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Sandler A, Sun L. The Socio-Environmental Determinants of Childhood Malnutrition: A Spatial and Hierarchical Analysis. Nutrients 2024; 16:2014. [PMID: 38999762 PMCID: PMC11243526 DOI: 10.3390/nu16132014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/11/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
Despite a remarkable reduction in global poverty and famines, substantial childhood malnutrition continues to persist. In 2017, over 50 million and 150 million young children suffered from acute malnutrition (wasting) and chronic malnutrition (stunting), respectively. Yet, the measurable impact of determinants is obscure. We evaluate proposed socio-environmental related determinants of stunting and wasting across Kenya and Nigeria and quantify their effectiveness. We combine health and demographic data from Kenya and Nigeria Demographic Health Surveys (2003, 2008-2009, 2013, 2014) with spatially explicit precipitation, temperature, and vegetation data. Geospatial and disaggregated data help to understand better who is at risk and where to target mitigation efforts. We evaluate the responsiveness of malnutrition indicators using a four-level random intercept hierarchical generalized logit model. We find that spatial and hierarchical relationships explain 28% to 36% of malnutrition outcome variation. Temporal variation in precipitation, temperature, and vegetation corresponds with more than a 50% change in malnutrition rates. Wasting is most impacted by mother's education, family wealth, clinical delivery, and vaccinations. Stunting is most impacted by family wealth, mother's education, clinical delivery, vaccinations, and children asymptomatic of fever, cough, or diarrhea. Remotely monitored climatic variables are powerful determinants, however, their effects are inconsistent across different indicators and locations.
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Affiliation(s)
- Austin Sandler
- Department of Agricultural and Resource Economics, University of Connecticut, 1376 Storrs Rd., Unit 4021W.B. Young 302, Storrs, CT 06269, USA;
| | - Laixiang Sun
- Department of Geographical Sciences, University of Maryland, 2181 LeFrak Hall, 7251 Preinkert Dr., College Park, MD 20740, USA
- School of Finance & Management, SOAS University of London, London WC1H 0XG, UK
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2
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Mertens A, Benjamin-Chung J, Colford JM, Hubbard AE, van der Laan MJ, Coyle J, Sofrygin O, Cai W, Jilek W, Rosete S, Nguyen A, Pokpongkiat NN, Djajadi S, Seth A, Jung E, Chung EO, Malenica I, Hejazi N, Li H, Hafen R, Subramoney V, Häggström J, Norman T, Christian P, Brown KH, Arnold BF. Child wasting and concurrent stunting in low- and middle-income countries. Nature 2023; 621:558-567. [PMID: 37704720 PMCID: PMC10511327 DOI: 10.1038/s41586-023-06480-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/25/2023] [Indexed: 09/15/2023]
Abstract
Sustainable Development Goal 2.2-to end malnutrition by 2030-includes the elimination of child wasting, defined as a weight-for-length z-score that is more than two standard deviations below the median of the World Health Organization standards for child growth1. Prevailing methods to measure wasting rely on cross-sectional surveys that cannot measure onset, recovery and persistence-key features that inform preventive interventions and estimates of disease burden. Here we analyse 21 longitudinal cohorts and show that wasting is a highly dynamic process of onset and recovery, with incidence peaking between birth and 3 months. Many more children experience an episode of wasting at some point during their first 24 months than prevalent cases at a single point in time suggest. For example, at the age of 24 months, 5.6% of children were wasted, but by the same age (24 months), 29.2% of children had experienced at least one wasting episode and 10.0% had experienced two or more episodes. Children who were wasted before the age of 6 months had a faster recovery and shorter episodes than did children who were wasted at older ages; however, early wasting increased the risk of later growth faltering, including concurrent wasting and stunting (low length-for-age z-score), and thus increased the risk of mortality. In diverse populations with high seasonal rainfall, the population average weight-for-length z-score varied substantially (more than 0.5 z in some cohorts), with the lowest mean z-scores occurring during the rainiest months; this indicates that seasonally targeted interventions could be considered. Our results show the importance of establishing interventions to prevent wasting from birth to the age of 6 months, probably through improved maternal nutrition, to complement current programmes that focus on children aged 6-59 months.
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Affiliation(s)
- Andrew Mertens
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA.
| | - Jade Benjamin-Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - John M Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Alan E Hubbard
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Mark J van der Laan
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Jeremy Coyle
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Oleg Sofrygin
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Wilson Cai
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Wendy Jilek
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Sonali Rosete
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Anna Nguyen
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Nolan N Pokpongkiat
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Stephanie Djajadi
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Anmol Seth
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Esther Jung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Esther O Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Ivana Malenica
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Nima Hejazi
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Haodong Li
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Ryan Hafen
- Hafen Consulting, West Richland, WA, USA
| | | | | | - Thea Norman
- Quantitative Sciences, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kenneth H Brown
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.
