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Urinary schistosomiasis remains a major contributor to the disease burden along the southern coast of Kenya. Selective identification of transmission hot spots offers the potential for more effective, highly-focal snail control and human chemotherapy to reduce Schistosoma haematobium transmission. In the present study, a geographic information system was used to integrate demographic, parasitologic, and household location data for an endemic village and neighboring households with the biotic, abiotic, and location data for snail collection/water contact sites. A global spatial statistic was used to detect area-wide trends of clustering for human infection at the household level. Local spatial statistics were then applied to detect specific household clusters of infection, and, as a focal spatial statistic, to evaluate clustering of infection around a putative transmission site. High infection intensities were clustered significantly around a water contact site with high numbers of snails shedding S. haematobium cercariae. When age was considered, clustering was found to be significant at different distances for different age groups.
Received October 24, 2003. Accepted for publication December 14, 2003.
Acknowledgments: We thank the residents of Milalani, Mabatani, Nganja, and Marigiza villages for their gracious participation. We are especially thankful to Anthony Chome and Iddi Masemo as well as Malick Ndzovu, Jackson Muinde, and Joyce Bongo in helping locate households. Also, we are thankful for help from Grace Mathenge in coordinating field operations and data entry. Drs. Melinda Brady and Evelin Grijalva provided helpful comments. This paper was published with the kind permission of the Director of Medical Services, Ministry of Health, Kenya.
Financial support: This research was supported by grants from the National Institutes of Health under grants AI-45473 (National Institute of Allergy and Infectious Diseases) and TW/ES01543 (Fogarty International Center).
Authors’ addresses: Julie A. Clennon and Uriel Kitron, Division of Epidemiology and Preventive Medicine, Department of Veterinary Pathobiology, University of Illinois, 2001 South Lincoln Avenue, Urbana, IL 61802, Telephone: 217-244-5954, Fax: 217-244-7421, E-mail: jaclenno{at}uiuc.edu. Charles H. King, Center for Global Health and Diseases, Wolstein Research Building, Room 4126, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106-7286, Telephone: 216-368-4818, Fax: 216-368-4825, E-mail: chk{at}po.cwru.edu. Eric M. Muchiri and H. Curtis Kariuki, Division of Vector Borne Diseases, Ministry of Health, PO Box 20750, Nairobi, Kenya, Telephone: 254-20-725-833, Fax: 254-20-720-030, E-mail:schisto{at}wananchi.com. John H. Ouma, Kenya Medical Research Institute, Mbagathi Road, Nairobi, Kenya, Telephone: 254-20-722-541, Fax: 254-20-720-030. Peter Mungai, c/o Case Western Reserve University/Division of Vector-Borne Diseases/Kenya Medical Research Institute Filariasis-Schistosomiasis Research Unit, PO Box 8, Msambweni, Kenya, Telephone: 254-40-52267, E-mail: dvbdcwru{at}wananchi.com.
Reprint requests: Charles H. King, Center for Global Health and Diseases, Wolstein Research Building, Room 4126, Case Western Reserve Univeristy School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106-7286.
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