Application of longitudinal multilevel zero inflated Poisson regression in modeling of infectious diseases among infants in Ethiopia

• Published in: BMC infectious diseases Vol. 24; no. 1; pp. 927 - 14
• Main Authors: Yirdaw, Bezalem Eshetu, Debusho, Legesse Kassa, Samuel, Aregash
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 07.09.2024; BioMed Central; BMC
• Subjects: Age; Breast feeding; Breastfeeding & lactation; Children; Children & youth; Colds; Common cold; Common Cold - epidemiology; Communicable diseases; Communicable Diseases - epidemiology; Data analysis; Diarrhea; Diarrhea - epidemiology; Ethiopia - epidemiology; Female; Goodness of fit; Health aspects; Humans; Infant; Infants; Infectious disease; Infectious diseases; Influenza; Influenza, Human - epidemiology; Longitudinal analysis; Longitudinal Studies; Male; Models, Statistical; Morbidity; Multilevel; Multilevel analysis; Multilevel zero inflated Poisson regression; Pediatric research; Poisson density functions; Poisson Distribution; Poisson's equation; Quadratic trend; Random variables; Regression analysis; Regression models; Respiration; Respiratory tract infection; Risk factors; Socioeconomic factors; Statistics; Ethiopia; Infectious disease; Longitudinal analysis; Infants; Multilevel zero inflated Poisson regression; Quadratic trend
• ISSN: 1471-2334; 1471-2334
• 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.