Disease Ecology in the Democratic Republic of the Congo: Integration of Spatial Analysis and Population Surveillance Public Deposited

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  • March 20, 2019
  • Messina, Jane P.
    • Affiliation: College of Arts and Sciences, Department of Geography
  • In countries like the Democratic Republic of the Congo (DRC) that have limited public health infrastructures, only educated guesses have been made about the spatial distribution of important diseases. This research estimates the spatial distribution of HIV, malaria and anemia prevalence in the DRC, and determines the population, environmental and behavioral drivers underlying these distributions. Using molecular diagnostics from dried blood spots from a 2007 Demographic and Health Survey (DHS) and demographic data available from this survey, the primary research aims are addressed via spatial analysis and multilevel modeling. The creation of an extensive Geographic Information Systems (GIS) database and selection of individual questionnaire responses is informed by disease ecology theory. In addition to discerning patterns and drivers of disease prevalence in the DRC, this research demonstrates how well population-representative surveillance data can be used to improve understanding of disease transmission in other developing countries. While older people were at greater risk for HIV and anemia, younger people were at greater risk for malaria. Individual wealth increased HIV risk, while it protected against malaria. Increased risk for anemia was found in certain cultural groups. Living near urban areas increased risk for HIV and decreased risk for malaria. Certain types of agriculture were protective against anemia. Greater density of nearby conflict since 1994 decreased malaria risk and proximity to a refugee camp was protective against anemia in women. Certain population characteristics and behaviors were equally or more important at the community level as at the individual level. Greater individual wealth was protective against malaria along with the average wealth of the community in which one lived. This research extends beyond the scope of what would have been possible with the DHS dataset alone. The molecular results for malaria parasitaemia as well as habitat data from a variety of sources contributed to the creation of a complex database which enabled all aspects of disease ecology to be explored.
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  • In Copyright
  • "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Geography."
  • Emch, Michael
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  • Chapel Hill, NC
  • Open access

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