Assessing the validity of school-attending children as predictors of community onchocerciasis prevalence in Burundi, Ethiopia, Kenya, and Malawi Restricted; Files Only

Sielbach, Heidi (Spring 2024)

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Onchocerciasis, commonly known as river blindness, is a neglected tropical disease caused by the parasite Onchocerca volvulus. The disease is transmitted through bites from infected black flies and can lead to irreversible blindness. Onchocerciasis can be treated with antifilarial medications like ivermectin, which is administered annually through mass drug administration (MDA) programs in affected regions. Global elimination efforts utilize a standardized Onchocerciasis Elimination Mapping (OEM) protocol. Making progress towards onchocerciasis elimination by 2030 is a key component of the United Nations' Sustainable Development Goals. Collecting the necessary number of samples can be time- and labor-intensive under current OEM strategies. Utilizing school-attending children to predict onchocerciasis prevalence in neighboring villages, if valid, would increase the efficiency of OEM in hypo-endemic areas.


This study used data collected between September 2018 and June 2023 in Burundi, Ethiopia, Kenya, and Malawi using standard OEM data collection protocols. Participant samples were analyzed using two serological tests: an Ov16 rapid biplex field test and an Ov16 SD ELISA laboratory test. Data was analyzed in SAS to evaluate the correlation between onchocerciasis prevalence in school-attending children and adults in geographically paired villages.


Prevalence rates varied significantly between stratification levels and between serological tests. Discrepancies between the tests were assessed at the district level and between individual school/village pairs. Spearman's rank correlation suggested minimal evidence of a non-linear relationship between the prevalence of onchocerciasis in school-attending children and in village adults when analyzed at the paired school/village level, and a moderate strength relationship at the district level. The diversity of the study’s results highlights the impact of geographic and demographic influences on disease endemicity.


These results indicate that onchocerciasis prevalence in school-attending children does not accurately predict adult prevalence within paired villages, with correlation coefficients ranging from very low to moderate depending on the test and analysis scale. This study, conducted in four countries with varying disease endemicity, underscores the limitations of relying solely on school-based prevalence data for community-wide health assessments. The findings advocate for improved diagnostic tools and continued research into more effective disease mapping and elimination approaches, particularly in hypo-endemic areas. 

Table of Contents

Introduction... 1

Methods... 6

Results... 10

Discussion... 12

Conclusions and Public Health Limitations... 14

Appendix... 16

References... 34

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