Co-morbidity of childhood anaemia and malaria with a district-level spatial effect.
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Date
2021
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Abstract
Anaemia and malaria are the leading causes of sub-Saharan African childhood morbidity
and mortality. This thesis aimed to explore the risk factors as well as the
complex relationship between anaemia and malaria in young children across the districts
or counties of four contiguous sub-Saharan African countries, namely Kenya,
Malawi, Tanzania and Uganda. Nationally representative data from the Demographic
and Health Surveys conducted in all four countries was used. The observed
prevalence of anaemia and malaria was 52.5% and 19.7%, respectively, with
a 15.1% prevalence of co-infection. Machine learning based exploratory classification
methods were used to gain insight into the relationships and patterns among
the explanatory variables and the two responses. The administrative districts are
the level at which public health decisions are made within each of the countries.
Accordingly, the best linear unbiased predictor (BLUP) ranking and selection approach
was adopted to investigate the district-level spatial effects, while controlling
for child-level, household-level and environmental factors. Further to the geoadditive
model, a generalised additive mixed model with a spatial effect based on the geographical
coordinates of the sampled clusters within the districts was applied. The
relationship between the two diseases was further explored using joint modelling
approaches: a bivariate copula geoadditive model and shared component model.
The child’s age, mother’s education level, household wealth index and cluster altitude
were found to be significantly associated with both the anaemia and malaria
status of the child. The results of this study can help policy makers target the correct
set of interventions or prevent the use of incorrect interventions for anaemia and
malaria control and prevention. This aids in the targeted allocation of limited district
health system resources within each of these countries.
Description
Doctoral Degree. University of KwaZulu-Natal, Durban.