ASN13 Final Research Project Data Analysis

(1)Introduction

Malaria is a disease that has been well documented throughout the years. There
have been numerous reports regarding the disease, the medications involved in treating
it, and the procedures set in place to prevent it. Analytics are also a well-established
part of this field. There have been numerous reports documenting the evolution of the
disease, recording the number of people affected, and other important findings
regarding the illness. The primary objective in our research is to focus on African
countries, because that is where most cases of malaria are reported. Through this
focus, we want to answer the question of which treatment or method of prevention is
more prevalent and effective in fighting malaria: insecticide treated netting, insecticide
treated curtains, mosquito coils, or residual indoor spraying (Aikins, M. I. C., Pickering,
H., & Greenwood, B. M. (1994). Attitudes to malaria, traditional practices and bed nets
(mosquito nets) as vector control measures: a comparative. Journal of Tropical Medicine
and Hygiene, 97, 8l-86). Also, our research concentrates on other factors such as, the
wealth of a particular country and thats influence on the number of people who contract
the malaria disease (McElroy, B., Wiseman, V., Matovu, F., & Mwengee, W. (2009)
Malaria prevention in northeastern Tanzania: patterns of expenditure and determinants
of demand at the household level. Malaria Journal, 8, 1-10). In addition to this, our
research also concentrates on outside organizations and their role in the fight against
malaria.

In order to determine the results, we had to examine raw data for the rate of
usage of antimalarial prevention per year in Sub-Saharan African regions (Erhun, W. O.,
Agbani, E. O., & Adesanya, S. O. (2005). Malaria prevention: Knowledge, attitude and
practice in a southwestern Nigerian community. African Journal of Biomedical Research,
8(1), 25-29). The information obtained from this raw data will determine which
prevention is most utilized. However, the purpose of our research is to see if the most
prevailing inhibitor is effective in restricting the number of people infected with the
malaria disease. Consequently, our research had to examine raw data for the mortality
rate in Africa (R.W. Snow, S.W. Lindsay, R.J. Hayes, B.M. Greenwood;
Permethrin-treated bed nets (mosquito nets) prevent malaria in Gambian children,
Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 82, Issue
6, 1 November 1988, Pages 838–842).This data was then compared to the raw data of
the number of people utilizing mosquito netting in the Congo, as well as in Central Africa
(Kampango, A., Bragança, M., de Sousa, B., & Charlwood, J. D. (2013). Netting
Barriers to Prevent Mosquito Entry into Houses in Southern Mozambique: A Pilot Study.
Malaria Journal, 12(1), 1-7.) to see if a correlation existed between the two variables.

In order to identify whether the wealth of a country had any influence over the
amount of people who contracted the malaria disease, our research examined the gross
national income per capita (GNI) of particular countries (McElroy, B., Wiseman, V.,
Matovu, F., & Mwengee, W. (2009) Malaria prevention in northeastern Tanzania:
patterns of expenditure and determinants of demand at the household level. Malaria
Journal, 8, 1-10). The research in specific examined the raw data for the GNI of these
countries through the atlas methodology, which measures a country's income in terms
of United States dollars whereas, the purchasing power parity method measures in
terms of international dollars. This data was then compared to the number of malaria
caused deaths to see if a country's wealth does in fact influence the number affected by
the disease.

To examine foreign influence on the fight against malaria, we focused on the Red
Cross. The research looked at raw data regarding the number of mosquito nets that
were donated to specific countries in the African region by the Red Cross (Taylor, T. A.,
& Xiao, W. (2014). Subsidizing the distribution channel: Donor funding to improve the
availability of malaria drugs. Management Science, 60(10), 2461-2477), as well as the
estimated cases of malaria in those same regions (R.W. Snow, S.W. Lindsay, R.J.
Hayes, B.M. Greenwood; Permethrin-treated bed nets (mosquito nets) prevent malaria
in Gambian children, Transactions of The Royal Society of Tropical Medicine and
Hygiene, Volume 82, Issue 6, 1 November 1988, Pages 838–842). The two sets were
used to see whether the number of nets donated to a certain region correlated to the
reported cases of malaria in that same area.
 (2)Data Sources

Name Description URL

Reported Indigenous This data shows various http://apps.who.int/gho/dat
Confirmed Data by Country countries and their a/node.main.A1364?lang=
reported cases of malaria, en
which focuses on cases of
people living in the country,
ignoring tourist cases. In
some of the Sub-Saharan
countries, there are gaps in
the data or sudden
increases and decreases.
The data itself offers no
explanation, but the gaps
can be filled when
correlated with another
source.

