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.



Palma, Fabiana Almerinda G ORCID: 0000-0002-7345-4914, Costa, Federico, Lustosa, Ricardo ORCID: 0000-0001-5033-690X, Mogaji, Hammed O ORCID: 0000-0001-7330-2892, de Oliveira, Daiana Santos, Souza, Fábio Neves ORCID: 0000-0002-3542-8918, Reis, Mitermayer G ORCID: 0000-0002-3051-9060, Ko, Albert I ORCID: 0000-0001-9023-2339, Begon, Michael ORCID: 0000-0003-1715-5327 and Khalil, Hussein ORCID: 0000-0001-9982-6387
(2022) 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. PLOS global public health, 2 (12). e0000408-.

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Abstract

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.

Item Type: Article
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Depositing User: Symplectic Admin
Date Deposited: 25 Jan 2023 11:46
Last Modified: 31 Mar 2023 06:16
DOI: 10.1371/journal.pgph.0000408
Open Access URL: https://doi.org/10.1371/journal.pgph.0000408
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3167876