Compartmental mathematical modelling of dynamic transmission of COVID-19 in Rwanda.

Objectives: Mathematical modelling is of interest to study the dynamics of coronavirus disease 2019 (COVID-19), and models such as SEIR (Susceptible-Exposed-Infected-Recovered) have been considered. This article describes the development of a compartmental transmission network model - Susceptible-Exposed-Quarantine-Infectious-Infectious, undetected-Infectious, home-based care-Hospitalized-Vaccinated-Recovered-Dead - to simulate the dynamics of COVID-19 in order to account for specific measures put into place by the Government of Rwanda to prevent further spread of the disease. Methods: The compartments of this model are connected by parameters, some of which are known from the literature, and others are estimated from available data using the least squares method. For the stability of the model, equilibrium points were determined and the basic reproduction number R 0 was studied; R 0 is an indicator for contagiousness. Results: The model showed that secondary infections are generated from the exposed group, the asymptomatic group, the infected (symptomatic) group, the infected (undetected) group, the infected (home-based care) group and the hospitalized group. The formulated model was reliable and fit the data. Furthermore, the estimated R 0 of 2.16 shows that COVID-19 will persist without the application of control measures. Conclusions: This article presents results regarding predicted spread of COVID-19 in Rwanda.

A combined model of child malnutrition and morbidity in Ethiopia using structural equation models.

Malnutrition and morbidity are substantial problems in Ethiopia and are still pervasive and persistent. Despite this, there has been scant research on the coexistence of malnutrition and morbidity indicators. Moreover, previous studies were based on all data records of measurements from manifest data. Thus, this study aims to identify the correlates and coexistence of child malnutrition and morbidity within this country. Cross-sectional data which is collected by Ethiopia Demographic and Health Survey were used. The generalized structural equation models were used to examine the association between child malnutrition, morbidity, and potential risk factors. The generalized structural equation models help to provide latent effects of child malnutrition and morbidity within a combined modeling framework. In addition, the generalized structural equation models make it possible to analyze malnutrition as a mediator of the association between selected risk factors and latent variable morbidity. The data analysis was done using SPSS AMOS and R software. The analysis indicated that children born to nourished mothers (AOR = 0.71, 95% CI 0.68-0.75), born to enough birth space between 24 and 47 months and (AOR = 0.93, 95% CI 0.88-0.99), 48 months and above (AOR = 0.71, 95% CI 0.65-0.76), being from middle-income households (AOR = 0.85, 95% CI 0.78-0.91), high-income households (AOR = 0.66, 95% CI 0.61-0.72), from mother with primary or secondary (AOR = 0.79, 95% CI 0.75-0.85) and higher education level (AOR = 0.57, 95% CI 0.41-0.78) were less affected by malnutrition. It also revealed that a child born second to third (AOR = 0.87, 95% CI 0.77-0.99), fourth and higher (AOR = 0.88, 95% CI 0.79-0.99) and children from a husband-educated higher level (AOR = 0.76, 95% CI 0.64-0.89) were less likely to be ill. Children who breastfeed (AOR = 0.98, 95% CI 0.80-0.99), from nourished mothers (AOR = 0.96, 95% CI 0.94-0.097), from middle income (AOR = 0.97, 95% CI 0.96-0.99), high-income households (AOR = 0.94, 95% CI 0.93-0.96), birth spacing 24-47 months (AOR = 0.99, 95% CI 0.98-1.00) and 48 months and above (AOR = 0.96, 95% CI 0.94-0.97) were indirectly affected by morbidity via malnutrition. This investigation has revealed that childhood malnutrition and morbidity remain major child health challenges in Ethiopia with demographic, socioeconomic, maternal, child, and geographic variables playing significant roles. Efforts to resolve these issues need to take these factors into account. Therefore, malnutrition and morbidity prevention should include encouraging birth spacing, mother education programs, and breastfeeding practices.

Examining the spatial variations of co-morbidity among young children in Ethiopia.