Prevention and Treatment This data shows the http://apps.who.int/gho/dat

Data by Country percentage of children a/node.main.A1369?lang=
under the age of five that en
are using mosquito netting
or antimalaria vaccines.
The data is not localized in
Africa, but covers the
Middle East and Asia as
well. It also covers the
children who are aged
under five with a fever, who
received treatment with
antimalarial drugs.

The fight against malaria This data shows malaria https://www.kaggle.com/te

incidence, death and ajay/the-fight-against-malar
prevention from around the ia/data
world. It has both countries
and the specific location,
as well as where the data
is from. While it has other
countries, this dataset
primarily focuses on Africa.
Overview of insecticide This data shows numerous http://apps.who.int/gho/dat
status data by country countries and the number a/node.main.IRPREV?lang
of insecticides being used =en
in those areas. This data
can be utilized to see if the
use of insecticides is a
reasonable control of
malaria. There are gaps in
the data, where in many
countries, there were no
tests or reports. Most of
these countries are
developing ones, where
data keeping may not be
the best.

Bionomic database for the This data displays the http://datadryad.org/bitstre

dominant vectors of most prominent areas in am/handle/10255/dryad.1
Africa that are affected by 03067/Bionomics%20Afric
malaria in Africa
malaria. This will help us a.csv?sequence=1
further understand the
scope of the disease, as
well as the scope and
advancement in treatment.
The data also talks about
physical antimalarial
prevention and its rate of
use. This data also has
gaps, but if correlated with
data from the World
Health Organization, many
of these gaps can be
filled.

Gross National Income This raw data displays the https://data.worldbank.org/

Per Capita, 2016 Atlas GNI for multiple countries, country/ethiopia
represented through both
Method and PPP
the atlas method and the
purchasing power parity.
The atlas method records
a country's gross national
income in terms of United
States dollars. Whereas,
the purchasing power
parity method records a
country's national income
in terms of international
dollars.
 (3)Results Achieved

We wanted to analyze whether malaria treatment methods, specifically mosquito

netting, are effective in preventing deaths caused by malaria in Africa. In order to
discover this, we looked at data that shows the number of people that died due to
malaria for four different years in between 2000 and 2013. We also did the same thing
for the amount of people that use mosquito netting in the Congo from 2005 to 2015 and
Central African Republic from 2000 to 2013. We put everything in a pivot table. The
countries and the years were listed on one side, and the sum of the people that died in
each country each year was listed on the other side. We then picked the countries that
we were interested in, the Congo and the Central African Republic. We made a table for
each country. We put the year, and the amount of people that died in the table, and
made a line graph. This result is in Figure 1 and Figure 2. We then needed to compare
this data to the deaths caused by malaria in Africa. In order to do this, we created
another pivot table. We sorted by the year on one side of the pivot table. On the other
side, we put the sum of deaths due to malaria during each of these years. We made a
table, where we put data from four different years between 2000 and 2013. We then
graphed this data in a line graph. This result is Figure 6.

In our research we also wanted to analyze organizations that donated mosquito

netting to countries and compare that to the number of malaria cases reported in those
areas. In the data we obtained below, we wanted to discover if the amount of help
countries in Africa received from the Red Cross was helpful in preventing malaria. In
order to do this, we looked at Rwanda, Zambia, Ethiopia, Kenya, and Gambia. We first
looked at the amount of mosquito nets each of these countries received from the Red
Cross in 2006-2007. In order to do this, we created a pivot table of our data. On one
side, we had the different companies that donated nets, and which countries they
donated to. On the other side, we had the sum of the donations that were given by each
company. We then made a table of the donations from the Red Cross to Rwanda,
Zambia, Ethiopia, Kenya, and Gambia. We then made a bar graph out of this data. This
result is featured in Figure 3. We then wanted to see the cases of malaria in these
African countries. In order to find this, we made another pivot table. On one side, we put
the years, and the countries that had data for that year. On the other side, we put the
sum of the cases of malaria in each of these countries. We then made a table of the
countries we selected, and the sum of malaria in each country in 2010. We decided to
look at 2010, because it was the closest date after the donations were given, that our
data source had. We then put this data in a bar graph. This result is pictured in Figure 4.
 We wanted to discover whether or not the income of these African countries had
an affect on the deaths due to malaria. In order to do this we decided to compare the
gross national income per capita of Rwanda, Zambia, Ethiopia, Kenya, and Gambia to
the amount of cases of malaria in each of these countries. In order to do this we first
found data that contained the gross national income of each of these countries in 2016.
We decided to look at 2016 because it was the closest date to our data for the amount
of cases of malaria, in the dataset. First, we made a table that contained gross national
income of each of these countries, and the country name. Our data included both the
purchasing power parity and the atlas method. The purchasing power parity shows the
international currency, and the atlas method shows the United States currency. We
decided to use the atlas method because it was easier for us to read and understand,
since we live in the United States, and use US dollars regularly. Then we made a new
table with the new gross national incomes. We then put this data into a bar graph. The
results of this data are pictured in Figure 7.

