Abstract
BackgroundAnaemia and malaria are the leading causes of sub-Saharan African childhood morbidity and mortality. This study aimed to explore 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, while accounting for the effects of socio-economic, demographic and environmental factors. Geospatial maps were constructed to visualise the relationship between the two responses across the districts of the countries.MethodsA joint bivariate copula regression model was used, which estimates the correlation between the two responses conditional on the linear, non-linear and spatial effects of the explanatory variables considered. The copula framework allows the dependency structure between the responses to be isolated from their marginal distributions. The association between the two responses was set to vary according to the district of residence across the four countries.ResultsThe study revealed a positive association between anaemia and malaria throughout the districts, the strength of which varied across the districts of the four countries. Due to this heterogeneous association between anaemia and malaria, we further considered the joint probability of each combination of outcome of anaemia and malaria to further reveal more about the relationship between the responses. A considerable number of districts had a high joint probability of a child being anaemic but not having malaria. This might suggest the existence of other significant drivers of childhood anaemia in these districts.ConclusionsThis study presents an alternative technique to joint modelling of anaemia and malaria in young children which assists in understanding more about their relationship compared to techniques of multivariate modelling. The approach used in this study can aid in visualising the relationship through mapping of their correlation and joint probabilities. These maps produced can then help policy makers target the correct set of interventions, or prevent the use of incorrect interventions, particularly for childhood anaemia, the causes of which are multiple and complex.
Highlights
Anaemia and malaria are the leading causes of sub-Saharan African childhood morbidity and mortality
This study aimed to explore the relationship between anaemia and malaria in young children across the districts/counties of Kenya, Malawi, Tanzania and Uganda by making use of a joint bivariate copula regression model
We varied the association according to the district of residence. This revealed a positive association between anaemia and malaria throughout the districts, the strength of which varied across the districts of the four countries
Summary
Anaemia and malaria are the leading causes of sub-Saharan African childhood morbidity and mortality. This study aimed to explore 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, while accounting for the effects of socio-economic, demographic and environmental factors. Anaemia and malaria are major contributors of childhood morbidity and mortality, in sub-Saharan Africa [1, 2]. Young children are yet to develop an immunity to malaria, are more vulnerable. This is observed in the 2018 total malaria deaths worldwide, of which 67% were young children [4]. A significant proportion of these deaths are likely due to anaemia, directly or indirectly [5]
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