Time to first antenatal care visit among pregnant women in Ethiopia: secondary analysis of EDHS 2016; application of AFT shared frailty models

Abstract Background The survival of pregnant women is one of great interest of the world and especially to a developing country like Ethiopia which had the highest maternal mortality ratios in the world due to low utilization of maternal health services including antenatal care (ANC). Survival analysis is a statistical method for data analysis where the outcome variable of interest is the time to occurrence of an event. This study demonstrates the applications of the Accelerated Failure Time (AFT) model with gamma and inverse Gaussian frailty distributions to estimate the effect of different factors on time to first ANC visit of pregnant women in Ethiopia. Methods This study was conducted by using 2016 EDHS data about factors associated with the time to first ANC visit of pregnant women in Ethiopia. A total of 4328 women from nine regions and two city administrations whose age group between 15 and 49 years were included in the study AFT models with gamma and inverse Gaussian frailty distributions have been compared using Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) to select the best model. Results The factors residence, media exposure, wealth index, education level of women, education level of husband and husband occupation are found to be statistically significant (P-value < 0.05) for the survival time of time to first ANC visit of pregnant women in Ethiopia. Inverse Gaussian shared frailty model with Weibull as baseline distribution is found to be the best model for the time to first ANC visit of pregnant women in Ethiopia. The model also reflected there is strong evidence of the high degree of heterogeneity between regions of pregnant women for the time to first ANC visit. Conclusion The median time of the first ANC visit for pregnant women was 5 months. From different candidate models, Inverse Gaussian shared frailty model with Weibull baseline is an appropriate approach for analyzing time to first ANC visit of pregnant women data than without frailty model. It is essential that maternal and child health policies and strategies better target women’s development and design and implement interventions aimed at increasing the timely activation of prenatal care by pregnant women. The researchers also recommend using more powerful designs (such as cohorts) for the research to establish timeliness and reduce death.

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Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: Cox-gamma shared frailty model

PLoS ONE ◽

10.1371/journal.pone.0246349 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246349

Author(s):

Reta Dewau ◽

Amare Muche ◽

Zinabu Fentaw ◽

Melaku Yalew ◽

Gedamnesh Bitew ◽

...

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Health Facility ◽

Media Exposure ◽

Wealth Index ◽

Frailty Model ◽

Household Wealth ◽

Care Visit ◽

Shared Frailty Model ◽

Shared Frailty

Background Timely initiating antenatal care (ANC) is crucial in the countries that have high maternal morbidity and mortality. However, in developing countries including Ethiopia, pregnant mother’s time to initiate antenatal care was not well-studied. Therefore, this study aimed to assess time to first ANC and its predictors among pregnant women in Ethiopia. Methods A community-based cross-sectional study was conducted among 7,543 pregnant women in Ethiopia using the Ethiopian Demographic Health Survey (EDHS), 2016 data. A two-stage stratified cluster sampling was employed. The Kaplan-Meier (KM) method was used to estimate time to first antenatal care visit. Cox-gamma shared frailty model was applied to determine predictors. Adjusted Hazard Ratio (AHR) with 95% confidence interval was reported as the effect size. Model adequacy was assessed by using the Cox-Snell residual plot. Statistical significance was considered at p value <0.05. For data management and analysis Stata 14 was used. Results The median time to first ANC was 5 months with IQR (3,-). The independent predictors of time to first ANC visit were primary education [AHR: 1.24 (95%CI, 1.13–1.35)], secondary education [AHR: 1.28(95% CI, 1.11–1.47)], higher education [AHR: 1.43 (1.19–1.72)] as compared to women with no formal education. Having media exposure [AHR: 1.13 (95% CI, 1.03–1.24)], early initiation of ANC increases by 25% [AHR: 1.25 (95% CI, 1.12–1.40)] in poorer, 32% [AHR: 1.32 (95% CI, 1.17–1.49)] in middle, 37% [AHR: 1.37 (95% CI, 1.20–1.56)] in richer and 41% [AHR: 1.41 (95%CI, 1.1.19–1.67)] in richest households as compared to poorest household wealth index. Living in city administration, media exposure and community women literacy were also enabler factors, while, long distance from health facility and nomadic region residency were hindering factors of early ANC visit. Conclusions The current study revealed that women’s time to first antenatal care visit was by far late in Ethiopia as compared to the world health organization recommendation (WHO). The predictors of time to first ANC visit were education status of women, having media exposure, level of household wealth index, community women literacy ad distance to health facility. It is vital that maternal and child health policies and strategies better to be directed at women development and also designing and applying interventions that intended to increase timely initiation ANC among pregnant-women. Researchers also recommended conducting studies using a stronger design like a cohort to establish temporality and reduce biases.

