FACTORS AFFECTING INFECTION OR REINFECTION WITH SCHISTOSOMA HAEMATOBIUM IN COASTAL KENYA: SURVIVAL ANALYSIS DURING A NINE-YEAR, SCHOOL-BASED TREATMENT PROGRAM

SUDTIDA A. SATAYATHUM Department of Epidemiology and Biostatistics, and Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Vector Borne Diseases, Ministry of Health, Nairobi, Kenya; Biomedical Science and Technology Programme, Maseno University, Maseno, Kenya

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ERIC M. MUCHIRI Department of Epidemiology and Biostatistics, and Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Vector Borne Diseases, Ministry of Health, Nairobi, Kenya; Biomedical Science and Technology Programme, Maseno University, Maseno, Kenya

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JOHN H. OUMA Department of Epidemiology and Biostatistics, and Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Vector Borne Diseases, Ministry of Health, Nairobi, Kenya; Biomedical Science and Technology Programme, Maseno University, Maseno, Kenya

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CHRISTOPHER C. WHALEN Department of Epidemiology and Biostatistics, and Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Vector Borne Diseases, Ministry of Health, Nairobi, Kenya; Biomedical Science and Technology Programme, Maseno University, Maseno, Kenya

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CHARLES H. KING Department of Epidemiology and Biostatistics, and Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Vector Borne Diseases, Ministry of Health, Nairobi, Kenya; Biomedical Science and Technology Programme, Maseno University, Maseno, Kenya

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Urinary schistosomiasis remains a significant burden for Africa and the Middle East. Success of regional control strategies will depend, in part, on what influence local environmental and behavioral factors have on individual risk for primary infection and/or reinfection. Based on experience in a multi-year (1984–1992), school-based Schistosoma haematobium control program in Coast Province, Kenya, we examined risk for infection outcomes as a function of age, sex, pretreatment morbidity, treatment regimen, water contact, and residence location, with the use of life tables and Cox proportional-hazards analysis. After adjustment, location of residence, age less than 12 years, pretreatment hematuria, and incomplete treatment were the significant independent predictors of infection, whereas sex and frequency of water contact were not. We conclude that local physical features and age-related factors play a predominant role in S. haematobium transmission in this setting. In large population-based control programs, treatment allocation strategies may need to be tailored to local conditions on a village-by-village basis.

Author Notes

Reprint requests: Charles H. King, Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Wolstein 4126, 2103 Cornell Road, Cleveland, OH 44106-7286.
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