1
|
Chiziba C, Mercer LD, Diallo O, Bertozzi-Villa A, Weiss DJ, Gerardin J, Ozodiegwu ID. Socioeconomic, Demographic, and Environmental Factors May Inform Malaria Intervention Prioritization in Urban Nigeria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:78. [PMID: 38248543 PMCID: PMC10815685 DOI: 10.3390/ijerph21010078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/22/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024]
Abstract
Urban population growth in Nigeria may exceed the availability of affordable housing and basic services, resulting in living conditions conducive to vector breeding and heterogeneous malaria transmission. Understanding the link between community-level factors and urban malaria transmission informs targeted interventions. We analyzed Demographic and Health Survey Program cluster-level data, alongside geospatial covariates, to describe variations in malaria prevalence in children under 5 years of age. Univariate and multivariable models explored the relationship between malaria test positivity rates at the cluster level and community-level factors. Generally, malaria test positivity rates in urban areas are low and declining. The factors that best predicted malaria test positivity rates within a multivariable model were post-primary education, wealth quintiles, population density, access to improved housing, child fever treatment-seeking, precipitation, and enhanced vegetation index. Malaria transmission in urban areas will likely be reduced by addressing socioeconomic and environmental factors that promote exposure to disease vectors. Enhanced regional surveillance systems in Nigeria can provide detailed data to further refine our understanding of these factors in relation to malaria transmission.
Collapse
Affiliation(s)
- Chilochibi Chiziba
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL 60611, USA
| | | | - Ousmane Diallo
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL 60611, USA
| | | | - Daniel J. Weiss
- Telethon Kids Institute, Nedlands, WA 6009, Australia
- Faculty of Health Sciences, Curtin University, Bently, WA 6102, Australia
| | - Jaline Gerardin
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL 60611, USA
| | - Ifeoma D. Ozodiegwu
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL 60611, USA
- Department of Health Informatics and Data Science, Loyola University, Health Sciences Campus, Maywood, IL 60153, USA
| |
Collapse
|
2
|
Semakula HM, Liang S, Mukwaya PI, Mugagga F, Nseka D, Wasswa H, Mwendwa P, Kayima P, Achuu SP, Nakato J. Bayesian belief network modelling approach for predicting and ranking risk factors for malaria infections among children under 5 years in refugee settlements in Uganda. Malar J 2023; 22:297. [PMID: 37794401 PMCID: PMC10552276 DOI: 10.1186/s12936-023-04735-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 09/29/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Malaria risk factors at household level are known to be complex, uncertain, stochastic, nonlinear, and multidimensional. The interplay among these factors, makes targeted interventions, and resource allocation for malaria control challenging. However, few studies have demonstrated malaria's transmission complexity, control, and integrated modelling, with no available evidence on Uganda's refugee settlements. Using the 2018-2019 Uganda's Malaria Indicator Survey (UMIS) data, an alternative Bayesian belief network (BBN) modelling approach was used to analyse, predict, rank and illustrate the conceptual reasoning, and complex causal relationships among the risk factors for malaria infections among children under-five in refugee settlements of Uganda. METHODS In the UMIS, household level information was obtained using standardized questionnaires, and a total of 675 children under 5 years were tested for malaria. From the dataset, a casefile containing malaria test results, demographic, social-economic and environmental information was created. The casefile was divided into a training (80%, n = 540) and testing (20%, n = 135) datasets. The training dataset was used to develop the BBN model following well established guidelines. The testing dataset was used to evaluate model performance. RESULTS Model accuracy was 91.11% with an area under the receiver-operating characteristic curve of 0.95. The model's spherical payoff was 0.91, with the logarithmic, and quadratic losses of 0.36, and 0.16 respectively, indicating a strong predictive, and classification ability of the model. The probability of refugee children testing positive, and negative for malaria was 48.1% and 51.9% respectively. The top ranked malaria risk factors based on the sensitivity analysis included: (1) age of child; (2) roof materials (i.e., thatch roofs); (3) wall materials (i.e., poles with mud and thatch walls); (4) whether children sleep under insecticide-treated nets; 5) type of toilet facility used (i.e., no toilet facility, and pit latrines with slabs); (6) walk time distance to water sources (between 0 and 10 min); (7) drinking water sources (i.e., open water sources, and piped water on premises). CONCLUSION Ranking, rather than the statistical significance of the malaria risk factors, is crucial as an approach to applied research, as it helps stakeholders determine how to allocate resources for targeted malaria interventions within the constraints of limited funding in the refugee settlements.
Collapse
Affiliation(s)
- Henry Musoke Semakula
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P.O Box 7062, Kampala, Uganda.
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, 2055 Mowry Rd, Gainesville, FL, 32610, USA.
- Department of Environmental Health Sciences, School of Public Health & Health Sciences, University of Massachusetts, Amherst, 01003, USA.
| | - Song Liang
- Department of Environmental Health Sciences, School of Public Health & Health Sciences, University of Massachusetts, Amherst, 01003, USA
| | - Paul Isolo Mukwaya
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Frank Mugagga
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Denis Nseka
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Hannington Wasswa
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Patrick Mwendwa
- Department of Horticulture and Food Security, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00200, Nairobi, Kenya
| | - Patrick Kayima
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Simon Peter Achuu
- National Environmental Management Authority (NEMA), Plot 17/19/21 Jinja Road, P.O. Box 22255, Kampala, Uganda
| | - Jovia Nakato
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P.O Box 7062, Kampala, Uganda
| |
Collapse
|