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A space-time analysis of recurrent malnutrition-related hospitalisations in Kilifi, Kenya for children under-5 years
BMC Nutrition Pub Date : 2019-06-04 , DOI: 10.1186/s40795-019-0296-5
Kennedy Mwai Wambui 1 , Eustasius Musenge 1
Affiliation  

Globally, malnutrition underlies 45% of under-5 s mortality, mainly from potentiating common infections such as diarrhoea and pneumonia. Malnutrition as a public health problem is not evenly disbursed because of disparities in food insecurity and health, and children commonly suffer recurrent episodes of opportunistic infections. We aimed to understand better the spatial and temporal structure of multiple paediatric hospital admissions associated with malnutrition-related illnesses. This paper aimed to investigate the spatial-temporal variations in malnutrition-related recurrent morbidity of children under-5 years from the Kilifi County in Kenya between 2002 and 2015. The study included data from children under-5 years old who had more than one admission to a rural district hospital in Kenya within the Kilifi Health and Demographic Surveillance System (KHDSS). The primary outcome was a malnutrition-related admission, based on wasting (WHZ < -2) or nutritional oedema. Individual, household and environmental level covariates were examined as exposures. We first fitted a SARIMA model for the temporality, and the Moran’s Index affirmed spatial clustering in malnutrition admissions. Kulldorf Statistics using SaTScan were applied to detect hotspots. Then, bivariate analysis was done using repeated values tabulation and analysis of covariance (ANCOVA). Inferential analysis was done using a mixed effect multivariable negative-binomial regression model, adjusting for spatiotemporal random effects. A total of 2821 children were admitted more than once, giving a total of 6375 admissions. Of these 6375 admissions, 1866 were malnutrition-related, and 3.9% (109/2821) of the children with repeat admissions died. There was a seasonal pattern of re-admissions, peaking from May to July over the years. Hotspots were found in both the Northern and Southern areas of the KHDSS, while the areas near Kilifi Town were least affected. We found that disease severity was most likely associated with a malnutrition re-admission to the hospital. Disease severity was strongly associated with admission with malnutrition but its effect reduced after adjusting for the spatial and temporal random effects. Adjusting for clustering in space and in time (spatial-temporal) in models helps to improve the understanding of recurrent hospitalisations involving malnutrition.

中文翻译:

肯尼亚 Kilifi 5 岁以下儿童因营养不良反复住院的时空分析

在全球范围内,营养不良是 45% 的 5 岁以下儿童死亡率的基础,主要是由于腹泻和肺炎等常见感染。由于粮食不安全和健康方面的差异,营养不良作为一个公共卫生问题没有得到平均分配,儿童经常遭受机会性感染的反复发作。我们旨在更好地了解与营养不良相关疾病相关的多次儿科住院的时空结构。本文旨在调查 2002 年至 2015 年间肯尼亚 Kilifi 县 5 岁以下儿童营养不良相关复发性疾病的时空变化。该研究包括 5 岁以下儿童的数据,这些儿童在 Kilifi 健康和人口监测系统 (KHDSS) 内曾多次入住肯尼亚农村地区医院。主要结果是营养不良相关入院,基于消瘦(WHZ < -2)或营养性水肿。个人、家庭和环境水平的协变量被检查为暴露。我们首先为时间性拟合了 SARIMA 模型,Moran 指数确认了营养不良入院的空间聚类。使用 SaTScan 的 Kulldorf Statistics 用于检测热点。然后,使用重复值制表和协方差分析(ANCOVA)进行双变量分析。使用混合效应多变量负二项式回归模型进行推理分析,调整时空随机效应。共有2821名儿童不止一次被录取,共录取6375人。在这 6375 名入院患者中,1866 人与营养不良有关,3.9% (109/2821) 的重复入院儿童死亡。有一个季节性的重新录取模式,多年来从 5 月到 7 月达到顶峰。在 KHDSS 的北部和南部地区都发现了热点,而 Kilifi 镇附近的地区受影响最小。我们发现疾病的严重程度很可能与再次入院的营养不良有关。疾病严重程度与因营养不良入院密切相关,但在调整空间和时间随机效应后其影响降低。在模型中调整空间和时间(时空)聚类有助于提高对涉及营养不良的反复住院的理解。
更新日期:2020-04-22
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