03039nas a2200277   4500000000100000008004100001653003900042653003700081653002400118653003100142653001000173100001700183700001300200700001100213700001700224700001400241700001300255700001400268700001400282245008200296856009900378300001300477490000700490520225000497022001402747       2018                            d10aNeglected tropical diseases (NTDs)10aGeneral contextual effects (GCE)10aSchistosoma mansoni10aSoil-transmitted helminths10aKenya1 aGlanville WA1 aThomas L1 aCook E1 aBronsvoort B1 aWardrop N1 aWamae CN1 aKariuki S1 aFèvre EM00aGeneral contextual effects on neglected tropical disease risk in rural Kenya.  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0007016&type=printable  ae00070160 v123 a<p>The neglected tropical diseases (NTDs) are characterized by their tendency to cluster within groups of people, typically the poorest and most marginalized. Despite this, measures of clustering, such as within-group correlation or between-group heterogeneity, are rarely reported from community-based studies of NTD risk. We describe a general contextual analysis that uses multi-level models to partition and quantify variation in individual NTD risk at multiple grouping levels in rural Kenya. The importance of general contextual effects (GCE) in structuring variation in individual infection with Schistosoma mansoni, the soil-transmitted helminths, Taenia species, and Entamoeba histolytica/dispar was examined at the household-, sublocation- and constituency-levels using variance partition/intra-class correlation co-efficients and median odds ratios. These were compared with GCE for HIV, Plasmodium falciparum and Mycobacterium tuberculosis. The role of place of residence in shaping infection risk was further assessed using the spatial scan statistic. Individuals from the same household showed correlation in infection for all pathogens, and this was consistently highest for the gastrointestinal helminths. The lowest levels of household clustering were observed for E. histolytica/dispar, P. falciparum and M. tuberculosis. Substantial heterogeneity in individual infection risk was observed between sublocations for S. mansoni and Taenia solium cysticercosis and between constituencies for infection with S. mansoni, Trichuris trichiura and Ascaris lumbricoides. Large overlapping spatial clusters were detected for S. mansoni, T. trichiura, A. lumbricoides, and Taenia spp., which overlapped a large cluster of elevated HIV risk. Important place-based heterogeneities in infection risk exist in this community, and these GCEs are greater for the NTDs and HIV than for TB and malaria. Our findings suggest that broad-scale contextual drivers shape infectious disease risk in this population, but these effects operate at different grouping-levels for different pathogens. A general contextual analysis can provide a foundation for understanding the complex ecology of NTDs and contribute to the targeting of interventions.</p>
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