Active trachoma among children in Mali: Clustering and environmental risk factors
Active trachoma is not uniformly distributed in endemic areas, and local environmental factors influencing its prevalence are not yet adequately understood. Determining whether clustering is a consistent phenomenon may help predict likely modes of transmission and help to determine the appropriate l...
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Published in | PLoS neglected tropical diseases Vol. 4; no. 1; p. e583 |
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Main Authors | , , , , , , , |
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Language | English |
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01.01.2010
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Abstract | Active trachoma is not uniformly distributed in endemic areas, and local environmental factors influencing its prevalence are not yet adequately understood. Determining whether clustering is a consistent phenomenon may help predict likely modes of transmission and help to determine the appropriate level at which to target control interventions. The aims of this study were, therefore, to disentangle the relative importance of clustering at different levels and to assess the respective role of individual, socio-demographic, and environmental factors on active trachoma prevalence among children in Mali.
We used anonymous data collected during the Mali national trachoma survey (1996-1997) at different levels of the traditional social structure (14,627 children under 10 years of age, 6,251 caretakers, 2,269 households, 203 villages). Besides field-collected data, environmental variables were retrieved later from various databases at the village level. Bayesian hierarchical logistic models were fit to these prevalence and exposure data. Clustering revealed significant results at four hierarchical levels. The higher proportion of the variation in the occurrence of active trachoma was attributable to the village level (36.7%), followed by household (25.3%), and child (24.7%) levels. Beyond some well-established individual risk factors (age between 3 and 5, dirty face, and flies on the face), we showed that caretaker-level (wiping after body washing), household-level (common ownership of radio, and motorbike), and village-level (presence of a women's association, average monthly maximal temperature and sunshine fraction, average annual mean temperature, presence of rainy days) features were associated with reduced active trachoma prevalence.
This study clearly indicates the importance of directing control efforts both at children with active trachoma as well as those with close contact, and at communities. The results support facial cleanliness and environmental improvements (the SAFE strategy) as population-health initiatives to combat blinding trachoma. |
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AbstractList |
Background
Active trachoma is not uniformly distributed in endemic areas, and local environmental factors influencing its prevalence are not yet adequately understood. Determining whether clustering is a consistent phenomenon may help predict likely modes of transmission and help to determine the appropriate level at which to target control interventions. The aims of this study were, therefore, to disentangle the relative importance of clustering at different levels and to assess the respective role of individual, socio-demographic, and environmental factors on active trachoma prevalence among children in Mali.
Methodology/Principal Findings
We used anonymous data collected during the Mali national trachoma survey (1996-1997) at different levels of the traditional social structure (14,627 children under 10 years of age, 6,251 caretakers, 2,269 households, 203 villages). Besides field-collected data, environmental variables were retrieved later from various databases at the village level. Bayesian hierarchical logistic models were fit to these prevalence and exposure data. Clustering revealed significant results at four hierarchical levels. The higher proportion of the variation in the occurrence of active trachoma was attributable to the village level (36.7%), followed by household (25.3%), and child (24.7%) levels. Beyond some well-established individual risk factors (age between 3 and 5, dirty face, and flies on the face), we showed that caretaker-level (wiping after body washing), household-level (common ownership of radio, and motorbike), and village-level (presence of a women's association, average monthly maximal temperature and sunshine fraction, average annual mean temperature, presence of rainy days) features were associated with reduced active trachoma prevalence.
