Background: In epidemiological studies, several diseases share common risk factors or co-exist in their spatial prevalence. Disease mapping allows the health practitioners and epidemiologists to hypothesize the disease aetiology and gain better understanding of the geographical prevalence of the disease risks.Objective: This paper investigates the differences in small scale geographical variations and the underlying risk factors of child’s health outcomes (anemia, stunting and wasting) in Sub-Saharan Africa using spatial epidemiology. Method: The study first carried out an independent univariate analysis on each malnutrition indicator to identify underlying risk factors. A multivariate conditional autoregressive prior was explored to jointly model the spatial correlation between the undernutrition indicators and the small area-geographical disparities at sub-national levels in two sub-Saharan African countries.Results: The approach was implemented on data from National cross-sectional household- based demographic and health surveys conducted in 17,307 under-five children in Burkina Faso and Mozambique in 2010-2012. Out of these children, 31.8% are found to be stunted, 15.5% wasted and 30.9% had anemia among Burkina Faso children, while 42.5% of Mozambican children were stunted, 5.9% wasted and 30.9% suffered from iron-deficiency anemia. The multivariate analysis revealed that the spatial prevalence existed across regions in Burkina Faso with geographical variations in stunting estimated as: 0.7549, CI (0.4693, 1.264); wasting 0.9197; (95%CI : 0.535, 1.591)and anemia : 0.734; (0.4606, 1.214). In additin, the spatial correlation between stunting and wasting was negatively correlated: -0.998; 95% CI (-1.000, -0.984), and a perfect negative correlation;(-1) between stunting and anemia, and positive for wasting and anemia: 0.997; (0.978, 1.000). The spatial occurrence across provinces in Mozambique indicated that there was strong positive correlation between stunting and wasting; 0.986; (0.899, 1.000) and a significant negative correlation between stunting and anemia: -0.720, (-0.934, -0.308) and wasting and anemia: -0.640; (-0.903 -0.174) with individual geographical variability in child stunting: 1427, (913.6, 2268); wasting:1751, (1117, 2803) and anemia: 556, (279.5, 978.9). These extra random effect parameters computed in our multivariate approach would outperform a univariate analysis in similar studies. Our model further detected high prevalent of malnutrition and anemia in the northern Burkina Faso, but high anemia prevalent found in central Mozambique, and high stunting and wasting identified Southern Mozambique. In addition, the risk factors of malnutrition and iron deficiency anemia included household poverty, morbidity, short birth interval (less 18 months), breast feeding, antenatal attendance and maternal literacy.Conclusion: The statistical relevance of the identified risk factors in this study is useful to target specific individual interventions and the maps of the geographical inequalities in sub-national region can be used for designing nutrition interventions and allocation of scarce health resources.Keywords: Joint spatial mapping, childhood anemia, malnutrition, sub-Saharan Africa.

The main objective of this study is to identify the key determinants of malnutrition of children under five years in

Childhood anemia is among the most significant health problems faced by public health departments in developing countries. This study aims at assessing the determinants and possible spatial effects associated with childhood anemia in Rwanda. The 2014/2015 Rwanda Demographic and Health Survey (RDHS) data was used. The analysis was done using the structured spatial additive quantile regression model. The findings of this study revealed that the child’s age; the duration of breastfeeding; gender of the child; the nutritional status of the child (whether underweight and/or wasting); whether the child had a fever; had a cough in the two weeks prior to the survey or not; whether the child received vitamin A supplementation in the six weeks before the survey or not; the household wealth index; literacy of the mother; mother’s anemia status; mother’s age at the birth are all significant factors associated with childhood anemia in Rwanda. Furthermore, significant structured spatial location effects on childhood anemia was found.