- Department of Ophthalmology, University of California, San Francisco, CA, USA.
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Dwivedi LK, Bhatia M, Bansal A, Mishra R, P. S, Jana S, Subramanian SV, Unisa S. Role of seasonality variation in prevalence and trend of childhood wasting in India: An empirical analysis using National Family Health Surveys, 2005-2021. Health Sci Rep 2023; 6:e1093. [PMID: 36817627 PMCID: PMC9935817 DOI: 10.1002/hsr2.1093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 02/19/2023] Open
Abstract
Background Wasting develops over a short period and can be reversed with short-term interventions. The prevalence of wasting typically varies from season to season-becoming higher during the monsoon (June to September) season as compared to the winter (October to January) and summer (February to May) seasons every year in a cyclical fashion. However, to the best of our knowledge, using nationally representative demographic surveys to extensively study the impact of the timing of the survey on the results and trends around wasting has not been done so far. Objectives The goal of this study is to ascertain whether seasonality has an impact on the trend and levels of wasting between NFHS-3 (2005-2006) and NFHS-5 (2019-2021). Methods The analysis was based on data on 51,555, 259,627, and 232,920 children under 5 years included in NFHS-3, NFHS-4, and NFHS-5 respectively. Multivariable logistic regression analysis and the predicted probabilities approach were employed to examine the effect of the months of interview on the prevalence of wasting. The analysis was conducted for 9 states of India which had data for comparable months to compute wasting levels. Results We found that at the national level, wasting increased in India by one per cent from NFHS-3 to NFHS-4 but declined by 2% from NFHS-4 to NFHS-5. The results show that seasonality significantly influenced the prevalence of wasting. It was observed that compared to January, the odds of wasting were particularly higher in summer and monsoon seasons, especially in the month of August across all three rounds, indicating the influence of seasonality in the prevalence of wasting in the country. Discussion The prevalence of wasting in India needs to be interpreted across seasonal changes as seasonality affects many of the variables intrinsically related to child health and nutritional status.
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Affiliation(s)
- Laxmi Kant Dwivedi
- Department of Survey Research & Data AnalyticsInternational Institute for Population SciencesMumbaiIndia
| | - Mrigesh Bhatia
- Department of Health PolicyLondon School of EconomicsLondonUK
| | - Anjali Bansal
- Department of Survey Research & Data AnalyticsInternational Institute for Population SciencesMumbaiIndia
| | - Rahul Mishra
- Department of Survey Research & Data AnalyticsInternational Institute for Population SciencesMumbaiIndia
| | - Shirisha P.
- Department of Humanities and Social SciencesIIT MadrasChennaiIndia
| | - Somnath Jana
- Department of Survey Research & Data AnalyticsInternational Institute for Population SciencesMumbaiIndia
| | - S. V. Subramanian
- Population Health and GeographyHarvard UniversityBostonMassachusettsUSA
| | - Sayeed Unisa
- Department of Bio‐statistics and EpidemiologyInternational Institute for Population SciencesMumbaiIndia
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Gasparinho C, Gonçalves MH, Chissaque A, Silva GL, Fortes F, Gonçalves L. Wasting, Stunting, and Anemia in Angolan Children after Deworming with Albendazole or a Test-and-Treat Approach for Intestinal Parasites: Binary Longitudinal Models with Temporal Structure in a Four-Arm Randomized Trial. Nutrients 2022; 14:nu14112185. [PMID: 35683985 PMCID: PMC9183140 DOI: 10.3390/nu14112185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023] Open
Abstract
Undernutrition, anemia, and intestinal parasitic infections are public health problems in Angola, especially in pre-school children. We analyzed binary data from a longitudinal four-arm randomized parallel trial conducted in Bengo Province, northern Angola, over the course of two years, with seven follow-up assessments to explore the effects of four interventions (deworming and a test-and-treat approach for intestinal parasites, at both the individual and household levels) on wasting and stunting, and to understand their indirect benefits for anemia, malaria, diarrhea, and vomiting. A total of 121 children with intestinal parasitic infections received baseline treatment, and were allocated to the four arms (1:1:1:1). Using continuous outcome variables of height-for-age (HAZ) and weight-for-height (WHZ) statistical approaches did not reveal a clear benefit of any particular arm (Pathogens 2021, 10, 309). Next, HAZ and WHZ were transformed into binary variables of stunting and wasting, respectively, considering their mild-to-severe (Z-score < −1) and moderate-to-severe degrees (Z-score < −2). Original clinical data (on anemia, diarrhea, vomiting, and malaria) were also analyzed. From a binary longitudinal analysis with different dependence structures, using the R package bild, fitted models revealed the potential benefit of a test-and-treat approach at the individual level for wasting compared with annual albendazole at the individual level, especially considering mild-to-severe forms (ORadj = 0.27; p = 0.007). All arms showed similar effects on stunting, compared with annual albendazole, at a 5% significance level. Time and age at baseline presented favorable effects in the percentage of stunting using both severity degrees. Results showed a decreased chance of having anemia and diarrhea over time, although with no significant differences between arms. Data from longitudinal studies are essential to study the direct and indirect effects of interventions, such as deworming, and to explore additional approaches aiming at better understanding the temporal structure of nutrition and health outcomes in children.