We also wanted to research the rate of usage of different malaria prevention

methods in Sub-Saharan African countries. The malaria prevention methods we looked
at are insecticide treated nets (ITN), insecticide treated curtains (IT curtains), internal
residual spraying (IRS), a combination of the three, and insecticide coils. We looked at
the usage of these prevention methods in Tanzania, Kenya, and Gambia. In order to
organize this data, we first created a pivot table. On one side, we put all of the different
countries in the dataset, and the prevention methods that each of the country used. On
the other side, we put the average number of these prevention methods used from
between 1986 and 2011, since this is the range of dates that our dataset found data for.
Then, we made a table of the average amount the citizens of Tanzania, Kenya, and
Zambia used each of the prevention methods Tanzania and Kenya both used
insecticide coils, combination, internal residual spraying, and insecticide treated nets,
however Zambia only had data for combination and insecticide treated curtains. We
then put this data into a bar graph. Since we were looking at averages, we added error
bars to our graph. These results can be found in Figure 5.

In order to create all of these graphs, we used data from “The fight against
malaria” on Kaggle, “Gross National Income Per Capita, 2016 Atlas Method and PPP”
on the World Bank, “Bionomic database for the dominant vectors of malaria in Africa”
on Data Dryad, and “Reported Indigenous Confirmed Data by Country,” “Prevention and
Treatment Data by Country,” and “Overview of insecticide status data by country” on the
World Health Organization. We had to use our knowledge on excel to sort and filter
data. Also, we had to create many pivot datas, in order to make our data very easy to
read, so that we could put our data into tables and create graphs. We also had to
decide whether we would use the sum or average of the data we found. Since we used
the average for some of our data, we had to make sure we included error bars on our
graphs. Also, we had to choose the correct graph, so that our data would be easy to
read, and would make sense.

Figure 1

Figure 2

Figure 3
Figure 4

Figure 5

Figure 6
Figure 7
(4) Discussion

From our graphs, we could make the connection that the decrease in malaria
mortality rate is related to the increase in usage of physical preemptive methods. We
can compare Figures 1 and 2 to Figure 6 to understand this. The two data sets showed
very strong negative correlations of -0.83819 and -0.97641. Since there was an
increase in use of mosquito netting, as well as a decrease in the amount of deaths from
malaria, this led to our conclusion that mosquito netting is a very beneficial method for
malaria prevention. This direct relation shows that mosquito netting has an effect on
malaria, and it is causing malaria-related deaths to decrease.

In Figure 3, we saw that Rwanda received the least mosquito nets from the Red Cross.
Zambia and Kenya received the same amount, which was 1000 more than Rwanda
received. Ethiopia received double what Zambia and Kenya received. Gambia received
slightly more than that, which meant that they were given the most mosquito nets from
the Red Cross. When looking at the amount of cases of malaria in each of these
countries, we saw that Gambia had the least amount of cases than the other countries
mentioned above, as referenced in Figure 4. In order of least to greatest amount of
cases, Rwanda had the least, while Kenya had the most. Ethiopia had the largest
amount of cases of malaria in 2010, which is possibly why that country received
significantly more mosquito nets than Kenya, Zambia, and Rwanda. This is another
piece of evidence that the decrease in malaria mortality rate is related to the increase in
physical preemptive methods.

There are clearly other types of physical antimalarial prevention that exist, and we
wanted to determine which type was the most well-known and the most accessible.
Figure 5 displays the popularity of preemptive methods in different Sub-Saharan African
countries. It is seen that using ITNs, or insecticide-treated mosquito nets, is the most
popular type of prevention. This is also true in other countries, where the rate of malaria
disease mortality is low. While other types of prevention, such as antimalarial drugs,
helped decrease mortality rate, the use of insecticide treated nets is far more accessible
and more widespread. Other preemptive methods are still effective in preventing
malaria, so in the case of countries where insecticide-treated nets are inaccessible or
unpopular, that could be why the mortality rate caused by malaria is also low.

