Why is leptospirosis hard to avoid for the impoverished? Deconstructing leptospirosis transmission risk and the drivers of knowledge, attitudes, and practices in a disadvantaged community in Salvador, Brazil.
Why is leptospirosis hard to avoid for the impoverished? Deconstructing leptospirosis transmission risk and the drivers of knowledge, attitudes, and practices in a disadvantaged community in Salvador, Brazil.
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DOI：
10.1371/journal.pgph.0000408
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发表时间：
2022
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一些研究已经确定了传染病的社会经济和环境风险因素，但这些因素与知识、态度和实践（KAP）之间的关系，更重要的是它们对个体感染风险的影响网络，以前没有被评估过。我们在巴西萨尔瓦多的一个城市弱势社区进行了一项横断面KAP调查，利用同时收集的关于钩端螺旋体病传播的精细规模环境和流行病学数据。居民的知识影响他们的态度，从而影响他们的做法。然而，不同的KAP变量是由不同的社会经济和环境因素驱动的;虽然改进的KAP变量可以降低风险，但社会经济和环境因素对风险还有额外的影响。例如，男性和社会经济地位较低的人风险更大，但一旦我们控制了KAP，男性性别和较低的社会经济地位本身并不是血清阳性的直接驱动因素。就业与更好的知识和污染较少的环境有关，因此风险较低，但就业与钩端螺旋体病传播的风险较高而不是较低独立相关，这表明上班旅行是一种高风险活动。我们的研究结果显示了如何解开这种复杂的影响网络。它们表明，公共卫生信息和干预措施应考虑到这一复杂性，并优先考虑限制接触和支持适当预防做法的因素。
Several studies have identified socioeconomic and environmental risk factors for infectious disease, but the relationship between these and knowledge, attitudes, and practices (KAP), and more importantly their web of effects on individual infection risk, have not previously been evaluated. We conducted a cross-sectional KAP survey in an urban disadvantaged community in Salvador, Brazil, leveraging on simultaneously collected fine-scale environmental and epidemiological data on leptospirosis transmission. Residents’ knowledge influenced their attitudes which influenced their practices. However, different KAP variables were driven by different socioeconomic and environmental factors; and while improved KAP variables reduced risk, there were additional effects of socioeconomic and environmental factors on risk. For example, males and those of lower socioeconomic status were at greater risk, but once we controlled for KAP, male gender and lower socioeconomic status themselves were not direct drivers of seropositivity. Employment was linked to better knowledge and a less contaminated environment, and hence lower risk, but being employed was independently associated with a higher, not lower risk of leptospirosis transmission, suggesting travel to work as a high risk activity. Our results show how such complex webs of influence can be disentangled. They indicate that public health messaging and interventions should take into account this complexity and prioritize factors that limit exposure and support appropriate prevention practices.