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Affiliation(s)
- Carolina Gasparinho
- Centro de Investigação em Saúde de Angola (CISA), Rua Direita de Caxito, Caxito, Angola
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), 1349-008 Lisbon, Portugal; (A.C.); (F.F.)
- Correspondence: (C.G.); (L.G.)
| | - Maria Helena Gonçalves
- Departamento de Matemática, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 8005-139 Faro, Portugal;
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Faculdade de Ciências da Universidade de Lisboa, 1749-016 Lisbon, Portugal;
| | - Assucênio Chissaque
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), 1349-008 Lisbon, Portugal; (A.C.); (F.F.)
- Instituto Nacional de Saúde, Distrito de Marracuene, Maputo 264, Mozambique
| | - Giovani L. Silva
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Faculdade de Ciências da Universidade de Lisboa, 1749-016 Lisbon, Portugal;
- Departamento de Matemática, Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001 Lisbon, Portugal
| | - Filomeno Fortes
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), 1349-008 Lisbon, Portugal; (A.C.); (F.F.)
| | - Luzia Gonçalves
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), 1349-008 Lisbon, Portugal; (A.C.); (F.F.)
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Faculdade de Ciências da Universidade de Lisboa, 1749-016 Lisbon, Portugal;
- Correspondence: (C.G.); (L.G.)
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Spatial Variations and Determinants of Acute Malnutrition Among Under-Five Children in Ethiopia: Evidence from 2019 Ethiopian Demographic Health Survey. Ann Glob Health 2021; 87:114. [PMID: 34900614 PMCID: PMC8622002 DOI: 10.5334/aogh.3500] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and aims: Childhood acute malnutrition, in the form of wasting defined by a severe weight loss as a result of acute food shortage and/or illness. It is a critical public health problem that needs urgent attention in developing countries, like Ethiopia. Despite its variation between localities, the risk factors and its geospatial variation were not addressed enough across the various corner of the country. Therefore, the current study was undertaken to assess spatial variation and factors associated with acute malnutrition among under-five children in Ethiopia. Methods: A total weighted sample of 4 955 under-five children were included from the 2019 Demographic and Health Survey. Getis-Ord spatial statistical tool used to identify the hot and cold spot areas of severe and acute malnutrition. A multilevel multivariable logistic regression model using was used to examine predictors of acute malnutrition. In the multivariable multilevel analysis, Adjusted Odds Ratio with 95% CI was used to declare significant determinants of acute malnutrition among children. Result: Among 4 955 under-five children, 7% of them were wasted and 1% of them were severely wasted in Ethiopia during the 2019 national demographic survey. The distribution was followed some spatial geo-locations where most parts of Somali were severely affected (RR = 1.46, P37 value <0.001), and the distribution affected few areas of Afar, Gambella, and Benishangul Gumz regions. Factors that significantly associated with childhood wasting were: gender(male)1.9 (1.3–2.7), age (above 36 months) 0.5 (0.2–0.9), wealth index(richest) 0.5 (0.2–0.8), and water source (unimproved source) 1.5 (1.0–2.3). Conclusions: Our finding implies, the distribution of childhood wasting was not random. Regions like Afar, Somali, and pocket areas in Gambella and SNNP should be considered as priority areas nutritional interventions for reducing acute malnutrition. The established socio-demographic and economic characteristics can be also used to develop strategies.
