Application of machine learning methods for predicting under-five mortality: analysis of Nigerian demographic health survey 2018 dataset.

BACKGROUND: Under-five mortality remains a significant public health issue in developing countries. This study aimed to assess the effectiveness of various machine learning algorithms in predicting under-five mortality in Nigeria and identify the most relevant predictors. METHODS: The study used nationally representative data from the 2018 Nigeria Demographic and Health Survey. The study evaluated the performance of the machine learning models such as the artificial neural network, k-nearest neighbourhood, Support Vector Machine, Naïve Bayes, Random Forest, and Logistic Regression using the true positive rate, false positive rate, accuracy, precision, F-measure, Matthew's correlation coefficient, and the Area Under the Receiver Operating Characteristics. RESULTS: The study found that machine learning models can accurately predict under-five mortality, with the Random Forest and Artificial Neural Network algorithms emerging as the best models, both achieving an accuracy of 89.47% and an AUROC of 96%. The results show that under-five mortality rates vary significantly across different characteristics, with wealth index, maternal education, antenatal visits, place of delivery, employment status of the woman, number of children ever born, and region found to be the top determinants of under-five mortality in Nigeria. CONCLUSIONS: The findings suggest that machine learning models can be useful in predicting U5M in Nigeria with high accuracy. The study emphasizes the importance of addressing social, economic, and demographic disparities among the population in Nigeria. The study's findings can inform policymakers and health workers about developing targeted interventions to reduce under-five mortality in Nigeria.

The spatial effects of the household's food insecurity levels in Ethiopia: by ordinal geo-additive model.

Background: Food insecurity and vulnerability in Ethiopia are historical problems due to natural- and human-made disasters, which affect a wide range of areas at a higher magnitude with adverse effects on the overall health of households. In Ethiopia, the problem is wider with higher magnitude. Moreover, this geographical distribution of this challenge remains unexplored regarding the effects of cultures and shocks, despite previous case studies suggesting the effects of shocks and other factors. Hence, this study aims to assess the geographic distribution of corrected-food insecurity levels (FCSL) across zones and explore the comprehensive effects of diverse factors on each level of a household's food insecurity. Method: This study analyzes three-term household-based panel data for years 2012, 2014, and 2016 with a total sample size of 11505 covering the all regional states of the country. An extended additive model, with empirical Bayes estimation by modeling both structured spatial effects using Markov random field or tensor product and unstructured effects using Gaussian, was adopted to assess the spatial distribution of FCSL across zones and to further explore the comprehensive effect of geographic, environmental, and socioeconomic factors on the locally adjusted measure. Result: Despite a chronological decline, a substantial portion of Ethiopian households remains food insecure (25%) and vulnerable (27.08%). The Markov random field (MRF) model is the best fit based on GVC, revealing that 90.04% of the total variation is explained by the spatial effects. Most of the northern and south-western areas and south-east and north-west areas are hot spot zones of food insecurity and vulnerability in the country. Moreover, factors such as education, urbanization, having a job, fertilizer usage in cropping, sanitation, and farming livestock and crops have a significant influence on reducing a household's probability of being at higher food insecurity levels (insecurity and vulnerability), whereas shocks occurrence and small land size ownership have worsened it. Conclusion: Chronically food insecure zones showed a strong cluster in the northern and south-western areas of the country, even though higher levels of household food insecurity in Ethiopia have shown a declining trend over the years. Therefore, in these areas, interventions addressing spatial structure factors, particularly urbanization, education, early marriage control, and job creation, along with controlling conflict and drought effect by food aid and selected coping strategies, and performing integrated farming by conserving land and the environment of zones can help to reduce a household's probability of being at higher food insecurity levels.

Key predictors of food security and nutrition in Africa: a spatio-temporal model-based study.

