Henry Mwambi

Estimating dispersal and survival of Anopheles gambiae and Anopheles funestus along the Kenyan coast by using mark-release-recapture methods.

Abstract Mark-release-recapture (MRR) experiments were conducted with emerging Anopheles gambiae s.l. and Anopheles funestus Giles at Jaribuni and Mtepeni in Kilifi, along the Kenyan Coast. Of 739 and 1,246 Anopheles released at Jaribuni and Mtepeni, 24.6 and 4.33% were recaptured, respectively. The daily survival probability was 0.96 for An. funestus and 0.95 for An. gambiae in Jaribuni and 0.83 and 0.95, respectively, in Mtepeni. The maximum flight distance recorded was 661 m. The high survival probability of An. gambiae and An. funestus estimated accounts for the continuous transmission of malaria along the Kenyan coast. This study also shows that the release of young, emergent female Anopheles improves the recapture rates and may be a better approach to MRR studies.

Prevalence and risk factors of malaria in Ethiopia

BackgroundMore than 75% of the total area of Ethiopia is malarious, making malaria the leading public health problem in Ethiopia. The aim of this study was to investigate the prevalence rate and the associated socio-economic, geographic and demographic factors of malaria based on the rapid diagnosis test (RDT) survey results.MethodsFrom December 2006 to January 2007, a baseline malaria indicator survey in Amhara, Oromiya and Southern Nation Nationalities and People (SNNP) regions of Ethiopia was conducted by The Carter Center. This study uses this data. The method of generalized linear model was used to analyse the data and the response variable was the presence or absence of malaria using the rapid diagnosis test (RDT).ResultsThe analyses show that the RDT result was significantly associated with age and gender. Other significant covariates confounding variables are source of water, trip to obtain water, toilet facility, total number of rooms, material used for walls, and material used for roofing. The prevalence of malaria for households with clean water found to be less. Malaria rapid diagnosis found to be higher for thatch and stick/mud roof and earth/local dung plaster floor. Moreover, spraying anti-malaria to the house was found to be one means of reducing the risk of malaria. Furthermore, the housing condition, source of water and its distance, gender, and ages in the households were identified in order to have two-way interaction effects.ConclusionIndividuals with poor socio-economic conditions are positively associated with malaria infection. Improving the housing condition of the household is one of the means of reducing the risk of malaria. Children and female household members are the most vulnerable to the risk of malaria. Such information is essential to design improved strategic intervention for the reduction of malaria epidemic in Ethiopia.

Prevalence and Risk Factors of Anaemia among Children Aged between 6 Months and 14 Years in Kenya

Background Anaemia is one of the significant public health problems among children in the world. Understanding risk factors of anaemia provides more insight to the nature and types of policies that can be put up to fight anaemia. We estimated the prevalence and risk factors of anaemia in a population-based, cross-sectional survey. Methodology Blood samples from 11,711 children aged between 6 months and 14 years were collected using a single-use, spring-loaded, sterile lancet to make a finger prick. Anaemia was measured based on haemoglobin concentration level. The generalized linear model framework was used to analyse the data, in which the response variable was either a child was anemic or not anemic. Results The overall prevalence of anaemia among the children in Kenya was estimated to be 28.8%. The risk of anaemia was found to decrease with age progressively with increase in each year of age; children below 1 year were at highest risk of anaemia. The risk of anaemia was significantly higher in male than female children. Mothers with secondary and above education had a protective effect on the risk of anaemia on their children. Malaria diagnosis status of a child was positively associated with risk anaemia. Conclusion Controlling co-morbidity of malaria and improving maternal knowledge are potential options for reducing the burden of anaemia.