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Aheto JMK, Dagne GA. Geostatistical analysis, web-based mapping, and environmental determinants of under-5 stunting: evidence from the 2014 Ghana Demographic and Health Survey. Lancet Planet Health 2021; 5:e347-e355. [PMID: 34119009 DOI: 10.1016/s2542-5196(21)00080-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Stunting rates in children younger than 5 years are among the most important health indicators globally. At the national level, malnutrition accounts for about 40% of under-5 deaths in Ghana. Disease risk mapping provides opportunities for disease surveillance and targeted interventions. We aimed to estimate and map under-5 stunting prevalence in Ghana, with the goal of identifying communities at higher risk where interventions and further research can be targeted. METHODS For this modelling study, we used data from the 2014 Ghana Demographic and Health Survey. Analyses were done on 2734 children residing in 415 geographical clusters. The outcome variable was the number of stunted children younger than 5 years in each sampled cluster. We employed a Bayesian geostatistical model to investigate both measured and unmeasured spatial risk factors for child stunting, comparing the performance of non-spatial (adjusting for selected covariates without spatial correlation), spatial (including spatial correlation), and null spatial (without the selected covariates) models. We then visualised the stunting prevalence across Ghana by mapping the predicted prevalence and exceedance probabilities to resolutions as refined as 5 km × 5 km. FINDINGS In 2014, 535 (19·6%) of 2734 children surveyed in Ghana were stunted. Elevation (log odds mean -0·0017, 95% credible interval -0·0034 to -0·0001), precipitation (0·0403, 0·0192 to 0·0615), and aridity (-3·7013, -6·5478 to -0·8723) were environmental and climatic factors associated with stunting in the non-spatial model, but were not significant in the spatial model. Substantial geographical variations in prevalence of childhood stunting were found. The predicted mean stunting prevalence was 27·7% (SD 3·7%) with predicted prevalence ranging from 4·2% to 45·1% across Ghana. Children residing in parts of the Northern region were at highest risk of stunting, whereas parts of the Greater Accra, Brong-Ahafo, Ashanti, and Eastern regions showed some of the lowest prevalence. INTERPRETATION There are substantial geographical differences in childhood stunting across Ghana. Our prevalence maps can be used as an effective tool to identify communities that require targeted interventions by programme managers and implementers, as part of an overall strategy to reduce the burden of malnutrition in a country with limited public health resources. FUNDING None.
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Affiliation(s)
- Justice Moses K Aheto
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana; College of Public Health, University of South Florida, Tampa, FL, USA.
| | - Getachew A Dagne
- College of Public Health, University of South Florida, Tampa, FL, USA
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Marshak A, Venkat A, Young H, Naumova EN. How Seasonality of Malnutrition Is Measured and Analyzed. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1828. [PMID: 33668508 PMCID: PMC7918225 DOI: 10.3390/ijerph18041828] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 12/28/2022]
Abstract
Seasonality is a critical source of vulnerability across most human activities and natural processes, including the underlying and immediate drivers of acute malnutrition. However, while there is general agreement that acute malnutrition is highly variable within and across years, the evidence base is limited, resulting in an overreliance on assumptions of seasonal peaks. We review the design and analysis of 24 studies exploring the seasonality of nutrition outcomes in Africa's drylands, providing a summary of approaches and their advantages and disadvantages. Over half of the studies rely on two to four time points within the year and/or the inclusion of time as a categorical variable in the analysis. While such approaches simplify interpretation, they do not correspond to the climatic variability characteristic of drylands or the relationship between climatic variability and human activities. To better ground our understanding of the seasonality of acute malnutrition in a robust evidence base, we offer recommendations for study design and analysis, including drawing on participatory methods to identify community perceptions of seasonality, use of longitudinal data and panel analysis with approaches borrowed from the field of infectious diseases, and linking oscillations in nutrition data with climatic data.
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Affiliation(s)
- Anastasia Marshak
- Feinstein International Center, Tufts University, Boston, MA 02111, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Aishwarya Venkat
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Helen Young
- Feinstein International Center, Tufts University, Boston, MA 02111, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Elena N Naumova
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
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Amegbor PM, Zhang Z, Dalgaard R, Sabel CE. Multilevel and spatial analyses of childhood malnutrition in Uganda: examining individual and contextual factors. Sci Rep 2020; 10:20019. [PMID: 33208763 PMCID: PMC7676238 DOI: 10.1038/s41598-020-76856-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 10/29/2020] [Indexed: 12/14/2022] Open
Abstract
In this study, we examine the concepts of spatial dependence and spatial heterogeneity in the effect of macro-level and micro-level factors on stunting among children aged under five in Uganda. We conducted a cross-sectional analysis of 3624 Ugandan children aged under five, using data from the 2016 Ugandan Demographic and Health Survey. Multilevel mixed-effect analysis, spatial regression methods and multi-scale geographically weight regression (MGWR) analysis were employed to examine the association between our predictors and stunting as well as to analyse spatial dependence and variability in the association. Approximately 28% of children were stunted. In the multilevel analysis, the effect of drought, diurnal temperature and livestock per km2 on stunting was modified by child, parent and household factors. Likewise, the contextual factors had a modifiable effect on the association between child’s sex, mother’s education and stunting. The results of the spatial regression models indicate a significant spatial error dependence in the residuals. The MGWR suggests rainfall and diurnal temperature had spatial varying associations with stunting. The spatial heterogeneity of rainfall and diurnal temperature as predictors of stunting suggest some areas in Uganda might be more sensitive to variability in these climatic conditions in relation to stunting than others.