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Determinants of Time-to-recovery from Hypertension using a Comparison of Various Parametric Shared Frailty Models: In Case of Felege Hiwot Refral Hospital.

10.21203/rs.3.rs-608412/v1 ◽

2021 ◽

Author(s):

Nigist Mulu ◽

Yeshambel Kindu ◽

Abay Kassie

Keyword(s):

Survival Time ◽

Blood Urea Nitrogen ◽

Normal Condition ◽

Recovery Time ◽

Frailty Model ◽

Frailty Models ◽

Inverse Gaussian ◽

Urea Nitrogen ◽

Shared Frailty Model ◽

Shared Frailty

Abstract Background: Hypertension is a major public health problem that is responsible for morbidity and mortality. In Ethiopia hypertension is becoming a double burden due to urbanization. The study aimed to identify factors that affect time-to-recovery from hypertension at Felege Hiwot Referral Hospital. Retrospective study design was used at FHRH. Methods: The data was collected in patient’s chart from September 2016 to January 2018. Kaplan-Meier survival estimate and Log-Rank test were used to compare the survival time. The AFT and parametric shared frailty models were employed to identify factors associated with the recovery time of hypertension patients. All the fitted models were compared by using AIC and BIC. Results: Eighty one percent of sampled patients were recovered to normal condition and nineteen percent of patients were censored observations. The median survival time of hypertensive patients to attain normal condition was 13 months. Weibull- inverse Gaussian shared frailty model was found to be the best model for predicting recovery time of hypertension patients. The unobserved heterogeneity in residences as estimated by the Weibull-Inverse Gaussian shared frailty model was θ=0.385 (p-value=0.00). Conclusion: The final model showed that age, systolic blood pressure, related disease, creantine, blood urea nitrogen and the interaction between blood urea nitrogen and age were the determinants factors of recovery status of patients at 5% level of significance. The result showed that patients creantine >1.5 Mg/dl compared to creantine ≤1.5 Mg/dl and SBP were prolonged the recovery time of patients whereas patients having kidney disease, other disease and had no any disease compared to diabetic patients and the interaction BUN and age were shorten recovery status of hypertension patients.

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Incidence of neonatal mortality and its predictors among live births in Ethiopia: Gompertz gamma shared frailty model

Italian Journal of Pediatrics ◽

10.1186/s13052-020-00893-6 ◽

2020 ◽

Vol 46 (1) ◽

Author(s):

Zemenu Tadesse Tessema ◽

Getayeneh Antehunegn Tesema

Keyword(s):