We also looked at the GNI, or gross national income per capita, of some countries, as
seen in Figure 7. We wanted to see if a country’s wealth affects malaria disease
propagation and mortality rate. Kenya has the highest GNI, but it also has one of the
highest amounts of reported malaria cases. There is a possibility that wealth alone does
not affect the quality of healthcare in a country, as a country’s wealth- or an individual in
a country’s wealth- goes to other things outside of medical research and treatment.
There could be an issue with mosquito overpopulation that is particularly extant in
Kenya, as well. A higher population can be a problem, as overcrowding and
understaffing of hospitals can occur. Finally, there can be other diseases that the
healthcare system of a country is paying more attention to, as there can be other more
severe epidemics occurring at the same time. Again, hospital overcrowding and a
blurred focus on healthcare is a possible issue.
(5) Literature Support

R.W. Snow, S.W. Lindsay, R.J. Hayes, B.M. Greenwood; Permethrin-treated bed nets
(mosquito nets) prevent malaria in Gambian children, Transactions of The Royal Society
of Tropical Medicine and Hygiene, Volume 82, Issue 6, 1 November 1988, Pages
838–842.
This study looked at the effectiveness of mosquito netting among children in
Gambia, a country located in West Africa. The researchers wanted to see if there was a
significant difference in using ordinary mosquito netting as opposed to permethrin
treated mosquito netting in preventing against mosquito bites. The study concluded that
those who slept under permethrin treated nets had less mosquito bites than those who
slept under ordinary non-treated nets. The researchers were able to establish that
treated mosquito netting was an adequate form of malaria control because the number
of those who died from the disease was significantly less for those who slept under the
treated mosquito nets.

Aikins, M. I. C., Pickering, H., & Greenwood, B. M. (1994). Attitudes to malaria,

traditional practices and bednets (mosquito nets) as vector control measures: a
comparative. Journal of Tropical Medicine and Hygiene, 97, 8l-86.
The researchers in this study wanted to focus and see if the geographical and
cultural differences of various regions had an effect on malaria control. This study
wanted to examine whether the malaria controls in one area of West Africa would be as
effective in another area. They investigated four west African countries and compared
those findings to the findings from the Gambia study, mentioned in the above
paragraph. In the end, the study concluded that people in Guinea Bissau just like people
in Gambia used mosquito netting as their form of malaria control. However, the
countries of Sierra Leone and Ghana utilized other forms of malaria control such as,
herbal practices and aerosol anti-insect spray. The reason why these areas do not use
bed nettings was concluded to be due to the scarcity of bed nets in local markets.

Zaim, M., Aitio, A., & Nakashima, N. (2000). Safety of pyrethroid‐treated mosquito nets.
Medical and veterinary entomology, 14(1), 1-5.
In this study, researchers wanted to check the safety of the mosquito nets.
Rather than looking at whether mosquito netting helped to decrease the number of
people infected with the disease, the researchers wanted to see whether the netting
was causing more harm to people than good. Since most mosquito netting is treated
with insecticides, scientists wanted to see if the insecticides were causing any side
effects or disservices to the people using them. They conducted research to see if the
nets treated with insecticides were harmful to humans by giving low doses of the
insecticide to animals over time. At the end of the experiment it was concluded that the
treated nets did not pose any threat to those who were sleeping under them and that
the greatest threat that they posed were to those who were dipping and treating the nets
in the insecticides.

Kampango, A., Bragança, M., de Sousa, B., & Charlwood, J. D. (2013). Netting Barriers
to Prevent Mosquito Entry into Houses in Southern Mozambique: A Pilot Study. Malaria
Journal, 12(1), 1-7.
This study tested 3 different types of mosquito netting material against
Anopheles funestus and Anopheles gambiae s.l into village houses in Mozambique
when applied over the large opening at the gables and both gables and eaves.
Mosquito entry rates were assessed by light-trap collection and the efficacy of the
different materials was determined in terms of incidence rate ratio of mosquito entry in a
treated house compared to the untreated house. They discovered that houses treated
with mosquito netting or the untreated shade cloth had fewer An. funestus in relation to
untreated houses, but there was no difference in An. funestus in houses treated with the
deltamethrin-impregnated shade cloth compared to untreated houses. Houses treated
with mosquito netting reduced entry rates of An. gambiae s.l, by 84%, while untreated
shade cloth reduced entry rates by 69% and entry rates were reduced by 76% in
houses fitted with deltamethrin-impregnated shade cloth.

