Developing pediatric prognostic model using finite mixture models

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dc.contributor.authorOgero, Morris Ondieki
dc.date.accessioned2017-11-20T12:11:03Z
dc.date.available2017-11-20T12:11:03Z
dc.date.issued2017
dc.descriptionThesis submitted in partial fulfillment of the requirements for the Degree of Master of Science in Statistical Sciences (MSc.SS) at Strathmore Universityen_US
dc.description.abstractBackground: World Health Organization (WHO) guidelines recommend early identification of patients who have emergency features for early medical intervention with the aim of reducing child mortality and morbidity. Prognostic models have been developed to be used in clinical setups, but their performance in external validations has been dismal. These poor performances have been attributed to suboptimal statistical methods used for derivation of these scores. Methods: The Bayesian finite mixture model was used to succinctly identify subpopulations in a population of 47,596 patients from different geographical regions. Mixed models were used to derive a final prognostic model taking into account subgroups of the population. Clinically relevant yet routinely available prognostic factors were used in model development. Results: Amongst the 23 risk factors used, the AVPU scale which measures unconsciousness was the strongest predictor of mortality with odds of (AOR=2.94, 95% CI= 2.57 - 3.36). Oedema (AOR= 2.66, 95% CI= 2.18 - 3.24), pallor (AOR=2.09, 95% CI= 1.86 - 2.36) and the presence of >= 3 severe comorbidities (AOR=2.19, 95% CI= 1.73 - 2.74) were also associated with an increased risk of death. Conclusion: Given that patient are not alike, a statistical methodology that clusters patients into homogeneous subpopulations should be used to account for the inherent variability in the medical patients. Computational methodology such as mixture models should be used to identify inherent subpopulations that underlie the population of medical patients under study. Limitation: The use of diagnostic episodes as one of predictors in the model was based on the clinician’s impression (not a laboratory test) thus the possibility of false positives could not be ruled out.en_US
dc.identifier.urihttp://hdl.handle.net/11071/5624
dc.language.isoenen_US
dc.publisherStrathmore Universityen_US
dc.subjectWorld Health Organizationen_US
dc.subjectChild Mortalityen_US
dc.subjectChild Morbidityen_US
dc.subjectPrognostic modelsen_US
dc.subjectBayesian Finite Mixture Modelen_US
dc.titleDeveloping pediatric prognostic model using finite mixture modelsen_US
dc.typeThesisen_US
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MSc.SS Theses and Dissertations (2017)