Multiple correspondence analysis as a tool for analysis of large health surveys in African settings

BACKGROUND More than two thirds of the total population of Ethiopia is estimated to be at risk of malaria. Therefore, malaria is the leading public health problem in Ethiopia. OBJECTIVE To investigate the determinants of malaria Rapid Diagnosis Test (RDT) result and the association between socio-economic, demographic and geographic factors. METHOD The study used data from household cluster malaria survey which was conducted from December 2006 to January 2007. A total of 224 clusters of about 25 households each were selected from the Amhara, Oromiya and Southern Nation Nationalities and People (SNNP) regions of Ethiopia. A multiple correspondence analysis was used to jointly analyse malaria RDT result, socio-economic, demographic and geographic factors. RESULTS The result from multiple correspondence analysis shows that there is association between malaria RDT result and different socio-economic, demographic and geographic variables. CONCLUSION There is an indication that some socio-economic, demographic and geographic factors have joint effects. It is important to confirm the association between socio-economic, demographic and geographic factors using advanced statistical techniques.

Theoretical analysis of mixed Plasmodium malariae and Plasmodium falciparum infections with partial cross-immunity

A deterministic model for assessing the dynamics of mixed species malaria infections in a human population is presented to investigate the effects of dual infection with Plasmodium malariae and Plasmodium falciparum. Qualitative analysis of the model including positivity and boundedness is performed. In addition to the disease free equilibrium, we show that there exists a boundary equilibrium corresponding to each species. The isolation reproductive number of each species is computed as well as the reproductive number of the full model. Conditions for global stability of the disease free equilibrium as well as local stability of the boundary equilibria are derived. The model has an interior equilibrium which exists if at least one of the isolation reproductive numbers is greater than unity. Among the interesting dynamical behaviours of the model, the phenomenon of backward bifurcation where a stable boundary equilibrium coexists with a stable interior equilibrium, for a certain range of the associated invasion reproductive number less than unity is observed. Results from analysis of the model show that, when cross-immunity between the two species is weak, there is a high probability of coexistence of the two species and when cross-immunity is strong, competitive exclusion is high. Further, an increase in the reproductive number of species i increases the stability of its boundary equilibrium and its ability to invade an equilibrium of species j. Numerical simulations support our analytical conclusions and illustrate possible behaviour scenarios of the model.

Modelling HIV and MTB Co-Infection Including Combined Treatment Strategies

A new host-pathogen model is described that simulates HIV-MTB co-infection and treatment, with the objective of testing treatment strategies. The model includes CD4+ and CD8+ T cells, resting and activated macrophages, HIV and Mycobacterium tuberculosis (MTB). For TB presentation at various stages of HIV disease in a co-infected individual, combined treatment strategies were tested with different relative timings of treatment for each infection. The stages were early HIV disease, late HIV disease and AIDS. The main strategies were TB treatment followed by anti-retroviral therapy (ART) after delays of 15 days, 2 months and 6 months. ART followed by TB treatment was an additional strategy that was tested. Treatment was simulated with and without drug interaction. Simulation results were that TB treatment first followed by ART after a stage-dependent delay has the best outcome. During early HIV disease a 6 month delay is acceptable. During late HIV disease, a 2 month delay is best. During AIDS it is better to start ART after 15 days. However, drug interaction works against the benefits of early ART. These results agree with expert reviews and clinical trials.

Bayesian Spatial Semi-Parametric Modeling of HIV Variation in Kenya

Spatial statistics has seen rapid application in many fields, especially epidemiology and public health. Many studies, nonetheless, make limited use of the geographical location information and also usually assume that the covariates, which are related to the response variable, have linear effects. We develop a Bayesian semi-parametric regression model for HIV prevalence data. Model estimation and inference is based on fully Bayesian approach via Markov Chain Monte Carlo (McMC). The model is applied to HIV prevalence data among men in Kenya, derived from the Kenya AIDS indicator survey, with n = 3,662. Past studies have concluded that HIV infection has a nonlinear association with age. In this study a smooth function based on penalized regression splines is used to estimate this nonlinear effect. Other covariates were assumed to have a linear effect. Spatial references to the counties were modeled as both structured and unstructured spatial effects. We observe that circumcision reduces the risk of HIV infection. The results also indicate that men in the urban areas were more likely to be infected by HIV as compared to their rural counterpart. Men with higher education had the lowest risk of HIV infection. A nonlinear relationship between HIV infection and age was established. Risk of HIV infection increases with age up to the age of 40 then declines with increase in age. Men who had STI in the last 12 months were more likely to be infected with HIV. Also men who had ever used a condom were found to have higher likelihood to be infected by HIV. A significant spatial variation of HIV infection in Kenya was also established. The study shows the practicality and flexibility of Bayesian semi-parametric regression model in analyzing epidemiological data.

