Date Published: August 13, 2008
Publisher: Public Library of Science
Author(s): Daniel C. Medina, Sally E. Findley, Seydou Doumbia, Giovanna Raso
Abstract: BackgroundMuch of the developing world, particularly sub-Saharan Africa, exhibits high levels of morbidity and mortality associated with infectious diseases. The incidence of Schistosoma sp.—which are neglected tropical diseases exposing and infecting more than 500 and 200 million individuals in 77 countries, respectively—is rising because of 1) numerous irrigation and hydro-electric projects, 2) steady shifts from nomadic to sedentary existence, and 3) ineffective control programs. Notwithstanding the colossal scope of these parasitic infections, less than 0.5% of Schistosoma sp. investigations have attempted to predict their spatial and or temporal distributions. Undoubtedly, public health programs in developing countries could benefit from parsimonious forecasting and early warning systems to enhance management of these parasitic diseases.Methodology/Principal FindingsIn this longitudinal retrospective (01/1996–06/2004) investigation, the Schistosoma haematobium time-series for the district of Niono, Mali, was fitted with general-purpose exponential smoothing methods to generate contemporaneous on-line forecasts. These methods, which are encapsulated within a state–space framework, accommodate seasonal and inter-annual time-series fluctuations. Mean absolute percentage error values were circa 25% for 1- to 5-month horizon forecasts.Conclusions/SignificanceThe exponential smoothing state–space framework employed herein produced reasonably accurate forecasts for this time-series, which reflects the incidence of S. haematobium–induced terminal hematuria. It obliquely captured prior non-linear interactions between disease dynamics and exogenous covariates (e.g., climate, irrigation, and public health interventions), thus obviating the need for more complex forecasting methods in the district of Niono, Mali. Therefore, this framework could assist with managing and assessing S. haematobium transmission and intervention impact, respectively, in this district and potentially elsewhere in the Sahel.
Partial Text: Prevalent parasitic infectious diseases frequently evade the public health radar because infected individuals present with a clinical history that is characterized by a highly heterogeneous symptomatology. Schistosoma sp., also known as bilharzias, expose and infect more than 500 and 200 million individuals in 77 countries, respectively ,; however, only those with severe symptoms seek available treatment. Though sub-clinical Schistosoma sp. infection detrimentally impacts the health of infected individuals, the enormous impact of seemingly asymptomatic and mildly symptomatic infection remains difficult to quantify. Furthermore, Schistosoma sp. incidence continues to rise because of 1) numerous irrigation and hydro-electric projects, 2) steady shifts from nomadic to sedentary existence, and 3) ineffective control programs unable to cope with population growth. With the mounting evidence that Schistosoma sp. impose an enormous burden on, as well as their control have paramount importance to improve public health in, developing countries, intervention programs therein could benefit from parsimonious forecasting and early warning systems to enhance management and hazard mitigation of these parasitic infections –.
This longitudinal retrospective (01/1996–06/2004) investigation analyzed the S. haematobium consultation rate TS for the district of Niono, Mali. In Figure 4, the observed amalgamated S. haematobium consultation rate TS is symbolized by black lines. The TS is excessively noisy from 1996 to 1999 when a sharp rise in consultation rates clearly ensues. From 2001 onwards, consultation rates decline because of large-scale prophylactic de-parasitation programs. Regardless, 2- to 5-month horizon forecasts clearly captured these inter-annual tendencies (Fig. 4)—red traces correspond to contemporaneous on-line 2-, 3-, 4-, and 5-month horizon forecasts (panels A, B, C, and D, respectively) whilst their 95% PI values are depicted in dots of the same color. Abscissa TS projections span 102 months (01/1996–06/2004) while ordinate scales represent the number of newly diagnosed (or forecasted) S. haematobium–induced terminal hematuria cases per 1000 individuals.
Schistosoma sp. expose and infect more than 500 and 200 million individuals in 77 countries, respectively. In the Sahel, S. haematobium is endemic and highly prevalent , –. The few reports evaluating S. haematobium transmission in Mali –, particularly in the district of Niono (Fig. 1), suggest that forecasting S. haematobium consultation rate TS may locally assist with reducing morbidity. For instance, S. haematobium is the 5th most frequently diagnosed infection (the 6th commonest consultation etiology); it accounts for 2.5% of total CSCOM service area consultations , with 50 to 75% community prevalence , in the district of Niono. Paradoxically, temporal S. haematobium analyses are scarcely reported in the parasitic literature e.g. – probably because 1) this neglected tropical disease is endemic whereas most infectious disease TS forecasts usually attempt to detect epidemics, i.e. unexpected rises in consultation rate first moments, assisting with tailoring control measures; 2) S. haematobium TS tend to be excessively noisy, hindering analyses; finally, 3) long delays between S. haematobium infection and diagnosis challenge efforts to relate predicted high consultation rates to their potentially preventable sources. Notice that, though endemic, S. haematobium TS does fluctuate.