Geo-additive modelling of malaria in Burundi

Abstract Background Malaria is a major public health issue in Burundi in terms of both morbidity and mortality, with around 2.5 million clinical cases and more than 15,000 deaths each year. It is still the single main cause of mortality in pregnant women and children below five years of age. Because of the severe health and economic burden of malaria, there is still a growing need for methods that will help to understand the influencing factors. Several studies/researches have been done on the subject yielding different results as which factors are most responsible for the increase in malaria transmission. This paper considers the modelling of the dependence of malaria cases on spatial determinants and climatic covariates including rainfall, temperature and humidity in Burundi. Methods The analysis carried out in this work exploits real monthly data collected in the area of Burundi over 12 years (1996-2007). Semi-parametric regression models are used. The spatial analysis is based on a geo-additive model using provinces as the geographic units of study. The spatial effect is split into structured (correlated) and unstructured (uncorrelated) components. Inference is fully Bayesian and uses Markov chain Monte Carlo techniques. The effects of the continuous covariates are modelled by cubic p-splines with 20 equidistant knots and second order random walk penalty. For the spatially correlated effect, Markov random field prior is chosen. The spatially uncorrelated effects are assumed to be i.i.d. Gaussian. The effects of climatic covariates and the effects of other spatial determinants are estimated simultaneously in a unified regression framework. Results The results obtained from the proposed model suggest that although malaria incidence in a given month is strongly positively associated with the minimum temperature of the previous months, regional patterns of malaria that are related to factors other than climatic variables have been identified, without being able to explain them. Conclusions In this paper, semiparametric models are used to model the effects of both climatic covariates and spatial effects on malaria distribution in Burundi. The results obtained from the proposed models suggest a strong positive association between malaria incidence in a given month and the minimum temperature of the previous month. From the spatial effects, important spatial patterns of malaria that are related to factors other than climatic variables are identified. Potential explanations (factors) could be related to socio-economic conditions, food shortage, limited access to health care service, precarious housing, promiscuity, poor hygienic conditions, limited access to drinking water, land use (rice paddies for example), displacement of the population (due to armed conflicts).</p

Bayesian modelling of the effect of climate on malaria in Burundi

<p>Abstract</p> <p>Background</p> <p>In Burundi, malaria is a major public health issue in terms of both morbidity and mortality with around 2.5 million clinical cases and more than 15,000 deaths each year. It is the single main cause of mortality in pregnant women and children below five years of age. Due to the severe health and economic cost of malaria, there is still a growing need for methods that will help to understand the influencing factors. Several studies have been done on the subject yielding different results as which factors are most responsible for the increase in malaria. The purpose of this study has been to undertake a spatial/longitudinal statistical analysis to identify important climatic variables that influence malaria incidences in Burundi.</p> <p>Methods</p> <p>This paper investigates the effects of climate on malaria in Burundi. For the period 1996-2007, real monthly data on both malaria epidemiology and climate in the area of Burundi are described and analysed. From this analysis, a mathematical model is derived and proposed to assess which variables significantly influence malaria incidences in Burundi. The proposed modelling is based on both generalized linear models (GLM) and generalized additive mixed models (GAMM). The modelling is fully Bayesian and inference is carried out by Markov Chain Monte Carlo (MCMC) techniques.</p> <p>Results</p> <p>The results obtained from the proposed models are discussed and it is found that malaria incidence in a given month in Burundi is strongly positively associated with the minimum temperature of the previous month. In contrast, it is found that rainfall and maximum temperature in a given month have a possible negative effect on malaria incidence of the same month.</p> <p>Conclusions</p> <p>This study has exploited available real monthly data on malaria and climate over 12 years in Burundi to derive and propose a regression modelling to assess climatic factors that are associated with monthly malaria incidence. The results obtained from the proposed models suggest a strong positive association between malaria incidence in a given month and the minimum temperature (night temperature) of the previous month. An open question is, therefore, how to cope with high temperatures at night.</p

Spatiotemporal association between Malaria and climate in Burundi

In our thesis we proposed the statistical modelling concept to assess: 1.Which climatic factors are the most associated with malaria prevalence in Burundi. 2.Whether the forecasted increase in (global) temperature will result in increasing malaria transmission in Burundi. 3.Which amongst the well-known forecasting methods can provide a better forecasting of malaria cases in Burundi, when taking into account the effects of climatic factors. 4.Whether there exist spatial patterns of malaria which are explained by factors other than climate. To achieve the objectives in our thesis, monthly data on malaria epidemiology and meteorology over 12 years for each province (of the area of Burundi) were collected from Burundi. Using these data, four studies are carried out. The first study proposes the analysis method based on a mathematical regression model to assess which variables significantly influence the malaria incidence in Burundi. The proposed modelling concept is based on both generalized linear models (GLM) and generalized additive mixed models (GAMM). The results obtained from these models reveal that malaria incidence in a given month in Burundi is strongly positively associated with the minimum temperature of the previous month. In contrast, it is found that rainfall and maximum temperature in a given month have a possible negative effect on malaria incidence of the same month. The second study proposes a Bayesian generalised additive model (GAM) to assess the impact of the predicted increase in temperature on malaria transmission in Burundi. The results obtained from the proposed model reveal that although malaria transmission is positively associated with minimum temperature, increasing temperature in Burundi will not result in increasing malaria transmission. In the third study we propose a hierarchical analysis approach to assess which method allows a better forecasting of malaria cases in Burundi when taking into account association between climatic factors and the disease. It is found that based on in-sample mean average percentage error (MAPE), the multiplicative exponential smoothing state space model with multiplicative error and seasonality leads to better forecasts (i.e. more accurate results). The fourth study proposes an analysis method based on the semi-parametric regression modelling of the dependence of malaria cases on spatial determinants and climatic covariates in Burundi. The results obtained from the modelling reveal some regional patterns of malaria that are related to factors other than climatic variables without being able to explain them.Keine Zusammenfassung vorhandenHermenegilde NkurunzizaAbweichender Titel laut Übersetzung der Verfasserin/des VerfassersZsfassung in franz. SpracheKlagenfurt, Alpen-Adria-Univ., Diss., 2010KB2010 25OeBB(VLID)241443