Active Trachoma among Children in Mali Clustering and Environmental Risk Factors 英文参考文献.docVIP

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Active Trachoma among Children in Mali Clustering and Environmental Risk Factors 英文参考文献.doc

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Active Trachoma among Children in Mali Clustering and Environmental Risk Factors 英文参考文献

ActiveTrachomaamongChildreninMali:Clusteringand EnvironmentalRiskFactors MathieuHa¨gi1,Jean-Franc?oisSche′mann2,Fre′de′ricMauny1,GermainMomo3,DoulayeSacko4 ,Lamine Traore′3,DenisMalvy2,Jean-Franc?ois Viel1* 1CNRSUMR6249‘‘Chrono-Environment’’,FacultyofMedicine,Besanc?on, France,2UniversityofBordeaux2(EA3677andCentreRene′ Labusquie`re),Bordeaux,France, 3InstituteofAfricanTropicalOphthalmology(IOTA),Bamako,Mali,4WestAfricanHealthOrganization,Vision2020coordinationgroup,Bobo-Dioulasso,BurkinaFaso Abstract Background:Activetrachomaisnotuniformlydistributedinendemicareas,andlocalenvironmentalfactorsinfluencingits prevalence are not yet adequately understood. Determining whether clustering is a consistent phenomenon may help predictlikelymodesoftransmissionandhelptodeterminetheappropriatelevelatwhichtotargetcontrolinterventions. Theaimsofthisstudywere,therefore,todisentangletherelativeimportanceofclusteringatdifferentlevelsandtoassess the respective role of individual, socio-demographic, and environmental factors on active trachoma prevalence among childreninMali. Methodology/Principal Findings: We used anonymous data collected during the Mali national trachoma survey (1996– 1997)at differentlevelsof thetraditionalsocial structure (14,627 children under10 yearsof age,6,251 caretakers, 2,269 households,203villages).Besidesfield-collecteddata,environmentalvariableswereretrievedlaterfromvariousdatabases atthevillagelevel.Bayesianhierarchicallogisticmodelswerefittotheseprevalenceandexposuredata.Clusteringrevealed significantresultsatfourhierarchicallevels.Thehigherproportionofthevariationintheoccurrenceofactivetrachomawas attributable to the village level (36.7%), followed by household (25.3%), and child (24.7%) levels. Beyond some well- establishedindividualriskfactors(agebetween3and5,dirtyface,andfliesontheface),weshowedthatcaretaker-level (wipingafterbodywashing),household-level(commonownershipofradio,andmotorbike),andvillage-level(presenceofa women’s associat