Public Health ◽

Antenatal Care ◽

Neonatal Mortality ◽

Frailty Model ◽

Live Births ◽

Large Size ◽

Shared Frailty Model ◽

Shared Frailty ◽

Male Sex ◽

Size At Birth

Abstract Background Neonatal mortality remains a serious public health concern in developing countries including Ethiopia. Ethiopia is one of the countries with the highest neonatal mortality in Africa. However, there is limited evidence on the incidence and predictors of neonatal mortality at the national level. Therefore, this study aimed to investigate the incidence of neonatal mortality and its predictors among live births in Ethiopia. Investigating the incidence and predictors of neonatal mortality is essential to design targeted public health interventions to reduce neonatal mortality. Methods A secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 11,022 live births was included in the analysis. The shared frailty model was applied since the EDHS data has hierarchical nature, and neonates are nested within-cluster, and this could violate the independent and equal variance assumption. For checking the proportional hazard assumption, Schoenfeld residual test was applied. Akakie Information Criteria (AIC), Cox-Snell residual test, and deviance were used for checking model adequacy and for model comparison. Gompertz gamma shared frailty model was the best-fitted model for this data since it had the lowest deviance, AIC value, and the Cox-Snell residual graph closet to the bisector. Variables with a p-value of less than 0.2 were considered for the multivariable Gompertz gamma shared frailty model. In the multivariable Gompertez gamma shared frailty model, the Adjusted Hazard Ratio (AHR) with a 95% confidence interval (CI) was reported to identify significant predictors of neonatal mortality. Results Overall, the neonatal mortality rate in Ethiopia was 29.1 (95% CI: 26.1, 32.4) per 1000 live births. In the multivariable Gompertz gamma shared frailty model; male sex (AHR = 1.92, 95% CI: 1.52, 2.43), twin birth (AHR = 5.22, 95% CI: 3.62, 7.53), preceding birth interval less than 18 months (AHR = 2.07, 95% CI: 1.51, 2.85), small size at birth (AHR = 1.64, 95% CI: 1.24, 2.16), large size at birth (AHR = 1.53, 95% CI: 1.16, 2.01) and did not have Antenatal Care (ANC) visit (AHR = 2.10, 95% CI: 1.44, 3.06) were the significant predictors of neonatal mortality. Conclusion Our study found that neonatal mortality remains a public health problem in Ethiopia. Shorter birth interval, small and large size at birth, ANC visits, male sex, and twin births were significant predictors of neonatal mortality. These results suggest that public health programs that increase antenatal care service utilization should be designed to reduce neonatal mortality and special attention should be given for twin births, large and low birth weight babies. Besides, providing family planning services for mothers to increase birth intervals and improving accessibility and utilization of maternal health care services such as ANC is crucial to improve neonatal survival.

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Time to early initiation of postnatal care service utilization and its predictors among women who gave births in the last 2 years in Ethiopia: a shared frailty model

Archives of Public Health ◽

10.1186/s13690-021-00575-7 ◽

2021 ◽

Vol 79 (1) ◽

Author(s):

Ayal Debie ◽

Getayeneh Antehunegn Tesema

Keyword(s):

