Sociological variety and the transmission efficiency of Mycobacterium tuberculosis: a secondary analysis of qualitative and quantitative data from 15 communities in Zambia
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 of Mycobacterium tuberculosis infection and tuberculosis (TB) disease across these communities. We sought...
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BMJ Publishing Group
2021-12-01
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| author | Richard G White Virginia Bond Peter J Dodd Ben Marais Helen Ayles Emma J Murray Kwame Shanaube Albertus Schaap |
| author_facet | Richard G White Virginia Bond Peter J Dodd Ben Marais Helen Ayles Emma J Murray Kwame Shanaube Albertus Schaap |
| author_sort | Richard G White |
| collection | DOAJ |
| description | 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 of Mycobacterium tuberculosis infection and tuberculosis (TB) disease across these communities. We sought to clarify whether specific communities could have been more/less vulnerable to M. tuberculosis transmission 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 of M. tuberculosis transmission. 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 in M. tuberculosis transmission 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. |
| format | Article |
| id | doaj-art-f25390d066cb40fcbe5ae869d8dbd8ad |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-f25390d066cb40fcbe5ae869d8dbd8ad2024-12-09T23:15:12ZengBMJ Publishing GroupBMJ Open2044-60552021-12-01111210.1136/bmjopen-2020-047136Sociological variety and the transmission efficiency of Mycobacterium tuberculosis: a secondary analysis of qualitative and quantitative data from 15 communities in ZambiaRichard G White0Virginia Bond1Peter J Dodd2Ben Marais3Helen Ayles4Emma J Murray5Kwame Shanaube6Albertus Schaap7TB Modelling Group, London School of Hygiene & Tropical Medicine, London, UK4 Zambart, University of Zambia, Lusaka, ZambiaSchool of Health and Related Research, The University of Sheffield, Sheffield, UKSydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, New South Wales, Australia1 Zambart, Lusaka, ZambiaIndependent researcher, Cambridge, UK1 Zambart, Lusaka, ZambiaDepartment of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UKObjectives 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 of Mycobacterium tuberculosis infection and tuberculosis (TB) disease across these communities. We sought to clarify whether specific communities could have been more/less vulnerable to M. tuberculosis transmission 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 of M. tuberculosis transmission. 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 in M. tuberculosis transmission 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.https://bmjopen.bmj.com/content/11/12/e047136.full |
| spellingShingle | Richard G White Virginia Bond Peter J Dodd Ben Marais Helen Ayles Emma J Murray Kwame Shanaube Albertus Schaap Sociological variety and the transmission efficiency of Mycobacterium tuberculosis: a secondary analysis of qualitative and quantitative data from 15 communities in Zambia BMJ Open |
| title | Sociological variety and the transmission efficiency of Mycobacterium tuberculosis: a secondary analysis of qualitative and quantitative data from 15 communities in Zambia |
| title_full | Sociological variety and the transmission efficiency of Mycobacterium tuberculosis: a secondary analysis of qualitative and quantitative data from 15 communities in Zambia |
| title_fullStr | Sociological variety and the transmission efficiency of Mycobacterium tuberculosis: a secondary analysis of qualitative and quantitative data from 15 communities in Zambia |
| title_full_unstemmed | Sociological variety and the transmission efficiency of Mycobacterium tuberculosis: a secondary analysis of qualitative and quantitative data from 15 communities in Zambia |
| title_short | Sociological variety and the transmission efficiency of Mycobacterium tuberculosis: a secondary analysis of qualitative and quantitative data from 15 communities in Zambia |
| title_sort | sociological variety and the transmission efficiency of mycobacterium tuberculosis a secondary analysis of qualitative and quantitative data from 15 communities in zambia |
| url | https://bmjopen.bmj.com/content/11/12/e047136.full |
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