Structural Equation Modeling (SEM) of Cysticercosis in School-Aged Children in Tibetan Rural Farming Areas of Western China: Implications for Intervention Planning

Huan Zhou, Qingzhi Wang, Junmin Zhou, Tiaoying Li, Alexis Medina, Stephen A. Felt, Scott Rozelle and John J. Openshaw
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Huan Zhou: West China School of Public Health, Sichuan University, Chengdu 610041, China
Qingzhi Wang: West China School of Public Health, Sichuan University, Chengdu 610041, China
Junmin Zhou: West China School of Public Health, Sichuan University, Chengdu 610041, China
Tiaoying Li: Institute of Parasitic Diseases, Sichuan Centers for Disease Control and Prevention, Chengdu 610041, China
Alexis Medina: Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA 94305, USA
Stephen A. Felt: Department of Comparative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
John J. Openshaw: Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA 94305, USA

IJERPH, 2019, vol. 16, issue 5, 1-9

Abstract: Neurocysticercosis (NCC) significantly contributes to morbidity in developing countries. We recently published a study of prevalence and risk factors in school-aged children in three mountainous areas in Sichuan province of western China. Using structural equation modeling (SEM) on data from that study to guide intervention planning, here we examine risk factors grouped into three broad interventional categories: sociodemographics, human behavior, and sources of pork and pig husbandry. Because neuroimaging is not easily available, using SEM allows for the use of multiple observed variables (serological tests and symptoms) to represent probable NCC cases. Data collected from 2608 students was included in this analysis. Within this group, seroprevalence of cysticercosis IgG antibodies was 5.4%. SEM results showed that sociodemographic factors ( β = 0.33, p < 0.05), sources of pork and pig husbandry ( β = 0.26, p < 0.001), and behavioral factors ( β = 0.33, p < 0.05) were all directly related to probable NCC in school-aged children. Sociodemographic factors affected probable NCC indirectly via sources of pork and pig husbandry factors ( β = 0.07, p < 0.001) and behavioral variables ( β = 0.07, p < 0.001). Both sociodemographic factors ( β = 0.07, p < 0.05) and sources of pork and pig husbandry factors ( β = 0.10, p < 0.01) affected probable NCC indirectly via behavioral variables. Because behavioral variables not only had a large direct effect but also served as a critical bridge to strengthen the effect of sociodemographics and sources of pork and pig husbandry on probable NCC, our findings suggest that interventions targeting behavioral factors may be the most effective in reducing disease.

Keywords: neurocysticercosis; school-aged children; intervention planning; structural equation model (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
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