A Spatial Analysis of Malaria and Related Health Outcomes in Pregnant Women in Guatemala Open Access

Parish, Alice Elizabeth (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/pr76f3998?locale=en
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Abstract

This paper focused on the spatial distribution of subclinical malaria cases and related health outcomes among pregnant women in Fray Bartolome de las Casas, Guatemala. Clinical data were gathered at a local health clinic during antenatal care visits; spatial data, including household points and routes, were gathered using GPS tracking devices. These data were linked, using a unique identification number, to test for spatial clustering of health outcomes and associations with physical access to care, with regards to distance. The binary health outcomes of interest were subclinical malaria (of any species), subclinical P. vivax, subclinical P. falciparum, anemia, severe anemia, delivery of a low birth weight infant, and premature delivery. It was found that there was no significant difference in distance from the health facility between the two possible outcomes for each of these factors when applying a t-test. Logistic regression was used to determine significant associations between distance, maternal age, number of previous gestations, and mother's weight for each of the binary health outcomes. Mother's weight was a significant predictor for subclinical P. vivax, low birth weight, and severe anemia (p-values = 0.019, 0.0001, 0.023, respectively) when controlling for all other factors. Maternal age is also significantly associated with the risk of subclinical P. vivax (p-value = 0.0355) when holding all other variables constant. Ripley's K function and Kulldorff spatial scan methods were applied to the same variables as before to assess global and local clustering. Ripley's K function, with edge correction, determined strong spatial clustering of cases at all distances within the study area. Three significant clusters were calculated with Kulldorff's scan method - two clusters of subclinical P. falciparum (p-values = 0.010, 0.011) and one cluster of anemia (p-value = 0.046). These results and further research will help reduce the risk of malaria in pregnancy and related health outcomes for women in this region of Guatemala through education, behavior change, and policy reform.

Table of Contents

Chapter 1: Introduction and Background …………………………………………………………1
Chapter 2: Review of the Literature ……………………………………………………………....5
Chapter 3: Methodology ………………………………………………………………………...10
Chapter 4: Results ……………………………………………………………………………….14
Chapter 5: Discussion …………………………………………………………………………...18
Works Cited ……………………………………………………………………………………..23
Appendix A: Tables ……………………………………………………………………………..26
Appendix B: Figures …………………………………………………………………...………..32
Appendix C: Maps ……………………………………………………………………………....36

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