There is voluminous literature on Food Security in Africa. This study explicitly considers the spatio-temporal factors in addition to the usual FAO-based metrics in modeling and understanding the dynamics of food security and nutrition across the African continent. To better understand the complex trajectory and burden of food insecurity and nutrition in Africa, it is crucial to consider space-time factors when modeling and interpreting food security. The spatio-temporal anova model was found to be superior(employing statistical criteria) to the other three models from the spatio-temporal interaction domain models. The results of the study suggest that dietary supply adequacy, food stability, and consumption status are positively associated with severe food security, while average food supply and environmental factors have negative effects on Food Security and Nutrition. The findings also indicate that severe food insecurity and malnutrition are spatially and temporally correlated across the African continent. Spatio-temporal modeling and spatial mapping are essential components of a comprehensive practice to reduce the burden of severe food insecurity. likewise, any planning and intervention to improve the average food supply and environment to promote sustainable development should be regional instead of one size fit all.

Spatial regression models to assess variations of composite index for anthropometric failure across the administrative zones in Ethiopia.

BACKGROUND: There are a number of previous studies that investigated undernutrition and its determinants in Ethiopia. However, the national average in the level of undernutrition conceals large variation across administrative zones of Ethiopia. Hence, this study aimed to determine the geographic distribution of composite index for anthropometric failure (CIAF) and identify the influencing factors it' might be more appropriate. METHODS: We used the zonal-level undernutrition data for the under-five children in Ethiopia from the Ethiopian Demographic and Health Survey (EDHS) dataset. Different spatial models were applied to explore the spatial distribution of the CIAF and the covariates. RESULTS: The Univariate Moran's I statistics for CIAF showed spatial heterogeneity of undernutrition in Ethiopian administrative zones. The spatial autocorrelation model (SAC) was the best fit based on the AIC criteria. Results from the SAC model suggested that the CIAF was positively associated with mothers' illiteracy rate (0.61, pvalue 0.001), lower body mass index (0.92, pvalue = 0.023), and maximum temperature (0.2, pvalue = 0.0231) respectively. However, the CIAF was negatively associated with children without any comorbidity (-0.82, pvalue = 0.023), from families with accessibility of improved drinking water (-0.26, pvalue = 0.012), and minimum temperature (-0.16). CONCLUSION: The CIAF across the administrative zones of Ethiopia is spatially clustered. Improving women's education, improving drinking water, and improving child breast feeding can reduce the prevalence of undernutrition (CIAF) across Ethiopian administrative zones. Moreover, targeted intervention in the geographical hotspots of CIAF can reduce the burden of CIAF across the administrative zones.

Rural-urban differentials in child body mass index over time.

BACKGROUND: The body mass index is a simple index based on weight and height that can be used to screen children and adults for potential weight problems. The objective of this study was to investigate urban-rural variations in child BMI and its distribution from 2006 to 2016 in four low and middle-income countries. METHODS: This study used data from the Young Lives prospective cohort study conducted in Ethiopia, India, Peru, and Vietnam to assess the BMI change for children aged 5 to 15 between 2006 and 2016. We adopted a mixed-effect model to analyze the data. RESULTS: The study revealed substantial changes and rises in BMI in Vietnam, Peru, India, and Ethiopia between 2006 and 2016. Peru had the highest BMI changes in both urban-rural areas. A low BMI was observed in Ethiopia and India. Urban-rural differences had a significant role in determining BMI variation. In urban Ethiopia, the mean BMI increased from 14.56 kg/m2 to 17.52 kg/m2, and in rural areas, it increased from 14.57 kg/m2 to 16.67 kg/m2. Similarly, in urban Vietnam, the BMI increased from 16 kg/m2 to 20.3 kg/m2, and in rural areas, it increased from 14.69 kg/m2 to 18.93 kg/m2. CONCLUSIONS: The findings showed an increase in BMI changes in Ethiopia, India, Peru, and Vietnam from 2006 to 2016. Urban-rural differences have a significant contribution to determining BMI variation.

Analysis of heterogeneous growth changes in longitudinal height of children.

