Sub-district spatial heterogeneity in trachoma seroprevalence as populations approach elimination

Abstract Programmatic decisions regarding surveillance and intervention for trachoma are made at the district level, reflecting an implicit assumption that transmission within districts is sufficiently homogeneous. However, as transmission declines, residual pockets of transmission may become spatially heterogeneous at sub-district scales. Using cluster-level data from 12 districts in Amhara, Ethiopia (2019–2023), we assess the spatial structure of Pgp3 antibody responses, a sensitive measure of infection transmission. Spatial clustering was evident in higher prevalence districts but diminished as populations approached elimination. We show that as districts approach elimination sub-district heterogeneity likely disappears, and district-level summaries may be sufficient to guide decision-making.

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Publication Details

Journal
The Journal of Infectious Diseases
Published
2026-07-17
DOI
https://doi.org/10.1093/infdis/jiag375
Primary Topic
Reproductive tract infections research
Type
article
Field-Weighted Citation Impact
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article

Sub-district spatial heterogeneity in trachoma seroprevalence as populations approach elimination

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The Journal of Infectious Diseases
Reproductive tract infections research
article

Sub-district spatial heterogeneity in trachoma seroprevalence as populations approach elimination

Diana L. Martin, Adisu Abebe, Benjamin F. Arnold, Pearl Anne Ante-Testard, Scott D. Nash, Ariktha Srivathsan, Eshetu Sata, E. Kelly Callahan, Jeremy D. Keenan, Sarah Gwyn, Thomas M. Lietman, Ambahun Chernet, Everlyn Kamau, Karana Wickens, Getahun Ayenew, Tania A Gonzalez, Zerihun Tadesse
article en

Abstract

Abstract Programmatic decisions regarding surveillance and intervention for trachoma are made at the district level, reflecting an implicit assumption that transmission within districts is sufficiently homogeneous. However, as transmission declines, residual pockets of transmission may become spatially heterogeneous at sub-district scales. Using cluster-level data from 12 districts in Amhara, Ethiopia (2019–2023), we assess the spatial structure of Pgp3 antibody responses, a sensitive measure of infection transmission. Spatial clustering was evident in higher prevalence districts but diminished as populations approached elimination. We show that as districts approach elimination sub-district heterogeneity likely disappears, and district-level summaries may be sufficient to guide decision-making.

The Journal of Infectious Diseases
Carter Center (US), University of California, San Francisco (US), San Francisco Foundation (US), Amhara Regional Health Bureau (ET), The Carter Center (ET), Global Brain Health Institute (US), Division of Parasitic Diseases and Malaria (US)
Peace, Justice and strong institutions
Openalex Percentile: Top 9%
Reproductive tract infections research
DOIOpen Access PDFOpenAlex
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