title: Contrasting patterns in the small-scale heterogeneity of human helminth infections in urban and rural environments in Brazil.
abstract: Marked heterogeneity exists in the patterns of parasitic infection between individuals, households and communities. Analysis of parasite distributions within populations is complicated by the fact that parasite distributions are highly aggregated and few studies have explicitly incorporated this distribution when investigating small-scale spatial heterogeneities. This study aimed to quantify the small-scale (within- and between-household) heterogeneity of helminth infection in an area of Minas Gerais State, Brazil, with rural and urban sectors. Parasitological data from a cross-sectional survey of 1,249 individuals aged 0-86 years from 242 households were analysed. Within-household clustering of infection was assessed using random effect logistic regression models and between-household spatial heterogeneity was assessed using a Bayesian negative binomial spatial model. The overall prevalence of hookworm (Necator americanus) was 66.9%, the prevalence of Schistosoma mansoni was 44.9% and the prevalence of Ascaris lumbricoides was 48.8%. Statistical analysis indicated significant (within) household and (between household) spatial clustering of hookworm in both rural and urban areas and of S. mansoni in rural areas. There was no evidence of either household or spatial clustering of S. mansoni in urban areas. The spatial correlation of S. mansoni was estimated to reduce by half over a distance of 700 m in the rural area. Rural hookworm had a much smaller half-distance (28 m) and urban hookworm showed an even smaller half-distance (12 m). We suggest that such species-specific differences in patterns of infection by environment are primarily due to variation in exposure and parasite life cycle, although host genetic factors cannot be ruled out.
authors.affiliation: Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, WCIE 7HT, UK. simon.brooker@lshtm.ac.uk
authors.forename: Simon
authors.initials: S
authors.lastname: Brooker
authors.forename: Neal
authors.initials: N
authors.lastname: Alexander
authors.forename: Stefan
authors.initials: S
authors.lastname: Geiger
authors.forename: Rana A
authors.initials: RA
authors.lastname: Moyeed
authors.forename: Julian
authors.initials: J
authors.lastname: Stander
authors.forename: Fiona
authors.initials: F
authors.lastname: Fleming
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hotez
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Correa-Oliveira
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Bethony
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001196:Ascariasis / Q000453:epidemiology; D017164:Ascaris lumbricoides; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005243:Feces / Q000469:parasitology; D005260:Female; D006373:Helminthiasis / Q000453:epidemiology*; D006725:Hookworm Infections / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007411:Intestinal Diseases, Parasitic / Q000453:epidemiology*; D008018:Life Cycle Stages; D008297:Male; D008875:Middle Aged; D010270:Parasite Egg Count; D015995:Prevalence; D012424:Rural Population; D012552:Schistosomiasis / Q000453:epidemiology; D012555:Schistosomiasis mansoni; D017678:Sex Distribution; D012931:Social Environment; D014505:Urban Population