A space-time analysis of recurrent malnutrition-related hospitalisations in Kilifi, Kenya for children under-5 years
Abstract Background Globally, malnutrition underlies 45% of under-5 s mortality, mainly from potentiating common infections such as diarrhoea and pneumonia. Malnutrition as a public health problem is not evenly disbursed because of disparities in food insecurity and health, and children commonly suf...
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| Format: | Article |
| Language: | English |
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BMC
2019-06-01
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| Series: | BMC Nutrition |
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| Online Access: | http://link.springer.com/article/10.1186/s40795-019-0296-5 |
| _version_ | 1818302775482646528 |
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| author | Kennedy Mwai Wambui Eustasius Musenge |
| author_facet | Kennedy Mwai Wambui Eustasius Musenge |
| author_sort | Kennedy Mwai Wambui |
| collection | DOAJ |
| description | Abstract Background Globally, malnutrition underlies 45% of under-5 s mortality, mainly from potentiating common infections such as diarrhoea and pneumonia. Malnutrition as a public health problem is not evenly disbursed because of disparities in food insecurity and health, and children commonly suffer recurrent episodes of opportunistic infections. We aimed to understand better the spatial and temporal structure of multiple paediatric hospital admissions associated with malnutrition-related illnesses. This paper aimed to investigate the spatial-temporal variations in malnutrition-related recurrent morbidity of children under-5 years from the Kilifi County in Kenya between 2002 and 2015. Methods The study included data from children under-5 years old who had more than one admission to a rural district hospital in Kenya within the Kilifi Health and Demographic Surveillance System (KHDSS). The primary outcome was a malnutrition-related admission, based on wasting (WHZ < -2) or nutritional oedema. Individual, household and environmental level covariates were examined as exposures. We first fitted a SARIMA model for the temporality, and the Moran’s Index affirmed spatial clustering in malnutrition admissions. Kulldorf Statistics using SaTScan were applied to detect hotspots. Then, bivariate analysis was done using repeated values tabulation and analysis of covariance (ANCOVA). Inferential analysis was done using a mixed effect multivariable negative-binomial regression model, adjusting for spatiotemporal random effects. Results A total of 2821 children were admitted more than once, giving a total of 6375 admissions. Of these 6375 admissions, 1866 were malnutrition-related, and 3.9% (109/2821) of the children with repeat admissions died. There was a seasonal pattern of re-admissions, peaking from May to July over the years. Hotspots were found in both the Northern and Southern areas of the KHDSS, while the areas near Kilifi Town were least affected. We found that disease severity was most likely associated with a malnutrition re-admission to the hospital. Conclusion Disease severity was strongly associated with admission with malnutrition but its effect reduced after adjusting for the spatial and temporal random effects. Adjusting for clustering in space and in time (spatial-temporal) in models helps to improve the understanding of recurrent hospitalisations involving malnutrition. |
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| format | Article |
| id | doaj.art-6c80593f7f7e40139eda2660c2f7a8bf |
| institution | Directory Open Access Journal |
| issn | 2055-0928 |
| language | English |
| last_indexed | 2024-12-13T05:44:16Z |
| publishDate | 2019-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nutrition |
| spelling | doaj.art-6c80593f7f7e40139eda2660c2f7a8bf2022-12-21T23:57:43ZengBMCBMC Nutrition2055-09282019-06-01511910.1186/s40795-019-0296-5A space-time analysis of recurrent malnutrition-related hospitalisations in Kilifi, Kenya for children under-5 yearsKennedy Mwai Wambui0Eustasius Musenge1Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the WitwatersrandDivision of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the WitwatersrandAbstract Background Globally, malnutrition underlies 45% of under-5 s mortality, mainly from potentiating common infections such as diarrhoea and pneumonia. Malnutrition as a public health problem is not evenly disbursed because of disparities in food insecurity and health, and children commonly suffer recurrent episodes of opportunistic infections. We aimed to understand better the spatial and temporal structure of multiple paediatric hospital admissions associated with malnutrition-related illnesses. This paper aimed to investigate the spatial-temporal variations in malnutrition-related recurrent morbidity of children under-5 years from the Kilifi County in Kenya between 2002 and 2015. Methods The study included data from children under-5 years old who had more than one admission to a rural district hospital in Kenya within the Kilifi Health and Demographic Surveillance System (KHDSS). The primary outcome was a malnutrition-related admission, based on wasting (WHZ < -2) or nutritional oedema. Individual, household and environmental level covariates were examined as exposures. We first fitted a SARIMA model for the temporality, and the Moran’s Index affirmed spatial clustering in malnutrition admissions. Kulldorf Statistics using SaTScan were applied to detect hotspots. Then, bivariate analysis was done using repeated values tabulation and analysis of covariance (ANCOVA). Inferential analysis was done using a mixed effect multivariable negative-binomial regression model, adjusting for spatiotemporal random effects. Results A total of 2821 children were admitted more than once, giving a total of 6375 admissions. Of these 6375 admissions, 1866 were malnutrition-related, and 3.9% (109/2821) of the children with repeat admissions died. There was a seasonal pattern of re-admissions, peaking from May to July over the years. Hotspots were found in both the Northern and Southern areas of the KHDSS, while the areas near Kilifi Town were least affected. We found that disease severity was most likely associated with a malnutrition re-admission to the hospital. Conclusion Disease severity was strongly associated with admission with malnutrition but its effect reduced after adjusting for the spatial and temporal random effects. Adjusting for clustering in space and in time (spatial-temporal) in models helps to improve the understanding of recurrent hospitalisations involving malnutrition.http://link.springer.com/article/10.1186/s40795-019-0296-5Spatiotemporal analysisChild malnutritionBayesianChild mortality |
| spellingShingle | Kennedy Mwai Wambui Eustasius Musenge A space-time analysis of recurrent malnutrition-related hospitalisations in Kilifi, Kenya for children under-5 years BMC Nutrition Spatiotemporal analysis Child malnutrition Bayesian Child mortality |
| title | A space-time analysis of recurrent malnutrition-related hospitalisations in Kilifi, Kenya for children under-5 years |
| title_full | A space-time analysis of recurrent malnutrition-related hospitalisations in Kilifi, Kenya for children under-5 years |
| title_fullStr | A space-time analysis of recurrent malnutrition-related hospitalisations in Kilifi, Kenya for children under-5 years |
| title_full_unstemmed | A space-time analysis of recurrent malnutrition-related hospitalisations in Kilifi, Kenya for children under-5 years |
| title_short | A space-time analysis of recurrent malnutrition-related hospitalisations in Kilifi, Kenya for children under-5 years |
| title_sort | space time analysis of recurrent malnutrition related hospitalisations in kilifi kenya for children under 5 years |
| topic | Spatiotemporal analysis Child malnutrition Bayesian Child mortality |
| url | http://link.springer.com/article/10.1186/s40795-019-0296-5 |
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