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Background: In sub-Saharan African countries, preventable and manageable diseases such as diarrhea and acute respiratory infections still claim the lives of children. Hence, this study aims to estimate the rate of change in the log expected number of days a child suffers from Diarrhea (NOD) and flu/common cold (NOF) among children aged 6 to 11 months at the baseline of the study. Methodology: This study used secondary data which exhibit a longitudinal and multilevel structure. Based on the results of exploratory analysis, a multilevel zero-inflated Poisson regression model with a rate of change in the log expected NOD and NOF described by a quadratic trend was proposed to efficiently analyze both outcomes accounting for correlation between observations and individuals through random effects. Furthermore, residual plots were used to assess the goodness of fit of the model. Results: Considering subject and cluster-specific random effects, the results revealed a quadratic trend in the rate of change of the log expected NOD. Initially, low dose iron Micronutrient Powder (MNP) users exhibited a higher rate of change compared to non-users, but this trend reversed over time. Similarly, the log expected NOF decreased for children who used MNP and exclusively breastfed for six months, in comparison to their counterparts. In addition, the odds of not having flu decreased with each two-week increment for MNP users, as compared to non-MNP users. Furthermore, an increase in NOD resulted in an increase in the log expected NOF. Region and exclusive breastfeeding also have a significant relationships with both NOD and NOF. Conclusion: The findings of this study underscore the importance of commencing analysis of data generated from a study with exploratory analysis. The study highlights the critical role of promoting EBF for the first six months and supporting children with additional food after six months to reduce the burden of infectious diseases. [ABSTRACT FROM AUTHOR]

Background: The distribution of HIV is not uniform in Ethiopia with some regions recording higher prevalence than others. However, reported regional HIV prevalence estimates mask the heterogeneity of the epidemic within regions. The main purpose of this study was to assess the district differences in HIV prevalence and other factors that affect the prevalence of HIV infection in Jimma zone, Oromia region of Ethiopia. We aimed to identify districts which had higher or lower than zone average HIV prevalence. Such in-depth analysis of HIV data at district level may help to develop effective strategies to reduce the HIV transmission rate.Methods: Data collected from 8440 patients who were tested for HIV status in government clinics at the 22 Districts between September 2018 to August 2019 in Jimma zone were used for the analyses. A generalized linear mixed effects model with district random effects was applied to assess the factors associated with HIV infection and the best linear unbiased prediction was used to identify districts that had higher or lower HIV infection. Both likelihood and Bayesian methods were considered.Results: The statistical test on district random effects variance suggested the need for district random effects in all the models. The results from applying both methods on full data show that the odds of HIV infection are significantly associated with covariates considered in this study. Disaggregation of prevalence by gender also highlighted the persistent features of the HIV epidemic in Jimma zone. After controlling for covariates effects, the results from both techniques revealed that there was heterogeneity in HIV infection prevalence among districts within Jimma zone, where some of them had higher and some had lower HIV infection prevalence compared to the zone average HIV infection prevalence.Conclusions: The study recommends government to give attention to those districts which had higher HIV infection and to conduct further research to improve their intervention strategies. Further, related to those districts which had lower infection, it would be advantageous to identify reasons for their performance and may apply them to overcome HIV infection among residents in those districts which had higher HIV infection. The approach used in this study can also help to assess the effect of interventions introduced by the authorities to control the epidemic and it can easily be extended to assess the regions HIV infection rate relative to the rate at the national level, or zones HIV infection rate relative to the rate at a region level. [ABSTRACT FROM AUTHOR]