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.

Autor:	Palma FAG; Federal University of Bahia, Salvador/Institute Health Collective, Salvador, Bahia, Brazil., Costa F; Federal University of Bahia, Salvador/Institute Health Collective, Salvador, Bahia, Brazil.; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brazil., Lustosa R; Federal University of Bahia, Salvador/Institute Health Collective, Salvador, Bahia, Brazil., Mogaji HO; Federal University of Bahia, Salvador/Institute Health Collective, Salvador, Bahia, Brazil., de Oliveira DS; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brazil., Souza FN; Federal University of Bahia/Institute of Biology, Salvador, Bahia, Brazil., Reis MG; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brazil.; Faculdade de Medicina da Bahia, Federal University of Bahia, Salvador, Brazil.; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America., Ko AI; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brazil.; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America., Begon M; Department of Evolution, Ecology and Behaviour, The University of Liverpool, United Kingdom., Khalil H; Department of Wildlife, Fish, and Environmental Studies, Swedish University of Agricultural Sciences, Umeå, Sweden.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2022 Dec 09; Vol. 2 (12), pp. e0000408. Date of Electronic Publication: 2022 Dec 09 (Print Publication: 2022).
DOI:	10.1371/journal.pgph.0000408
Abstrakt:	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. Competing Interests: The authors have declared that no competing interests exist. (Copyright: © 2022 Palma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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