Spatial Clustering of Intestinal Parasitic Infections Among Schoolchildren in Conflict-Affected Yemen: A GIS-Based Epidemiological Study

This project contains all supplementary materials, datasets, and analysis scripts supporting the manuscript entitled "Spatial Heterogeneity of Intestinal Parasitic Infections Among Schoolchildren in Rural Yemen: A Geographic Information Systems (GIS) Analysis." The study investigated the geographic distribution and spatial clustering of intestinal parasitic infections (IPIs) among 1,200 schoolchildren across all nine districts of Al-Dhalea Governorate, Yemen. --- Background Intestinal parasitic infections remain a significant public health challenge in low-income countries, particularly affecting school-aged children. In Yemen, protracted conflict since 2015 has devastated health infrastructure and disrupted water and sanitation systems, creating conditions ideal for enteric pathogen transmission. While traditional epidemiological studies report prevalence estimates and identify risk factors, they rarely examine the spatial dimensions of infection distribution. Geographic Information Systems (GIS) and spatial analysis techniques offer powerful tools to visualize disease patterns, identify clusters of elevated risk, and generate hypotheses about underlying environmental determinants. This study represents the first spatial analysis of IPIs in Yemen, addressing an important gap in the literature and providing evidence for targeted, geographically informed public health interventions. --- Study Objectives 1. To visualize the geographic distribution of IPI prevalence across all nine districts of Al-Dhalea Governorate, Yemen. 2. To detect and characterize statistically significant spatial clusters of high and low infection risk using global and local spatial autocorrelation methods. 3. To explore associations between infection prevalence and environmental variables including water source quality, population density, and elevation. 4. To provide a fully reproducible analysis with publicly available data and code to facilitate transparency and future research. --- Key Findings · Overall prevalence: 46.2% (555/1,200) of schoolchildren were infected with at least one intestinal parasite. · Geographic variation: Prevalence ranged from 39.1% in Juban district to 53.0% in Jahaf district (absolute difference of 13.9 percentage points). · Spatial clustering: Global Moran's I revealed significant positive spatial autocorrelation (I = 0.342, p = 0.021), indicating that districts with similar prevalence rates were geographically clustered. · Hotspot identification: A statistically significant high-risk cluster (hotspot) comprising Jahaf, Al-Hasha, and Damt districts was identified (Relative Risk = 1.28, p = 0.003). · Coldspot identification: A statistically significant low-risk cluster (coldspot) comprising Juban and Al-Husain districts was identified (Relative Risk = 0.76, p = 0.012). · Environmental correlates: A significant negative correlation was observed between IPI prevalence and access to protected water sources (r = -0.71, p = 0.03).