Conclusions/Significance
This study clearly indicates the importance of directing control efforts both at children with active trachoma as well as those with close contact, and at communities. The results support facial cleanliness and environmental improvements (the SAFE strategy) as population-health initiatives to combat blinding trachoma. Active trachoma is not uniformly distributed in endemic areas, and local environmental factors influencing its prevalence are not yet adequately understood. Determining whether clustering is a consistent phenomenon may help predict likely modes of transmission and help to determine the appropriate level at which to target control interventions. The aims of this study were, therefore, to disentangle the relative importance of clustering at different levels and to assess the respective role of individual, socio-demographic, and environmental factors on active trachoma prevalence among children in Mali. We used anonymous data collected during the Mali national trachoma survey (1996-1997) at different levels of the traditional social structure (14,627 children under 10 years of age, 6,251 caretakers, 2,269 households, 203 villages). Besides field-collected data, environmental variables were retrieved later from various databases at the village level. Bayesian hierarchical logistic models were fit to these prevalence and exposure data. Clustering revealed significant results at four hierarchical levels. The higher proportion of the variation in the occurrence of active trachoma was attributable to the village level (36.7%), followed by household (25.3%), and child (24.7%) levels. Beyond some well-established individual risk factors (age between 3 and 5, dirty face, and flies on the face), we showed that caretaker-level (wiping after body washing), household-level (common ownership of radio, and motorbike), and village-level (presence of a women's association, average monthly maximal temperature and sunshine fraction, average annual mean temperature, presence of rainy days) features were associated with reduced active trachoma prevalence. This study clearly indicates the importance of directing control efforts both at children with active trachoma as well as those with close contact, and at communities. The results support facial cleanliness and environmental improvements (the SAFE strategy) as population-health initiatives to combat blinding trachoma. BACKGROUND: Active trachoma is not uniformly distributed in endemic areas, and local environmental factors influencing its prevalence are not yet adequately understood. Determining whether clustering is a consistent phenomenon may help predict likely modes of transmission and help to determine the appropriate level at which to target control interventions. The aims of this study were, therefore, to disentangle the relative importance of clustering at different levels and to assess the respective role of individual, socio-demographic, and environmental factors on active trachoma prevalence among children in Mali. METHODOLOGY/PRINCIPAL FINDINGS: We used anonymous data collected during the Mali national trachoma survey (1996-1997) at different levels of the traditional social structure (14,627 children under 10 years of age, 6,251 caretakers, 2,269 households, 203 villages). Besides field-collected data, environmental variables were retrieved later from various databases at the village level. Bayesian hierarchical logistic models were fit to these prevalence and exposure data. Clustering revealed significant results at four hierarchical levels. The higher proportion of the variation in the occurrence of active trachoma was attributable to the village level (36.7%), followed by household (25.3%), and child (24.7%) levels. Beyond some well-established individual risk factors (age between 3 and 5, dirty face, and flies on the face), we showed that caretaker-level (wiping after body washing), household-level (common ownership of radio, and motorbike), and village-level (presence of a women's association, average monthly maximal temperature and sunshine fraction, average annual mean temperature, presence of rainy days) features were associated with reduced active trachoma prevalence. CONCLUSIONS/SIGNIFICANCE: This study clearly indicates the importance of directing control efforts both at children with active trachoma as well as those with close contact, and at communities. The results support facial cleanliness and environmental improvements (the SAFE strategy) as population-health initiatives to combat blinding trachoma. Active trachoma is not uniformly distributed in endemic areas, and local environmental factors influencing its prevalence are not yet adequately understood. Determining whether clustering is a consistent phenomenon may help predict likely modes of transmission and help to determine the appropriate level at which to target control interventions. In this work, we estimated the magnitude of clustering at different levels and investigated the influence of socio-economic factors and environmental features on active trachoma prevalence among children in Mali (1996–1997 nationwide survey). Clustering revealed significant results at the child, caretaker, household, and village levels. Moreover, beyond some well-established individual risk factors (age between 3 and 5, dirty face, and flies on the face), we found that temperature, sunshine fraction, and presence of rainy days were negatively associated with active trachoma prevalence. This study clearly indicates the importance of directing control efforts both at children with active trachoma as well as those with close contact, and at communities. These results support facial cleanliness and environmental improvements as population-health initiatives to combat blinding trachoma. |
