A mixed-effects model of the determinants of measles incidence: a nationwide study in Malaysia, 2018 to 2022 10.55131/jphd/2025/230117
Article Sidebar
Main Article Content
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.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Abdul Shukor SF, Mustafa Khan NJ, Ghazali F. Compulsory Vaccination For Children: Violation of Human Rights? UUM Journal of Legal Studies 2021;12(2):115–140; doi: 10.32890/uumjls2021.12.2.6.
Zaini N, Idris IB, Mhd. Din IA, et al. Resurgence of measles infection among children: findings from a surveillance-based population study. Paediatr Indones 2023;63(3):162–8; doi: 10.14238/pi63.3.2023.162-8.
Ab Manan N, Suli Z, A Shukor AH. Measles in Hulu Langat 2018: What we have done to reduce the incidence rate? International Journal of Public Health and Clinical Sciences 2020;7(5):95–106.
Mat Daud MRH, Yaacob NA, Ibrahim MI, et al. Five-Year Trend of Measles and Its Associated Factors in Pahang, Malaysia: A Population-Based Study. Int J Environ Res Public Health 2022;19(13):8017; doi: 10.3390/ijerph19138017.
Qamruddin AA, Qamruddin R, Malik A. Analysis and Factors Associated with Measles in Larut, Matang and Selama Districts, Perak, Malaysia. Malaysian Journal of Medical Sciences 2020;27(5):130–140; doi: 10.21315/mjms2020.27.5.13.
Qin S, Ding Y, Yan R, et al. Measles in Zhejiang, China, 2004-2017: Population Density and Proportion of Floating Populations Effects on Measles Epidemic. Health Secur 2019;17(3):193–199; doi: 10.1089/hs.2019.0011.
Aworabhi-Oki N, Numbere T, Balogun MS, et al. Trends in measles cases in Bayelsa state, Nigeria: A five-year review of case-based surveillance data (2014-2018). BMC Public Health 2020;20(1); doi: 10.1186/s12889-020-09070-0.
de Glanville WA, Thomas LF, Cook EAJ, et al. Household socio-economic position and individual infectious disease risk in rural Kenya. Sci Rep 2019;9(1); doi: 10.1038/s41598-019-39375-z.
Scarbrough AW, Holt MM, Hill J, et al. Is there a Relationship between Income and Infectious Disease: Evidence from Cameron County. International Journal of Community Well-Being 2019;2(1):3–13; doi: 10.1007/s42413-019-00020-2.
Andrianou XD, Del Manso M, Bella A, et al. Spatiotemporal distribution and determinants of measles incidence during a large outbreak, Italy, september 2016 to july 2018. Eurosurveillance 2019;24(17); doi: 10.2807/1560-7917.ES.2019.24.17.1800679.
Yorulmaz M, Nabilah Mohamed N. Malaysia Health System Review: Overviews and Opinions, International Health Administration and Education. Sanitas Magisterium 2019;5(1):45–57.
Hierink F, Okiro EA, Flahault A, et al. The winding road to health: A systematic scoping review on the effect of geographical accessibility to health care on infectious diseases in low- And middle-income countries. PLoS One 2021;16(1 January); doi: 10.1371/journal.pone.0244921.
Plans-Rubió P. Low percentages of measles vaccination coverage with two doses of vaccine and low herd immunity levels explain measles incidence and persistence of measles in the European Union in 2017–2018. European Journal of Clinical Microbiology and Infectious Diseases 2019;38(9):1719–1729; doi: 10.1007/s10096-019-03604-0.
Comfort H, Lafta RK, Flaxman AD, et al. Association Between Subnational Vaccine Coverage, Migration, and Incident Cases of Measles, Mumps, and Rubella in Iraq, 2001–2016. Front Public Health 2022;9(January):1–10; doi: 10.3389/fpubh.2021.689458.
Lim X-J, Junus S, Edwin-Amir L, et al. Vaccination Refusal in Children under 2 Years of Age in Malaysia 2016-2019. Asian Journal of Medicine and Health 2023;21(6):1–13; doi: 10.9734/ajmah/2023/v21i6816.
Peng L, Zhao X, Tao Y, et al. The effects of air pollution and meteorological factors on measles cases in Lanzhou, China. Environmental Science and Pollution Research 2020;27(12):13524–13533; doi: 10.1007/s11356-020-07903-4.
Tang KHD. Climate Change in Malaysia: Trends, Contributors, Impacts, Mitigation and Adaptations. Science of the Total Environment 2019;650:1858–1871; doi: 10.1016/j.scitotenv.2018.09.316.
