title: Historical Perspective and Risk of Multiple Neglected Tropical Diseases in Coastal Tanzania: Compositional and Contextual Determinants of Disease Risk.
abstract: BACKGROUND
  In the past decade, research on neglected tropical diseases (NTDs) has intensified in response to the need to enhance community participation in health delivery, establish monitoring and surveillance systems, and integrate existing disease-specific treatment programs to control overlapping NTD burdens and detrimental effects. In this paper, we evaluated the geographical distribution of NTDs in coastal Tanzania.
  
  
  RESULTS
  We also assessed the collective (compositional and contextual) factors that currently determine risks to multiple NTDs using a cross sectional survey of 1253 individuals in coastal Tanzania. The results show that the effect size in decreasing order of magnitude for non-binary predictors of NTD risks is as follows: NTD comorbidities > poverty > educational attainment > self-reported household quality of life > ethnicity. The multivariate analysis explained 95% of the variance in the relationship between NTD risks and the theoretically-relevant covariates. Compositional (biosocial and sociocultural) factors explained more variance at the neighbourhood level than at the regional level, whereas contextual factors, such as access to health services and household quality, in districts explained a large proportion of variance at the regional level but individually had modest statistical significance, demonstrating the complex interactions between compositional and contextual factors in generating NTD risks.
  
  
  CONCLUSIONS
  NTD risks were inequitably distributed over geographic space, which has several important policy implications. First, it suggests that localities of high burden of NTDs are likely to diminish within statistical averages at higher (regional or national) levels. Second, it indicates that curative or preventive interventions will become more efficient provided they can be focused on the localities, particularly as populations in these localities are likely to be burdened by several NTDs simultaneously, further increasing the imperative of multi-disease interventions.
authors.affiliation: Environmental Health and Hazards Laboratory, Department of Geography, University of Western Ontario, London, Ontario, Canada.
authors.forename: Frederick Ato
authors.initials: FA
authors.lastname: Armah
authors.affiliation: Biological, Environmental & Occupational Health Sciences, School of Public Health College of Health Science, University of Ghana, Legon, Accra, Ghana; Noguchi Memorial Institute for Medical Research, College of Health Science, University of Ghana, Legon, Accra, Ghana.
authors.forename: Reginald
authors.initials: R
authors.lastname: Quansah
authors.affiliation: Department of Geography, University of Western Ontario, London, Ontario, Canada.
authors.forename: Isaac
authors.initials: I
authors.lastname: Luginaah
authors.affiliation: Department of Geography, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
authors.forename: Ratana
authors.initials: R
authors.lastname: Chuenpagdee
authors.affiliation: Department of Geography, University of Dar es Salaam, Dar es Salaam, Tanzania.
authors.forename: Herbert
authors.initials: H
authors.lastname: Hambati
authors.affiliation: Indian Ocean World Centre (IOWC), Montréal, Quebec, Canada.
authors.forename: Gwyn
authors.initials: G
authors.lastname: Campbell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008297:Male; D008875:Middle Aged; D058069:Neglected Diseases / Q000191:economics / Q000453:epidemiology* / Q000266:history; D011788:Quality of Life; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult