Impact of ignoring sampling design in the prediction of binary health outcomes through logistic regression: evidence from Malawi demographic and health survey under-five mortality data; 2000-2016.

The birth and death rates of a population are among the crucial vital statistics for socio-economic policy planning in any country. Since the under-five mortality rate is one of the indicators for monitoring the health of a population, it requires regular and accurate estimation. The national demographic and health survey data, that are readily available to the puplic, have become a means for answering most health-related questions among African populations, using relevant statistical methods. However, many of such applications tend to ignore survey design effect in the estimations, despite the availability of statistical tools that support the analyses. Little is known about the amount of inaccurate information that is generated when predicting under-five mortality rates. This study estimates and compares the bias encountered when applying unweighted and weighted logistic regression methods to predict under-five mortality rate in Malawi using nationwide survey data. The Malawi demographic and health survey data of 2004, 2010, and 2015-16 were used to determine the bias. The analyses were carried out in R software version 3.6.3 and Stata version 12.0. A logistic regression model that included various bio- and socio-demographic factors concerning the child, mother and households was used to estimate the under-five mortality rate. The results showed that accuracy of predicting the national under-five mortality rate hinges on cluster-weighting of the overall predicted probability of child-deaths, regardless of whether the model was weighted or not. Weighting the model caused small positive and negative changes in various fixed-effect estimates, which diffused the result of weighting in the fitted probabilities of deaths. In turn, there was no difference between the overall predicted mortality rate obtained using the weighted model and that obtained in the unweighted model. We recommend considering survey cluster-weights during the computation of overall predicted probability of events for a binary health outcome. This can be done without worrying about the weights during model fitting, whose aim is prediction of the population parameter.

Analysing outlier communities to child birth weight outcomes in Malawi: application of multinomial logistic regression model diagnostics.

Studies have reported significant effect of geographically shared variables on new-born baby weight. Although there is growing use of community-based child health interventions in public health research, such as through provinces, schools, or health facilities, there has been less interest by researchers to study outlying communities to child birth weight outcomes. We apply multinomial logistic regression model diagnostics to identify outlier communities to child birth weight in Malawi. We use a random sample of 850 clusters, each with at least 7 households based on 2015-16 Malawi demographic and health survey data. There were a total of 11,680 children with measured birth weight, that was categorised as either low ([Formula: see text] grams), normal ([Formula: see text] grams) or high ([Formula: see text] grams). The analyses were done in STATA version 15 and R version 3.6.3. Based on a multinomial logit model with various socio-demographic factors associated with child birth weight, the results showed that two clusters from rural parts of Southern region of Malawi had overly influence on estimated effects of the factors on birth weight. Both clusters had normal to high birth weight babies, with no child having low birth weight. There could be some desired motherhood practices applied by mothers in the two rural clusters worth learning from by policy makers in the child healthcare sector.

A novel outlier statistic in multivariate survival models and its application to identify unusual under-five mortality sub-districts in Malawi.

Although under-five mortality (U5M) rates have declined worldwide, many countries in sub-Saharan Africa still have much higher rates. Detection of subnational areas with unusually higher U5M rates could support targeted high impact child health interventions. We propose a novel group outlier detection statistic for identifying areas with extreme U5M rates under a multivariate survival data model. The performance of the proposed statistic was evaluated through a simulation study. We applied the proposed method to an analysis of child survival data in Malawi to identify sub-districts with unusually higher or lower U5M rates. The simulation study showed that the proposed outlier statistic can detect unusual high or low mortality groups with a high accuracy of at least 90%, for datasets with at least 50 clusters of size 80 or more. In the application, at most 7 U5M outlier sub-districts were identified, based on the best fitting model as measured by the Akaike information criterion (AIC).

Bivariate logistic regression model diagnostics applied to analysis of outlier cancer patients with comorbid diabetes and hypertension in Malawi.

The joint occurrence of diabetes and hypertension conditions in a patient is common. The two diseases share a number of risk factors, and are hence usually modelled concurrently using bivariate logistic regression. However, the postestimation assessment for the model, such as analysis of outlier observations, is seldom carried out. In this article, we apply outlier detection methods for multivariate data models to study characteristics of cancer patients with joint outlying diabetes and hypertension outcomes observed from among 398 randomly selected cancer patients at Queen Elizabeth and Kamuzu Central Hospitals in Malawi. We used R software version 4.2.2 to perform the analyses and STATA version 12 for data cleaning. The results showed that one patient was an outlier to the bivariate diabetes and hypertension logit model. The patient had both diabetes and hypertension and was based in rural area of the study population, where it was observed that comorbidity of the two diseases was uncommon. We recommend thorough analysis of outlier patients to comorbid diabetes and hypertension before rolling out interventions for managing the two diseases in cancer patients to avoid misaligned interventions. Future research could perform the applied diagnostic assessments for the bivariate logit model on a wider and larger dataset of the two diseases.