Spatial Distribution of Malaria Prevalence in Ethiopia Based on Village Level Environmental, Socio-Economic, and Demographic Parameters Public

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

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Mot-clé	The Carter Center epidemiology Ethiopia spatial analysis poisson regression SNNP malaria Oromiya clustering Amhara
Committee Chair / Thesis Advisor	Kitron, Uriel, Emory University
Committee Members	Graves, Patricia, The Carter Center
Partnering Agencies	Emory University schools, faculty or affiliated programs International Non-governmental organization (e.g., CARE, Inc.) University, college or educational institution (other than Emory)

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