Background: Malaria remains a public health problem in developing countries and Malawi is no different. Although there has been an improvement in reducing malaria in Malawi, it remains a problem, especially in children less than five years old. The primary objective of the study was to assess whether socio-economic, geographic and demographic factors are associated with malaria, using the generalized additive mixed model (GAMM). Data and methodology: The study used a 2017 dataset from the Malawi Malaria Indicator Survey (MMI) with a total number of 2724 children under five years old. The study also utilized the GAMM to analyze data. The outcome was that either the child had malaria or did not, as detected using the malaria Rapid Diagnostic Test (RDT) (Ayele et al., 2014a). Results: In this study, more than 37 % of the total number of children who were tested showed a positive malaria result. In addition, the results from this study using GAMM indicated that anaemia, mother's education level, wealth index, child's age, the altitude of the place of residence, region, place of residence, toilet facility and electricity were significantly associated with a positive malaria RDT. Conclusion:The study revealed that socio-economic, geographical and demographic variables are the key factors in improving malaria vectors in children. Improving income levels and supporting the poorer rural community mostly from the Central Region would be a great achievement in reducing malaria vectors in Malawi. In addition, improving health care in rural areas, especially at higher altitudes, would contribute to controlling malaria and reducing anaemia.

Background:Anemia is an important public health problem affecting all age groups of the population. The objective of this study was to identify the risk factors associated with anemia among women of childbearing age in Rwanda and map their spatial variation.Methods:The 2014/15 Rwanda Demographic and Health survey data was used and the structured logistic regression model was fitted to the data, where fixed effects were modeled parametrically, non-linear effects were modeled non-parametrically using second order random walk priors and spatial effects were modeled using Markov Random field priors.Results:The prevalence of anemia among non-pregnant women of reproductive age was 18.9%. Women from the households which use water from the unprotected well had a higher risk of having anemia than a woman from the household where they use water piped into dwelling or yard. The risk of anemia was higher among underweight women and women living in households without toilet facilities. The anemia was less pronounced among the women using contraception, literate women, women from the households which use a bed net and living in rich households.Conclusion:The findings from this study highlighted the districts with the highest number of anemic women and this can help the policymakers and other public health institutions to design a specific programme targeting these districts in order to improve the health status and living conditions of these women. The findings also suggest an improvement of toilet facilities, bed net use and source of drinking water in affected households.

Contraceptive use is considered as essential for protecting women’s health and rights, influencing fertility and population growth, and helping to promote economic development. The main objective of this study was to analysis the factors and spatial correlates of contraceptive use among women of childbearing age. The 2015 Rwanda Demographic and Health Survey (RDHS) data were used to identify the factors associated with contraceptive use in Rwanda. A Bayesian geo-additive model was used in order to account for fixed effects, nonlinear effects, spatial and random effects inherent in the data. The overall prevalence of use of any contraceptive method among married women of childbearing age in Rwanda was 52.7%. A woman’s age, wealth quintile, level of education, working status, number of living children, and exposure to the media was found to increase contraceptive use. The findings from the study also found disparities in contraceptive use at provincial and district level, where prevalence was higher in districts of Northern provinces and lower in districts of western provinces. The findings of this study suggest that exposure to information on contraceptive use in health centres, empowerment of women to access quality contraceptive-use services and religions to play an important role in explaining and informing their adherents on the importance of using a contraceptive method.

Malaria is a major public health risk in Rwanda where children and pregnant women are most vulnerable. This infectious disease remains the main cause of morbidity and mortality among children in Rwanda. The main objectives of this study were to assess the prevalence of malaria among children aged six months to 14 years old in Rwanda and to identify the factors associated with malaria in this age group. This study used data from the 2017 Rwanda Malaria Indicator Survey. Due to the complex design used in sampling, a survey logistic regression model was used to fit the data and the outcome variable was the presence or absence of malaria. This study considered 8209 children in the analysis and the prevalence of malaria was 14.0%. This rate was higher among children aged 5–9 years old (15.6%), compared to other age groups. Evidently, the prevalence of malaria was also higher among children from poor families (19.4%) compared to children from the richest families (4.3%). The prevalence of malaria was higher among children from rural households (16.2%) compared to children from urban households (3.4%). The results revealed that other significant factors associated with malaria were: the gender of the child, the number of household members, whether the household had mosquito bed nets for sleeping, whether the dwelling had undergone indoor residual spraying in the 12 months prior to the survey, the location of the household’s source of drinking water, the main wall materials of the dwelling, and the age of the head of the household. The prevalence of malaria was also high among children living in houses with walls built from poorly suited materials; this suggests the need for intervention in construction materials. Further, it was found that the Eastern Province also needs special consideration in malaria control due to the higher prevalence of the disease among its residents, compared to those in other provinces.

The use of the asset index in poverty targeting is a modern technique. We used the principal component analysis (PCA)