Sociological variety and the transmission efficiency ofMycobacterium tuberculosis: a secondary analysis of qualitative and quantitative data from 15 communities in Zambia
Year: 2021
Type: article
Abstract: Objectives Selected Zambian communities formed part of a cluster randomised trial: the Zambia and South Africa TB and AIDS Reduction study (ZAMSTAR). There was wide variability in the prevalence ofMycobacterium tuberculosisinfection and tuberculosis (TB) disease across these communities. We sought to clarify whether specific communities could have been more/less vulnerable toM. tuberculosistransmission as a result of sociological variety relevant to transmission efficiency. Design We conducted a mixed methods secondary analysis using existing data sets. First, we analysed qualitative data to categorise and synthesise patterns of socio-spatial engagement across communities. Second, we compared emergent sociological variables with a measure of transmission efficiency: the ratio of the annual risk of infection to TB prevalence. Setting ZAMSTAR communities in urban and peri-urban Zambia, spanning five provinces. Participants Fifteen communities, each served by a health facility offering TB treatment to a population of at least 25 000. TB notification rates were at least 400 per 100 000 per annum and HIV seroprevalence was estimated to be high. Results Crowding, movement, livelihoods and participation in recreational activity differed across communities. Based on 12 socio-spatial indicators, communities were qualitatively classified as more/less spatially crowded and as more/less socially ‘open’ to contact with others, with implications for the presumptive risk ofM. tuberculosistransmission. For example, watching video shows in poorly ventilated structures posed a presumptive risk in more socially open communities, while outdoor farming and/or fishing were particularly widespread in communities with lower transmission measures. Conclusions A dual dynamic of ‘social permeability’ and crowding appeared relevant to disparities inM. tuberculosistransmission efficiency. To reduce transmission, certain socio-spatial aspects could be adjusted (eg, increasing ventilation on transport), while more structural aspects are less malleable (eg, reliance on public transport). We recommend integrating community level typologies with genome sequencing techniques to further explore the significance of ‘social permeability’. Trial registration number ISRCTN36729271 .
Source: BMJ Open
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,839
Funders: Bill and Melinda Gates Foundation, World Health Organization, Wellcome Trust, National Institute for Health and Care Research, European Commission, Universiteit Stellenbosch, National Institutes of Health, Medical Research Council, Economic and Social Research Council, National Institute of Allergy and Infectious Diseases, European and Developing Countries Clinical Trials Partnership
Awards: G127891921, G1637947929, G1683766189, Improving scientific and public health decision making by developing technologies to increase use of robust methods to calibrate and analyse complex mathematical models, G2143945370, G2347075150, Infection prevention and control for drug-resistant tuberculosis in South Africa in the era of decentralised care: a whole systems approach, G242513792, G2597196005, G2660122252, G3490516762, Defining drivers of TB transmission in the era of universal ART, and implications for finding the walking well, G4728353148, G5322665643, London School of Hygiene and Tropical Medicine - to understand which investments in novel clinical advances in TB vaccines would have greatest impact, Determining the importance of different locations to Mycobacterium tuberculosis transmission in high tuberculosis burden settings, G5704504746, G7063735130, A mathematical modeling framework for tuberculosis burden estimation and economic evaluation of pharmaceutical interventions
OpenAlex ID: W4200410488