Application of multivariate binary logistic regression grouped outlier statistics and geospatial logistic model to identify villages having unusual health-seeking habits for childhood malaria in Malawi.

BACKGROUND: Early diagnosis and prompt treatment of malaria in young children are crucial for preventing the serious stages of the disease. If delayed treatment-seeking habits are observed in certain areas, targeted campaigns and interventions can be implemented to improve the situation. METHODS: This study applied multivariate binary logistic regression model diagnostics and geospatial logistic model to identify traditional authorities in Malawi where caregivers have unusual health-seeking behaviour for childhood malaria. The data from the 2021 Malawi Malaria Indicator Survey were analysed using R software version 4.3.0 for regressions and STATA version 17 for data cleaning. RESULTS: Both models showed significant variability in treatment-seeking habits of caregivers between villages. The mixed-effects logit model residual identified Vuso Jere, Kampingo Sibande, Ngabu, and Dzoole as outliers in the model. Despite characteristics that promote late reporting of malaria at clinics, most mothers in these traditional authorities sought treatment within twenty-four hours of the onset of malaria symptoms in their children. On the other hand, the geospatial logit model showed that late seeking of malaria treatment was prevalent in most areas of the country, except a few traditional authorities such as Mwakaboko, Mwenemisuku, Mwabulambya, Mmbelwa, Mwadzama, Zulu, Amidu, Kasisi, and Mabuka. CONCLUSIONS: These findings suggest that using a combination of multivariate regression model residuals and geospatial statistics can help in identifying communities with distinct treatment-seeking patterns for childhood malaria within a population. Health policymakers could benefit from consulting traditional authorities who demonstrated early reporting for care in this study. This could help in understanding the best practices followed by mothers in those areas which can be replicated in regions where seeking care is delayed.

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.

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.