BAYESIAN GEOSTATISTICAL MODELING OF DIARRHOEA PREVALENCE IN UNDER-FIVE CHILDREN IN MALAWI

Abstract

Diarrhoeal disease is the second leading cause of mortality and morbidity among children under the age of five globally. It accounts for 1.7 billion global death cases. It is a major public health problem in low- and middle-income countries, and Malawi is no exception. Higher spatial variations in all districts still mark the prevalence of diarrhoea in Malawi for children under five. This thesis aimed to investigate the spatial distribution of diarrhoea prevalence in children under the age of five by identifying the individual household and community level factors in order to identify hotspot areas where interventions may be targeted. The study used the 2015-2016 Malawi Demographic and Health Surveys (MDHS) data. The MDHS used the 2008 Malawi Population and Housing Census (MPHC) sampling frame covering all EAs to monitor the prevalence of diarrhoea among children under the age of 5 in all communities. The data included 17,286 children under the age of 5 in 850 enumeration areas (EAs), including 173 EAs in urban and 667 in rural across the 28 districts of Malawi. We fitted the Bayesian geostatistical logistic models to model diarrhoea prevalence at the individual, household, and community levels in all 850 EAs in Malawi. We found that diarrhoea prevalence for children in Malawi was 22%. Diarrhoea prevalence distribution maps showed spatial heterogeneity and the presence of hotspots. Factors associated with diarrhoea included individual, household and community level. The prevalence of diarrhoea was positively associated with the low education level of the mother, central region, child age between 6 to 11 months, poorest household wealth, breastfeeding, low birth weight, poor waste disposal, and rural residence. The findings of this study have important policy implications for childhood diarrhoeal disease intervention programs. They will help the Malawi government and local managers to target diarrhoea control interventions in areas with the greatest prevalence. It is also ready for assessment in other diseases.