The pattern of variation between diarrhoea and malaria coexistence with corresponding risk factors in, Chikhwawa, Malawi: a bivariate multilevel analysis

Salule Joseph Masangwi, Neil Ferguson, Anthony Grimason, Tracy Morse, Lawrence Kazembe

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Developing countries face a huge burden of infectious diseases, a number of which co-exist. This paper estimates the pattern and variation of malaria and diarrhea coexistence in Chikhwawa, a district in Southern Malawi using bivariate multilevel modelling with Bayesian estimation. A probit link was employed to examine hierarchically built data from a survey of individuals (n = 6,727) nested within households (n = 1,380) nested within communities (n = 33). Results show significant malaria [σ2ul = 0.901 (95% CI : 0.746,1.056) ] and diarrhea [σ2ul = 1.009  (95% CI : 0.860,1.158) ] variations with a strong correlation between them [ru(1,2) = 0.565 ] at household level. There are significant malaria [σ2v1 = 0.053 (95% CI : 0.018,0.088) ] and diarrhea [σ2v2 = 0.099 (95% CI : 0.030,0.168 ] variations at community level but with a small correlation [rv(1,2) = 0.124 ] between them. There is also significant correlation between malaria and diarrhea at individual level [re(1,2) 0.241]. These results suggest a close association between reported malaria-like illness and diarrheal illness especially at household and individual levels in Southern Malawi.
Original languageEnglish
Pages (from-to)8526-8541
Number of pages16
JournalInternational Journal of Environmental Research and Public Health
Issue number7
Publication statusPublished - 21 Jul 2015


  • malaria and diarrhoea coexistence
  • random effects
  • Bayesian analysis
  • bivariate multilevel analysis
  • household anad community variation
  • Southern Malawi

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