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General contextual effects on neglected tropical disease risk in rural Kenya

General contextual effects on neglected tropical disease risk in rural Kenya
General contextual effects on neglected tropical disease risk in rural Kenya

The neglected tropical diseases (NTDs) are characterized by their tendency to cluster within groups of people, typically the poorest and most marginalized. Despite this, measures of clustering, such as within-group correlation or between-group heterogeneity, are rarely reported from community-based studies of NTD risk. We describe a general contextual analysis that uses multi-level models to partition and quantify variation in individual NTD risk at multiple grouping levels in rural Kenya. The importance of general contextual effects (GCE) in structuring variation in individual infection with Schistosoma mansoni, the soil-transmitted helminths, Taenia species, and Entamoeba histolytica/dispar was examined at the household-, sublocation- and constituency-levels using variance partition/intra-class correlation co-efficients and median odds ratios. These were compared with GCE for HIV, Plasmodium falciparum and Mycobacterium tuberculosis. The role of place of residence in shaping infection risk was further assessed using the spatial scan statistic. Individuals from the same household showed correlation in infection for all pathogens, and this was consistently highest for the gastrointestinal helminths. The lowest levels of household clustering were observed for E. histolytica/dispar, P. falciparum and M. tuberculosis. Substantial heterogeneity in individual infection risk was observed between sublocations for S. mansoni and Taenia solium cysticercosis and between constituencies for infection with S. mansoni, Trichuris trichiura and Ascaris lumbricoides. Large overlapping spatial clusters were detected for S. mansoni, T. trichiura, A. lumbricoides, and Taenia spp., which overlapped a large cluster of elevated HIV risk. Important place-based heterogeneities in infection risk exist in this community, and these GCEs are greater for the NTDs and HIV than for TB and malaria. Our findings suggest that broad-scale contextual drivers shape infectious disease risk in this population, but these effects operate at different grouping-levels for different pathogens. A general contextual analysis can provide a foundation for understanding the complex ecology of NTDs and contribute to the targeting of interventions.

1935-2727
1-19
de Glanville, William A.
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Thomas, Lian F.
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Cook, Elizabeth A.J.
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Bronsvoort, Barend M.de C.
cb3f169a-7e77-49ac-82d8-3a466c4067ab
Wardrop, Nicola
8f3a8171-0727-4375-bc68-10e7d616e176
Wamae, Claire N.
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Kariuki, Samuel
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Fèvre, Eric M.
6a168bf3-21be-42c7-b588-7a6b5bad64e5
de Glanville, William A.
e94a9693-471d-49d9-9bea-ea03cbf82038
Thomas, Lian F.
9cdf9af9-09c1-4526-af3b-a954eeba2e46
Cook, Elizabeth A.J.
ba09618f-528d-4ff5-b2a8-43e45fe9f91a
Bronsvoort, Barend M.de C.
cb3f169a-7e77-49ac-82d8-3a466c4067ab
Wardrop, Nicola
8f3a8171-0727-4375-bc68-10e7d616e176
Wamae, Claire N.
c845b5b3-5b87-4f52-af93-d9b2a3537723
Kariuki, Samuel
0766f6b2-aaea-45d2-956b-ab10c9979b3f
Fèvre, Eric M.
6a168bf3-21be-42c7-b588-7a6b5bad64e5

de Glanville, William A., Thomas, Lian F., Cook, Elizabeth A.J., Bronsvoort, Barend M.de C., Wardrop, Nicola, Wamae, Claire N., Kariuki, Samuel and Fèvre, Eric M. (2018) General contextual effects on neglected tropical disease risk in rural Kenya. PLoS Neglected Tropical Diseases, 12 (12), 1-19. (doi:10.1371/journal.pntd.0007016).

Record type: Article

Abstract

The neglected tropical diseases (NTDs) are characterized by their tendency to cluster within groups of people, typically the poorest and most marginalized. Despite this, measures of clustering, such as within-group correlation or between-group heterogeneity, are rarely reported from community-based studies of NTD risk. We describe a general contextual analysis that uses multi-level models to partition and quantify variation in individual NTD risk at multiple grouping levels in rural Kenya. The importance of general contextual effects (GCE) in structuring variation in individual infection with Schistosoma mansoni, the soil-transmitted helminths, Taenia species, and Entamoeba histolytica/dispar was examined at the household-, sublocation- and constituency-levels using variance partition/intra-class correlation co-efficients and median odds ratios. These were compared with GCE for HIV, Plasmodium falciparum and Mycobacterium tuberculosis. The role of place of residence in shaping infection risk was further assessed using the spatial scan statistic. Individuals from the same household showed correlation in infection for all pathogens, and this was consistently highest for the gastrointestinal helminths. The lowest levels of household clustering were observed for E. histolytica/dispar, P. falciparum and M. tuberculosis. Substantial heterogeneity in individual infection risk was observed between sublocations for S. mansoni and Taenia solium cysticercosis and between constituencies for infection with S. mansoni, Trichuris trichiura and Ascaris lumbricoides. Large overlapping spatial clusters were detected for S. mansoni, T. trichiura, A. lumbricoides, and Taenia spp., which overlapped a large cluster of elevated HIV risk. Important place-based heterogeneities in infection risk exist in this community, and these GCEs are greater for the NTDs and HIV than for TB and malaria. Our findings suggest that broad-scale contextual drivers shape infectious disease risk in this population, but these effects operate at different grouping-levels for different pathogens. A general contextual analysis can provide a foundation for understanding the complex ecology of NTDs and contribute to the targeting of interventions.

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journal.pntd.0007016 - Accepted Manuscript
Available under License Creative Commons Attribution.
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Accepted/In Press date: 22 November 2018
e-pub ahead of print date: 21 December 2018

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Local EPrints ID: 427421
URI: https://eprints.soton.ac.uk/id/eprint/427421
ISSN: 1935-2727
PURE UUID: 29655204-e30e-4f86-bfee-da13c888ec5c

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Date deposited: 16 Jan 2019 17:30
Last modified: 13 Mar 2019 17:38

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Contributors

Author: William A. de Glanville
Author: Lian F. Thomas
Author: Elizabeth A.J. Cook
Author: Barend M.de C. Bronsvoort
Author: Nicola Wardrop
Author: Claire N. Wamae
Author: Samuel Kariuki
Author: Eric M. Fèvre

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