A mixed-effects model of the determinants of measles incidence: a nationwide study in Malaysia, 2018 to 2022
Journal Title: Journal of Public Health and Development - Year 2025, Vol 23, Issue 1
Abstract
Measles remains a significant global public health concern, particularly in Malaysia. Despite national vaccination coverage exceeding 90%, measles continues to persist, highlighting the need for a deeper understanding of the multifaceted factors influencing its transmission dynamics. This study aimed to explore the determinants of measles incidence in Malaysia, focusing on local demographic profiles, healthcare-related factors, and environmental factors at the district level from 2018 to 2022. Data for this study were collected from the e-measles database of Malaysia’s Ministry of Health, including statistics on the number of cases reported in each district. Additionally, vaccination coverage data were obtained from the Malaysian Health Informatics Centre. Local demographic profiles, such as median household income, population density, and urbanisation, were sourced from the Department of Statistics Malaysia (DOSM). Data on the number of health and rural clinics were also extracted from DOSM. Environmental data, including relative humidity, temperature, and PM2.5 levels, were obtained from the Department of Environment (DOE). A negative binomial mixed-effects model was employed for data analysis using R software, and the results were interpreted to identify significant determinants of measles incidence. The analysis revealed that median household income (adjusted incidence rate ratio [aIRR] 1.02, 95% confidence interval [CI]: 1.01, 1.03) and the number of health and rural clinics (aIRR 1.02, 95% CI: 1.01, 1.04) were positively associated with measles incidence. Conversely, temperature (aIRR 0.85, 95% CI: 0.74, 0.99) and the year of observation (aIRR 0.51, 95% CI: 0.47, 0.56) were negatively correlated with measles incidence. These findings highlight the complex interplay between socioeconomic, healthcare, and environmental factors in measles transmission, underscoring the need for comprehensive public health strategies to maintain high vaccination rates and adapt to varying local conditions.
Authors and Affiliations
Mohd Rujhan Hadfi Mat Daud, Nor Azwany Yaacob, Wan Nor Arifin, Jamiatul Aida Md Sani, Wan Abdul Hannan Wan Ibadullah
Keywords
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- EP ID EP754618
- DOI 10.55131/jphd/2025/230117
- Views 2
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