title: Changing patterns of spatial clustering of schistosomiasis in Southwest China between 1999-2001 and 2007-2008: assessing progress toward eradication after the World Bank Loan Project.
abstract: We compared changes in the spatial clustering of schistosomiasis in Southwest China at the conclusion of and six years following the end of the World Bank Loan Project (WBLP), the control strategy of which was focused on the large-scale use of chemotherapy. Parasitological data were obtained through standardized surveys conducted in 1999-2001 and again in 2007-2008. Two alternate spatial cluster methods were used to identify spatial clusters of cases: Anselin's Local Moran's I test and Kulldorff's spatial scan statistic. Substantial reductions in the burden of schistosomiasis were found after the end of the WBLP, but the spatial extent of schistosomiasis was not reduced across the study area. Spatial clusters continued to occur in three regions: Chengdu Plain, Yangtze River Valley, and Lancang River Valley during the two periods, and regularly involved five counties. These findings suggest that despite impressive reductions in burden, the hilly and mountainous regions of Southwest China remain at risk of schistosome re-emergence. Our results help to highlight specific locations where integrated control programs can focus to speed the elimination of schistosomiasis in China.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai 200032, China. huy@lreis.ac.cn.
authors.forename: Yi
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai 200032, China. xiongchenglong@fudan.edu.cn.
authors.forename: Chenglong
authors.initials: C
authors.lastname: Xiong
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai 200032, China. epistat@gmail.com.
authors.forename: Zhijie
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai 200032, China. cherry12204@163.com.
authors.forename: Can
authors.initials: C
authors.lastname: Luo
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai 200032, China. tcohen@hsph.harvard.edu.
authors.forename: Ted
authors.initials: T
authors.lastname: Cohen
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai 200032, China. agao1224@163.com.
authors.forename: Jie
authors.initials: J
authors.lastname: Gao
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai 200032, China. zhanglijuan727@163.com.
authors.forename: Lijuan
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai 200032, China. jiangqw@fudan.edu.cn.
authors.forename: Qingwu
authors.initials: Q
authors.lastname: Jiang
mesh_terms: D002681:China; D060740:Disease Eradication; D006801:Humans; D015995:Prevalence; D012552:Schistosomiasis / Q000453:epidemiology* / Q000517:prevention & control; D014480:United Nations