Childhood malaria in the Gambia: a case-study in model-based geostatistics

The paper develops a spatial generalized linear mixed model to describe the variation in the prevalence of malaria among a sample of village resident children in the Gambia. The response from each child is a binary indicator of the presence of malarial parasites in a blood sample. The model includes terms for the effects of child level covariates (age and bed net use), village level covariates (inclusion or exclusion from the primary health care system and greenness of surrounding vegetation as derived from satellite information) and separate components for residual spatial and non-spatial extrabinomial variation. The results confirm and quantify the progressive increase in prevalence with age, and the protective effects of bed nets. They also show that the extrabinomial variation is spatially structured, suggesting an environmental effect rather than variation in familial susceptibility. Neither inclusion in the primary health care system nor the greenness of the surrounding vegetation appeared to affect the prevalence of malaria. The method of inference was Bayesian using vague priors and a Markov chain Monte Carlo implementation.