Using step selection functions to analyse human mobility using telemetry data in infectious disease epidemiology: a case study of leptospirosis

Reviewer #1 (Public review):

Summary:

The study investigated how individuals living in urban slums in Salvador, Brazil, interact with environmental risk factors, particularly focusing on domestic rubbish piles, open sewers, and a central stream. The study makes use of the step selection functions using telemetry data, which is a method to estimate how likely individuals move towards these environmental features, differentiating among groups by gender, age, and leptospirosis serostatus. The results indicated that women tended to stay closer to the central stream while avoiding open sewers more than men. Furthermore, individuals who tested positive for leptospirosis tended to avoid open sewers, suggesting that behavioral patterns might influence exposure to risk factors for leptospirosis, hence ensuring more targeted interventions.

Strengths:

(1) The use of step selection functions to analyze human movement represents an innovative adaptation of a method typically used in animal ecology. This provides a robust quantitative framework for evaluating how people interact with environmental risk factors linked to infectious diseases (in this case, leptospirosis).

(2) Detailed differentiation by gender and serological status allows for nuanced insights, which can help tailor targeted interventions and potentially improve public health measures in urban slum settings.

(3) The integration of real-world telemetry data with epidemiological risk factors supports the development of predictive models that can be applied in future infectious disease research, helping to bridge the gap between environmental exposure and health outcomes.

Weaknesses:

(1) The sample size for the study was not calculated, although it was a nested cohort study.

(2) The step‐selection functions, though a novel method, may face challenges in fully capturing the complexity of human decision-making influenced by socio-cultural and economic factors that were not captured in the study.

(3) The study's context is limited to a specific urban slum in Salvador, Brazil, which may reduce the generalizability of its findings to other geographical areas or populations that experience different environmental or socio-economic conditions.

(4) The reliance on self-reported or telemetry-based movement data might include some inaccuracies or biases that could affect the precision of the selection coefficients obtained, potentially limiting the study's predictive power.

(5) Some participants with less than 50 relocations within the study area were excluded without clear justification, see line 149.

(6) Some figures are not clear (see Figure 4 A & B).

(7) No statement on conflict of interest was included, considering sponsorship of the study.

Reviewer #2 (Public review):

Summary:

Pablo Ruiz Cuenca et al. conducted a GPS logger study with 124 adult participants across four different slum areas in Salvador, Brazil, recording GPS locations every 35 seconds for 48 hours. The aim of their study was to investigate step-selection models, a technique widely used in movement ecology to quantify contact with environmental risk factors for exposure to leptospires (open sewers, community streams, and rubbish piles). The authors built two different types of models based on distance and based on buffer areas to model human environmental exposure to risk factors. They show differences in movement/contact with these risk factors based on gender and seropositivity status. This study shows the existence of modest differences in contact with environmental risk factors for leptospirosis at small spatial scales based on socio-demographics and infection status.

Strengths:

The authors assembled a rich dataset by collecting human GPS logger data, combined with field-recorded locations of open sewers, community streams, and rubbish piles, and testing individuals for leptospirosis via serology. This study was able to capture fine-scale exposure dynamics within an urban environment and shows differences by gender and seropositive status, using a method novel to epidemiology (step selection).

Weaknesses:

Due to environmental data being limited to the study area, exposure elsewhere could not be captured, despite previous research by Owers et al. showing that the extent of movement was associated with infection risk. Limitations of step selection for use in studying human participants in an urban environment would need to be explicitly discussed.