Spatial Distribution of Malaria Prevalence in Ethiopia Based on Village Level Environmental, Socio-Economic, and Demographic Parameters Público
Cunningham, Marc Justin (2011)
Published
Abstract
Spatial Distribution of Malaria Prevalence in Ethiopia Based on
Village Level
Environmental, Socio-Economic, and Demographic
Parameters
By Marc Cunningham
Environmental parameters detectable through remote sensing often
correlate
well with aspects of vector habitat or suitability. Investigation
of these parameters in
the context of existing malaria interventions provides a clearer
understanding of the
disease distribution. Specifically, we discovered that the previous
two weeks average
land surface temperature, the previous six months average daily
rainfall, the previous
two weeks average vegetation, and population density were
significantly associated
(positively or negatively) with prevalence of malaria in Ethiopia
in 2006.
Stratification of risk in Ethiopia has historically been done based
on elevation.
Although altitude serves as a proxy for temperature, we suggest
that temperature itself
is the driving risk factor (Prevalence Ratio: 1.13). Further, given
the role we saw these
parameters play in disease distribution, we suggest that
evaluations of programmatic
work which fail to account for variations in environment over time
may be biased.
Based on spatial clustering in the eastern portion of the State of
Southern
Nations, Nationalities and Peoples (SNNP) Region, and poisson
regression results, we
suggest further research into the role higher rural population
density or peri-urban
environments may play in focal transmission.
Spatial Distribution of Malaria Prevalence in Ethiopia Based on Vil age Level
Environmental, Socio-Economic, and Demographic Parameters
By
Marc Cunningham
MPH 2011
Epidemiology
BA Plan II Honors
University of Texas at Austin
2007
BA Mathematics
University of Texas at Austin
2007
Faculty Advisor: Uriel Kitron, MPH, PhD
A thesis submitted to the Faculty of the
Rollins School of Public Health of Emory University
in partial fulfil ment of the requirements for the degree of
Master of Public Health
in Epidemiology
2011
Table of Contents
iii
Table of Contents
ACRONYMS
..................................................................................................................................
I
ACKNOWLEDGMENTS
.................................................................................................................
II
INTRODUCTION TO SPATIAL
EPIDEMIOLOGY
................................................................................1
BACKGROUND
.............................................................................................................................6
HISTORICAL MALARIA IN ETHIOPIA
.......................................................................................................6
MALARIA AND ECOLOGY
....................................................................................................................6
CURRENT MALARIA IN ETHIOPIA
..........................................................................................................7
SURVEY INFORMATION
......................................................................................................................8
RESEARCH HYPOTHESIS
...................................................................................................................
10
METHODS
..................................................................................................................................
12
SPATIAL ANALYSIS OF CLUSTERING
.....................................................................................................
12
REGRESSION VARIABLES
..................................................................................................................
12
MODELING STRATEGY:
....................................................................................................................
15
RESULTS
....................................................................................................................................
17
SPATIAL ANALYSIS
..........................................................................................................................
17
TABLE 0: MORAN'S I EVALUATING GLOBAL
AND REGIONAL CLUSTERING OF MALARIA IN AMHARA, OROMIYA,
AND
SNNP (2006 BASELINE)
............................................................................................................................
17
DESCRIPTIVE RESULTS
.....................................................................................................................
17
UNIVARIATE ASSOCIATIONS IN POISSON
REGRESSION
.............................................................................
18
TABLE 1: PREVALENCE, LLIN COVERAGE,
AND REMOTE SENSED VARIABLE MEANS BY SURVEY PERIOD IN
AMHARA,
OROMIYA, AND SNNP (2006 BASELINE
SURVEY)
..........................................................................................
20
TABLE 2: UNIVARIATE ASSOCIATIONS IN
POISSON REGRESSION COMPARING PREVALENCE WITH VILLAGE
LEVEL
DEMOGRAPHIC, BEHAVIOURAL, MALARIA
CONTROL, AND ENVIRONMENTAL FACTORS IN AMHARA, OROMIYA,
AND
SNNP (2006 BASELINE SURVEY)
................................................................................................................
21
MULTIVARIATE ASSOCIATIONS IN
POISSON REGRESSION
..........................................................................
22
TABLE 3: FULLY ADJUSTED ASSOCIATIONS
IN POISON REGRESSION BETWEEN MALARIA PREVALENCE,
DEMOGRAPHICS,
NET COVERAGE, AND ENVIRONMENTAL
FACTORS IN AMHARA, OROMIYA, AND SNNP (2006 BASELINE SURVEY) ....
23
DISCUSSION
...............................................................................................................................
24
PUBLIC HEALTH IMPLICATIONS
...................................................................................................
28
LIMITATIONS
.............................................................................................................................
31
FURTHER RESEARCH
...................................................................................................................
32
MAPS
........................................................................................................................................
34
iv
FUNDING
...................................................................................................................................
39
AUTHOR DETAILS
.......................................................................................................................
39
AUTHORS' CONTRIBUTIONS
.......................................................................................................
39
COMPETING INTERESTS
..............................................................................................................
39
BIBLIOGRAPHY
...........................................................................................................................
40
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