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Affiliation(s)
- Prince M Amegbor
- Big Data Centre for Environment and Health (BERTHA), Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark. .,Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark.
| | - Zhaoxi Zhang
- Big Data Centre for Environment and Health (BERTHA), Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark.,Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
| | - Rikke Dalgaard
- Big Data Centre for Environment and Health (BERTHA), Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark.,Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
| | - Clive E Sabel
- Big Data Centre for Environment and Health (BERTHA), Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark.,Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
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Belayneh M, Loha E, Lindtjørn B. Seasonal Variation of Household Food Insecurity and Household Dietary Diversity on Wasting and Stunting among Young Children in A Drought Prone Area in South Ethiopia: A Cohort Study. Ecol Food Nutr 2020; 60:44-69. [PMID: 32672490 DOI: 10.1080/03670244.2020.1789865] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study was conducted to evaluate seasonal patterns of household food insecurity, dietary diversity, and household characteristics on wasting and stunting among children in households followed for 1 year in the drought-prone areas of Sidama, Ethiopia. A cohort study design was employed. Data were collected on the pre-harvest season (March and June) and post-harvest season (September and December) of 2017. We studied 935 children aged 6 to 47 months. At four seasons over a year, we had 3,449 observations from 897 households and 82% (2,816) (95% CI: 80.3-82.9) were food in-secured households. Severe food insecurity was higher in the pre-harvest (March; food scarcity season) which was 69% as compared to 50% of September (P < .001). From 3,488 observations, 44% (1,533) (95% CI: 42.3-45.6) of children were stunted. Stunting showed seasonal variations with 38% (95% CI: 34.7-41.0) in March and 49% (95% CI: 45.8-52.5) in December. Six percent (95% CI: 5.0-6.6) of children were wasted, with higher prevalence in March (8%) as compared to 3% of September (P < .001). Moreover, household characteristics such as poverty level, education, occupation and the household food insecurity and dietary diversity were associated with subsequent wasting and stunting.
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Affiliation(s)
- Mehretu Belayneh
- School of Public Health, College of Medicine and Health Sciences, Hawassa University , Hawassa, Ethiopia.,Centre for International Health, University of Bergen , Bergen, Norway
| | - Eskindir Loha
- School of Public Health, College of Medicine and Health Sciences, Hawassa University , Hawassa, Ethiopia.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , London, UK
| | - Bernt Lindtjørn
- School of Public Health, College of Medicine and Health Sciences, Hawassa University , Hawassa, Ethiopia.,Centre for International Health, University of Bergen , Bergen, Norway
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Brown ME, Backer D, Billing T, White P, Grace K, Doocy S, Huth P. Empirical studies of factors associated with child malnutrition: highlighting the evidence about climate and conflict shocks. Food Secur 2020. [DOI: 10.1007/s12571-020-01041-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AbstractChildren who experience poor nutrition during the first 1000 days of life are more vulnerable to illness and death in the near term, as well as to lower work capacity and productivity as adults. These problems motivate research to identify basic and underlying factors that influence risks of child malnutrition. Based on a structured search of existing literature, we identified 90 studies that used statistical analyses to assess relationships between potential factors and major indicators of child malnutrition: stunting, wasting, and underweight. Our review determined that wasting, a measure of acute malnutrition, is substantially understudied compared to the other indicators. We summarize the evidence about relationships between child malnutrition and numerous factors at the individual, household, region/community, and country levels. Our results identify only select relationships that are statistically significant, with consistent signs, across multiple studies. Among the consistent predictors of child malnutrition are shocks due to variations in climate conditions (as measured with indicators of temperature, rainfall, and vegetation) and violent conflict. Limited research has been conducted on the relationship between violent conflict and wasting. Improved understanding of the variables associated with child malnutrition will aid advances in predictive modeling of the risks and severity of malnutrition crises and enhance the effectiveness of responses by the development and humanitarian communities.
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Manda S, Haushona N, Bergquist R. A Scoping Review of Spatial Analysis Approaches Using Health Survey Data in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3070. [PMID: 32354095 PMCID: PMC7246597 DOI: 10.3390/ijerph17093070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 01/03/2023]
Abstract
Spatial analysis has become an increasingly used analytic approach to describe and analyze spatial characteristics of disease burden, but the depth and coverage of its usage for health surveys data in Sub-Saharan Africa are not well known. The objective of this scoping review was to conduct an evaluation of studies using spatial statistics approaches for national health survey data in the SSA region. An organized literature search for studies related to spatial statistics and national health surveys was conducted through PMC, PubMed/Medline, Scopus, NLM Catalog, and Science Direct electronic databases. Of the 4,193 unique articles identified, 153 were included in the final review. Spatial smoothing and prediction methods were predominant (n = 108), followed by spatial description aggregation (n = 25), and spatial autocorrelation and clustering (n = 19). Bayesian statistics methods and lattice data modelling were predominant (n = 108). Most studies focused on malaria and fever (n = 47) followed by health services coverage (n = 38). Only fifteen studies employed nonstandard spatial analyses (e.g., spatial model assessment, joint spatial modelling, accounting for survey design). We recommend that for future spatial analysis using health survey data in the SSA region, there must be an improve recognition and awareness of the potential dangers of a naïve application of spatial statistical methods. We also recommend a wide range of applications using big health data and the future of data science for health systems to monitor and evaluate impacts that are not well understood at local levels.
