Predicting the environmental suitability for onchocerciasis in Africa as an aid to elimination planning.

Elizabeth A Cromwell ORCID logo; Joshua CP Osborne; Thomas R Unnasch ORCID logo; Maria-Gloria Basáñez ORCID logo; Katherine M Gass ORCID logo; Kira A Barbre ORCID logo; Elex Hill ORCID logo; Kimberly B Johnson ORCID logo; Katie M Donkers; Shreya Shirude; +214 more... 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Olalekan A Uthman; Natalie VS Vinkeles Melchers ORCID logo; Francesco S Violante ORCID logo; Haileab Fekadu Wolde; Tewodros Eshete Wonde ORCID logo; Tomohide Yamada; Sanni Yaya ORCID logo; Vahid Yazdi-Feyzabadi ORCID logo; Paul Yip; Naohiro Yonemoto ORCID logo; Hebat-Allah Salah A Yousof; Chuanhua Yu; Yong Yu; Hasan Yusefzadeh; Leila Zaki; Sojib Bin Zaman ORCID logo; Maryam Zamanian ORCID logo; Zhi-Jiang Zhang ORCID logo; Yunquan Zhang; Arash Ziapour ORCID logo; Simon I Hay ORCID logo; David M Pigott; (2021) Predicting the environmental suitability for onchocerciasis in Africa as an aid to elimination planning. PLoS neglected tropical diseases, 15 (7). e0008824-. ISSN 1935-2727 DOI: 10.1371/journal.pntd.0008824
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Recent evidence suggests that, in some foci, elimination of onchocerciasis from Africa may be feasible with mass drug administration (MDA) of ivermectin. To achieve continental elimination of transmission, mapping surveys will need to be conducted across all implementation units (IUs) for which endemicity status is currently unknown. Using boosted regression tree models with optimised hyperparameter selection, we estimated environmental suitability for onchocerciasis at the 5 × 5-km resolution across Africa. In order to classify IUs that include locations that are environmentally suitable, we used receiver operating characteristic (ROC) analysis to identify an optimal threshold for suitability concordant with locations where onchocerciasis has been previously detected. This threshold value was then used to classify IUs (more suitable or less suitable) based on the location within the IU with the largest mean prediction. Mean estimates of environmental suitability suggest large areas across West and Central Africa, as well as focal areas of East Africa, are suitable for onchocerciasis transmission, consistent with the presence of current control and elimination of transmission efforts. The ROC analysis identified a mean environmental suitability index of 0·71 as a threshold to classify based on the location with the largest mean prediction within the IU. Of the IUs considered for mapping surveys, 50·2% exceed this threshold for suitability in at least one 5 × 5-km location. The formidable scale of data collection required to map onchocerciasis endemicity across the African continent presents an opportunity to use spatial data to identify areas likely to be suitable for onchocerciasis transmission. National onchocerciasis elimination programmes may wish to consider prioritising these IUs for mapping surveys as human resources, laboratory capacity, and programmatic schedules may constrain survey implementation, and possibly delaying MDA initiation in areas that would ultimately qualify.


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