ArticlePLOS global public health2026
Identifying age-common and age-specific factors of Plasmodium infection in Nigerian children under five: Application of a cluster-aware multistage selection framework to the 2018 Nigeria Demographic and Health Survey.
Article in PLOS global public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Despite developmental heterogeneity, children under five are often analyzed as a single group, obscuring age-related differences in Plasmodium infection. Using the 2018 Nigeria Demographic and Health Survey data, we analyzed 2,914 younger children (6-23.9 months) and 5,553 older children (24-59 months) to identify age-common and age-specific factors. We applied a Cluster-aware Multistage Selection (CMS) framework integrating penalized regression, interaction testing, and bidirectional selection while accounting for sampling weights, clustering, and stratification. Plasmodium prevalence was 37.3% in younger children and 49.4% in older children. Each 10-percentage-point increase in community-level livestock and agricultural land ownership was associated with 2.5% (PR = 1.025; 95% CI: 1.011-1.039) and 4.6% (PR = 1.046; 95% CI: 1.029-1.062) higher prevalence, respectively. Socioeconomic disadvantage was associated with higher prevalence. Children in the lowest wealth quintile had 80.7% higher prevalence than those in the richest quintile (PR = 1.807; 95% CI: 1.467-2.224), and children whose mothers had no formal education had 55.8% higher prevalence than those with higher education (PR = 1.558; 95% CI: 1.225-1.980). Severe maternal anemia was associated with 22.5% higher prevalence (PR = 1.225; 95% CI: 1.012-1.483). Stunting and household insecticide-treated net (ITN) ownership were associated with 8.0% (PR = 1.080; 95% CI: 1.024-1.139) and 10.4% (PR = 1.104; 95% CI: 1.017-1.198) higher prevalence, respectively. Conversely, sleeping under an ITN (PR = 0.916; 95% CI: 0.858-0.977), breastfeeding (PR = 0.845; 95% CI: 0.764-0.934), maternal internet use (PR = 0.638; 95% CI: 0.475-0.857), and overweight-for-height (PR = 0.761; 95% CI: 0.631-0.917) were associated with lower prevalence. Age-specific associations were observed only in younger children, including paternal lack of education (PR = 1.301; 95% CI: 1.025-1.652) and rural residence (PR = 1.462; 95% CI: 1.266-1.688). These findings support age-tailored Plasmodium prevention and highlight the utility of CMS for complex population data.
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