title: The Pattern of Variation between Diarrhea and Malaria Coexistence with Corresponding Risk Factors in, Chikhwawa, Malawi: A Bivariate Multilevel Analysis.
abstract: Developing countries face a huge burden of infectious diseases, a number of which co-exist. This paper estimates the pattern and variation of malaria and diarrhea coexistence in Chikhwawa, a district in Southern Malawi using bivariate multilevel modelling with Bayesian estimation. A probit link was employed to examine hierarchically built data from a survey of individuals (n = 6,727) nested within households (n = 1,380) nested within communities (n = 33). Results show significant malaria [σ²μ₁=0.901 (95% CI:0.746,1.056)] and diarrhea [σ²μ₂=1.009 (95% CI:0.860,1.158)] variations with a strong correlation between them [r(¹,²)μ=0.565] at household level. There are significant malaria [σ²ν₁=0.053 (95% CI: 0.018,0.088)] and diarrhea [σ²ν₂=0.099(95% CI : 0.030,0.168) ] variations at community level but with a small correlation [r(¹,²) ν=0.124] between them. There is also significant correlation between malaria and diarrhea at individual level [ r(¹,²) e=0.241]. These results suggest a close association between reported malaria-like illness and diarrheal illness especially at household and individual levels in Southern Malawi.
authors.affiliation: Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), University of Malawi, The Polytechnic, P/B 303, Blantyre, Malawi. salule.masangwi@strath.ac.uk.|Department of Mathematics and Statistics, University of Malawi, The Polytechnic, P/B 303, Blantyre, Malawi. salule.masangwi@strath.ac.uk.
authors.forename: Salule
authors.initials: S
authors.lastname: Masangwi
authors.affiliation: Department of Civil Engineering, University of Strathclyde, Glasgow G4 0NG, UK. n.s.ferguson@strath.ac.uk.
authors.forename: Neil
authors.initials: N
authors.lastname: Ferguson
authors.affiliation: Scotland Chikhwawa Health Initiative (SCHI), P.O. Box 30376, Blantyre 3, Malawi. a.m.grimason@strath.ac.uk.|Africa Academy for Environmental Health, P.O. Box 15574, Sinoville 0129, South Africa. a.m.grimason@strath.ac.uk.
authors.forename: Anthony
authors.initials: A
authors.lastname: Grimason
authors.affiliation: Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), University of Malawi, The Polytechnic, P/B 303, Blantyre, Malawi. a.m.grimason@strath.ac.uk.|Department of Civil Engineering, University of Strathclyde, Glasgow G4 0NG, UK. a.m.grimason@strath.ac.uk.|Scotland Chikhwawa Health Initiative (SCHI), P.O. Box 30376, Blantyre 3, Malawi. a.m.grimason@strath.ac.uk.|Africa Academy for Environmental Health, P.O. Box 15574, Sinoville 0129, South Africa. a.m.grimason@strath.ac.uk.
authors.forename: Tracy
authors.initials: T
authors.lastname: Morse
authors.affiliation: Department of Statistics and Population Studies, 340 Mandume Ndemufayo Avenue, Pionerspark, P/Bag 13301, Windhoek, Namibia. lkazembe@yahoo.com.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Kazembe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001499:Bayes Theorem; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries / Q000706:statistics & numerical data; D003967:Diarrhea / Q000453:epidemiology*; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000453:epidemiology*; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D012044:Regression Analysis; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D055815:Young Adult
keywords: Bayesian Analysis; Southern Malawi; bivariate multilevel analysis; household and community variation; malaria and diarrhea coexistence; random effects