Functional, randomized and smoothed multivariate quantile regions

Abstract Background More than a quarter of global neonatal deaths are reported from India, and a large proportion of these deaths are preventable. However, in the absence of robust public health care systems in several states in India, informal health care providers (IHCPs) with no formal medical education are the first contact service providers. The aim of this study was to assess the knowledge of IHCPs in basic evidence-based practices in neonatal care in Ujjain district and investigated factors associated with differences in levels of knowledge. Methods A cross-sectional survey was conducted using a questionnaire with multiple-choice questions covering the basic elements of neonatal care. The total score of the IHCPs was calculated. Multivariate quantile regression model was used to look for association of IHCPs knowledge score with: the practitioners’ age, years of experience, number of patients treated per day, and whether they attended children in their practice. Results Of the 945 IHCPs approached, 830 (88%) participated in the study. The mean ± SD score achieved was 22.3 ± 7.7, with a median score of 21 out of maximum score of 48. Although IHCPs could identify key tenets of enhancing survival chances of neonates, they scored low on the specifics of cord care, breastfeeding, vitamin K use to prevent neonatal hemorrhage, and identification and care of low-birth-weight babies. The practitioners particularly lacked knowledge about neonatal resuscitation, and only a small proportion reported following up on immunizations. Results of quantile regression analysis showed that more than 5 years of practice experience and treating more than 20 patients per day had a statistically significant positive association with the knowledge score at higher quantiles (q75th and q90th) only. IHCPs treating children had significantly better scores across quantiles accept at the highest quantile (90th). Conclusions The present study highlighted that know-do gap exists in evidence-based practices for all key areas of neonatal care tested among the IHCPs. The study provides the evidence that some IHCPs do possess knowledge in basic evidence-based practices in neonatal care, which could be built upon by future educational interventions. Targeting IHCPs can be an innovative way to reach a large rural population in the study setting and to improve neonatal care services.

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Identifying the know-do gap in evidence-based neonatal care practices among informal health care providers—A cross-sectional study from Ujjain, India

10.21203/rs.3.rs-27837/v2 ◽

2020 ◽

Author(s):

Isaac Gikandi Mungai ◽

Sumit Singh Baghel ◽

Suchi Soni ◽

Shailja Vagela ◽

Megha Sharma ◽

...

Keyword(s):

Health Care ◽

Quantile Regression ◽

Health Care Providers ◽

Knowledge Score ◽

Neonatal Care ◽

Evidence Based ◽

Care Providers ◽

Cross Sectional ◽

Evidence Based Practices ◽

Multivariate Quantile

Abstract Background: More than a quarter of global neonatal deaths are reported from India, and a large proportion of these deaths are preventable. However, in the absence of robust public health care systems, informal health care providers (IHCPs) with no formal medical education are the first contact service providers. The aim of this study was to assess the knowledge of IHCPs in basic evidence-based practices in neonatal care in Ujjain district and investigated factors associated with differences in levels of knowledge. Methods: A cross-sectional survey was conducted using a questionnaire with multiple-choice questions covering the basic elements of neonatal care. The total score of the IHCPs was calculated. Multivariate quantile regression model was used to study association of IHCPs knowledge score with: the practitioners’ age, years of experience, number of patients treated per day, and whether they attended children in their practice. Results: Of the 945 IHCPs approached, 830 (88%) participated in the study. The mean±SD score achieved was 22.3±7.7, with a median score of 21 out of maximum score of 48. Although IHCPs could identify key tenets of enhancing survival chances of neonates, they scored low on the cord care, breastfeeding, vitamin K use to prevent neonatal hemorrhage, and care of low-birth-weight babies. The practitioners particularly lacked knowledge about neonatal resuscitation, and only a small proportion reported following up on immunizations. Results of quantile regression analysis showed that more than 5 years of practice experience and treating more than 20 patients per day had a statistically significant positive association with the knowledge score at higher quantiles (q75 th and q90 th ) only. IHCPs treating children had significantly better scores across quantiles accept at the highest quantile (90 th ). Conclusions: The present study highlighted that know-do gap exists in evidence-based practices for all key areas of neonatal care tested among the IHCPs. The study provides the evidence that some IHCPs do possess knowledge in basic evidence-based practices in neonatal care, which could be built upon in future educational interventions. Targeting IHCPs can be an innovative way to reach a large rural population and to improve neonatal care services.

