Geostatistical modelling of the association between malaria and child growth in Africa.
Geostatistical modelling of the association between malaria and child growth in Africa.
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DOI：
10.1186/s12942-018-0127-y
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发表时间：
2018-02-27
影响因子：
4.9
通讯作者：
Diggle PJ
中科院分区：
文献类型：
--
作者：
Amoah B;Giorgi E;Heyes DJ;van Burren S;Diggle PJ
在许多低收入和中等收入国家，5岁以下儿童营养不良仍然是一个公共卫生挑战，可能导致生长发育迟缓。传染病也可能影响儿童的成长，但其对后者的实际影响可能难以量化。在本文中，我们分析了在13个非洲国家进行的20次人口与健康调查（DHS）的数据，以调查疟疾和发育迟缓之间的关系。我们的目标是推断疟疾发病率之间的关联在第一年的生活和身高年龄Z分数（HAZ）。我们开发了一个HAZ的地统计模型，作为可测量和不可测量的儿童特定和空间风险因素的函数。我们通过绘制HAZ低于-2的预测概率，在20个分析调查中的每一个中可视化发育迟缓风险。最后，我们进行了荟萃分析，通过建模的估计影响疟疾发病率HAZ从每个DHS作为一个线性回归的国家发展指标，从世界银行。HAZ对疟疾发病率的非空间单变量线性回归显示，20项调查中有18项呈负相关。然而，在调整空间风险因素并控制混杂效应后，我们发现HAZ与疟疾之间的关联较弱，正负估计值混合，其中20个中有3个在传统的5%水平上与零显著不同。荟萃分析表明，疟疾发病率对HAZ估计影响的这种变化与可耕地数量显着相关。疟疾与发育迟缓之间的相互影响因国家和时间而异。地统计学分析提供了一个有用的框架，可以考虑未测量的空间混杂因素。要确定疟疾与发育迟缓之间是否存在因果关系，就需要对个别儿童进行纵向跟踪。本文的在线版本（10.1186/s12942-018-0127-y）包含补充材料，可供授权用户使用。
Undernutrition among children under 5 years of age continues to be a public health challenge in many low- and middle-income countries and can lead to growth stunting. Infectious diseases may also affect child growth, however their actual impact on the latter can be difficult to quantify. In this paper, we analyse data from 20 Demographic and Health Surveys (DHS) conducted in 13 African countries to investigate the relationship between malaria and stunting. Our objective is to make inference on the association between malaria incidence during the first year of life and height-for-age Z-scores (HAZs). We develop a geostatistical model for HAZs as a function of both measured and unmeasured child-specific and spatial risk factors. We visualize stunting risk in each of the 20 analysed surveys by mapping the predictive probability that HAZ is below − 2. Finally, we carry out a meta-analysis by modelling the estimated effects of malaria incidence on HAZ from each DHS as a linear regression on national development indicators from the World Bank. A non-spatial univariate linear regression of HAZ on malaria incidence showed a negative association in 18 out of 20 surveys. However, after adjusting for spatial risk factors and controlling for confounding effects, we found a weaker association between HAZ and malaria, with a mix of positive and negative estimates, of which 3 out of 20 are significantly different from zero at the conventional 5% level. The meta-analysis showed that this variation in the estimated effect of malaria incidence on HAZ is significantly associated with the amount of arable land. Confounding effects on the association between malaria and stunting vary both by country and over time. Geostatistical analysis provides a useful framework that allows to account for unmeasured spatial confounders. Establishing whether the association between malaria and stunting is causal would require longitudinal follow-up data on individual children. The online version of this article (10.1186/s12942-018-0127-y) contains supplementary material, which is available to authorized users.
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影响因子：
4.2
作者：
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通讯作者：
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