Department of Statistics, University of South Africa, c/o Christiaan de Wet Road & Pioneer Avenue, Johannesburg, 1709, Florida, South Africa.
Ethiopian Public Health Institute, Gulele Sub City, Addis Ababa, Ethiopia.
BMC Infect Dis. 2024 Sep 7;24(1):927. doi: 10.1186/s12879-024-09820-0.
In sub-Saharan African countries, preventable and manageable diseases such as diarrhea and acute respiratory infections still claim the lives of children. Hence, this study aims to estimate the rate of change in the log expected number of days a child suffers from Diarrhea (NOD) and flu/common cold (NOF) among children aged 6 to 11 months at the baseline of the study.
This study used secondary data which exhibit a longitudinal and multilevel structure. Based on the results of exploratory analysis, a multilevel zero-inflated Poisson regression model with a rate of change in the log expected NOD and NOF described by a quadratic trend was proposed to efficiently analyze both outcomes accounting for correlation between observations and individuals through random effects. Furthermore, residual plots were used to assess the goodness of fit of the model.
Considering subject and cluster-specific random effects, the results revealed a quadratic trend in the rate of change of the log expected NOD. Initially, low dose iron Micronutrient Powder (MNP) users exhibited a higher rate of change compared to non-users, but this trend reversed over time. Similarly, the log expected NOF decreased for children who used MNP and exclusively breastfed for six months, in comparison to their counterparts. In addition, the odds of not having flu decreased with each two-week increment for MNP users, as compared to non-MNP users. Furthermore, an increase in NOD resulted in an increase in the log expected NOF. Region and exclusive breastfeeding also have a significant relationships with both NOD and NOF.
The findings of this study underscore the importance of commencing analysis of data generated from a study with exploratory analysis. The study highlights the critical role of promoting EBF for the first six months and supporting children with additional food after six months to reduce the burden of infectious diseases.
在撒哈拉以南非洲国家，腹泻和急性呼吸道感染等可预防和可治疗的疾病仍导致儿童死亡。因此，本研究旨在估计研究基线时 6 至 11 个月儿童患腹泻（NOD）和流感/普通感冒（NOF）的预期天数对数变化率。
本研究使用了具有纵向和多层次结构的二次数据。基于探索性分析的结果，提出了一种多层次零膨胀泊松回归模型，用于对数预期 NOD 和 NOF 的变化率，该模型由二次趋势描述，通过随机效应有效地分析两个结果，同时考虑到观察结果和个体之间的相关性。此外，还使用残差图来评估模型的拟合优度。
考虑到个体和聚类特定的随机效应，结果显示对数预期 NOD 的变化率呈二次趋势。最初，低剂量铁微营养素粉（MNP）使用者的变化率高于非使用者，但随着时间的推移，这种趋势发生了逆转。同样，与对照相比，使用 MNP 且纯母乳喂养六个月的儿童的预期 NOF 对数下降。此外，与非 MNP 使用者相比，MNP 使用者每增加两周，患流感的几率就会降低。此外，NOD 的增加会导致预期 NOF 的对数增加。地区和纯母乳喂养也与 NOD 和 NOF 有显著关系。
本研究的结果强调了对研究产生的数据进行探索性分析的重要性。研究强调了推广前六个月纯母乳喂养和支持六个月后儿童食用额外食物的重要性，以减轻传染病的负担。