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A Multivariate Quantile-Matching Bias Correction Approach with Auto- and Cross-Dependence across Multiple Time Scales: Implications for Downscaling

Journal of Climate ◽

10.1175/jcli-d-15-0356.1 ◽

2016 ◽

Vol 29 (10) ◽

pp. 3519-3539 ◽

Cited By ~ 49

Author(s):

Rajeshwar Mehrotra ◽

Ashish Sharma

Keyword(s):

Water Resources ◽

Time Scales ◽

Bias Correction ◽

Time Scale ◽

General Circulation ◽

Circulation Model ◽

Multiple Time Scales ◽

Multiple Time ◽

Multiple Variables ◽

Multivariate Quantile

Abstract A novel multivariate quantile-matching nesting bias correction approach is developed to remove systematic biases in general circulation model (GCM) outputs over multiple time scales. This is a significant advancement over typical quantile-matching alternatives available for bias correction, as they implicitly assume that correction of individual variable attributes will lead to correction of dependence biases between multiple variables. Furthermore, existing approaches perform bias correction at a given time scale (e.g., daily), whereas applications often require biases to be addressed at more than one time scale (such as annual in the case of most water resources planning projects). The proposed approach addresses all these issues, and additionally attempts to correct for lag-1 dependence (and cross-dependence) attributes across multiple time scales. The approach is called multivariate recursive quantile nesting bias correction (MRQNBC). The fidelity of the approach is demonstrated by applying it to a vector of CSIRO Mk3 GCM atmospheric variables and comparing the results with the commonly used quantile-matching approach. Following this, the implications of the approach in hydrology- and water resources–related applications are demonstrated by feeding the bias-corrected data to a rainfall downscaling model and comparing the downscaled rainfall attributes for current and future climate. The proposed approach is shown to represent the variability and persistence related attributes better and can thus be expected to have important consequences for the simulation of occurrence and intensity of extreme events such as floods and droughts in downscaled simulations, of importance in various climate impact assessment applications.

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Likelihood-free Bayesian estimation of multivariate quantile distributions

Computational Statistics & Data Analysis ◽

10.1016/j.csda.2011.03.019 ◽

2011 ◽

Vol 55 (9) ◽

pp. 2541-2556 ◽

Cited By ~ 27

Author(s):

Christopher C. Drovandi ◽

Anthony N. Pettitt

Keyword(s):

Bayesian Estimation ◽

Multivariate Quantile

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Gender-specific association between carbohydrate consumption and blood pressure in Chinese adults

BMJ Nutrition, Prevention & Health ◽

10.1136/bmjnph-2020-000165 ◽

2021 ◽

pp. bmjnph-2020-000165

Author(s):

Ruru Liu ◽

Baibing Mi ◽

Yaling Zhao ◽

Qiang Li ◽

Shaonong Dang ◽

...

Keyword(s):

Blood Pressure ◽

Sodium Intake ◽

Activity Level ◽

Carbohydrate Intake ◽

Cross Sectional Survey ◽

Carbohydrate Consumption ◽

Total Carbohydrates ◽

Specific Association ◽

Multivariate Quantile ◽

Gender Specific

BackgroundThe association between dietary carbohydrate consumption and blood pressure (BP) is controversial. The present study aimed to evaluate the possible gender-specific association of carbohydrate across the whole BP distribution.MethodCross-sectional survey including 2241 rural adults was conducted in northwestern China in 2010. BP was measured by trained medical personnel. Dietary information was collected by semiquantitative Food-Frequency Questionnaire. Multivariate quantile regression model was used to estimate the association between total carbohydrates consumption and systolic BP (SBP) and diastolic BP (DBP) at different quantiles. Gender-specific β coefficient and its 95% CI was calculated.ResultsThe average carbohydrate intake was 267.4 (SD 112.0) g/day in males and 204.9 (SD 90.7) g/day in females, with only 10.6% of males and 6.5% females consumed at least 65% of total energy from carbohydrates. And more than 80% carbohydrates were derived from refined grains. In females, increased total carbohydrates intake was associated with adverse SBP and DBP. An additional 50 g carbohydrates per day was positively associated with SBP at low and high quantiles (10th–20th and 60th–80th) and with DBP almost across whole distribution (30th–90th), after adjusting for age, fortune index, family history of hypertension, body mass index, physical activity level, alcohol intake and smoke, energy, two nutrient principal components, protein and sodium intake. Both relatively low and high carbohydrate intake were associated with increased SBP, with minimum level observed at 130–150 g carbohydrate intake per day from restricted cubic splines. However, no significant associations were observed in males.ConclusionsHigher total carbohydrates consumption might have an adverse impact on both SBP and DBP in Chinese females but not males. Additionally, the positive association varies across distribution of BP quantiles. Further research is warranted to validate these findings and clarify the causality.