BACKGROUND: Addressing the issues of childhood comorbidity remains a crucial global public health issue due to its consequences in child wellbeing. This study aims to account for nonlinear, spatial effect and to evaluate spatial variation in childhood co-morbidity at cluster level while controlling for important risk factors. METHODS: Using the 2016 Ethiopia DHS data, a multinomial logistic model was assessed by linear, nonlinear and random effects. The study also employed a spatial analysis tool which is Getis-Ord to identify hotspot areas of child comorbidity at the cluster level. The model with fixed, nonlinear and spatial effects identified as the best model to identify risk factors related to the coexistence of childhood illnesses. RESULTS: The results indicated that statistically significant high hotspots of comorbidity were found in Tigray and Oromia whereas low hotspots were found in Harari and Somali regions. Children between 10 and 15 months old were at high risk of co-morbidity in Ethiopia. Besides, our findings revealed that being male children, not-breastfed children, from households lack of toilet facility, children from households who use spring water, children born first, children from working mother, anemic children and children from uneducated mother are at high risk of multiple illnesses. CONCLUSIONS: Comorbidity in childhood is not random in the country, with high hotspots of comorbidity in the regions of Tigray and Oromia. The results show a critical upshot for a combined morbidity control method for decreasing children's illnesses and death. The maps remain novel to design appropriate healthcare interventions at regional as well as cluster level. Regions with high hotspots of child comorbidity should be considered for health healthcare interventions.

Risk factors of morbidity among children under age five in Ethiopia.

BACKGROUND: Childhood morbidities are a major cause of mortality of children in the developing countries particularly in Ethiopia. Regardless of the noticeable improvement in the reduction of under-five death in Ethiopia, childhood diarrhea and fever are still the leading cause of death. In Ethiopia, the burden of child mortality is alarming and calls for determined efforts in combating such health problems. Therefore, this study aimed to investigate the risk factors for childhood morbidity specifically for diarrhea and fever. METHODS: To gain insight into children's health issues, the 2016 Ethiopian Demographic and Health Survey data were used. Among the marginal models, alternating logistic regression that is an extension of the generalized estimating equation model was used to investigate the risk factors of childhood morbidity explicitly for diarrhea and fever. RESULTS: The results show that the child's sex, child's age, anemia level, husband education level, mother's work status, mother's marital status, breastfeeding status and region are all chosen significant risk factors related with childhood diarrhea disease and fever disease. CONCLUSION: The study indicated that male children, 0-11 months aged children, 12-23 months aged children, anemic children, husband with a lower education, mothers paid employment, non-breastfed children, regions of Amhara, Afar, Dire Dawa, Benishangul, Gambela, Oromia, SNNPR, Somali and Tigray were significantly associated with higher odds of morbidity in Ethiopia. Therefore, there is a need for children morbidity interventions intended to improve child health outcomes in the country.

Understanding correlates of child stunting in Ethiopia using generalized linear mixed models.

BACKGROUND: Stunting is an indicator of the devastating result of malnutrition in early childhood. The effects of childhood stunting are irreparable physical and cognitive harm. It is an issue of the great public health importance throughout Sub-Saharan African countries including Ethiopia. Therefore, identification of the risk factors of child stunting from recent data is very important for timely intervention. METHODS: The 2016 Ethiopian Demographic and Health Survey data were used for this study. A generalized linear mixed model which is an extension of the general linear model was employed to identify socioeconomic, demographic, environmental and health related risk factors for stunted under-five children. RESULTS: The result shows that the age and sex of the child, preceding birth interval, mother's body mass index, household wealth index, mother's education level, breastfeeding period, type of toilet facility, use of internet and source of drinking water were the major determinants of stunting of under-five children in Ethiopia. CONCLUSION: The study indicated that children from undernourished mothers, who are not breastfeeding, from poor households, households that have no toilet facilities, who are male, older age (between 12 to 59 months), who have illiterate mother and short birth spacing were associated with stunting problems. Therefore, family planning education and policy is required for the country to improve on under-five age stunting problems.