Spatial distribution of malaria problem in three regions of Ethiopia

BackgroundThe transmission of malaria is the leading public health problem in Ethiopia. From the total area of Ethiopia, more than 75% is malarious. The aim of this study was to identify socio-economic, geographic and demographic risk factors of malaria based on the rapid diagnosis test (RDT) survey results and produce the prevalence map of the area illustrating variation in malaria risk.MethodsThis study accounts for spatial correlation in assessing the effects of socio- economic, demographic and geographic factors on the prevalence of malaria in Ethiopia. A total of 224 clusters of about 25 households each were selected from the Amhara, Oromiya and Southern Nation Nationalities and People’s (SNNP) regions of Ethiopia. A generalized linear mixed model with spatial covariance structure was used to analyse the data where the response variable was the presence or absence of malaria using the RDT.ResultsThe results showed that households in the SNNP region were found to be at more risk than Amhara and Oromiya regions. Moreover, households which have toilet facilities clean drinking water, and a greater number of rooms and mosquito nets in the rooms, have less chance of having household members testing positive for RDT. Moreover, from this study, it can be suggested that incorporating spatial variability is necessary for understanding and devising the most appropriate strategies to reduce the risk of malaria.

Structured additive regression models with spatial correlation to estimate under-five mortality risk factors in Ethiopia

BackgroundThe risk of a child dying before reaching five years of age is highest in Sub-Saharan African countries. But Child mortality rates have shown substantial decline in Ethiopia. It is important to identify factors affecting under-five mortality.MethodsA structured additive logistic regression model which accounts the spatial correlation was adopted to estimate under-five mortality risk factors. The 2011 Ethiopian Demographic and Health Survey data was used for this study.ResultsThe analysis showed that the risk of under-five mortality increases as the family size approaches seven and keeps increasing. With respect to socio-economic factors, the greater the household wealth, the lower the mortality. Moreover, for older mothers, the chance of their child to dying before reaching five is diminishes.ConclusionThe model enables simultaneous modeling of possible nonlinear effects of covariates, spatial correlation and heterogeneity. Our findings are relevant because the identified risk factors can be used to provide priority areas for intervention activities by the government to combat under-five mortality in Ethiopia.

Geographic distribution of cardiovascular comorbidities in South Africa: a national cross-sectional analysis

Objectives: We sought to estimate the spatial coexistence of hypertension, coronary heart disease (CHD), stroke and hypercholesterolaemia in South Africa. Design: Cross-sectional. Setting: Sub-Saharan Africa and South Africa. Participants: Data were from 13,827 adults (mean±SD age 39±18 years, 58.4% women) interviewed in the 1998 South African Health and Demographic Survey. Interventions: N/A. Primary and secondary outcome measures: We used multivariate spatial disease models to estimate district-level shared and disease-specific spatial risk components, controlling for known individual risk factors. Results: In univariate analysis, observed prevalence of hypertension and CHD is was high in the south-western parts, and low in the north east. Stroke and high blood cholesterol prevalence appeared to be evenly distributed across the country. In multivariate analysis (adjusting for age, gender, ethnicity, education, urban-dwelling, smoking, alcohol consumption and obesity), hypertension and stroke prevalence were highly concentrated in the south-western parts, whilst CHD and hypercholesterolaemia were highly prevalent in central and top north-eastern corridor, respectively. The shared component, which we took to represent nutrition and other lifestyle factors not accounted for in the model, had a larger effect on cardiovascular disease prevalence in the south-western areas of the country. It appeared to have greater effect on hypertension and CHD. Conclusion: This study suggests a clear geographic distribution of cardiovascular disease in South Africa, driven possibly by shared lifestyle behaviours. These findings might be useful for public health resource allocation in low-income settings.