Abstract
BackgroundSome villages, labeled “persistent hotspots (PHS),” fail to respond adequately in regard to prevalence and intensity of infection to mass drug administration (MDA) for schistosomiasis. Early identification of PHS, for example, before initiating or after 1 or 2 years of MDA could help guide programmatic decision making.MethodsIn a study with multiple rounds of MDA, data collected before the third MDA were used to predict PHS. We assessed 6 predictive approaches using data from before MDA and after 2 rounds of annual MDA from Kenya and Tanzania.ResultsGeneralized linear models with variable selection possessed relatively stable performance compared with tree-based methods. Models applied to Kenya data alone or combined data from Kenya and Tanzania could reach over 80% predictive accuracy, whereas predicting PHS for Tanzania was challenging. Models developed from one country and validated in another failed to achieve satisfactory performance. Several Year-3 variables were identified as key predictors.ConclusionsStatistical models applied to Year-3 data could help predict PHS and guide program decisions, with infection intensity, prevalence of heavy infections (≥400 eggs/gram of feces), and total prevalence being particularly important factors. Additional studies including more variables and locations could help in developing generalizable models.
Highlights
Some villages, labeled “persistent hotspots (PHS),” fail to respond adequately in regard to prevalence and intensity of infection to mass drug administration (MDA) for schistosomiasis
Models applied to Kenya data alone or combined data from Kenya and Tanzania could reach over 80% predictive accuracy, whereas predicting PHS for Tanzania was challenging
Statistical models applied to Year-3 data could help predict PHS and guide program decisions, with infection intensity, prevalence of heavy infections (≥400 eggs/gram of feces), and total prevalence being important factors
Summary
In a study with multiple rounds of MDA, data collected before the third MDA were used to predict PHS. The analyses presented here use data from studies that took place in 150 villages in Kenya and 148 villages in Tanzania in areas around Lake Victoria having ≥25% prevalence of Schistosoma mansoni infection among SAC. In both the Kenya and Tanzania studies, villages were randomized to 1 of 6 arms (Figure 1). In Years 1 and 2, CWT was conducted by community drug distributors, who distributed PZQ by going house-to-house. In Years 3 and 4, in addition to house-to-house distribution, in CWT villages PZQ was delivered in schools by teachers
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