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Affiliation(s)
- Samuel Manda
- Biostatistics Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Statistics, University of Pretoria, Pretoria 0002, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg 3209, South Africa
| | - Ndamonaonghenda Haushona
- Biostatistics Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Division of Epidemiology and Biostatistics, University of Stellenbosch, Cape Town 8000, South Africa
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Grace K, Billingsley S, Van Riper D. Building an interdisciplinary framework to advance conceptual and technical aspects of population-environment research focused on women's and children's health. Soc Sci Med 2020; 250:112857. [PMID: 32151780 PMCID: PMC7426241 DOI: 10.1016/j.socscimed.2020.112857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/30/2019] [Accepted: 02/13/2020] [Indexed: 11/25/2022]
Abstract
Great gains have been made in providing researchers geo-spatial data that can be combined with population health data. This development is crucial given concerns over the human health outcomes associated with a changing climate. Merging population and environmental data remains both conceptually and technically challenging because of a large range of temporal and spatial scales. Here we propose a framework that addresses and advances both conceptual and technical aspects of population-environment research. This framework can be useful for considering how any time or space-based environmental occurrence influences population health outcomes and can be used to guide different data aggregation strategies. The primary consideration discussed here is how to properly model the space and time effects of environmental context on individual-level health outcomes, specifically maternal, child and reproductive health outcomes. The influx of geospatial health data and highly detailed environmental data, often at daily scales, provide an opportunity for population-environment researchers to move towards a more theoretically and analytically sound approach for studying environment and health linkages.
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Affiliation(s)
- Kathryn Grace
- Department of Geography, Environment and Society and the Minnesota Population Center, University of Minnesota, USA.
| | | | - David Van Riper
- Institute for Social Research and Data Innovation, University of Minnesota, USA.
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13
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Seasonality: a missing link in preventing undernutrition. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 4:e3. [PMID: 31676194 DOI: 10.1016/s2352-4642(19)30343-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/13/2019] [Accepted: 10/14/2019] [Indexed: 12/17/2022]
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Jin Z, Chang HH, Ponicki WR, Gaidus A, Waller LA, Morrison CN, Gruenewald PJ. Longitudinal impacts of two causal drivers of alcohol demand on outlet concentrations within community settings: Population size and income effects. Spat Spatiotemporal Epidemiol 2018; 27:21-28. [PMID: 30409373 PMCID: PMC6233730 DOI: 10.1016/j.sste.2018.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/12/2018] [Accepted: 07/11/2018] [Indexed: 11/16/2022]
Abstract
We analyzed counts of licensed bars, restaurants and off-premise alcohol outlets within 53 California cities from 2000-2013. Poisson models were used to assess overall space-time associations between outlet numbers and population size and median household income in local and spatially adjacent block groups. We then separated covariate effects into distinct spatial and temporal components ("decomposed" models). Overall models showed that densities of all outlet types were generally greatest within block groups that had lower income, were adjacent to block groups with lower income, had greater populations, and were adjacent to block groups that had greater populations. Decomposed models demonstrate that over time greater income was associated with increased counts of bars, and greater population was associated with greater numbers of restaurants and off-premise outlets. Acknowledging the many negative consequences for populations living in areas of high outlet density, these effects are a predictable and powerful social determinant of health.
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Affiliation(s)
- Zhuxuan Jin
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, United States
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, United States
| | - William R Ponicki
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Avenue, Suite 601, Berkeley, CA 94704, United States
| | - Andrew Gaidus
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Avenue, Suite 601, Berkeley, CA 94704, United States
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, United States
| | - Christopher N Morrison
- Penn Injury Science Center, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States; Monash University, Department of Epidemiology and Preventive Medicine, 99 Commercial Road, Melbourne, VIC 3004, Australia
| | - Paul J Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Avenue, Suite 601, Berkeley, CA 94704, United States.