BACKGROUND: There have been methodologies developed for a wide range of longitudinal data types; nevertheless, the conventional growth study is restricted if individuals in the sample have heterogeneous growth trajectories across time. Using growth mixture modeling approaches, we aimed to investigate group-level heterogeneities in the growth trajectories of children aged 1 to 15 years. METHOD: This longitudinal study examined group-level growth heterogeneities in a sample of 3401 males and 3200 females. Data were analyzed using growth mixture modeling approaches. RESULTS: We examined different trajectories of growth change in children across four low- and middle-income countries using a data-driven growth mixture modeling technique. The study identified two-group trajectories: the most male samples group (n = 4260, 69.7%) and the most female samples group (n = 2341, 81.6%). The findings show that the two groups had different growth trajectories. Gender and country differences were shown to be related to growth factors; however, the association varied depending on the trajectory group. In both latent groups, females tended to have lower growth factors (initial height and rate of growth) than their male counterparts. Compared with children from Ethiopia, children from Peru and Vietnam tended to exhibit faster growth in height over time: In contrast, children from India showed a lower rate of change in both latent groups than that of children from Ethiopia. CONCLUSIONS: The height of children in four low- and middle-income countries showed heterogeneous changes over time with two different groups of growth trajectories.

Linear mixed model to identify the relationship between grain yield and other yield related traits and genotype selection for sorghum.

Sorghum is the most popular crop in arid and semi-arid areas, especially in Sub-Saharan African countries. Genotype effects, environmental and the interaction of genotype by environmental factors have an influence on phenotypic traits. The aim of the study is to identify the relationship between grain yield and other yield-related traits and select the genotypes which perform better in grain yield as well as to examine the association between the uncorrelated phenotypic traits and grain yield via mixed model. The data was generated using a lattice square design. Principal component analysis was used to generate uncorrelated variables for the mixed model. The study revealed that there was a difference in grain yield due to the treatment and there was a pairwise relationship among the phenotypic variables. 77.12% of the total variance of the original phenotypic variables was explained by the first three principal components and decided to use PCAs as input variables for the mixed model. All PCs had significant effects on grain yield as well as grain yield variability due to random effects associated with genotypes, genotype interaction by treatment, and replication within the treatment. The variability of grain yield due to genotype effect was explained about 45.73%, the variation of grain yield due to the interaction of genotype by the treatment was also explained about 39.06% and 1.55% of the variation of grain was explained by replication within treatment. The best performer genotypes recommended for mass production were G40 (Genotype 40), G186 (Genotype 186) and G196 (Genotype 196) without any constraint of environment. The genotypes recommended for mass production under irrigation conditions were G40 (Genotype 40), G62 (Genotype 62) and G192 (Genotype 192). G26 (Genotype 26), G55 (Genotype 55) and G49 (Genotype 49) were the genotypes recommended for mass production under stress conditions. Overall, the study recommends using a mixed model to fit the grain yield, and future work will focus on to evaluate the performance of genotypes under different environments and years of production.

Household food insecurity levels in Ethiopia: quantile regression approach.

Introduction: Numerous natural and man-made factors have afflicted Ethiopia, and millions of people have experienced food insecurity. The current cut-points of the WFP food consumption score (FCS) have limitations in measuring the food insecurity level of different feeding patterns due to the diversified culture of the society. The aim of this study is to adapt the WFP food security score cut-points corrected for the different feeding cultures of the society using effect-driven quantile clustering. Method: The 2012, 2014, and 2016 Ethiopian socio-economic household-based panel data set with a sample size of 3,835 households and 42 variables were used. Longitudinal quantile regression with fixed individual-specific location-shift intercept of the free distribution covariance structure was adopted to identify major indicators that can cluster and level quantiles of the FCS. Result: Household food insecurity is reduced through time across the quintiles of food security score distribution, mainly in the upper quantiles. The leveling based on effect-driven quantile clustering brings 35.5 and 49 as the FCS cut-points corrected for cultural diversity. This corrected FCS brings wider interval for food insecure households with the same interval range for vulnerable households, where the WFP FCS cut-points under estimate it by 7 score. Education level, employment, fertilizer usage, farming type, agricultural package, infrastructure-related factors, and environmental factors are found to be the significant contributing factors to food security. On the other hand, the age of the head of the household, dependency ratio, shock, and no irrigation in households make significant contributions to food insecurity. Moreover, households living in rural areas and farming crops on small lands are comparatively vulnerable and food insecure. Conclusion: Measuring food insecurity in Ethiopia using the WFP FCS cut-off points underestimates households' food insecurity levels. Since the WFP FCS cut-points have universality and comparability limitations, there is a need for a universally accepted local threshold, corrected for local factors those resulted in different consumption patterns in the standardization of food security score. Accordingly, the quantile regression approach adjusts the WFP-FCS cut points by adjusting for local situations. Applying WFP cut-points will wrongly assign households on each level, so the proportion of households will be inflated for the security level and underestimated for the insecure level, and the influence of factors can also be wrongly recommended the food security score for the levels. The quantile clustering approach showed that cropping on a small land size would not bring about food security in Ethiopia. This favors the Ethiopian government initiative called integrated farming "ኩታ ገጠም እርሻ" which Ethiopia needs to develop and implement a system that fits and responds to this technology and infrastructure.

