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. 2023 Dec 21:14:155-165.
doi: 10.2147/POR.S437485. eCollection 2023.

Prediction Model with Validation for Polioseronegativity in Malnourished Children from Poliomyelitis Transmission High-Risk Area of the Democratic Republic of the Congo (DRC)

Guillaume Ngoie Mwamba  1   2 , Michel Kabamba  1   2 , Nicole A Hoff  3 , Patrick K Mukadi  4 , Kamy Kaminye Musene  5 , Sue K Gerber  6 , Megan Halbrook  3 , Cyrus Sinai  3 , Trevon Fuller  3 , Arie Voorman  6 , Paul Makan Mawaw  7 , Oscar Luboya Numbi  7 , Emile Okitolonda Wemakoy  8 , Patricia N Mechael  9 , Jean Jacques Muyembe Tamfum  4 , Mala Ali Mapatano #  10 , Anne W Rimoin #  3 , Paul-Samson Lusamba Dikassa #  8
Affiliations

Prediction Model with Validation for Polioseronegativity in Malnourished Children from Poliomyelitis Transmission High-Risk Area of the Democratic Republic of the Congo (DRC)

Guillaume Ngoie Mwamba et al. Pragmat Obs Res. .

Abstract

Background: Malnutrition is identified as a risk factor for insufficient polio seroconversion in the context of a vaccine-derived poliovirus (VDPV) outbreak-prone region. In the Democratic Republic of Congo (DRC), underweight decreased from 31% (in 2001) to 26% (in 2018). Since 2004, VDPV serotype 2 outbreaks (cVDPV2) have been documented and were geographically limited around the Haut-Lomami and Tanganyika Provinces.

Methods: To develop and validate a predictive model for poliomyelitis vaccine response in malnourished infants, a cross-sectional household study was carried out in the Haut-Lomami and Tanganyika provinces. Healthy children aged 6 to 59 months (n=968) were enrolled from eight health zones (HZ) out of 27, in March 2018. We performed a bivariate and multivariate logistics analysis. Final models were selected using a stepwise Wald method, and variables were selected based on the criterion p < 0.05. The association between nutritional variables, explaining polio seronegativity for the three serotypes, was assessed using the receiver operating characteristic curve (ROC curve).

Results: Factors significantly associated with seronegativity to the three polio serotypes were underweight, non-administration of vitamin A, and the age group of 12 to 59 months. The sensitivity was 10.5%, and its specificity was 96.4% while the positive predictive values (PPV) and negative (PNV) were 62.7% and 65.3%, respectively. We found a convergence of the curves of the initial sample and two split samples. Based on the comparison of the overlapping confidence intervals of the ROC curve, we concluded that our prediction model is valid.

Conclusion: This study proposed the first tool which variables are easy to collect by any health worker in charge of vaccination or in charge of nutrition. It will bring on top, the collaboration between the Immunization and the Nutritional programs in DRC integration policy, and its replicability in other low- and middle-income countries with endemic poliovirus.

Keywords: DRC; child health; child nutrition; malnutrition; polio serotype; poliomyelitis-neutralizing antibodies; prediction model; seronegativity; serotypes; underweight; validation.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
ROC curves of nutritional factors explaining seronegativity to the three polio serotypes in the initial model.
Figure 2
Figure 2
ROC curves of nutritional factors explaining seronegativity to the three polio serotypes in the split model.
Figure 3
Figure 3
Comparison between ROC curve of the initial sample and the split sample.
See this image and copyright information in PMC

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