Study Protocol: A Cross-Sectional Examination of Socio-Demographic and Ecological Determinants of Nutrition and Disease Across Madagascar

Golden, Christopher D.; Rice, Benjamin L.; Randriamady, Hervet J; Vonona, Arisoa Miadana; Randrianasolo, Jean F.; Tafangy, Ambinintsoa Nirina; Andrianantenaina, Mamy Yves; Arisco, Nicholas J.; Emile, Gauthier N; Lainandrasana, Faustin; Mahonjolaza, Robuste Fenoarison Faraniaina; Raelson, Hermann Paratoaly; Rakotoarilalao, Vololoniaina Ravo; Rakotomalala, Anjaharinony A. N. A.; Rasamison, Alex Dominique; Mahery, Rebaliha; Tantely, Michaël Luciano; Girod, Romain; Annapragada, Akshaya V.; Wesolowski, Amy; Winter, Amy; Hartl, Daniel L.; Hazen, James; Metcalf, C. Jessica E.

doi:10.3389/fpubh.2020.00500

Cited by 11 publications

(17 citation statements)

References 19 publications

(24 reference statements)

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“…Details of enrollment, ethical approval, and study design for the larger epidemiological studies from which these malaria prevalence analyses were an extension are explained by Golden et al 2017 [ 25 ], Golden et al 2019 [ 26 ], and Golden and Rice et al 2020 [ 27 ]. Briefly, for the northeast (NE) region, repeated cross-sectional samples, at 3–4 month intervals, were performed between July 2013 – March 2014 for sites NE.01–02 and between August 2016 – April 2017 for sites NE.03–07.…”

Section: Methodsmentioning

confidence: 99%

“…Individuals not sampled were either physically absent from the community at the time of sampling, often due to hunting, fishing, or charcoal production activity, or declined to participate in blood sampling. Males aged 15–30 were the most commonly observed to not participate in the blood sampling for those reasons [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

“…Blood sampling procedures were performed by local physicians and phlebotomists – either medical personnel from the local district health office or a trained team member from local partner development organizations with long-standing ties to local communities. Aside from individual consent or assent, efforts to obtain community-wide understanding of the purpose and protocol of blood sampling included public meetings with the community as a whole, with local officials, with traditional community leadership, and with individual family groups (for details, see Golden et al 2017 [ 25 ], Golden et al 2019 [ 26 ], and Golden and Rice et al 2020 [ 27 ]).…”

Section: Methodsmentioning

confidence: 99%

“…Details are described in Golden et al 2017 [ 25 ], Golden et al 2019 [ 26 ], and Golden and Rice et al 2020 [ 27 ]. Briefly, approval was obtained from the institutional review board (IRB) committee at the Harvard TH Chan School of Public Health’s Committee on the Use of Human Subjects, the Malagasy Ministry of Health, the ethical committee of the Institut National de Santé Publique et Communitaire in Madagascar, district medical inspectors, and local community leaders (e.g.…”

Section: Methodsmentioning

confidence: 99%

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Fine-scale variation in malaria prevalence across ecological regions in Madagascar: a cross-sectional study

et al. 2021

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Background Large-scale variation in ecological parameters across Madagascar is hypothesized to drive varying spatial patterns of malaria infection. However, to date, few studies of parasite prevalence with resolution at finer, sub-regional spatial scales are available. As a result, there is a poor understanding of how Madagascar’s diverse local ecologies link with variation in the distribution of infections at the community and household level. Efforts to preserve Madagascar’s ecological diversity often focus on improving livelihoods in rural communities near remaining forested areas but are limited by a lack of data on their infectious disease burden. Methods To investigate spatial variation in malaria prevalence at the sub-regional scale in Madagascar, we sampled 1476 households (7117 total individuals, all ages) from 31 rural communities divided among five ecologically distinct regions. The sampled regions range from tropical rainforest to semi-arid, spiny forest and include communities near protected areas including the Masoala, Makira, and Mikea forests. Malaria prevalence was estimated by rapid diagnostic test (RDT) cross-sectional surveys performed during malaria transmission seasons over 2013–2017. Results Indicative of localized hotspots, malaria prevalence varied more than 10-fold between nearby (< 50 km) communities in some cases. Prevalence was highest on average in the west coast region (Morombe district, average community prevalence 29.4%), situated near protected dry deciduous forest habitat. At the household level, communities in southeast Madagascar (Mananjary district) were observed with over 50% of households containing multiple infected individuals at the time of sampling. From simulations accounting for variation in household size and prevalence at the community level, we observed a significant excess of households with multiple infections in rural communities in southwest and southeast Madagascar, suggesting variation in risk within communities. Conclusions Our data suggest that the malaria infection burden experienced by rural communities in Madagascar varies greatly at smaller spatial scales (i.e., at the community and household level) and that the southeast and west coast ecological regions warrant further attention from disease control efforts. Conservation and development efforts in these regions may benefit from consideration of the high, and variable, malaria prevalences among communities in these areas.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Fine-scale variation in malaria prevalence across ecological regions in Madagascar: a cross-sectional study

