Integrative Perspectives on Environmental Determinants of Infectious Disease Across Scales: Patterns of Multidimensional Environmental Deprivations in Sub-Saharan Africa and Spatial Patterns of Malaria–Schistosomiasis Serology in Ifanadiana, Madagascar Open Access
Mugel, Stephen (Spring 2024)
Abstract
Background: Many of the highest burden infectious diseases are concentrated among the same communities and people. Yet, the distribution patterns of shared environmental risk factors are not well characterized, nor are multiple environmental interventions often integrated into most infectious disease prevention work.
Methods: In aim 1, we analyzed cross-sectional nationally representative datasets to describe patterns in concomitant deprivation in access to clean drinking water, safe sanitation and hygiene facilities, clean cooking fuels, and insecticide treated bednets in 38 countries in sub-Saharan Africa. In aim 2, we used the same data sources to estimate the interactive effects between these multidimensional deprivations with child mortality and diarrhea. In aim 3, we took a more local scale perspective and conduced descriptive and spatial serological analyses on cross-sectional data from Ifanadiana District, Madagascar, to explore patterns of Schistosoma mansoni and Plasmodium falciparum co-seropositivity.
Findings: In Aim 1, we found that multidimensional environmental deprivations are high throughout sub-Saharan Africa, but disparities across first administrative units, urban-rural divides, and levels of poverty were nearly universal. While specific deprivation profiles varied by country and urban-poverty strata, co-occurring deprivations in access to sanitation, hygiene, and cooking fuel were most common. In Aim 2, we found mixed evidence of some less than additive and more than additive interactions on mortality and diarrhea associated with interacting dimensions of environmental deprivations. Concurrent deprivations in sanitation, hygiene, and cooking fuel dimensions were associated with the largest relative decrements in mortality and diarrhea as compared to multidimensional profiles. In the third aim, we found 43% seroprevalence to S. mansoni and between 39.9 – 76% seroprevalence to different P. falciparum antibodies in Ifanadiana. Co-seroprevalence was 19.6 – 36.1% across antibody combinations, and was clustered in eastern villages in the district.
Conclusions: These results highlight ample opportunities to consider comprehensive environmental interventions to decrease multidimensional disparities in basic living conditions globally and improve child health outcomes. Future work should explore implementation synergies as well as causal mechanisms for interaction effects on child health. In Ifanadiana, potential synergies in malaria and schistosomiasis treatment and surveillance could be beneficial in the eastern portion of the district.
Table of Contents
Table of Contents
Chapter 1: Introduction and Literature Review ............................................................................................... 1
High burden infectious diseases ................................................................................................................. 1
Household environmental interventions ..................................................................................................... 4
Dissertation aims ...................................................................................................................................... 17
Research Aim 1 .................................................................................................................................... 18
Research Aim 2 .................................................................................................................................... 18
Research Aim 3 .................................................................................................................................... 19
Chapter 2: The prevalence and scope of multidimensional deprivations in access to healthy household environmental conditions in Sub-Saharan Africa .......................................................................................... 20
Abstract ................................................................................................................................................... 20
Introduction ............................................................................................................................................. 21
Methods ................................................................................................................................................... 24
Data sources ........................................................................................................................................ 24
Variable Definitions ............................................................................................................................. 24
Statistical analysis ................................................................................................................................. 27
Results ..................................................................................................................................................... 28
Patterns of environmental conditions ................................................................................................... 28
Patterns of multidimensional environmental deprivations..................................................................... 30
Multidimensional deprivation disparities associated with urbanicity and household poverty ................. 37
Mapping multidimensional environmental deprivations at the first administrative level ........................ 39
Discussion ............................................................................................................................................... 41
Chapter 3: Associations between multidimensional environmental deprivations and child mortality and diarrhea ........................................................................................................................................................ 49
Abstract ................................................................................................................................................... 49
Introduction ............................................................................................................................................. 50
Methods ................................................................................................................................................... 52
Survey Data Sources ............................................................................................................................. 52
Statistical Methods ............................................................................................................................... 55
Results ..................................................................................................................................................... 58
Mortality hazards .................................................................................................................................. 59
Diarrhea ............................................................................................................................................... 65
Discussion ............................................................................................................................................... 68
Strengths and Limitations ..................................................................................................................... 73
Conclusions and public health implications .......................................................................................... 75
Chapter 4: Spatial epidemiology of seroprevalence and co-seroprevalence to Plasmodium falciparum and Schistosoma mansoni antibodies in a rural district of Madagascar ...................................................................... 77
Abstract ................................................................................................................................................... 77
Introduction ............................................................................................................................................. 78
Methods ................................................................................................................................................... 80
Survey and serological data collection ................................................................................................... 80
Serological analysis and outcome definitions ........................................................................................ 80
Risk factor definitions .......................................................................................................................... 81
Statistical Analysis ................................................................................................................................ 82
Results ..................................................................................................................................................... 83
Discussion ............................................................................................................................................... 93
Limitations ........................................................................................................................................... 97
Conclusions and public health implications .......................................................................................... 98
Chapter 5: Summary, reflections, and directions for future research ............................................................. 99
Summary of results and public health implications ................................................................................... 99
Limitations and future directions ............................................................................................................ 103
Reflections ............................................................................................................................................. 104
Appendices ................................................................................................................................................ 108
Appendix A: Research Aim 1 Supplemental Material .............................................................................. 108
Appendix B: Research Aim 2 Supplemental Material .............................................................................. 140
Appendix C: Research Aim 3 Supplemental Material .............................................................................. 151
References.................................................................................................................................................. 153
About this Dissertation
| School | |
|---|---|
| Department | |
| Degree | |
| Submission | |
| Language |
|
| Research Field | |
| Keyword | |
| Committee Chair / Thesis Advisor | |
| Committee Members |
Primary PDF
| Thumbnail | Title | Date Uploaded | Actions |
|---|---|---|---|
|
|
Integrative Perspectives on Environmental Determinants of Infectious Disease Across Scales: Patterns of Multidimensional Environmental Deprivations in Sub-Saharan Africa and Spatial Patterns of Malaria–Schistosomiasis Serology in Ifanadiana, Madagascar () | 2024-04-22 21:43:49 -0400 |
|
Supplemental Files
| Thumbnail | Title | Date Uploaded | Actions |
|---|