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Bayesian spatial modeling of malnutrition and mortality among under-five children in sub-Saharan Africa.

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The aim of this thesis is to develop and extend Bayesian statistical models in the area of spatial modeling and apply them to child health outcomes, with particular focus on childhood malnutrition and mortality among under-five children. The easy availability of a geo-referenced database has stimulated a paradigm shift in methodological approaches to spatial analysis. This study reviewed the spatial methods and disease mapping models developed for areal (lattice) data analysis. Observational data collected from complex design surveys and geographical locations often violates the independent assumption of classical regression models. By relaxing the restrictive linearity and normality assumptions of classical regression models, this study first developed a flexible semi-parametric spatial model that accommodates the usual fixed effect, nonlinear and geographical component in a unified model. The approach was explored in the analysis of spatial patterns of child birth outcomes in Nigeria. The study also addressed the issue of disease clustering, which is of interest to epidemiologists and public health officials. The study then proposed a Bayesian hierarchical analysis approach for Poisson count data and formulated a Poisson version of generalized linear mixed models (GLMMs) for analyzing childhood mortality. The model simultaneously addressed the problem of overdispersion and spatial dependence by the inclusion of the risk factors and random effects in a single model. The proposed approach identified regions with elevated relative risk or clustering of high mortality and evaluated the small scale geographical disparities in sub-populations across the regions. The study identified another challenge in spatial data analysis, which are spatial autocorrelation and model misspecification. The study then fitted geoadditive mixed (GAM) models to analyze childhood anaemia data belonging to a family of exponential distributions (Gaussian, binary and multinomial). The GAM models are extension of generalized linear mixed models by allowing the inclusion of splines for continuous covariate (or time) trends with the parametric function. Lastly, the shared component model originally developed for multiple disease mapping was reviewed and modified to suit the binary data at hand. A multivariate conditional autoregressive (MCAR) model was developed and applied to jointly analyze three child malnutrition indicators. The approach facilitated the estimation of conditional correlation between the diseases; assess the spatial association with the regions and geographical variation of individual disease prevalence. The spatial analysis presented in this thesis is useful to inform health-care policy and resource allocation. This thesis contributes to methodological applications in life sciences, environmental sciences, public health and agriculture. The present study expands the existing methods and tools for health impact assessment in public health studies. KEYWORDS: Conditional Autoregressive (CAR) model, Disease Mapping Models, Multiple Disease mapping, Health Geography, Ecology Models, Spatial Epidemiology, Childhood Health outcomes.


Doctoral Degree. University of KwaZulu-Natal, Pietermaritzburg.