Classification of imbalanced data using machine learning algorithms to predict the risk of renal graft failures in Ethiopia.

INTRODUCTION: The prevalence of end-stage renal disease has raised the need for renal replacement therapy over recent decades. Even though a kidney transplant offers an improved quality of life and lower cost of care than dialysis, graft failure is possible after transplantation. Hence, this study aimed to predict the risk of graft failure among post-transplant recipients in Ethiopia using the selected machine learning prediction models. METHODOLOGY: The data was extracted from the retrospective cohort of kidney transplant recipients at the Ethiopian National Kidney Transplantation Center from September 2015 to February 2022. In response to the imbalanced nature of the data, we performed hyperparameter tuning, probability threshold moving, tree-based ensemble learning, stacking ensemble learning, and probability calibrations to improve the prediction results. Merit-based selected probabilistic (logistic regression, naive Bayes, and artificial neural network) and tree-based ensemble (random forest, bagged tree, and stochastic gradient boosting) models were applied. Model comparison was performed in terms of discrimination and calibration performance. The best-performing model was then used to predict the risk of graft failure. RESULTS: A total of 278 completed cases were analyzed, with 21 graft failures and 3 events per predictor. Of these, 74.8% are male, and 25.2% are female, with a median age of 37. From the comparison of models at the individual level, the bagged tree and random forest have top and equal discrimination performance (AUC-ROC = 0.84). In contrast, the random forest has the best calibration performance (brier score = 0.045). Under testing the individual model as a meta-learner for stacking ensemble learning, the result of stochastic gradient boosting as a meta-learner has the top discrimination (AUC-ROC = 0.88) and calibration (brier score = 0.048) performance. Regarding feature importance, chronic rejection, blood urea nitrogen, number of post-transplant admissions, phosphorus level, acute rejection, and urological complications are the top predictors of graft failure. CONCLUSIONS: Bagging, boosting, and stacking, with probability calibration, are good choices for clinical risk predictions working on imbalanced data. The data-driven probability threshold is more beneficial than the natural threshold of 0.5 to improve the prediction result from imbalanced data. Integrating various techniques in a systematic framework is a smart strategy to improve prediction results from imbalanced data. It is recommended for clinical experts in kidney transplantation to use the final calibrated model as a decision support system to predict the risk of graft failure for individual patients.

Longitudinal trends and determinants of stunting among children aged 1-15 years.

