Estimating prevalence of community morbidity due to intestinal helminths: prevalence of infection as an indicator of the prevalence of disease.

The rational design of helminth control programmes for endemic areas requires that the limited resources be focused on the communities in greatest need. The process of locality-targetting would be facilitated by a simple, inexpensive method of assessing morbidity at the community level. This paper describes how a simple model of the distribution of infection in human populations can use infection prevalence data to predict the proportion of heavy, and potentially clinically significant, infections in a community. Analysis of observed data for Ascaris lumbricoides indicates that the risk of clinical ascariasis increases non-linearly with the prevalence of infection. The predicted prevalence of morbidity is low up to approximately 60% prevalence of infection, but increases very rapidly thereafter. Analyses of data for Trichuris trichiura, Schistosoma mansoni, S. haematobium and the hookworms suggests qualitatively similar patterns. The application of the model in predicting resource requirements for control is illustrated using infection prevalence data for A. lumbricoides in Brazil.