Optimized strategy for schistosomiasis elimination: results from marginal benefit modeling

Poverty contributes to the transmission of schistosomiasis via multiple pathways, with the insufficiency of appropriate interventions being a crucial factor. The aim of this paper is to provide more economical and feasible intervention measures for endemic areas with varying levels of poverty. We collected and analyzed the prevalence patterns along with the cost of control measures in 11 counties over last 20 years in China. Seven machine learning models, including XGBoost, support vector machine, generalized linear model, regression tree, random forest, gradient boosting machine, and neural network, were used for training. Among them, the XGBoost model had the highest prediction accuracy with an R2 of 0.7308. The XGBoost model was then used to calculate the marginal benefit of each measure in reducing the prevalence of the disease and to obtain the optimal integrated control strategy. Results showed that risk surveillance, snail control with molluscicides and treatment were the most effective interventions in controlling schistosomiasis prevalence; The best combination of interventions was interlacing seven interventions, including risk surveillance, treatment, toilet construction, health education, snail control with molluscicides, cattle slaughter, and animal chemotherapy. The marginal benefit of risk surveillance is the most effective interven-tion among nine interventions, which was influenced by the prevalence of schistosomiasis and cost. In conclusion, in the elimination phase of the national schistosomiasis program, emphasizing risk surveillance holds significant importance in terms of cost-saving.