Using Measles Outbreaks to Identify Under-Resourced Health Systems in Low- and Middle-Income Countries: A Predictive Model
Abstract
:1. Introduction
2. Materials and Methods
2.1. Directed Acyclic Graph
2.2. Data Collection
2.2.1. Measles Outbreaks
2.2.2. Health Systems
2.2.3. Gini Coefficient
2.2.4. Proportion of Refugees and Asylum Seekers
2.3. Data Processing
2.4. Analysis Methods
2.4.1. Regression Model Fitting and Testing
2.4.2. Sensitivity Analyses
3. Results
3.1. Directed Acyclic Graph
3.2. Descriptive Statistics
3.3. Regression Analysis
3.4. Sensitivity Analyses
3.5. Missing Data
4. Discussion
4.1. Key Findings
4.2. Strengths and Limitations
4.3. Implications
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
LMIC | Low- and middle-income country |
WHO | World Health Organization |
DAG | Directed Acyclic Graph |
Appendix A
Appendix A.1
Large Outbreak Definition | Input Variable | Adjusted Odds Ratio | 95% Confidence Intervals | p-Value | Brier Score |
---|---|---|---|---|---|
≥20 cases per million | Proportion of births delivered in a health facility (%) | 1.02 | (0.97, 1.08) | 0.35 | 0.509 |
Number of nurses and midwives (per 10,000 population) | 0.99 | (0.94, 1.04) | 0.73 | ||
Health expenditure (per capita in US$) | 1.00 | (0.98, 1.01) | 0.42 | ||
≥50 cases per million | Proportion of births delivered in a health facility (%) | 1.01 | (0.97, 1.04) | 0.73 | 0.280 |
Number of nurses and midwives (per 10,000 population) | 1.03 | (0.98, 1.07) | 0.27 | ||
Health expenditure (per capita in US$) | 0.99 | (0.99, 1.00) | 0.20 | ||
≥150 cases per million | Proportion of births delivered in a health facility (%) | 1.01 | (0.97, 1.04) | 0.68 | 0.189 |
Number of nurses and midwives (per 10,000 population) | 1.03 | (0.99, 1.08) | 0.13 | ||
Health expenditure (per capita in US$) | 0.99 | (0.98, 1.00) | 0.07 | ||
≥200 cases per million | Proportion of births delivered in a health facility (%) | 1.00 | (0.96, 1.03) | 0.94 | 0.188 |
Number of nurses and midwives (per 10,000 population) | 1.04 | (1.00, 1.09) | 0.08 | ||
Health expenditure (per capita in US$) | 0.99 | (0.98, 1.00) | 0.10 | ||
WHO definition (20 laboratory-confirmed, clinically confirmed, or epidemiologically linked cases per million) | Proportion of births delivered in a health facility (%) | 0.98 | (0.92, 1.04) | 0.45 | 0.408 |
Number of nurses and midwives (per 10,000 population) | 1.01 | (0.96, 1.06) | 0.68 | ||
Health expenditure (per capita in US$) | 1.00 | (0.99, 1.01) | 0.44 |
Appendix A.2
Input Variable | Adjusted Odds Ratio | 95% Confidence Intervals | p-Value | Brier Score |
---|---|---|---|---|
Proportion of births delivered in a health facility (%) | 0.99 | (0.96, 1.03) | 0.75 | 0.216 |
Number of nurses and midwives (per 10,000 population) | 1.03 | (0.98, 1.08) | 0.24 | |
Health expenditure (per capita in US$) | 0.99 | (0.98, 1.00) | 0.17 |
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Health System Indicator (Median and IQR) | Large Measles Outbreaks (N = 28) | Non-Large Measles Outbreaks (N = 25) |
---|---|---|
Proportion of births delivered in a health facility (%) | 74.90 (35.40, 98.20) | 88.55 (57.40, 98.90) |
Number of nurses and midwives (per 10,000 population) | 10.96 (3.98, 45.52) | 18.33 (7.97, 29.81) |
Health expenditure (per capita in USD) | 18.80 (7.14, 116.45) | 97.16 (13.94, 260.50) |
Input Variable | Adjusted Odds Ratio | 95% Confidence Intervals | p-Value |
---|---|---|---|
Proportion of births delivered in a health facility (%) | 0.99 | (0.96, 1.03) | 0.74 |
Number of nurses and midwives (per 10,000 population) | 1.03 | (0.99, 1.08) | 0.14 |
Health expenditure (per capita in USD) | 0.99 | (0.98, 1.00) | 0.11 |
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MacKechnie, G.P.D.; Dalton, M.; Delport, D.; Vaccher, S. Using Measles Outbreaks to Identify Under-Resourced Health Systems in Low- and Middle-Income Countries: A Predictive Model. Vaccines 2025, 13, 367. https://doi.org/10.3390/vaccines13040367
MacKechnie GPD, Dalton M, Delport D, Vaccher S. Using Measles Outbreaks to Identify Under-Resourced Health Systems in Low- and Middle-Income Countries: A Predictive Model. Vaccines. 2025; 13(4):367. https://doi.org/10.3390/vaccines13040367
Chicago/Turabian StyleMacKechnie, Gabrielle P. D., Milena Dalton, Dominic Delport, and Stefanie Vaccher. 2025. "Using Measles Outbreaks to Identify Under-Resourced Health Systems in Low- and Middle-Income Countries: A Predictive Model" Vaccines 13, no. 4: 367. https://doi.org/10.3390/vaccines13040367
APA StyleMacKechnie, G. P. D., Dalton, M., Delport, D., & Vaccher, S. (2025). Using Measles Outbreaks to Identify Under-Resourced Health Systems in Low- and Middle-Income Countries: A Predictive Model. Vaccines, 13(4), 367. https://doi.org/10.3390/vaccines13040367