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Intensity profiles for helminths are used to describe population infection status, monitor effectiveness of control programs, and provide accurate data to validate transmission models. This study aims to accurately predict age/gender specific intensity profiles of endemic schistosomiasis japonica infection in the Philippines. Poor sensitivity of the Kato-Katz test and large heterogeneity in infection levels across villages complicate these predictions. Data from 1,989 individuals living in three endemic villages were analyzed with a Bayesian cumulative-logit model adjusting for nonproportional odds, variation between villages, and measurement error. The posterior uncertainty regarding the proportion of individuals in each egg category was high compared with that estimated using a model ignoring measurement error and villages’ heterogeneity. The intensity profiles were very different in children less than 7 years old compared with older children and adults. This model could easily be adapted to other parasitic infections or outcomes where an analysis by category would be recommended.
Received April 13, 2004. Accepted for publication July 21, 2004.
Financial support: This project was funded by the NIH/NSF Ecology of Infectious Diseases program, NIH Grant R01 TW01582. Hélène Carabin would like to thank the Wellcome Trust for support during the first part of this project. Lawrence Joseph is supported by a Senior Scientist Award from the Canadian Institutes of Health Research.
Authors’ addresses: Clare M. Marshall, Department of Epidemiology and Public Health, Division of Primary Health Care and Public Health, Faculty of Medicine, Imperial College, St-Mary’s Campus, Norfolk Place, London, W2 1PG, UK, E-mail: clare.marshall{at}imperial.ac.uk. Hélène Carabin, Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Room 303, 801 NE 13th Street, Oklahoma City, Oklahoma 73116, Telephone: (1) 405-271-2229 ext. 48083, Fax: (1) 405-271-2068, E-mail: helene-carabin{at}ouhsc.edu. Lawrence Joseph, Department of Epidemiology and Biostatistics, McGill University, and Division of Clinical Epidemiology, Montreal General Hospital, Livingston Hall, 10th Floor, 1650 Cedar Avenue, Montreal, Quebec, Canada, H3G 1A4, Telephone: (1) 514-934-1934 ext. 44713, Fax: (1) 514-934-8293, E-mail: lawrence.joseph{at}mcgill.ca. Steven Riley, Department of Infectious Disease Epidemiology, Division of Primary Health Care and Public Health, Faculty of Medicine, Imperial College, St-Mary’s Campus, Norfolk Place, London, W2 1PG, UK, Telephone: (44) 20-7594-3288, Fax: (44) 20-7262-3495, E-mail: s.riley{at}imperial.ac.uk. Remigio Olveda, Research Institute for Tropical Medicine, Department of Health Compound, FILINVEST Corporate City, Alabang, Muntinlupa City, 1781 Philippines, Telephone: (632) 809-7599, Fax: (632) 842-2245, E-mail: r.olveda{at}ritm.gov.ph. Stephen T. McGarvey, International Health Institute and Department of Community Health, Brown University, 171 Meeting Street, Box G-B495, Providence, RI 02912, Telephone: (1) 401-863-1354, Fax: (1) 401-863-1243, E-mail: Stephen_McGarvey{at}Brown.edu.
Reprint requests: Hélène Carabin, Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Room 303, 801 NE 13th Street, Oklahoma City, Oklahoma 73116, Telephone: (1) 405-271-2229 ext. 48083, Fax: (1) 405-271-2068, E-mail: helene-carabin{at}ouhsc.edu.
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