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Kinyoki DK, Moloney GM, Uthman OA, Odundo EO, Kandala NB, Noor AM, Snow RW, Berkley JA. Co-morbidity of malnutrition with falciparum malaria parasitaemia among children under the aged 6-59 months in Somalia: a geostatistical analysis. Infect Dis Poverty 2018; 7:72. [PMID: 29986753 PMCID: PMC6036667 DOI: 10.1186/s40249-018-0449-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 06/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Malnutrition and malaria are both significant causes of morbidity and mortality in African children. However, the extent of their spatial comorbidity remains unexplored and an understanding of their spatial correlation structure would inform improvement of integrated interventions. We aimed to determine the spatial correlation between both wasting and low mid upper arm circumference (MUAC) and falciparum malaria among Somalian children aged 6–59 months. Methods Data were from 49 227 children living in 888 villages between 2007 to 2010. We developed a Bayesian geostatistical shared component model in order to determine the common spatial distributions of wasting and falciparum malaria; and low-MUAC and falciparum malaria at 1 × 1 km spatial resolution. Results The empirical correlations with malaria were 0.16 and 0.23 for wasting and low-MUAC respectively. Shared spatial residual effects were statistically significant for both wasting and low-MUAC. The posterior spatial relative risk was highest for low-MUAC and malaria (range: 0.19 to 5.40) and relatively lower between wasting and malaria (range: 0.11 to 3.55). Hotspots for both wasting and low-MUAC with malaria occurred in the South Central region in Somalia. Conclusions The findings demonstrate a relationship between nutritional status and falciparum malaria parasitaemia, and support the use of the relatively simpler MUAC measurement in surveys. Shared spatial distribution and distinct hotspots present opportunities for targeted seasonal chemoprophylaxis and other forms of malaria prevention integrated within nutrition programmes. Electronic supplementary material The online version of this article (10.1186/s40249-018-0449-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Damaris K Kinyoki
- Spatial Health Metrics Group, INFORM Project, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.
| | - Grainne M Moloney
- Nutrition Section, United Nations Children's Fund (UNICEF), Kenya Country Office, UN Complex Gigiri, Nairobi, Kenya
| | - Olalekan A Uthman
- Warwick Medical School, Health Sciences Research Institute, Warwick Evidence, University of Warwick, Gibbet Hill, Coventry, CV4 7AL, UK
| | - Elijah O Odundo
- Food Security and Nutrition Analysis Unit (FSNAU) - Somalia, Food and Agriculture Organization of the United Nations, Ngecha Road Campus, Nairobi, Kenya
| | - Ngianga-Bakwin Kandala
- Department of Mathematics and Information sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK.,Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway.,Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Abdisalan M Noor
- Spatial Health Metrics Group, INFORM Project, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford, OX3 7LJ, UK
| | - Robert W Snow
- Spatial Health Metrics Group, INFORM Project, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford, OX3 7LJ, UK
| | - James A Berkley
- Kenya Medical Research Institute/ Wellcome Trust Research Programme, Centre for Geographic Medicine Research (coast), Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford, OX3 7LJ, UK
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Aheto JMK, Taylor BM, Keegan TJ, Diggle PJ. Modelling and forecasting spatio-temporal variation in the risk of chronic malnutrition among under-five children in Ghana. Spat Spatiotemporal Epidemiol 2017; 21:37-46. [DOI: 10.1016/j.sste.2017.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/11/2017] [Accepted: 02/21/2017] [Indexed: 11/30/2022]
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Kinyoki DK, Manda SO, Moloney GM, Odundo EO, Berkley JA, Noor AM, Kandala NB. Modelling the Ecological Comorbidity of Acute Respiratory Infection, Diarrhoea and Stunting among Children Under the Age of 5 Years in Somalia. Int Stat Rev 2017; 85:164-176. [PMID: 28450758 PMCID: PMC5396332 DOI: 10.1111/insr.12206] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 12/12/2016] [Accepted: 12/15/2016] [Indexed: 11/30/2022]
Abstract
The aim of this study was to assess spatial co-occurrence of acute respiratory infections (ARI), diarrhoea and stunting among children of the age between 6 and 59 months in Somalia. Data were obtained from routine biannual nutrition surveys conducted by the Food and Agriculture Organization 2007-2010. A Bayesian hierarchical geostatistical shared component model was fitted to the residual spatial components of the three health conditions. Risk maps of the common spatial effects at 1×1 km resolution were derived. The empirical correlations of the enumeration area proportion were 0.37, 0.63 and 0.66 for ARI and stunting, diarrhoea and stunting and ARI and diarrhoea, respectively. Spatially, the posterior residual effects ranged 0.03-20.98, 0.16-6.37 and 0.08-9.66 for shared component between ARI and stunting, diarrhoea and stunting and ARI and diarrhoea, respectively. The analysis showed clearly that the spatial shared component between ARI, diarrhoea and stunting was higher in the southern part of the country. Interventions aimed at controlling and mitigating the adverse effects of these three childhood health conditions should focus on their common putative risk factors, particularly in the South in Somalia.