Ministry of Health Malaysia. Case definitions for infectious diseases in Malaysia, 3rd Edition. 2017;(January):110.
Schober P, Vetter TR. Count Data in Medical Research: Poisson Regression and Negative Binomial Regression. Anesth Analg 2021;132(5):1378–1379; doi: 10.1213/ANE.0000000000005398.
Rodríguez-Urrego D, Rodríguez-Urrego L. Air Quality during the COVID-19: PM2.5 Analysis in the 50 Most Polluted Capital Cities in the World. Environmental Pollution 2020;266; doi: 10.1016/j.envpol.2020.115042.
Sy KTL, White LF, Nichols BE. Population density and basic reproductive number of COVID-19 across United States counties. PLoS One 2021;16(4 April); doi: 10.1371/journal.pone.0249271.
Tan Z, Shi F, Zhang H, et al. Household income, income inequality, and health-related quality of life measured by the EQ-5D in Shaanxi, China: a cross-sectional study. Int J Equity Health 2018;17(1):32; doi: 10.1186/s12939-018-0745-9.
Rohleder S, Stock C, Bozorgmehr K. Socioeconomic deprivation is inversely associated with measles incidence: A longitudinal small-area analysis, Germany, 2001 to 2017. Eurosurveillance 2021;26(17):27–37; doi: 10.2807/1560-7917.ES.2021.26.17.1900755.
Zaimah R. The probability factor influences the level of financial well-being of workers in Malaysia. Malaysian Journal of Society and Space 2019;15(3); doi: 10.17576/geo-2019-1503-09.
Danso SE, Frimpong A, Seneadza NAH, et al. Knowledge, attitudes, and practices of caregivers on childhood immunization in Okaikoi sub-metro of Accra, Ghana. Front Public Health 2023;11; doi: 10.3389/fpubh.2023.1230492.
Wong IKA, Fong LHN, Law R. A Longitudinal Multilevel Model of Tourist Outbound Travel Behavior and the Dual-Cycle Model. J Travel Res 2016;55(7):957–970; doi: 10.1177/0047287515601239.
Neiderud CJ. How urbanization affects the epidemiology of emerging infectious diseases. Afr J Disabil 2015;5(1); doi: 10.3402/iee.v5.27060.
Zhang Q, Feng S, Wong IOL, et al. A population-based study on healthcare-seeking behaviour of persons with symptoms of respiratory and gastrointestinal-related infections in Hong Kong. BMC Public Health 2020;20(1); doi: 10.1186/s12889-020-08555-2.
Gastanaduy P, Haber P, Rota PA, et al. Measles . In: The Epidemiology and Prevention of Vaccine-Preventable Diseases. (Hall E, Wodi AP, Hamborsky J, et al. eds) Public Health Foundation ; 2021; pp. 193–205.
Jia Y, Xu Q, Zhu Y, et al. Estimation of the relationship between meteorological factors and measles using spatiotemporal Bayesian model in Shandong Province, China. BMC Public Health 2023;23(1); doi: 10.1186/s12889-023-16350-y.
Yerdessov S, Abbay A, Makhammajanov Z, et al. Epidemiological characteristics and seasonal variation of measles, pertussis, and influenza in Kazakhstan between 2010-2020 years. Electronic Journal of General Medicine 2023;20(1); doi: 10.29333/ejgm/12621.
Yang Q, Fu C, Wang N, et al. The effects of weather conditions on measles incidence in Guangzhou, Southern China. Hum Vaccin Immunother 2014;10(4):1104–1110; doi: 10.4161/hv.27826.
Wang CC, Prather KA, Sznitman J, et al. Airborne Transmission of Respiratory Viruses. Science (1979) 2021;373(6558); doi: 10.1126/science.abd9149.
Yoshino Y, Yamamoto A, Misu K, et al. Exposure to low temperatures suppresses the production of B-cell activating factor via TLR3 in BEAS-2B cells. Biochem Biophys Rep 2020;24; doi: 10.1016/j.bbrep.2020.100809.
Liyanatul Najwa Z, Nadiatul Ima Z, Wan M, et al. The concept of district health management in Malaysia. International Journal of Public Health and Clinical Sciences 2016;3(1):1–16.
Qamruddin AA, Malek A, Rozali A, et al. Measles in Larut, Matang and Selama: Analysis and Evaluation of Clinical Case Definitions for 2015-2019. Malaysian Journal of Public Health Medicine 2020;20(1):130–140; doi: 10.37268/mjphm/vol.20/no.1/art.440.