährungsvielfalt für Kinder, Armut, umfangreicher Familiengröße, unsicherer Beschäftigung der Haushaltsvorstände und dem Leben im Hochland verbunden. Ein ungenügender Wohlstandsstatus der Haushalte und der Mangel an vielfältigem Nahrungsmittelanbau, insbesondere in Hochlandgebieten, waren ebenfalls stark mit einer geringeren Ernährungsvielfalt bei Kindern assoziiert.
Insgesamt hat diese Arbeit gezeigt, dass der epidemiologische Wandel in der Untersuchungsbevölkerung noch nicht abgeschlossen ist. Bevölkerungsbezogene Interventionsmaßnahmen sind zu empfehlen, die darauf abzielen, die NCD-bedingte Erwachsenensterblichkeit zu senken, indem sie auf die führenden Todesursachen abzielen und den Schwerpunkt auf die gefährdeten Bevölkerungsuntergruppen legen, wie die Großfamilie und die familienfremden Haushaltsmitbewohner. In dieser Studie gab es keinen Zusammenhang zwischen Unterernährung bei Kleinkindern und der Erwachsenensterblichkeit aufgrund chronischer Krankheiten. Die Erwachsenensterblichkeit aufgrund chronischer Krankheiten war jedoch mit der Unterernährung der Mütter verbunden. Unsere Ergebnisse erfordern offenbar sektorübergreifende Interventionen, vor allem in den Bereichen Landwirtschaft, Ernährung und Gesundheit, um das Ernährungswohl stillender Mütter und ihrer Kinder langfristig zu fördern
One-fourth of the prisoners are underweight in Northern Ethiopia: a cross-sectional study
No full textAbstract Background Despite the fact that prisoners are exposed to different health problems, prison health problems are often overlooked by researchers and no previous study has investigated nutritional problems of prisoners in Ethiopia. Methods Cross-sectional data were collected from 809 prisoners from nine major prison setups in the Tigray region of Ethiopia. A proportional stratified sampling technique was used to select the total number of participants needed from each prison site. The outcome of this study was underweight defined as body mass index (BMI) of less than 18.5 kg/m2. Multivariable binary logistic regression was performed to identify determinants of underweight at a p-value of less than 0.05. Results The prevalence of underweight was 25.2% (95% CI; 22.3%- 28.3%). Khat Chewing (OR = 2.08; 95% CI = 1.17, 3.70) and longer duration of incarceration (OR = 1.07; 95% CI = 1.01, 1.14) were associated with a significantly increased risk of underweight. Additionally, previous incarceration (OR = 1.54; 95% CI = 0.99, 2.42) was a relevant determinant of underweight with a borderline significance. In contrast, family support (OR = 0.61; 95% CI = 0.43, 0.85) and farmer occupation (OR = 0.59; 95% CI = 0.36, 0.98) compared to those who were unemployed were important protective determinants significantly associated with lower risk of underweight. Conclusion In summary, the burden of underweight was higher among prisoners in Tigray region who had respiratory tract infections. The study has enhanced our understanding of the determinants of underweight in the prison population. We strongly recommend that nutritional support, such as therapeutic feeding programs for severely or moderately underweight prisoners, and environmental health interventions of the prison setups should be urgently implemented to correct the uncovered nutritional problem and its associated factors for improving the health status of prisoners
Burden and Determinants of Smoking among Prisoners with Respiratory Tract Infection: A Cross-Sectional Study of Nine Major Prison Setups in Northern Ethiopia.