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Effect of School-Based Educational Water, Sanitation, and Hygiene Intervention on Students’ Knowledge in a Resource-Constrained Setting

10.21203/rs.3.rs-122523/v1 ◽

2020 ◽

Author(s):

Ommy Mushota ◽

Aditya Mathur ◽

Ashish Pathak

Keyword(s):

Educational Intervention ◽

Training Session ◽

Knowledge Score ◽

Repeated Measure ◽

School Type ◽

Post Intervention ◽

School Based ◽

Sanitation And Hygiene ◽

The Mean ◽

Multivariate Quantile

Abstract BackgroundGlobally, diarrhea is one of the major causes of under-5 mortality. India accounts for the highest number of childhood deaths globally. Therefore, facilitating the implementation of water, sanitation, and hygiene (WASH)-related interventions for adolescents in schools and communities is crucial. In the present study, we investigated the effectiveness of a school-based educational WASH intervention in improving students’ knowledge on prevention and management of diarrhea in Ujjain district, India.MethodsThe present pre–post intervention study with a two-stage (schools and classrooms) cluster sampling was conducted on 1781 students studying in 8th to 12th grades in schools located in Ujjain, Madhya Pradesh, India. The intervention comprised an educational training session by using a WASH training module. The means of pre- and post-intervention scores were compared using repeated measure analysis of variance. A multivariate quantile regression model was used to test the correlation between the change in score after intervention and the independent variables. A P value of <0.05 was considered statistically significant.ResultsThe proportions of students possessing knowledge on the treatment of diarrhea, use of zinc tablets during an episode of diarrhea, and the symptoms and signs of severe pediatric diarrhea were 28%, 27%, and 27%, respectively, before intervention. These proportions increased significantly (P < 0.001) after the educational intervention to 72%, 73%, and 74%, respectively. The mean post-intervention knowledge score (34.13) was significantly higher than the mean pre-intervention score (15.17) (F = 16513.36, P < 0.001). Age was significantly associated with the knowledge score at the 25th and higher quantile (q). Gender exhibited a greater effect at q10th. School location was positively associated at q25th and higher. School type was strongly associated at low quantiles (q10th and q25th). School medium exhibited a greater association at low quantiles (≤q25th).ConclusionWASH- and diarrhea-related knowledge among higher secondary school students increased after the educational intervention. Further research is required to evaluate the social demographic characteristics associated with change in the knowledge score to better evaluate school-based educational WASH interventions and improve the management and prevention of diarrhea.

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Effect of school-based educational water, sanitation, and hygiene intervention on student’s knowledge in a resource-limited setting

BMC Public Health ◽

10.1186/s12889-021-12279-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ommy Mushota ◽

Aditya Mathur ◽

Ashish Pathak

Keyword(s):

Educational Intervention ◽

Training Session ◽

Knowledge Score ◽

Repeated Measure ◽

School Type ◽

Post Intervention ◽

School Based ◽

Sanitation And Hygiene ◽

The Mean ◽

Multivariate Quantile

Abstract Background Globally, diarrhea is one of the major causes of under-5 mortality. India accounts for the highest number of childhood deaths from diarrhea globally. Therefore, facilitating the implementation of water, sanitation, and hygiene (WASH)-related interventions in schools and communities is crucial. In the present study, we investigated the effectiveness of a school-based educational WASH intervention in improving students’ knowledge on prevention and management of diarrhea in Ujjain district, India. Methods The present pre–post intervention study with a two-stage (schools and classrooms) cluster sampling was conducted on 1,781 students studying in grades: 8th–12th; age: 14–19 years) in schools located in Ujjain, Madhya Pradesh, India. The intervention comprised an educational training session using a WASH training module. The means of pre- and post-intervention scores were compared using repeated measure analysis of variance. A multivariate quantile regression model was used to test the correlation between the change in score after intervention and the independent variables. A P value of <0.05 was considered statistically significant. Results The proportions of students possessing knowledge on the treatment of diarrhea, use of zinc tablets during an episode of diarrhea, and the symptoms and signs of severe pediatric diarrhea were 28%, 27%, and 27%, respectively, before intervention. These proportions increased (P<0.001) after the educational intervention to 72%, 73%, and 74%, respectively. The mean post-intervention knowledge score (34.13) was higher than the mean pre-intervention score (15.17) (F = 16513.36, P< 0.001). Age was associated with the knowledge score at the 25th and higher quantile (q). Gender exhibited a greater effect at q10th. School location was positively associated at q25th and higher. School type was strongly associated at low quantiles (q10th and q25th). School medium exhibited a greater association at low quantiles (≤q25th). Conclusion WASH- and diarrhea-related knowledge among higher secondary school students increased after the educational intervention. Further research is required to evaluate the sociodemographic characteristics associated with change in the knowledge score to better evaluate school-based educational WASH interventions and improve the management and prevention of diarrhea.

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