Antenatal Care ◽

Service Utilization ◽

Postnatal Care ◽

Care Service ◽

Frailty Model ◽

Early Initiation ◽

Local Health ◽

Decentralized Decision Making ◽

Shared Frailty Model ◽

Shared Frailty

Abstract Background Most maternal and infant deaths occurred within the first month after birth. Nearly half of the maternal deaths and more than a million newborn deaths occurred within the first day of life but these were preventable through early initiation of postnatal care (PNC) services. However, the available evidence on the level of early initiation of PNC service utilization was not adequate to inform policy decisions. Therefore, this study aimed to assess time to early initiation of postnatal care and its predictors using the 2016 Ethiopian Demography and Health Survey (EDHS) datasets. Methods Two-stage stratified cluster sampling technique by separating each region into urban and rural areas. A total weighted sample of 6364 women of the 2016 EDHS datasets who gave birth within 2 years preceding the survey was used. Time to early initiation of the PNC visit was estimated using the Kaplan-Meier (K-M) method. Shared frailty model with baseline distributions (Weibull, Gompertz, exponential, log-logistic, and lognormal) and frailty distributions (gamma and inverse Gaussian) were used by taking enumeration areas/clusters as a random effect for predictors of time to early initiation of PNC visit. The adjusted hazard ratio (AHR) with a 95% confidence interval (CI) and p-value less than 0.05 were used to declare the significant predictor variables for time to early initiation of the PNC service utilization. Results The prevalence of women who utilized PNC services within 42 days was 13.27% (95% CI, 12.46, 14.13). Among these women, only 1.73% of them had got within the first 24 h of birth; 4.66% of them received within 48–72 h and 1.74% of them also had got within 7–14 days. Variables, such as parity (AHR = 1.61, 95% CI: 1.21, 2.15), media exposure (AHR = 1.42, 95% CI: 1.21, 1.68), place of delivery (AHR = 14.36, 95% CI: 11.76, 17.53), caesarean delivery (AHR = 2.17, 95% CI: 1.60, 2.95) and antenatal care visit (AHR = 2.07, 95% CI: 1.63, 2.63) had the higher hazard for PNC services utilization. On the other hand, women who faced with healthcare access problems (AHR = 0.74, 95% CI: 0.60, 0.87) had a lower hazard of PNC service utilization. Conclusion The overall postnatal care service utilization among women in the survey was low, particularly within the first 24 h of delivery. Policy-makers and implementers should promote the utilization of antenatal care and institutional delivery using mass media to increase the continuum of maternity care. The government should also design a new approach to enhance the uptake of postnatal care services for poor households and to scale up the PNC services, including the different possibilities for women who give births at the health facilities and homes. Future researchers had better assess the capacity and accessibility of the local health systems, the level of decentralized decision making, common cultural practices, knowledge, attitude, and perception of mothers towards PNC service utilization.

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Determinants of Time-to-Under-Five Mortality in Ethiopia

International Journal of Biomedical and Clinical Engineering ◽

10.4018/ijbce.2018010101 ◽

2018 ◽

Vol 7 (1) ◽

pp. 1-24

Author(s):

Abebe Argaw Wogi ◽

Shibru Temesgen Wakweya ◽

Yohannes Yebabe Tesfay

Keyword(s):

Economic Status ◽

Frailty Model ◽

Information Criterion ◽

Demographic Variables ◽

Age At First Birth ◽

Under Five ◽

Shared Frailty Model ◽

Shared Frailty ◽

Major Factors ◽

Best Fit

This article describes how under-five mortality rate is one of the critical indicators of development of a country. This rate tells of children's access to basic health interventions such as vaccinations, medical treatment and adequate nutrition. This article proposes to identify the determinants of time to under-five mortality in Ethiopia based on the 2014 data taken from the Ethiopian Mini Demographic and Health Survey of women of the age group15-49 years. In this survival quantitative analysis, this article considers relevant socioeconomic, demographic variables and environmental factors. Various parameters shared among frailty models are employed to identify the determinants of Time-To-Under-Five Mortality of Ethiopia. The selection of the best-fit survival model is done by applying the Akaike information criterion (AIC). The AIC prevailed that the Weibull-gamma multivariable-shared frailty model is relatively the best-fit model. The estimation result of the Weibull-gamma multivariable-shared frailty model predicted that the major factors identified for under-five mortality in Ethiopia were mothers' educational level, mothers' age at first birth, place of residence, household size, sex of child born, preceding birth interval, economic status of family, place of delivery, marital status of family, and source of drinking water. The result implied that vast work is expected from governmental and non-governmental bodies to reduce the under-five mortality in the country by considering the identified factors.

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Time to first birth and its predictors among reproductive-age women in Ethiopia: inverse Weibull gamma shared frailty model

BMC Women s Health ◽

10.1186/s12905-021-01254-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Reta Dewau ◽

Fantahun Ayenew Mekonnen ◽

Wullo Sisay Seretew

Keyword(s):

