背景: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控制的疾病仍然夺去儿童的生命。因此,本研究旨在估算6~11个月儿童在研究基线时发生腹泻(NOD)和流感/普通感冒(NOF)的对数预期天数的变化率.
方法:本研究使用了具有纵向和多层次结构的次级数据。根据探索性分析的结果,提出了一种多级零膨胀Poisson回归模型,其对数预期NOD和NOF的变化率由二次趋势描述,以通过随机效应有效地分析两种结果,说明观察值与个体之间的相关性.此外,残差图用于评估模型的拟合优度。
结果:考虑到主题和集群特定的随机效应,结果表明,对数预期NOD的变化率呈二次趋势。最初,低剂量铁微量营养素粉(MNP)使用者与非使用者相比表现出更高的变化率,但是随着时间的推移,这种趋势发生了逆转。同样,使用MNP和纯母乳喂养六个月的儿童的对数预期NOF下降,与他们的同行相比。此外,MNP用户每增加两周,没有流感的几率就会降低,与非MNP用户相比。此外,NOD的增加导致对数预期NOF的增加。区域和纯母乳喂养也与NOD和NOF有显著关系。
结论:本研究的结果强调了用探索性分析开始分析研究产生的数据的重要性。该研究强调了在前六个月促进EBF并在六个月后为儿童提供额外食物以减轻传染病负担的关键作用。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.