BACKGROUND: Stunting increases morbidity and mortality, hindering mental development and influencing cognitive capacity of children. This study aimed to examine the trends and determinants of stunting from infancy to middle adolescence in four countries: Ethiopia, India, Peru, and Vietnam. METHODS: A 15-year longitudinal data on the trends of stunting were obtained from the Young Lives cohort study. The study includes 38,361 observations from 4 countries. A generalized mixed-effects model was adopted to estimate the determinant of stunting. RESULTS: The patterns of stunting in children from aged 1 to 15 years have declined from an estimated 30% in 2002 to 20% in 2016. Stunting prevalence varied among four low- and middle-income countries with children in Ethiopia, India, and Peru being more stunted compared to children in Vietnam. The highest stunted was recorded in India and the lowest was recorded in Vietnam. In all four countries, the highest prevalence of severe stunting was observed in 2002 and moderate stunting was observed in 2006. Parents' education level played a significance role in determining a child stunting. Children of uneducated parents were shown to be at a higher risk of stunting. CONCLUSION: Disparities of stunting were observed between- and within-country of four low- and middle-income with the highest prevalence recorded in low-income country. Child stunting is caused by factors related to child's age, household wealth, household size, the mother's and father's education level, residence area and access to save drinking water.

Seasonal and spatial variations of malaria transmissions in northwest Ethiopia: Evaluating climate and environmental effects using generalized additive model.

The impacts of climate change and environmental predictors on malaria epidemiology remain unclear and not well investigated in the Sub-Sahara African region. This study was aimed to investigate the nonlinear effects of climate and environmental factors on monthly malaria cases in northwest Ethiopia, considering space-time interaction effects. The monthly malaria cases and populations sizes of the 152 districts were obtained from the Amhara public health institute and the central statistical agency of Ethiopia. The climate and environmental data were retrieved from US National Oceanic and Atmospheric Administration. The data were analyzed using a spatiotemporal generalized additive model. The spatial, temporal, and space-time interaction effects had higher contributions in explaining the spatiotemporal distribution of malaria transmissions. Malaria transmission was seasonal, in which a higher number of cases occurred from September to November. The long-term trend of malaria incidence has decreased between 2012 and 2018 and has turned to an increased pattern since 2019. Areas neighborhood to the Abay gorge and Benshangul-Gumuz, South Sudan, and Sudan border have higher spatial effects. Climate and environmental predictors had significant nonlinear effects, in which their effects are not stationary through the ranges of values of variables, and they had a smaller contributions in explaining the variabilities of malaria incidence compared to seasonal, spatial and temporal effects. Effects of climate and environmental predictors were nonlinear and varied across areas, ecology, and landscape of the study sites, which had little contribution to explaining malaria transmission variabilities with an account of space and time dimensions. Hence, exploring and developing an early warning system that predicts the outbreak of malaria transmission would have an essential role in controlling, preventing, and eliminating malaria in areas with lower and higher transmission levels and ultimately lead to the achievement of malaria GTS milestones.

Impact of ambient air pollution exposure during pregnancy on adverse birth outcomes: generalized structural equation modeling approach.

BACKGROUND: Air pollution and several prenatal factors, such as socio-demographic, behavioural, physical activity and clinical factors influence adverse birth outcomes. The study aimed to investigate the impact of ambient air pollution exposure during pregnancy adjusting prenatal risk factors on adverse birth outcomes among pregnant women in MACE birth cohort. METHODS: Data for the study was obtained from the Mother and Child in the Environment (MACE) birth cohort study in Durban, South Africa from 2013 to 2017. Land use regression models were used to determine household level prenatal exposure to PM2.5, SO2 and NOx. Six hundred and fifty-six births of pregnant females were selected from public sector antenatal clinics in low socio-economic neighbourhoods. We employed a Generalised Structural Equation Model with a complementary log-log-link specification. RESULTS: After adjustment for potential prenatal factors, the results indicated that exposure to PM2.5 was found to have both significant direct and indirect effects on the risk of all adverse birth outcomes. Similarly, an increased level of maternal exposure to SO2 during pregnancy was associated with an increased probability of being small for gestational age. Moreover, preterm birth act a mediating role in the relationship of exposure to PM2.5, and SO2 with low birthweight and SGA. CONCLUSIONS: Prenatal exposure to PM2.5 and SO2 pollution adversely affected birth outcomes after controlling for other prenatal risk factors. This suggests that local government officials have a responsibility for better control of air pollution and health care providers need to advise pregnant females about the risks of air pollution during pregnancy.

A combined model of child malnutrition and morbidity in Ethiopia using structural equation models.

