Abstract
BackgroundMansonella perstans is a widespread, but relatively unknown human filarial parasite transmitted by Culicoides biting midges. Although it is found in many parts of sub-Saharan Africa, only few studies have been carried out to deepen the understanding of its ecology, epidemiology, and health consequences. Hence, knowledge about ecological drivers of the vector and parasite distribution, integral to develop spatially explicit models for disease prevention, control, and elimination strategies, is limited.MethodologyWe analyzed data from a comprehensive nationwide survey of M. perstans infection conducted in 76 schools across Uganda in 2000–2003, to identify environmental drivers. A suite of Bayesian geostatistical regression models was fitted, and the best fitting model based on the deviance information criterion was utilized to predict M. perstans infection risk for all of Uganda. Additionally, we investigated co-infection rates and co-distribution with Wuchereria bancrofti and Plasmodium spp. infections observed at the same survey by mapping geographically overlapping areas.Principal FindingsSeveral bioclimatic factors were significantly associated with M. perstans infection levels. A spatial Bayesian regression model showed the best fit, with diurnal temperature range, normalized difference vegetation index, and cattle densities identified as significant covariates. This model was employed to predict M. perstans infection risk at non-sampled locations. The level of co-infection with W. bancrofti was low (0.3%), due to limited geographic overlap. However, where the two infections did overlap geographically, a positive association was found.Conclusions/SignificanceThis study presents the first geostatistical risk map for M. perstans in Uganda. We confirmed a widespread distribution of M. perstans, and identified important potential drivers of risk. The results provide new insight about the ecologic preferences of this otherwise poorly known filarial parasite and its Culicoides vector species in Uganda, which might be relevant for other settings in sub-Saharan Africa.
Highlights
The human filarial parasite Mansonella perstans has been considered as one of the most prevalent human parasites in Africa [1]
Positive associations with M. perstans infection status were observed with cattle densities, forested areas, and vegetation greenness, whereas negative associations were observed with land surface temperature
Of the 12,207 children examined for M. perstans microfilaremia, 11,606 were examined concurrently for infection with W. bancrofti (CFA)
Summary
The human filarial parasite Mansonella perstans has been considered as one of the most prevalent human parasites in Africa [1]. On-going large-scale surveys and control programs for other filarial infections (e.g., lymphatic filariasis and onchocerciasis), considered to be of greater health importance, have largely ignored M. perstans infections, even though these filarial infections frequently co-occur. This lack of attention mainly stems from its predominance in poor rural communities, and from a paucity of a distinct and clearly recognizable clinical picture [2]. Mansonella perstans is a widespread, but relatively unknown human filarial parasite transmitted by Culicoides biting midges It is found in many parts of sub-Saharan Africa, only few studies have been carried out to deepen the understanding of its ecology, epidemiology, and health consequences. Knowledge about ecological drivers of the vector and parasite distribution, integral to develop spatially explicit models for disease prevention, control, and elimination strategies, is limited
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