et al. 2021

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“…Marked inequality exists in both health and economic opportunities. Approximately 40% of women are anemic, and 50% of children are malnourished (FAO, 2020;Golden et al, 2011;Golden et al, 2020). Farmers face challenges of food security from many causes, including extreme weather patterns (Harvey et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Food insecurity related to agricultural practices and household characteristics in rural communities of northeast Madagascar

Herrera

Rabezara²,

Ravelomanantsoa

et al. 2021

Food Sec.

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Ending hunger and alleviating poverty are key goals for a sustainable future. Food security is a constant challenge for agrarian communities in low-income countries, especially in Madagascar. We investigated agricultural practices, household characteristics, and food security in northeast Madagascar. We tested whether agricultural practices, demographics, and socioeconomics in rural populations were related to food security. Over 70% of respondents reported times during the last three years during which food for the household was insufficient, and the most frequently reported cause was small land size (57%). The probability of food insecurity decreased with increasing vanilla yield, rice yield, and land size. There was an interaction effect between land size and household size; larger families with smaller land holdings had higher food insecurity, while larger families with larger land had lower food insecurity. Other socioeconomic and agricultural variables were not significantly related to food insecurity, including material wealth, education, crop diversity, and livestock ownership. Our results highlight the high levels of food insecurity in these communities and point to interventions that would alleviate food stress. In particular, because current crop and livestock diversity were low, agricultural diversification could improve outputs and mitigate food insecurity. Development of sustainable agricultural intensification, including improving rice and vanilla cultivation to raise yields on small land areas, would likely have positive impacts on food security and alleviating poverty. Increasing market access and off-farm income, as well as improving policies related to land tenure could also play valuable roles in mitigating challenges in food security.

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Predicting micronutrient deficiency with publicly available satellite data

et al. 2023

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Micronutrient deficiency (MND), which is a form of malnutrition that can have serious health consequences, is difficult to diagnose in early stages without blood draws, which are expensive and time-consuming to collect and process. It is even more difficult at a public health scale seeking to identify regions at higher risk of MND. To provide data more widely and frequently, we propose an accurate, scalable, low-cost, and interpretable regional-level MND prediction system. Specifically, our work is the first to use satellite data, such as forest cover, weather, and presence of water, to predict deficiency of micronutrients such as iron, Vitamin B12, and Vitamin A, directly from their biomarkers. We use real-world, ground truth biomarker data collected from four different regions across Madagascar for training, and demonstrate that satellite data are viable for predicting regional-level MND, surprisingly exceeding the performance of baseline predictions based only on survey responses. Our method could be broadly applied to other countries where satellite data are available, and potentially create high societal impact if these predictions are used by policy makers, public health officials, or healthcare providers.

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Study Protocol: A Cross-Sectional Examination of Socio-Demographic and Ecological Determinants of Nutrition and Disease Across Madagascar

Cited by 11 publications

References 19 publications

Fine-scale variation in malaria prevalence across ecological regions in Madagascar: a cross-sectional study

Fine-scale variation in malaria prevalence across ecological regions in Madagascar: a cross-sectional study

Food insecurity related to agricultural practices and household characteristics in rural communities of northeast Madagascar

Predicting micronutrient deficiency with publicly available satellite data

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