Malnutrition and morbidity are substantial problems in Ethiopia and are still pervasive and persistent. Despite this, there has been scant research on the coexistence of malnutrition and morbidity indicators. Moreover, previous studies were based on all data records of measurements from manifest data. Thus, this study aims to identify the correlates and coexistence of child malnutrition and morbidity within this country. Cross-sectional data which is collected by Ethiopia Demographic and Health Survey were used. The generalized structural equation models were used to examine the association between child malnutrition, morbidity, and potential risk factors. The generalized structural equation models help to provide latent effects of child malnutrition and morbidity within a combined modeling framework. In addition, the generalized structural equation models make it possible to analyze malnutrition as a mediator of the association between selected risk factors and latent variable morbidity. The data analysis was done using SPSS AMOS and R software. The analysis indicated that children born to nourished mothers (AOR = 0.71, 95% CI 0.68-0.75), born to enough birth space between 24 and 47 months and (AOR = 0.93, 95% CI 0.88-0.99), 48 months and above (AOR = 0.71, 95% CI 0.65-0.76), being from middle-income households (AOR = 0.85, 95% CI 0.78-0.91), high-income households (AOR = 0.66, 95% CI 0.61-0.72), from mother with primary or secondary (AOR = 0.79, 95% CI 0.75-0.85) and higher education level (AOR = 0.57, 95% CI 0.41-0.78) were less affected by malnutrition. It also revealed that a child born second to third (AOR = 0.87, 95% CI 0.77-0.99), fourth and higher (AOR = 0.88, 95% CI 0.79-0.99) and children from a husband-educated higher level (AOR = 0.76, 95% CI 0.64-0.89) were less likely to be ill. Children who breastfeed (AOR = 0.98, 95% CI 0.80-0.99), from nourished mothers (AOR = 0.96, 95% CI 0.94-0.097), from middle income (AOR = 0.97, 95% CI 0.96-0.99), high-income households (AOR = 0.94, 95% CI 0.93-0.96), birth spacing 24-47 months (AOR = 0.99, 95% CI 0.98-1.00) and 48 months and above (AOR = 0.96, 95% CI 0.94-0.97) were indirectly affected by morbidity via malnutrition. This investigation has revealed that childhood malnutrition and morbidity remain major child health challenges in Ethiopia with demographic, socioeconomic, maternal, child, and geographic variables playing significant roles. Efforts to resolve these issues need to take these factors into account. Therefore, malnutrition and morbidity prevention should include encouraging birth spacing, mother education programs, and breastfeeding practices.

Latent growth analysis of children's height growth trajectories.

Characterizing and quantifying the trajectories of variables of interest through time in their field of study is of interest to a range of disciplines. The aim of this study was to investigate the growth speed in height of children and its determinants. A total of 3401 males and 3200 females from four low- and middle-income countries with measured height on five occasions from 2002 to 2016 were included in the study. Data were analyzed using a latent growth model. The results of the study reported that children in four low- and middle-income countries exhibited substantial growth inequalities. There was a significant gender difference in change of growth with males had a higher baseline, rate of change, and acceleration in height growth than females. Comparing the component of slopes across countries, the growth change inequalities were observed among children. These inequalities were statistically significant, with the highest rate of change observed in Peru and Vietnam.

Shared component modelling of early childhood anaemia and malaria in Kenya, Malawi, Tanzania and Uganda.

BACKGROUND: Malaria and anaemia contribute substantially to child morbidity and mortality. In this study, we sought to jointly model the residual spatial variation in the likelihood of these two correlated diseases, while controlling for individual-level, household-level and environmental characteristics. METHODS: A child-level shared component model was utilised to partition shared and disease-specific district-level spatial effects. RESULTS: The results indicated that the spatial variation in the likelihood of malaria was more prominent compared to that of anaemia, for both the shared and specific spatial components. In addition, approximately 30% of the districts were associated with an increased likelihood of anaemia but a decreased likelihood of malaria. This suggests that there are other drivers of anaemia in children in these districts, which warrants further investigation. CONCLUSIONS: The maps of the shared and disease-specific spatial patterns provide a tool to allow for more targeted action in malaria and anaemia control and prevention, as well as for the targeted allocation of limited district health system resources.

