Spatial analysis of the distribution of intestinal nematode infections in Uganda

The spatial epidemiology of intestinal nematodes in Uganda was investigated using generalized additive models and geostatistical methods. The prevalence of Ascaris lumbricoides and Trichuris trichiura was unevenly distributed in the country with prevalence greatest in southwest Uganda whereas hookworm was more homogeneously distributed. A. lumbricoides and T. Trichiura prevalence were nonlinearly related to satellite sensor-based estimates of land surface temperature; hookworm was nonlinearly associated with rainfall. Semivariogram analysis indicated that T. trichiura prevalence exhibited no spatial structure and that A. lumbricoides exhibited some spatial dependency at small spatial distances, once large-scale, mainly environmental, trends had been removed. In contrast, there was much more spatial structure in hookworm prevalence although the underlying factors are at present unclear. The implications of the results are discussed in relation to parasite spatial epidemiology and the prediction of infection distributions.