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Application of longitudinal multilevel zero inflated Poisson regression in modeling of infectious diseases among
Bezalem Eshetu Yirdaw1, Legesse Kassa Debusho2, Aregash Samuel3
1Department of Statistics, University of South Africa, c/o Christiaan de Wet Road & Pioneer Avenue, Johannesburg, 1709, Florida, South Africa. 12962805@mylife.unisa.ac.za.
Insights
Micronutrient powders (MNP) and exclusive breastfeeding (EBF) significantly impact child illness duration in sub-Saharan Africa. MNP use and EBF reduced days of diarrhea and flu, highlighting their importance in combating childhood infectious diseases.
Area of Science:
- Child Health and Nutrition
- Epidemiology
- Biostatistics
Background:
- Sub-Saharan African children face high mortality from preventable diseases like diarrhea and respiratory infections.
- Understanding disease burden trends is crucial for effective public health interventions.
Purpose of the Study:
- To estimate the rate of change in the log expected number of days of diarrhea (NOD) and flu/common cold (NOF) in children aged 6-11 months.
- To analyze the impact of interventions like Micronutrient Powder (MNP) and exclusive breastfeeding (EBF) on these disease outcomes.
Main Methods:
- Utilized secondary longitudinal and multilevel data.
- Applied a multilevel zero-inflated Poisson regression model with a quadratic trend to analyze NOD and NOF.
- Assessed model fit using residual plots.
Main Results:
- Observed a quadratic trend in the rate of change for log expected NOD.
- Micronutrient Powder (MNP) users initially showed a higher rate of change in NOD, which later reversed; MNP use and exclusive breastfeeding (EBF) decreased log expected NOF.
- Increased odds of not having flu with MNP use, and a positive correlation between NOD and NOF.
Conclusions:
- Exploratory data analysis is vital for understanding complex health data.
- Promoting exclusive breastfeeding (EBF) for six months and appropriate complementary feeding is critical for reducing infectious disease burden in children.
Background:
In sub-Saharan African countries, preventable and manageable diseases such as diarrhea and acute respiratory infections still claim the lives of children. Hence, this study aims to estimate the rate of change in the log expected number of days a child suffers from Diarrhea (NOD) and flu/common cold (NOF) among children aged 6 to 11 months at the baseline of the study.
Methodology:
This study used secondary data which exhibit a longitudinal and multilevel structure. Based on the results of exploratory analysis, a multilevel zero-inflated Poisson regression model with a rate of change in the log expected NOD and NOF described by a quadratic trend was proposed to efficiently analyze both outcomes accounting for correlation between observations and individuals through random effects. Furthermore, residual plots were used to assess the goodness of fit of the model.
Results:
Considering subject and cluster-specific random effects, the results revealed a quadratic trend in the rate of change of the log expected NOD. Initially, low dose iron Micronutrient Powder (MNP) users exhibited a higher rate of change compared to non-users, but this trend reversed over time. Similarly, the log expected NOF decreased for children who used MNP and exclusively breastfed for six months, in comparison to their counterparts. In addition, the odds of not having flu decreased with each two-week increment for MNP users, as compared to non-MNP users. Furthermore, an increase in NOD resulted in an increase in the log expected NOF. Region and exclusive breastfeeding also have a significant relationships with both NOD and NOF.
Conclusion:
The findings of this study underscore the importance of commencing analysis of data generated from a study with exploratory analysis. The study highlights the critical role of promoting EBF for the first six months and supporting children with additional food after six months to reduce the burden of infectious diseases.
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