The spatial modification effect of predictors on household level food insecurity in Ethiopia.

Household food insecurity remains highly prevalent in developing countries (including in Ethiopia) and it has been recognized as a serious public health problem. Several factors such as demographic, economic, social, and clinical factors influence household food insecurity, and these vary geographically. In this work, we investigate the geographical modification of the effect of several factors on chronic food insecurity. The data is from the Ethiopia socioeconomic survey conducted by the Ethiopia Central Statistics Agency (ECSA) in collaboration with the World Bank. Ethiopia socioeconomic survey is a long-term project to collect nationally representative panel survey of over 6500 households. A geo-additive model which accounts the structured and unstructured special effect was adopted to estimate household food insecurity risk factors. The study also revealed significant spatial variations on household food insecurity among administrative zones. Mainly, household living in the Sidama, Gamo Gofa, Shinille, Basketo, Wolyita, Wag Hemira, Liben, Awi, Eastern Tigray and West Harerghe zones, having higher food insecurity than the other zones in Ethiopia. Moreover, the analysis also showed that availability of credit services, proximity to service centers, average years of schooling of members of the household, and household assets are negatively associated with household food insecurity, whereas shocks, age, and dependency ratio increase the odds of a household to be food insecured. The generalized geo-additive mixed-effects model enables simultaneous modeling of spatial correlation, heterogeneity and possible nonlinear effects of covariates. Our study investigated the spatial heterogeneity of household level food insecurity, and its association with shocks, age, dependency ratio, availability of credit services, average years of schooling, and household assets. Our findings have also an important implication for planning as well as in the search for the variables that might account for the residual spatial patterns.

Spatiotemporal Variation and Predictors of Unsuppressed Viral Load among HIV-Positive Men and Women in Rural and Peri-Urban KwaZulu-Natal, South Africa.

Unsuppressed HIV viral load is an important marker of sustained HIV transmission. We investigated the prevalence, predictors, and high-risk areas of unsuppressed HIV viral load among HIV-positive men and women. Unsuppressed HIV viral load was defined as viral load of ≥400 copies/mL. Data from the HIV Incidence District Surveillance System (HIPSS), a longitudinal study undertaken between June 2014 to June 2016 among men and women aged 15−49 years in rural and peri-urban KwaZulu-Natal, South Africa, were analysed. A Bayesian geoadditive regression model which includes a spatial effect for a small enumeration area was applied using an integrated nested Laplace approximation (INLA) function while accounting for unobserved factors, non-linear effects of selected continuous variables, and spatial autocorrelation. The prevalence of unsuppressed HIV viral load was 46.1% [95% CI: 44.3−47.8]. Predictors of unsuppressed HIV viral load were incomplete high school education, being away from home for more than a month, alcohol consumption, no prior knowledge of HIV status, not ever tested for HIV, not on antiretroviral therapy (ART), on tuberculosis (TB) medication, having two or more sexual partners in the last 12 months, and having a CD4 cell count of <350 cells/µL. A positive non-linear effect of age, household size, and the number of lifetime HIV tests was identified. The higher-risk pattern of unsuppressed HIV viral load occurred in the northwest and northeast of the study area. Identifying predictors of unsuppressed viral load in a localized geographic area and information from spatial risk maps are important for targeted prevention and treatment programs to reduce the transmission of HIV.

Space-time dynamics regression models to assess variations of composite index for anthropometric failure across the administrative zones in Ethiopia.

