Statistical study on childhood malnutrition and anaemia in Angola, Malawi and Senegal.

Abstract

Malnutrition and anaemia continue to be a concern to the future of developing countries. This thesis aimed to examine the risk factors associated with malnutrition and anaemia among under five-year-old children in Angola, Malawi and Senegal. Statistical models and techniques have improved over the years to give more insight into malnutrition and anaemia, in terms of demographic, socio-economic, environmental, and geographic factors. This thesis also assessed the spatial epidemiological overlaps between childhood malnutrition and anaemia diseases which can lead to various advantages in intervention planning, monitoring, controlling and total elimination of such diseases, especially in high-risk regions. This is a secondary data analysis where national representative data from the three countries was used. The Demographic and Health Survey data from Angola, Malawi and Senegal were merged to create a pooled sample which was then used for all the analyses conducted in this study. The relationship between exploratory variables to malnutrition and anaemia was assessed to obtain variables that explain the two outcomes. Consequently, a generalized linear mixed model was used to investigate the significance of the child-level, community-level and household-level factors to malnutrition and anaemia separately. The relationship between the two diseases was further examined using the three joint modelling approaches: (1) a joint generalised linear mixed model; (2) a structural equation model, and (3) a bivariate copula geo-additive model. For each model employed, the significant factors of both malnutrition and anaemia were identified. The GLMM results on malnutrition revealed that children’s place of residence, age, gender, mother’s level of schooling, wealth status, birth interval and birth order significantly explain malnutrition at the 5% level of significance. Whereas, the GLMM results on anaemia revealed that children‘s age, gender, mother’s level of schooling, wealth status and nutritional status significantly explain anaemia at 5% level of significance. The findings of copula geo-additive modelling of malnutrition and anaemia indicated that there is an association between malnutrition and anaemia. There was a strong association observed between malnutrition and anaemia in the north-west districts of Angola when compared to other districts. The results imply that the policymakers of Angola, Senegal and Malawi can control anaemia through the intervention of malnutrition controlling. The overall findings of this study provide meaningful insight to the policymakers of Angola, Malawi and Senegal which will lead to the implementation of interventions that can assist in achieving the Sustainable Development Goal (SDG) of 25 deaths per 1 000 live births by 2030. To properly eradicate all the causes of malnutrition and anaemia, programs such as parental education, financial education, children's dietary focus programs and mobile health facilities could add a significant value. The results also highlighted the national priority areas related to child-related factors, household factors and environmental factors for childhood malnutrition and anaemia morbidity control. It also provided policy makers with valuable geographical information for developing and implementing effective intervention. There is a greater need for partnership and collaboration among the studied countries to achieve the SGD target.