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Using community-level prevalence of Loa loa infection to predict the proportion of highly-infected individuals:statistical modelling to support Lymphatic Filariasis and Onchocerciasis elimination programs

Schlueter, Daniela Katrin and Ndeffo-Mbah, Martial L and Takougang, Innocent and Ukety, Tony and Wanji, Samuel and Galvani, Alison P and Diggle, Peter John (2016) Using community-level prevalence of Loa loa infection to predict the proportion of highly-infected individuals:statistical modelling to support Lymphatic Filariasis and Onchocerciasis elimination programs. PLoS Neglected Tropical Diseases, 10 (12). ISSN 1935-2727

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    Abstract

    Lymphatic Filariasis and Onchocerciasis (river blindness) constitute pressing public health issues in tropical regions. Global elimination programs, involving mass drug administration (MDA), have been launched by the World Health Organisation. Although the drugs used are generally well tolerated, individuals who are highly co-infected with Loa loa are at risk of experiencing serious adverse events. Highly infected individuals are more likely to be found in communities with high prevalence. An understanding of the relationship between individual infection and population-level prevalence can therefore inform decisions on whether MDA can be safely administered in an endemic community. Based on Loa loa infection intensity data from individuals in Cameroon, the Republic of the Congo and the Democratic Republic of the Congo we develop a statistical model for the distribution of infection levels in communities. We then use this model to make predictive inferences regarding the proportion of individuals whose parasite count exceeds policy-relevant levels. In particular we show how to exploit the positive correlation between community-level prevalence and intensity of infection in order to predict the proportion of highly infected individuals in a community given only prevalence data from the community in question. The resulting prediction intervals are not substantially wider, and in some cases narrower, than the corresponding binomial confidence intervals obtained from data that include measurements of individual infection levels. Therefore the model developed here facilitates the estimation of the proportion of individuals highly infected with Loa loa using only estimated community level prevalence. It can be used to assess the risk of rolling out MDA in a specific community, or to guide policy decisions.

    Item Type: Article
    Journal or Publication Title: PLoS Neglected Tropical Diseases
    Additional Information: © 2016 Schlüter et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
    Subjects:
    Departments: Faculty of Health and Medicine > Medicine
    ID Code: 83368
    Deposited By: ep_importer_pure
    Deposited On: 02 Dec 2016 09:56
    Refereed?: Yes
    Published?: Published
    Last Modified: 18 Dec 2017 08:23
    Identification Number:
    URI: http://eprints.lancs.ac.uk/id/eprint/83368

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