The epidemiology and small-scale spatial heterogeneity of urinary schistosomiasis in Lusaka province, Zambia

  • Christopher Simoonga | simoongachris@yahoo.com Ministry of Health, Lusaka, Zambia.
  • Lawrence N. Kazembe Mathematical Sciences Department, Chancellor College, University of Malawi, Zomba, Malawi.
  • Thomas K. Kristensen DBL – Centre for Health Research and Development, Faculty of Life Sciences, University of Copenhagen, Frederiksberg C, Denmark.
  • Annette Olsen DBL – Centre for Health Research and Development, Faculty of Life Sciences, University of Copenhagen, Frederiksberg C, Denmark.
  • Chris C. Appleton School of Biological and Conservation Sciences, University of KwaZulu-Natal, Dalbridge, South Africa.
  • Patricia Mubita Department of Biological Sciences, University of Zambia, Lusaka, Zambia.
  • Likezo Mubila Department of Biological Sciences, University of Zambia, Lusaka, Zambia.

Abstract

In line with the aims of the “National Bilharzia Control Programme” and the “School Health and Nutrition Programme” in Zambia, a study on urinary schistosomiasis was conducted in 20 primary schools of Lusaka province to further our understanding of the epidemiology of the infection, and to enhance spatial targeting of control. We investigated risk factors associated with urinary schistosomiasis, and examined small-scale spatial heterogeneity in prevalence, using data collected from 1,912 schoolchildren, 6 to 15-year-old, recruited from 20 schools in Kafue and Luangwa districts. The risk factors identified included geographical location, altitude, normalized difference vegetation index (NDVI), maximum temperature, age, sex of the child and intermediate host snail abundance. Three logistic regression models were fitted assuming different random effects to allow for spatial structuring. The mean prevalence rate was 9.6%, with significance difference between young and older children (odds ratio (OR) = 0.71; 95% confidence interval (CI) = 0.51-0.96). The risk of infection was related to intermediate host snail abundance (OR = 1.03; 95% CI = 1.00-1.05) and vegetation cover (OR = 1.04; 95% CI = 1.00-1.07). Schools located either on the plateau and the valley also differed in prevalence and intensity of infection for moderate infection to none (OR = 1.64; 95% CI = 1.36- 1.96). The overall predictive performance of the spatial random effects model was higher than the ordinary logistic regression. In addition, evidence of heterogeneity of the infection risk was found at the micro-geographical level. A sound understanding of small-scale heterogeneity, caused by spatial aggregation of schoolchildren, is important to inform health planners for implementing control schistosomiasis interventions.

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Published
2008-11-01
Section
Original Articles
Keywords:
urinary schistosomiasis, spatial epidemiology, Bayesian analysis, Zambia.
Statistics
Abstract views: 1378

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How to Cite
Simoonga, C., Kazembe, L. N., Kristensen, T. K., Olsen, A., Appleton, C. C., Mubita, P., & Mubila, L. (2008). The epidemiology and small-scale spatial heterogeneity of urinary schistosomiasis in Lusaka province, Zambia. Geospatial Health, 3(1), 57-67. https://doi.org/10.4081/gh.2008.232