Geographical analysis of the role of water supply and sanitation in the risk of helminth infections of children in West Africa
Geographical analysis of the role of water supply and sanitation in the risk of helminth infections of children in West Africa
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DOI：
10.1073/pnas.1106784108
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发表时间：
2011-12-13
影响因子：
11.1
通讯作者：
Clements, Archie C. A.
中科院分区：
文献类型：
--
作者：
Magalhaes, Ricardo J. Soares;Barnett, Adrian G.;Clements, Archie C. A.
在全球范围内，供水、环境卫生和个人卫生（WASH）不足是造成死亡率和疾病负担的主要因素。我们的目的是量化WASH在学龄儿童血吸虫、曼氏血吸虫和钩虫感染风险中的作用;估计WASH引起的蠕虫感染的人群归因分数（PAF）;并在空间上预测感染风险。我们使用空间风险模型生成了西非地区的预测地图，这些地区没有自来水，厕所设施和改善的家庭地板类型。我们的地图确定了西非在实现水和卫生方面千年发展目标方面落后的地区。与供水相比，厕所的地理覆盖率普遍提高，家庭地板类型也有所改善。这些预测，以及它们的不确定性，然后被用作协变量的三个蠕虫物种的贝叶斯地统计模型。我们估计了一个较小的可归因于供水的比例在S。mansoni（PAF 47%）与S.血小板活化因子（PAF）71%。S.自然地板型血吸虫感染（PAF 21%）与S.曼氏感染（PAF 16%），但钩虫感染（PAF 86%）显著更高。如果厕所设施得到改善，百分之五的钩虫病例是可以预防的。绘制针对讲卫生运动调整的感染风险分布图，可以确定西非的社区，在这些社区，预防性化疗与改善讲卫生运动的干预措施相结合，将产生最大的健康效益。
Globally, inadequate water supply, sanitation, and hygiene (WASH) are major contributors to mortality and burden of disease. We aimed to quantify the role of WASH in the risk of Schistosoma hematobium, Schistosoma mansoni, and hookworm infection in school-aged children; to estimate the population attributable fraction (PAF) of helminth infection due to WASH; and to spatially predict the risk of infection. We generated predictive maps of areas in West Africa without piped water, toilet facilities, and improved household floor types, using spatial risk models. Our maps identified areas in West Africa where the millennium development goal for water and sanitation is lagging behind. There was a generally better geographical coverage for toilets and improved household floor types compared with water supply. These predictions, and their uncertainty, were then used as covariates in Bayesian geostatistical models for the three helminth species. We estimated a smaller attributable fraction for water supply in S. mansoni (PAF 47%) compared with S. hematobium (PAF 71%). The attributable fraction of S. hematobium infection due to natural floor type (PAF 21%) was comparable to that of S. mansoni (PAF 16%), but was significantly higher for hookworm infection (PAF 86%). Five percent of hookworm cases could have been prevented if improved toilet facilities had been available. Mapping the distribution of infection risk adjusted for WASH allowed the identification of communities in West Africa where preventive chemotherapy integrated with interventions to improve WASH will yield the greatest health benefits.