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We conducted a school-based assessment of the geographic distribution of Wuchereria bancrofti infection in Leogane Commune, Haiti, using the immunochromatographic test. In multivariate analyses performed using generalized linear mixed models, children attending schools in the foothills and plains were 3.95 (95% confidence interval [CI] = 1.28–12.23) and 23.56 (95% CI = 8.99–61.79) times as likely to be infected, respectively, as children attending mountain schools. Infection prevalence decreased with increasing altitude, but some local foci of infection were detected at higher altitudes. Higher school tuition, a marker of socioeconomic status (SES), was not associated with decreased infection prevalence. Our results indicate that although the force of infection in Leogane Commune is greatest below 70 meters above sea level, higher altitude communities are not exempt from infection. Lymphatic filariasis (LF) elimination programs should consider extending infection mapping activities to presumed non-LF altitudes. In addition, higher SES does not confer protection against W. bancrofti infection.
Received September 22, 2003. Accepted for publication November 25, 2003.
Acknowledgments: We thank Joyanna Wendt and Jeanne Radday (Leogane Commune LF elimination program coordinators at the time this work was undertaken), Dr. Jack Lafontant (Director, Hôpital Sainte Croix), and Dr. Thomas Streit for their support during the school survey data collection. Dr. David Molyneux’s support and enthusiasm for the project were also much appreciated. We are very grateful to Allen Hightower for his invaluable advice and technical assistance, without which the GPS mapping work could not have been accomplished. We also thank Dr. Brian Stephens for the two months of hard work required to create the GPS base map of the Commune, and Renn Doyle for digitizing the only existing map of the Commune. We are indebted to the following elimination program staff members for their dedication to the program and for their willingness to travel the length and breadth of the Commune during data collection activities: Conus Brevaus, Jean Marc Brissau, Dardith Desire, Erubens Elaus, Shiler Emile, Fred Francis, Jean Steven Hilaire, Jean Willy Hilaire, Jesnel Jorseme, Michelet Leriche, Jean Clausel Louis, Rose Guertha Louis-Charles, Wesly Pierre, Osnel Sagaille, and Kethlie Toussaint.
Financial support: This work was supported by the Department for International Development, United Kingdom, through the Liverpool School of Tropical Medicine Lymphatic Filariasis Support Centre and by the CDC Emerging Infections Program.
Authors’ addresses: Heather A. Boyd, Department of Epidemiology, Rollins School of Public Health, Emory University, Room 468, 1518 Clifton Road, Atlanta, GA 30322 and Division of Parasitic Diseases, Centers for Disease Control and Prevention, Chamblee Facility, Mailstop F-22, Building 24, Room 1006, 4770 Buford Highway, Atlanta, GA 30341-3717, Telephone: 770-488-7595, Fax: 770-488-4465, E-mail: heb6{at}cdc.gov. Lance A. Waller, Department of Biostatistics, Rollins School of Public Health, Emory University, Room 326, 1518 Clifton Road, Atlanta, GA 30322, Telephone: 404-727-1057, Fax: 404-727-1370, E-mail: lwaller{at}sph.emory.edu. W. Dana Flanders, Department of Epidemiology, Rollins School of Public Health, Emory University, Room 464, 1518 Clifton Road, Atlanta, GA 30322, Telephone: 404-727-8716, Fax: 404-727-8737, E-mail: wflande{at}sph.emory.edu. Michael J. Beach, Centers for Disease Control and Prevention, Chamblee Facility, Building 102, Room 1411, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341-3717, Telephone: 770-488-7763, Fax: 770-488-7761, E-mail: mjb3{at}cdc.gov. J. Sony Sivilus and Rodrigue Lovince, Hôpital Sainte Croix, Leogâne, Haiti, Telephone: 509-235-1044; E-mails: jeanssivilus{at}yahoo.fr and Rodrigue.Lovince.1{at}nd.edu. Patrick J. Lammie, Centers for Disease Control and Prevention, Chamblee Facility, Building 23, Room 1021, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341-3717, Telephone: 770-488-4054, Fax: 770- 488-4108, E-mail: pjl1{at}cdc.gov. David G. Addiss, Centers for Disease Control and Prevention, Chamblee Facility, Building 24, Room 1007, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341-3717, Telephone: 770-488-7770, Fax: 770-488-4465, E-mail: dga1{at}cdc.gov.
Reprint requests: David G. Addiss, Centers for Disease Control and Prevention, Chamblee Facility, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341-3717.
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