Of the medieval town little more than the site of the upper town, clustered around the ruins of Rocca Ianula, can be discerned.
The old town, clustered around the ancient crossroads of the marketplace in the Marienplatz, has increasingly become a business centre and has lost much of its ancient character.
Finally, the Nouna town cluster which has been assigned to the social marketing only intervention could have introduced a bias; thus it was reassuring that an analysis without the Nouna town cluster has arrived at rather similar results.
The wide confidence interval is due to the reduced power after accounting for town clustering.
Another major finding from this study is the much lower all-cause as well as malaria-specific mortality observed in the Nouna town cluster as compared to the surrounding village clusters.
Residents of sparsely-settled communities travel, on average, 10 min further than residents of closely-settled communities (26.3 vs 16.9 min, p < 0.001), though this difference was not significant after controlling for town clustering.
Differences of maximum time remained significant after controlling for demographic and other constraints to access, such as transport availability or difficulties getting doctor appointments, as well as after controlling for town clustering and current travel times.
Kaplan-Meier charts were used to compare the association between increased distance and decreased travel propensity for closely-settled and sparsely-settled areas, and ordinal multivariate regression models tested significance after controlling for health-related travel moderating factors and town clustering.
Notably, the odds ratio of being prepared to travel longer for residents of sparsely-settled communities remains significant (OR 2.68, 95%% CI 1.78 4.03), compared to residents of closely-settled communities, even after accounting for both town clustering and current travel behaviour.