Frailty Model ◽

Education Level ◽

Reproductive Age ◽

Early Age ◽

Age Difference ◽

Age At First Birth ◽

First Birth ◽

Reproductive Age Women ◽

Shared Frailty Model ◽

Shared Frailty

Abstract Background High maternal and child death with high fertility rate have been reported in Ethiopia. Extreme age at first birth is linked with both maternal and child morbidity and mortality. However, literatures showed there were limited studies on the timing of the first birth and its predictors in the area so far. Therefore, determining the time to first birth and its predictors will help to design strategies to improve maternal and child survival. Methods A community-based cross-sectional study was conducted among reproductive-age women in Ethiopia using the Ethiopian demographic health survey, 2016 data. Stratified two-stage cluster sampling technique was used for sampling. The Kaplan–Meier method was used to estimate time to first birth. Inverse Weibull gamma shared frailty model applied to model the data at 95% confidence interval (CI), adjusted hazard ratio (AHR) and median hazard ratio (MHR) were reported as effect size. Proportional hazard assumption checked using Schoenfeld residual test. Information Criteria were applied to select a parsimonious model. Stratified analysis performed for the interaction terms and statistical significance was declared at p value < 0.05. Results The overall median age at first birth was found to be 20 years (IQR, 16–24 years). The independent predictors of time to first birth were: married 15–17 years (AHR = 2.33, 95% CI 2.08–2.63), secondary education level (AHR = 0.84, 95% CI 0.78–0.96), higher education level (AHR = 0.75, 95% CI 0.65–0.85), intercourse before 15 years in the married stratum (AHR = 23.81, 95% CI 22.22–25.64), intercourse 15–17 years in married stratum (AHR = 5.56, 95% CI 5.26–5.88), spousal age difference (AHR = 1.11, 95% CI 1.05–1.16),and use of contraceptives (AHR = 0.91, 95% CI 0.86–0.97). The median increase in the hazard of early childbirth in a cluster with higher early childbirth is 16% (MHR = 1.16, 95% CI 1.13–1.20) than low risk clusters adjusting for other factors. Conclusion In this study, first birth was found to be at an early age. Early age at first marriage, at first sexual intercourse and their interaction, high spousal age difference, being Muslim were found to increase early motherhood. Conversely, living in the most urban region, secondary and higher women education were identified to delay the first birth. Investing on women education and protecting them from early marriage is required to optimize time to first birth. The contextual differences in time to first birth are an important finding which requires more study and interventions.

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Time to first birth and its Predictors among reproductive-age women in Ethiopia: inverse Weibull gamma shared frailty model

10.21203/rs.3.rs-24244/v2 ◽

2020 ◽

Author(s):

Reta Dewau ◽

Fantahun Ayenew Mekonnen ◽

Wullo Sisay Seretew

Keyword(s):

Frailty Model ◽

Education Level ◽

Reproductive Age ◽

Early Age ◽

Age Difference ◽

Age At First Birth ◽

First Birth ◽

Reproductive Age Women ◽

Shared Frailty Model ◽

Shared Frailty

Abstract Background: High maternal and child death with high fertility rate have been reported in Ethiopia. Extreme age at first birth is linked with both maternal and child morbidity and mortality. However, literatures showed there were limited studies on the timing of the first birth and its predictors in the area so far. Therefore, determining the time to first birth and its predictors will help to design strategies to improve maternal and child survival. Methods: A community-based cross-sectional study was conducted among reproductive-age women in Ethiopia using the Ethiopian demographic health survey (EDHS), 2016 data. Stratified two-stage cluster sampling technique was used for sampling. The Kaplan-Meier (KM) method was used to estimate time to first birth. Inverse Weibull gamma shared frailty model applied to model the data at 95% confidence interval (CI), adjusted hazard ratio (AHR) and median hazard ratio (MHR) were reported as effect size. Proportional hazard assumption checked using Schoenfeld residual test. Information Criteria were applied to select a parsimonious model. Stratified analysis performed for the interaction terms and statistical significance was declared at p value<0.05. Results: The overall median age at first birth was found to be 20 years (IQR, 16-24 years). The independent predictors of time to first birth were: married 15-17 years (AHR=2.33,95% CI:2.08-2.63),secondary education level (AHR=0.84,95% CI:0.78-0.96), higher education level (AHR=0.75, 95% CI:0.65-0.85), intercourse before 15 years in the married stratum (AHR=23.81, 95% CI:22.22-25.64), intercourse 15-17 years in married stratum (AHR=5.56, 95% CI:5.26-5.88),spousal age difference (AHR=1.11, 95% CI:1.05-1.16),and use of contraceptives (AHR=0.91, 95% CI: 0.86-0.97). The median increase in the hazard of early childbirth in a cluster with higher early childbirth is 16% (MHR=1.16, 95% CI: 1.13-1.20) than low risk clusters adjusting for other factors.Conclusion:In this study, first birth was found to be at an early age. Early age at first marriage, at first sexual intercourse and their interaction, high spousal age difference, being Muslim were found to increase early motherhood. Conversely, living in the most urban region, secondary and higher women education were identified to delay the first birth. Investing on women education and protecting them from early marriage is required to optimize time to first birth. The contextual differences in time to first birth are an important finding which requires more study and interventions.