Author | Sacko, Doulaye Schémann, Jean-François Traoré, Lamine Momo, Germain Hägi, Mathieu Mauny, Frédéric Viel, Jean-François Malvy, Denis |
AuthorAffiliation | 4 West African Health Organization, Vision 2020 coordination group, Bobo-Dioulasso, Burkina Faso Ghana Health Service, Ghana 1 CNRS UMR 6249 “Chrono-Environment”, Faculty of Medicine, Besançon, France 2 University of Bordeaux 2 (EA 3677 and Centre René Labusquière), Bordeaux, France 3 Institute of African Tropical Ophthalmology (IOTA), Bamako, Mali |
AuthorAffiliation_xml | – name: 4 West African Health Organization, Vision 2020 coordination group, Bobo-Dioulasso, Burkina Faso – name: 1 CNRS UMR 6249 “Chrono-Environment”, Faculty of Medicine, Besançon, France – name: 3 Institute of African Tropical Ophthalmology (IOTA), Bamako, Mali – name: 2 University of Bordeaux 2 (EA 3677 and Centre René Labusquière), Bordeaux, France – name: Ghana Health Service, Ghana |
Author_xml | – sequence: 1 givenname: Mathieu surname: Hägi fullname: Hägi, Mathieu organization: CNRS UMR "Chrono-Environment", Besançon, France – sequence: 2 givenname: Jean-François surname: Schémann fullname: Schémann, Jean-François – sequence: 3 givenname: Frédéric surname: Mauny fullname: Mauny, Frédéric – sequence: 4 givenname: Germain surname: Momo fullname: Momo, Germain – sequence: 5 givenname: Doulaye surname: Sacko fullname: Sacko, Doulaye – sequence: 6 givenname: Lamine surname: Traoré fullname: Traoré, Lamine – sequence: 7 givenname: Denis surname: Malvy fullname: Malvy, Denis – sequence: 8 givenname: Jean-François surname: Viel fullname: Viel, Jean-François |
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Copyright | 2010 Hägi 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: Hägi M, Schémann J-F, Mauny F, Momo G, Sacko D, et al. (2010) Active Trachoma among Children in Mali: Clustering and Environmental Risk Factors. PLoS Negl Trop Dis 4(1): e583. doi:10.1371/journal.pntd.0000583 Distributed under a Creative Commons Attribution 4.0 International License Hägi et al. 2010 |
Copyright_xml | – notice: 2010 Hägi 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: Hägi M, Schémann J-F, Mauny F, Momo G, Sacko D, et al. (2010) Active Trachoma among Children in Mali: Clustering and Environmental Risk Factors. PLoS Negl Trop Dis 4(1): e583. doi:10.1371/journal.pntd.0000583 – notice: Distributed under a Creative Commons Attribution 4.0 International License – notice: Hägi et al. 2010 |
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Keywords | Climate Age Factors Mali Humans Risk Factors Child, Preschool Trachoma Female Male Child |
Language | English |
License | Distributed under a Creative Commons Attribution 4.0 International License: http://creativecommons.org/licenses/by/4.0 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 properly credited. Creative Commons Attribution License |
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Notes | Conceived and designed the experiments: JFS LT DM. Performed the experiments: JFS GM DS LT. Analyzed the data: MH FM JFV. Wrote the paper: MH JFV. |
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Snippet | Active trachoma is not uniformly distributed in endemic areas, and local environmental factors influencing its prevalence are not yet adequately understood.... Background Active trachoma is not uniformly distributed in endemic areas, and local environmental factors influencing its prevalence are not yet adequately... BACKGROUND: Active trachoma is not uniformly distributed in endemic areas, and local environmental factors influencing its prevalence are not yet adequately... Background Active trachoma is not uniformly distributed in endemic areas, and local environmental factors influencing its prevalence are not yet adequately... |
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SubjectTerms | Access to education Age Age Factors Alliances Behavior Child Child, Preschool Children & youth Climate Community Disease Ecology/Spatial and Landscape Ecology Environmental factors Environmental risk Female Health promotion Households Humans Hygiene Life Sciences Male Mali - epidemiology Population density Public Health and Epidemiology/Environmental Health Public Health and Epidemiology/Social and Behavioral Determinants of Health Risk Factors Santé publique et épidémiologie Social conditions Studies Temperature Trachoma - epidemiology Tropical diseases Womens health |
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Title | Active trachoma among children in Mali: Clustering and environmental risk factors |
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