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
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Chapter 5: Discussion
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Works Cited
……………………………………………………………………………………..23
Appendix A: Tables
……………………………………………………………………………..26
Appendix B: Figures
…………………………………………………………………...………..32
Appendix C: Maps
……………………………………………………………………………....36
About this Master's Thesis
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