McElroy, B., Wiseman, V., Matovu, F., & Mwengee, W. (2009) Malaria prevention in
northeastern Tanzania: patterns of expenditure and determinants of demand at the
household level. Malaria Journal, 8, 1-10.
This study discovered how the wealth a person has can affect the amount of
money they spend on malaria prevention nets. Expenditure was compared across bed
nets, aerosols, coils, indoor spraying, using smoke, drinking herbs and cleaning outside
environment. 68% of the households studied owned at least one bed net and 27% had
treated their nets in the past six months. 29% were unable to afford a net. Every two
weeks, households spent an average of 18 cents on nets and their treatment,
constituting about 47% of total prevention expenditure. Poor households living in rural
areas spend significantly less on all forms of malaria prevention compared to their richer
counterparts.

Okrah, J., Traoré, C., Palé, A., Sommerfeld, J., & Müller, O. (2002). Community factors
associated with malaria prevention by mosquito nets: an exploratory study in rural
Burkina Faso. Tropical Medicine & International Health, 7(3), 240-248.
 In this study, researchers wanted to look at small, rural villages in Africa and to
see what they believed caused malaria and what they did to prevent it. However, most
importantly, the researchers wanted to find the reason why the ownership of mosquito
nets were not as prominent in those areas. In the study, researchers collected both
qualitative and quantitative data. They collected data through surveys and interviews
that asked questions regarding personal views on the contraction of the malaria disease
as well as local treatments and preventions in their area. Through the interviews and
surveys the researchers concluded that locals of small, rural areas were aware of the
proper treatments, preventions and causes of the disease. However, they concluded
that the reason for not utilizing the proper treatments and preventions was due to the
costs and the limited availability of them at their markets.

Walker, K. (2000). Cost‐comparison of DDT and alternative insecticides for malaria

control. Medical and veterinary entomology, 14(4), 345-354.
In this research, scientists wanted to look at the use of indoor residual insecticide
sprays. The main objective of this research was to see whether the insecticide sprays
were a valuable tool in controlling the spread of malaria. The reason for this research
was because the mosquitos that were spreading the malaria disease were developing a
resistance to certain insecticides. To evaluate the value of insecticides the researchers
evaluated both the cost of the insecticide as well as how effect it was. The results from
this research concluded that insecticide sprays are still an effective form of malaria
control this is because only some mosquito populations have developed a resistance to
the sprays, whereas the majority of the populations have not.

Sirima, S. B., Konate, A., Tiono, A. B., Convelbo, N., Cousens, S., & Pagnoni, F. (2003).
Early treatment of childhood fevers with pre‐packaged antimalarial drugs in the home
reduces severe malaria morbidity in Burkina Faso. Tropical Medicine & International
Health, 8(2), 133-139.
In this research, scientists wanted to investigate whether proper drugs and
instructions on antimalarial drugs was an effective way to reduce the number of malaria
cases in children. Scientists provided antimalaria drugs to mothers in 32 random
villages and conducted surveys during the high transmission season for the malaria
disease. From the study period, scientist concluded that out of the 3202 fever cases in
children, only 8% of them were at risk to develop malaria. From these results, it was
concluded that antimalaria drugs and adequate instructions on the packaging were
effective in reducing the number of children that contract the malaria disease.

Taylor, T. A., & Xiao, W. (2014). Subsidizing the distribution channel: Donor funding to
improve the availability of malaria drugs. Management Science, 60(10), 2461-2477.
 In this study, researchers wanted to focus on the affordability and the availability
of recommended malarial drugs in the countries that bear the heaviest burden of
malaria. In the analysis, it was discovered that private-sectors control the distribution of
the malarial drugs. These companies have made the drugs extremely costly which has
limited the access to these drugs, especially to people in poor countries. Through this
realization, the next part of the researcher's process is to identify donors that can help to
buy these drugs from the private sectors for those who can not afford to. Another step in
the investigation is to attempt to negotiate a lower price for the drugs as well as other
forms of prevention so that more people can afford them.

Erhun, W. O., Agbani, E. O., & Adesanya, S. O. (2005). Malaria prevention: Knowledge,
attitude and practice in a southwestern Nigerian community. African Journal of
Biomedical Research, 8(1), 25-29.
The researchers in the study decided to analysis the knowledge, attitude and
practice that a southwestern Nigerian community acquired. The researchers believed
that analyzing these aspects were key for successful malaria control. The study
concluded that 35.5% will use malarial drugs, 0.9% will consult an herbalist, 13.4% will
use local herbs as treatment, 27.3% will go to the hospital, 1.7% will rely on
spiritual/ritual practices for a cure, 18.2% will pray for the disease to go away, and 3%
will ignore all signs and symptoms of the disease. Through the data gathered, the
researchers concluded that the treatment chosen was related to the level of education
that the person obtained. In order for more people to chose the correct and most
effective treatment, the scientists believe that malaria public awareness should become
more intensified.