{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T04:22:13Z","timestamp":1772166133827,"version":"3.50.1"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"vor","delay-in-days":32,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Malar J"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Malaria remains a major public health challenge in sub-Saharan Africa, and its burden may be influenced by access to clean water, sanitation, and childhood vitamin A supplementation. Understanding how these indicators relate to malaria incidence can help inform targeted prevention strategies.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Country-level data from global health databases were analyzed using nonparametric statistical tests and machine learning models. The Kruskal\u2013Wallis test and Dunn\u2019s post hoc comparisons were used to assess differences in malaria incidence across categories of water and sanitation access. Cliff\u2019s delta was used to measure effect sizes. Tree-based machine learning models and logistic regression were trained to evaluate the predictive strength of the three indicators.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Significant differences in malaria incidence were found across water and sanitation access groups, with the lowest access groups consistently exhibiting the highest incidence. Cliff\u2019s delta indicated large effect sizes, particularly between low and high access categories. Vitamin A supplementation showed statistically significant group differences, though effect sizes were generally small. Tree-based machine learning models showed moderate predictive performance and outperformed logistic regression in classification accuracy and recall.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Access to clean water and adequate sanitation are strongly associated with lower malaria incidence, underscoring their importance in malaria control efforts. While vitamin A supplementation shows weaker associations, it may still interact with broader health conditions. These findings highlight the essential role of basic infrastructure in reducing malaria burden and demonstrate the potential of predictive modeling to support future global health research.<\/jats:p>\n <\/jats:sec>","DOI":"10.1186\/s12936-025-05751-6","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T17:34:35Z","timestamp":1766770475000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Investigating the relationship between malaria incidence and public health infrastructure in sub-Saharan Africa"],"prefix":"10.1186","volume":"25","author":[{"given":"Jaebin","family":"Shin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,12,26]]},"reference":[{"key":"5751_CR1","unstructured":"WHO. Fact Sheet about Malaria. Geneva, World Health Organization, 2025. www.who.int\/news-room\/fact-sheets\/detail\/malaria. Accessed 29 June 2025."},{"key":"5751_CR2","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1111\/tmi.12329","volume":"19","author":"A Pr\u00fcss-Ust\u00fcn","year":"2014","unstructured":"Pr\u00fcss-Ust\u00fcn A, Bartram J, Clasen T, Colford JM, Cumming O, Curtis V, et al. Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries. Trop Med Int Health. 2014;19:894\u2013905.","journal-title":"Trop Med Int Health"},{"key":"5751_CR3","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1186\/1475-2875-5-76","volume":"5","author":"JM Chuma","year":"2006","unstructured":"Chuma JM, Thiede M, Molyneux CS. Rethinking the economic costs of malaria at the household level: evidence from applying a new analytical framework in rural Kenya. Malar J. 2006;5:76.","journal-title":"Malar J"},{"key":"5751_CR4","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/S0140-6736(98)08293-2","volume":"354","author":"AH Shankar","year":"1999","unstructured":"Shankar AH, Genton B, Semba RD, Baisor M, Paino J, Tamja S, et al. Effect of vitamin A supplementation on morbidity due to Plasmodium falciparum in young children in Papua New Guinea: a randomised trial. Lancet. 1999;354:203\u20139.","journal-title":"Lancet"},{"key":"5751_CR5","unstructured":"WorldBank. World Bank Group score card insights. www.worldbank.org\/ext\/en\/home. Accessed 29 June 2025."},{"key":"5751_CR6","unstructured":"WHO. Malaria cases, confirmed, number. Geneva, Global Health Observatory, World Health Organization. www.who.int\/data\/gho\/data\/indicators\/indicator-details\/GHO\/number-confirmed-malaria-cases. Accessed 29 June 2025."},{"key":"5751_CR7","unstructured":"JMP. Progress on household drinking water, sanitation and hygiene. https:\/\/washdata.org\/reports\/jmp-2025-wash-households. Accessed 29 June 2025."},{"key":"5751_CR8","unstructured":"UNICEF. Vitamin A deficiency in children. https:\/\/data.unicef.org\/topic\/nutrition\/vitamin-a-deficiency\/. Accessed 29 June 2025."}],"container-title":["Malaria Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12936-025-05751-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-025-05751-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-025-05751-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T06:39:37Z","timestamp":1769495977000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12936-025-05751-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,26]]},"references-count":8,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["5751"],"URL":"https:\/\/doi.org\/10.1186\/s12936-025-05751-6","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-7292923\/v1","asserted-by":"object"}]},"ISSN":["1475-2875"],"issn-type":[{"value":"1475-2875","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,26]]},"assertion":[{"value":"4 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable, no human participants, human data, or human biological materials were involved in this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"59"}}