Using mixed effects logistic regression models for complex survey data on malaria rapid diagnostic test results

Abstract

BackgroundThe effect of malaria in Nigeria is still worrisome and has remained a leading public health issue in the country. In 2016, Nigeria was the highest malaria burden country among the 15 countries in sub-Saharan Africa that accounted for the 80% global malaria cases. The purpose of this study is to utilize appropriate statistical models in identifying socio-economic, demographic and geographic risk factors that have influenced malaria transmission in Nigeria, based on malaria rapid diagnostic test survey results. This study contributes towards re-designing intervention strategies to achieve the target of meeting the Sustainable Development Goals 2030 Agenda for total malaria elimination.MethodsThis study adopted the generalized linear mixed models approach which accounts for the complexity of the sample survey design associated with the data. The 2015 Nigeria malaria indicator survey data of children between 6 and 59 months are used in the study.ResultsFrom the findings of this study, the cluster effect is significant (P<0.0001) which has suggested evidence of heterogeneity among the clusters. It was found that the vulnerability of a child to malaria infection increases as the child advances in age. Other major significant factors were; the presence of anaemia in a child, an area where a child resides (urban or rural), the level of the mother’s education, poverty level, number of household members, sanitation, age of head of household, availability of electricity and the type of material for roofing. Moreover, children from Northern and South-West regions were also found to be at higher risk of malaria disease and re-infection.ConclusionImprovement of socio-economic development and quality of life is paramount to achieving malaria free Nigeria. There is a strong link of malaria risk with poverty, under-development and the mother’s educational level.