BACKGROUND: A single anthropometric index such as stunting, wasting, or underweight does not show the holistic picture of under-five children's undernutrition status. To alleviate this problem, we adopted a multifaceted single index known as the composite index for anthropometric failure (CIAF). Using this undernutrition index, we investigated the disparities of Ethiopian under-five children's undernutrition status in space and time. METHODS: Data for analysis were extracted from the Ethiopian Demographic and Health Surveys (EDHSs). The space-time dynamics models were formulated to explore the effects of different covariates on undernutrition among children under five in 72 administrative zones in Ethiopia. RESULTS: The general nested spatial-temporal dynamic model with spatial and temporal lags autoregressive components was found to be the most adequate (AIC = -409.33, R2 = 96.01) model. According to the model results, the increase in the percentage of breastfeeding mothers in the zone decreases the CIAF rates of children in the zone. Similarly, the increase in the percentages of parental education, and mothers' nutritional status in the zones decreases the CIAF rate in the zone. On the hand, increased percentages of households with unimproved water access, unimproved sanitation facilities, deprivation of women's autonomy, unemployment of women, and lower wealth index contributed to the increased CIAF rate in the zone. CONCLUSION: The CIAF risk factors are spatially and temporally correlated across 72 administrative zones in Ethiopia. There exist geographical differences in CIAF among the zones, which are influenced by spatial neighborhoods of the zone and temporal lags within the zone. Hence these findings emphasize the need to take the spatial neighborhood and historical/temporal contexts into account when planning CIAF prevention.

Spatial small area estimates of undernutrition for under five children in Ethiopia via combining survey and census data.

A survey is typically designed to produce reliable estimates of target variables of the population at national and regional levels. For unplanned zones with small sample sizes, reliable estimates are needed in many ways. Because of the small sample sizes, direct survey estimates for unplanned zones are unreliable. This paper aims to improve the precision of estimates of undernutrition at zonal levels using small area estimation under the spatial Fay-Herriot (FH) model. Diagnostic measures are used to determine the reliability of spatial FH model assumptions and model-based spatial estimates. According to the results, model-based small area estimates under spatial association had higher precision than direct estimates and FH models that ignored spatial information. The spatial small area estimates of undernutrition were unevenly distributed across Ethiopian zones. Undernutrition estimates for children under five at the zonal level can be helpful for resource allocation, policymakers, and planners.

Identifying Potential Factors Associated with High HIV viral load in KwaZulu-Natal, South Africa using Multiple Correspondence Analysis and Random Forest Analysis.

BACKGROUND: Sustainable Human Immunodeficiency Virus (HIV) virological suppression is crucial to achieving the Joint United Nations Programme of HIV/AIDS (UNAIDS) 95-95-95 treatment targets to reduce the risk of onward HIV transmission. Exploratory data analysis is an integral part of statistical analysis which aids variable selection from complex survey data for further confirmatory analysis. METHODS: In this study, we divulge participants' epidemiological and biological factors with high HIV RNA viral load (HHVL) from an HIV Incidence Provincial Surveillance System (HIPSS) sequential cross-sectional survey between 2014 and 2015 KwaZulu-Natal, South Africa. Using multiple correspondence analysis (MCA) and random forest analysis (RFA), we analyzed the linkage between socio-demographic, behavioral, psycho-social, and biological factors associated with HHVL, defined as ≥400 copies per m/L. RESULTS: Out of 3956 in 2014 and 3868 in 2015, 50.1% and 41% of participants, respectively, had HHVL. MCA and RFA revealed that knowledge of HIV status, ART use, ARV dosage, current CD4 cell count, perceived risk of contracting HIV, number of lifetime HIV tests, number of lifetime sex partners, and ever diagnosed with TB were consistent potential factors identified to be associated with high HIV viral load in the 2014 and 2015 surveys. Based on MCA findings, diverse categories of variables identified with HHVL were, did not know HIV status, not on ART, on multiple dosages of ARV, with less likely perceived risk of contracting HIV and having two or more lifetime sexual partners. CONCLUSION: The high proportion of individuals with HHVL suggests that the UNAIDS 95-95-95 goal of HIV viral suppression is less likely to be achieved. Based on performance and visualization evaluation, MCA was selected as the best and essential exploration tool for identifying and understanding categorical variables' significant associations and interactions to enhance individual epidemiological understanding of high HIV viral load. When faced with complex survey data and challenges of variables selection in research, exploratory data analysis with robust graphical visualization and reliability that can reveal divers' structures should be considered.