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A shared frailty model for multivariate longitudinal data on adverse event of radiation therapy

Biometrical Journal ◽

10.1002/bimj.202000237 ◽

2021 ◽

Author(s):

Sung Won Kim ◽

Martin Schumacher ◽

Nicole H. Augustin

Keyword(s):

Adverse Event ◽

Radiation Therapy ◽

Longitudinal Data ◽

Frailty Model ◽

Multivariate Longitudinal Data ◽

Shared Frailty Model ◽

Shared Frailty

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Training Load and Baseline Characteristics Associated With New Injury/Pain Within an Endurance Sporting Population: A Prospective Study

International Journal of Sports Physiology and Performance ◽

10.1123/ijspp.2018-0644 ◽

2019 ◽

Vol 14 (5) ◽

pp. 590-597 ◽

Cited By ~ 9

Author(s):

Richard Johnston ◽

Roisin Cahalan ◽

Laura Bonnett ◽

Matthew Maguire ◽

Alan Nevill ◽

...

Keyword(s):

Confidence Interval ◽

Frailty Model ◽

Training Load ◽

Moving Averages ◽

Shared Frailty Model ◽

Shared Frailty ◽

History Of ◽

Baseline Characteristics ◽

A Prospective Study ◽

Exponentially Weighted

Purpose: To determine the association between training-load (TL) factors, baseline characteristics, and new injury and/or pain (IP) risk in an endurance sporting population (ESP). Methods: Ninety-five ESP participants from running, triathlon, swimming, cycling, and rowing disciplines initially completed a questionnaire capturing baseline characteristics. TL and IP data were submitted weekly over a 52-wk study period. Cumulative TL factors, acute:chronic workload ratios, and exponentially weighted moving averages were calculated. A shared frailty model was used to explore time to new IP and association to TL factors and baseline characteristics. Results: 92.6% of the ESP completed all 52 wk of TL and IP data. The following factors were associated with the lowest risk of a new IP episode: (a) a low to moderate 7-d lag exponentially weighted moving averages (0.8–1.3: hazard ratio [HR] = 1.21; 95% confidence interval [CI], 1.01–1.44; P = .04); (b) a low to moderate 7-d lag weekly TL (1200–1700 AU: HR = 1.38; 95% CI, 1.15–1.65; P < .001); (c) a moderate to high 14-d lag 4-weekly cumulative TL (5200–8000 AU: HR = 0.33; 95% CI, 0.21–0.50; P < .001); and (d) a low number of previous IP episodes in the preceding 12 mo (1 previous IP episode: HR = 1.11; 95% CI, 1.04–1.17; P = .04). Conclusions: To minimize new IP risk, an ESP should avoid high spikes in acute TL while maintaining moderate to high chronic TLs. A history of previous IP should be considered when prescribing TLs. The demonstration of a lag between a TL factor and its impact on new IP risk may have important implications for future ESP TL analysis.

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