title: Spatial co-distribution of neglected tropical diseases in the east African great lakes region: revisiting the justification for integrated control.
abstract: OBJECTIVE
  To determine spatial patterns of co-endemicity of schistosomiasis mansoni and the soil-transmitted helminths (STHs) Ascaris lumbricoides, Trichuris trichiura and hookworm in the Great Lakes region of East Africa, to help plan integrated neglected tropical disease programmes in this region.
  
  
  METHODS
  Parasitological surveys were conducted in Uganda, Tanzania, Kenya and Burundi in 28 213 children in 404 schools. Bayesian geostatistical models were used to interpolate prevalence of these infections across the study area. Interpolated prevalence maps were overlaid to determine areas of co-endemicity.
  
  
  RESULTS
  In the Great Lakes region, prevalence was 18.1% for Schistosoma mansoni, 50.0% for hookworm, 6.8% for A. lumbricoides and 6.8% for T. trichiura. Hookworm infection was ubiquitous, whereas S. mansoni, A. lumbricoides and T. trichiura were highly focal. Most areas were endemic (prevalence >or=10%) or hyperendemic (prevalence >or=50%) for one or more STHs, whereas endemic areas for schistosomiasis mansoni were restricted to foci adjacent large perennial water bodies.
  
  
  CONCLUSIONS
  Because of the ubiquity of hookworm, treatment programmes are required for STH throughout the region but efficient schistosomiasis control should only be targeted at limited high-risk areas. Therefore, integration of schistosomiasis with STH control is only indicated in limited foci in East Africa.
authors.affiliation: School of Population Health, University of Queensland, Herston, Qld, Australia. a.clements@uq.edu.au
authors.forename: Archie C A
authors.initials: AC
authors.lastname: Clements
authors.forename: Marie-Alice
authors.initials: MA
authors.lastname: Deville
authors.forename: Onésime
authors.initials: O
authors.lastname: Ndayishimiye
authors.forename: Simon
authors.initials: S
authors.lastname: Brooker
authors.forename: Alan
authors.initials: A
authors.lastname: Fenwick
mesh_terms: D000351:Africa, Eastern / Q000453:epidemiology; D000818:Animals; D001196:Ascariasis / Q000453:epidemiology / Q000517:prevention & control; D017164:Ascaris lumbricoides; D019033:Delivery of Health Care, Integrated / Q000379:methods; D019353:Endemic Diseases; D004812:Epidemiologic Methods; D005260:Female; D040362:Geographic Information Systems; D006373:Helminthiasis / Q000453:epidemiology* / Q000517:prevention & control; D006725:Hookworm Infections / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D012555:Schistosomiasis mansoni / Q000453:epidemiology / Q000517:prevention & control; D014257:Trichuriasis / Q000453:epidemiology / Q000517:prevention & control
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