Modeling global strategies for control and elimination of helminth infections
Abstract/Contents
- Abstract
- Schistosomiasis and soil-transmitted helminthiasis (STH) are helminth diseases that affect 1.5 billion people in the world's poorest regions. Given over a decade of experience on the public health control of these helminth infections, new strategies are now necessary to push towards more ambitious goals of optimal morbidity control and eventual elimination of transmission. In this thesis, I apply methods of mathematical epidemiology, health economics, and causal inference to evaluate new strategies to improve global control and elimination of these helminth infections. In chapter 2-3, I model transmission dynamics and cost-effectiveness to define optimal programmatic mass drug administration (MDA) against schistosomiasis and STH with reference to World Health Organization (WHO) guidelines. I find that expanding MDA from the status quo of only school-aged children to entire communities would avert substantial disease morbidity across all age groups, reduce reinfection rates, and be highly cost-effective. The strategy of annual MDA against schistosomiasis was highly cost-effective in treatment of school-aged children above 5% prevalence (WHO recommends 50%) and entire communities above 15%. Annual MDA against STH was highly cost-effective in treatment of school-aged children above 20% prevalence (WHO recommends 20%) and entire communities above 60%. Using cost-effective MDA recommendations, I estimate that treatment needs in sub-Saharan Africa would be 6-fold higher than current guidelines for praziquantel and 2-fold higher for albendazole. In chapter 4, I evaluate urine-pooling strategies for schistosomiasis surveillance to inform where MDA is needed using simulation modeling and primary epidemiologic data. I find that urine-pooling strategies can reduce the number of tests and cost for rapid Schistosoma prevalence estimation compared with traditional stool microscopy. In chapter 5, I perform a global empirical evaluation of relationships between deworming and health outcomes in over 320,000 pre-school age children using observational data from 45 countries. I detect a robust and consistent association between deworming and reduced stunting, with additional evidence for reduced anemia in sub-Saharan Africa. This dissertation provide rigorous epidemiologic analyses utilized by the international community to inform the global strategy against schistosomiasis and STH, and highlight further opportunities to avert the substantial disease burden caused by these neglected tropical diseases.
Description
| Type of resource | text |
|---|---|
| Form | electronic resource; remote; computer; online resource |
| Extent | 1 online resource. |
| Place | California |
| Place | [Stanford, California] |
| Publisher | [Stanford University] |
| Copyright date | 2019; ©2019 |
| Publication date | 2019; 2019 |
| Issuance | monographic |
| Language | English |
Creators/Contributors
| Author | Lo, Nathan C |
|---|---|
| Degree supervisor | Andrews, Jason |
| Degree supervisor | Bendavid, Eran |
| Thesis advisor | Andrews, Jason |
| Thesis advisor | Bendavid, Eran |
| Thesis advisor | Basu, Sanjay, 1980- |
| Thesis advisor | Parsonnet, Julie |
| Thesis advisor | Popat, Rita |
| Degree committee member | Basu, Sanjay, 1980- |
| Degree committee member | Parsonnet, Julie |
| Degree committee member | Popat, Rita |
| Associated with | Stanford University, Program in Epidemiology. |
Subjects
| Genre | Theses |
|---|---|
| Genre | Text |
Bibliographic information
| Statement of responsibility | Nathan Lo. |
|---|---|
| Note | Submitted to the Program in Epidemiology. |
| Thesis | Thesis Ph.D. Stanford University 2019. |
| Location | electronic resource |
Access conditions
- Copyright
- © 2019 by Nathan Lo
- License
- This work is licensed under a Creative Commons Attribution Non Commercial 3.0 Unported license (CC BY-NC).
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