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Proc Natl Acad Sci U S A. 2017 Sep 5;114(36):E7425-E7431. doi: 10.1073/pnas.1700166114. Epub 2017 Jul 24.

Social network fragmentation and community health.

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Department of Land Economy, University of Cambridge, Cambridge CB3 9EP, United Kingdom;
Department of Pathology, University of Cambridge, Cambridge CB2 1QP, United Kingdom.
Theory of Condensed Matter, Cavendish Laboratory, University of Cambridge, Cambridge CB3 0HE, United Kingdom.
Sainsbury Laboratory, University of Cambridge, Cambridge CB2 1LR, United Kingdom.
Schistosomiasis Control Initiative, Imperial College London, London W2 1PG, United Kingdom.
Vector Control Division, Bilharzia and Worm Control Programme, Uganda Ministry of Health, Kampala, Uganda.


Community health interventions often seek to intentionally destroy paths between individuals to prevent the spread of infectious diseases. Immunizing individuals through direct vaccination or the provision of health education prevents pathogen transmission and the propagation of misinformation concerning medical treatments. However, it remains an open question whether network-based strategies should be used in place of conventional field approaches to target individuals for medical treatment in low-income countries. We collected complete friendship and health advice networks in 17 rural villages of Mayuge District, Uganda. Here we show that acquaintance algorithms, i.e., selecting neighbors of randomly selected nodes, were systematically more efficient in fragmenting all networks than targeting well-established community roles, i.e., health workers, village government members, and schoolteachers. Additionally, community roles were not good proxy indicators of physical proximity to other households or connections to many sick people. We also show that acquaintance algorithms were effective in offsetting potential noncompliance with deworming treatments for 16,357 individuals during mass drug administration (MDA). Health advice networks were destroyed more easily than friendship networks. Only an average of 32% of nodes were removed from health advice networks to reduce the percentage of nodes at risk for refusing treatment in MDA to below 25%. Treatment compliance of at least 75% is needed in MDA to control human morbidity attributable to parasitic worms and progress toward elimination. Our findings point toward the potential use of network-based approaches as an alternative to role-based strategies for targeting individuals in rural health interventions.


community health; immunization; mass drug administration; percolation; social networks

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Conflict of interest statement

Conflict of interest statement: G.F.C. and S.E.A. declare no competing interests. N.B.K. is employed by the Schistosomiasis Control Initiative (SCI). E.M.T. is the Assistant Commissioner of Health Services for the Vector Control Division of Ministry of Health and the National Coordinator for SCI of the Neglected Tropical Disease Control/Elimination Programme in Uganda.

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