No full textBackgroundMorbidity, mortality and a wide range of associated risk factors are disproportionately clustered among prisoners compared to the general population. Smoking is one of the risk factors for the increased burden of unfavorable health outcomes particularly among prisoners. However, little is known about the level and determinants of smoking among the incarcerated population in Ethiopia.MethodsWe collected data from 738 prisoners in nine major prison setups in Tigray region by nurses and clinical officers. Data were entered in to Epi Data 3.1 and exported to stata 13.0 for cleaning and further analysis. Multivariable logistic regression model was fitted to identify determinants of smoking at p value of less than 5%.ResultThe prevalence of smoking was 21 per cent (95%CI = 18.2%, 24.1). Urban residence (AOR = 2.15; 95%CI = 1.20, 3.84), previous history of incarceration (AOR = 1.91; 95%CI = 1.08, 3.40) and alcohol use before incarcerated (AOR = 4.20; 95%CI = 2.57, 6.87) were significantly associated with risk of smoking. In contrast, risk of smoking was significantly lower for farmers (AOR = 0.20; 95% CI = 0.08, 0.49), prisoners with family support (AOR = 0.52; 95% CI = 0.32, 0.87) and for those who were jailed in Shire prison site (AOR = 0.43; 95%CI = 0.20, 0.95).ConclusionOur work clearly indicates that the observed smoking prevalence calls for the need of comprehensive and interdisciplinary interventions targeting prisoners
BMC Public Health
No full textBackgroundEthiopia has made large-scale healthcare investments to improve child health and survival. However, there is insufficient population level data on the current estimates of infant mortality rate (IMR)\ua0in the country. The aim of this study was\ua0to measure infant mortality rate, investigate risk factors for infant deaths and identify causes of death in a rural population of northern Ethiopia.MethodsLive\ua0births to a cohort of mothers under the Kilite Awlaelo Health and Demographic Surveillance System were followed up to their first birthday or death, between September 11, 2009 and September 10, 2013. Maternal and infant characteristics were collected at baseline and during the regular follow-up visit. Multiple-Cox regression was used to investigate risk factors for infant death. Causes of infant death were identified using physician review verbal autopsy method.ResultsOf the total 3684 infants followed, 174 of them died before their first birthday, yielding an IMR of 47 per 1000 live births (95 % CI: 41, 54) over the four years of follow-up. About 96\ua0% of infants survived up to their first birthday, and 56\ua0% of infant deaths occurred during the neonatal period. Infants born to mothers aged 15\u201319 years old had higher risk of death (HR\u2009=\u20092.68, 95\ua0% CI: 1. 74, 4.87) than those born to 25\u201329 years old. Infants of mothers who attained a secondary school and above had 56 % lower risk of death (HR\u2009=\u20090.44, 95\ua0% CI: 0.24, 0.81) compared to those whose mothers did not attend formal education. Sepsis, prematurity and asphyxia and acute lower respiratory tract infections were the commonest causes of death.ConclusionThe IMR for the four-year period was lower than the national and regional estimates. Our findings suggest the need to improve the newborn care, and empower teenagers to delay teenage pregnancy and attain higher levels of education.20152015-08-11T00:00:00ZU22 PS022179/PS/NCHHSTP CDC HHS/United States26260495PMC4531534691
Patterns of glioblastoma treatment and survival over a 16-years period: pooled data from the German Cancer Registries
No full textIntroduction!#!Glioblastoma multiforme (GBM) is a primary malignant brain tumour characterized by a very low long-term survival. The aim of this study was to analyse the distribution of treatment modalities and their effect on survival for GBM cases diagnosed in Germany between 1999 and 2014.!##!Methods!#!Cases were pooled from the German Cancer Registries with International Classification of Diseases for Oncology, third edition (ICD-O-3) codes for GBM or giant-cell GBM. Three periods, first (January 1999-December 2005), second (January 2006-December 2010) and a third period (January 2011-December 2014) were defined. Kaplan-Meier plots with long-rank test compared median overall survival (OS) between groups. Survival differences were assessed with Cox proportional-hazards models adjusted for available confounders.!##!Results!#!In total, 40,138 adult GBM cases were analysed, with a mean age at diagnosis 64.0 ± 12.4 years. GBM was more common in men (57.3%). The median OS was 10.0 (95% CI 9.0-10.0) months. There was an increase in 2-year survival, from 16.6% in the first to 19.3% in the third period. When stratified by age group, period and treatment modalities, there was an improved median OS after 2005 due to treatment advancements. Younger age, female sex, surgical resection, use of radiotherapy and chemotherapy, were independent factors associated with better survival.!##!Conclusion!#!The inclusion of temozolomide chemotherapy has considerably improved median OS in the older age groups but had a lesser effect in the younger age group of cases. The analysis showed survival improvements for each treatment option over time
Determinants of smoking among adult prisoners with respiratory infection in Tigray region in 2013/2014, Ethiopia (n = 738).
No full textDeterminants of smoking among adult prisoners with respiratory infection in Tigray region in 2013/2014, Ethiopia (n = 738).</p
Shows the lifestyle and prison related characteristics of prisoners with respiratory infection by smoking status in Tigray region in 2013/2014, northern Ethiopia (n = 738).
No full textShows the lifestyle and prison related characteristics of prisoners with respiratory infection by smoking status in Tigray region in 2013/2014, northern Ethiopia (n = 738).</p
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