title: Geostatistical modelling of malaria indicator survey data to assess the effects of interventions on the geographical distribution of malaria prevalence in children less than 5 years in Uganda.
abstract: BACKGROUND
  Malaria burden in Uganda has declined disproportionately among regions despite overall high intervention coverage across all regions. The Uganda Malaria Indicator Survey (MIS) 2014-15 was the second nationally representative survey conducted to provide estimates of malaria prevalence among children less than 5 years, and to track the progress of control interventions in the country. In this present study, 2014-15 MIS data were analysed to assess intervention effects on malaria prevalence in Uganda among children less than 5 years, assess intervention effects at regional level, and estimate geographical distribution of malaria prevalence in the country.
  
  
  METHODS
  Bayesian geostatistical models with spatially varying coefficients were used to determine the effect of interventions on malaria prevalence at national and regional levels. Spike-and-slab variable selection was used to identify the most important predictors and forms. Bayesian kriging was used to predict malaria prevalence at unsampled locations.
  
  
  RESULTS
  Indoor Residual Spraying (IRS) and Insecticide Treated Nets (ITN) ownership had a significant but varying protective effect on malaria prevalence. However, no effect was observed for Artemisinin Combination-based Therapies (ACTs). Environmental factors, namely, land cover, rainfall, day and night land surface temperature, and area type were significantly associated with malaria prevalence. Malaria prevalence was higher in rural areas, increased with the child's age, and decreased with higher household socioeconomic status and higher level of mother's education. The highest prevalence of malaria in children less than 5 years was predicted for regions of East Central, North East and West Nile, whereas the lowest was predicted in Kampala and South Western regions, and in the mountainous areas in Mid-Western and Mid-Eastern regions.
  
  
  CONCLUSIONS
  IRS and ITN ownership are important interventions against malaria prevalence in children less than 5 years in Uganda. The varying effects of the interventions calls for selective implementation of control tools suitable to regional ecological settings. To further reduce malaria burden and sustain malaria control in Uganda, current tools should be supplemented by health system strengthening, and socio-economic development.
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.|School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Julius
authors.initials: J
authors.lastname: Ssempiira
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.|School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Betty
authors.initials: B
authors.lastname: Nambuusi
authors.affiliation: Ministry of Health, Kampala, Uganda.
authors.forename: John
authors.initials: J
authors.lastname: Kissa
authors.affiliation: Ministry of Health, Kampala, Uganda.
authors.forename: Bosco
authors.initials: B
authors.lastname: Agaba
authors.affiliation: School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Fredrick
authors.initials: F
authors.lastname: Makumbi
authors.affiliation: School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Simon
authors.initials: S
authors.lastname: Kasasa
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Penelope
authors.identifier: http://orcid.org/0000-0002-4904-5352
authors.initials: P
authors.lastname: Vounatsou
mesh_terms: D000818:Animals; D000852:Anopheles / Q000469:parasitology; D001499:Bayes Theorem; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007303:Insect Vectors / Q000469:parasitology; D057148:Insecticide-Treated Bednets; D007306:Insecticides; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D015233:Models, Statistical; D015995:Prevalence; D012307:Risk Factors; D012923:Social Class; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology
chemical_list: D007306:Insecticides