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Infant mortality rate is a proxy measure of population health. Previous studies on the infant mortality rate in Ethiopia did not consider measurement errors in the measured variables and had a one-directional effect; little emphasis was placed on testing multiple causal paths at the same time. We used structural equation modelling for a better understanding of the direct, indirect, and total effects among causal variables in a single model. A path analysis was part of an algorithm providing equations that were relating the variances and covariances of the indicators. From the results, the maternal mortality ratio (MMR) was significantly mediating the influence of out-of-pocket expenditure (OOP) on infant mortality rate (IMR), and the fertility rate (FR) was significantly mediating the influence of GDP to IMR (β = 1.168, p < 0.001). The GDP affects the IMR directly and indirectly while the OOP affects IMR indirectly. This study showed that there was a causal linkage between the World Bank Health and Population Variables for causing IMR in Ethiopia. The MMR and FR were found to be the intermediate indicators in this study. Through the indicators, FR had the highest standardised coefficients for increasing the IMR. We recommended that the existing interventions to reduce IMR be strengthened.

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Obstetric fistula is the presence of a hole between a woman's genital tract and either the urinary or the intestinal tract. Better knowledge of the risk factors for obstetric fistula could help in preventing its occurrence. The purpose of this study was to assess the characteristics of obstetric fistula patients. A retrospective and cohort study was used and 289 patients was taken from a hospital records. The study includes obstetric fistula patients who were recorded in the medical record room of cards which have the vital data and the patients with missing main data for the research were excluded. The results from the Weibull regression model revealed that older ages at first marriage, weight < 50 kg, height of > 150 cm, follow-up of antenatal care, delivery at health center, duration of labour for < 2 day, vaginal delivery, urban residence, accessing education, width of fistula < 5 cm, intact of urethra and duration of incontinent of urine <3 month significantly (p < 0.05) contribute to shorter stay in hospital to treated and physically cured than their counterparts. The average survival times of a patient stay in the hospital to treated and physically cured is 5.19 weeks. The finding of this study showed that age at first marriage, height, antenatal care, weight, place of delivery, mode of delivery, duration of labour, duration of incontinent of urine, educational status, residence width of fistula, and status of urethra were influential affecting recovery time of obstetric fistula patient at the Hospital.

Breast cancer is the major public health problem throughout the world and it results in serious physical damages and death. This work proposes the use of joint model to study breast cancer in patients of Ayder Hospital. The primary motivation is to contribute to the understanding of the tumor cell progression of breast cancer, within Ayder Hospital, using a joint model that takes into account a possible existence of a serial correlation structure within a same subject observations from September 2015 till December 2018. The general aim of this study was to investigate the risk of longitudinal change in tumor cell level on time to death due to breast cancer among breast cancer patients. Hospital-based retrospective cohort study was conducted among breast cancer patients. A joint model of longitudinal and time to death model was used to determine the risk of longitudinal change in tumor cell level on time to death due to breast cancer patients. These were used by using JM package in R version. Results from joint models, showed that the longitudinal Tumor cell progression was signicantly associated with the survival probability of these patients(estimated association parameter(ɑ) in the joint model is 0.84 with corresponding (95% CI: 2.28,2.37). A comparison between parameter estimates obtained in this joint model and independent survival and longitudinal analysis lead us to conclude that independent analysis brings up bias parameter