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Affiliation(s)
- Damaris K Kinyoki
- Spatial Health Metrics Group, INFORM Project Kenya Medical Research Institute/Wellcome Trust Research Programme Nairobi Kenya
| | - Samuel O Manda
- Biostatistics Research Unit South African Medical Research Council Pretoria South Africa.,Division of Epidemiology and Biostatistics, School of Public Health University of Witwatersrand Johannesburg South Africa
| | - Grainne M Moloney
- Nutrition Section, United Nations Children's Fund (UNICEF) Kenya Country Office, UN Complex Gigiri Nairobi Kenya
| | - Elijah O Odundo
- Food Security and Nutrition Analysis Unit (FSNAU) for Somalia United Nations Food and Agricultural Organization Ngecha Road Campus Nairobi Kenya
| | - James A Berkley
- Kenyan Medical Research Institute/Wellcome Trust Research Programme Centre for Geographic Medicine Research (Coast) Kilifi Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine University of Oxford, CCVTM Oxford OX3 7LJ UK
| | - Abdisalan M Noor
- Spatial Health Metrics Group, INFORM Project Kenya Medical Research Institute/Wellcome Trust Research Programme Nairobi Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine University of Oxford, CCVTM Oxford OX3 7LJ UK
| | - Ngianga-Bakwin Kandala
- Division of Epidemiology and Biostatistics, School of Public Health University of Witwatersrand Johannesburg South Africa.,Warwick Evidence, Warwick Medical School University of Warwick Gibbet Hill Coventry CV4 7AL UK.,Department of Mathematics and Information Sciences, Faculty of Engineering and Environment Northumbria University Newcastle upon Tyne NE1 8ST UK
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Kinyoki DK, Kandala NB, Manda SO, Krainski ET, Fuglstad GA, Moloney GM, Berkley JA, Noor AM. Assessing comorbidity and correlates of wasting and stunting among children in Somalia using cross-sectional household surveys: 2007 to 2010. BMJ Open 2016; 6:e009854. [PMID: 26962034 PMCID: PMC4785320 DOI: 10.1136/bmjopen-2015-009854] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Wasting and stunting may occur together at the individual child level; however, their shared geographic distribution and correlates remain unexplored. Understanding shared and separate correlates may inform interventions. We aimed to assess the spatial codistribution of wasting, stunting and underweight and investigate their shared correlates among children aged 6-59 months in Somalia. SETTING Cross-sectional nutritional assessments surveys were conducted using structured interviews among communities in Somalia biannually from 2007 to 2010. A two-stage cluster sampling methodology was used to select children aged 6-59 months from households across three livelihood zones (pastoral, agropastoral and riverine). Using these data and environmental covariates, we implemented a multivariate spatial technique to estimate the codistribution and divergence of the risks and correlates of wasting and stunting at the 1 × 1 km spatial resolution. PARTICIPANTS 73,778 children aged 6-59 months from 1066 survey clusters in Somalia. RESULTS Observed pairwise child level empirical correlations were 0.30, 0.70 and 0.73 between weight-for-height and height-for-age; height-for-age and weight-for-age, and weight-for-height and weight-for-age, respectively. Access to foods with high protein content and vegetation cover, a proxy of rainfall or drought, were associated with lower risk of wasting and stunting. Age, gender, illness, access to carbohydrates and temperature were correlates of all three indicators. The spatial codistribution was highest between stunting and underweight with relative risk values ranging between 0.15 and 6.20, followed by wasting and underweight (range: 0.18-5.18) and lowest between wasting and stunting (range: 0.26-4.32). CONCLUSIONS The determinants of wasting and stunting are largely shared, but their correlation is relatively variable in space. Significant hotspots of different forms of malnutrition occurred in the South Central regions of the country. Although nutrition response in Somalia has traditionally focused on wasting rather than stunting, integrated programming and interventions can effectively target both conditions to alleviate common risk factors.
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Affiliation(s)
- Damaris K Kinyoki
- Spatial Health Metris Group, INFORM Project, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Ngianga-Bakwin Kandala
- Warwick Medical School, Health Sciences Research Institute, University of Warwick, Warwick Evidence, Coventry, UK
- Department of Mathematics and Information sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK
- Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Samuel O Manda
- Biostatistics Research Unit, South African Medical Research Council, Pretoria, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Elias T Krainski
- Department of Mathematical Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Statistics, Federal University of Paraná, Curitiba, Brazil
| | - Geir-Arne Fuglstad
- Department of Mathematical Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Grainne M Moloney
- Nutrition Section, United Nations Children's Fund (UNICEF), Kenya Country Office, UN Complex Gigiri, Nairobi, Kenya
| | - James A Berkley
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (coast), Kilifi, Kenya
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Abdisalan M Noor
- Spatial Health Metris Group, INFORM Project, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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