Influence of Sociospatial determinants on knowledge, attitudes and practices related to the plague in a population living in endemic areas in the central highlands, Madagascar

Sitraka Rakotosamimanana,Fanjasoa Rakotomanana,François Taglioni,Josélyne Ramamonjisoa,Feno Jacob Rakotoarimanana,Minoarisoa Rajerison,Vaomalala Raharimanga,Rindra Vatosoa Randremanana

doi:10.1186/s12889-021-11101-3

Abstract

BackgroundPlague is endemic to the central highlands of Madagascar. Sporadic human cases or outbreaks can occur annually in these areas. In Madagascar, the associations between endemicity and the knowledge, attitudes and practices (KAP) of the population with regard to this disease remain poorly documented. The aim of this study was to assess KAP related to plague among the population living in the central highlands.MethodsA cross-sectional survey was conducted in the general population from June to August 2017. Based on the reported cases of plague between 2006 and 2015 in two central highland districts, a KAP questionnaire was administered in the population. Based on the proportion of correct answers provided by respondents, KAP scores were classified into three KAP categories: low (< Mean - SD), medium (Mean ± SD) and good (> Mean + SD). Multivariate analyses were performed to determine the associations between population KAP scores related to plague and sociodemographic and epidemiological factors. In addition, individual interviews and focus groups with health professionals were conducted to assess plague perception.ResultsA total of 597 individuals participated in the survey; 20% (n = 119) had a good KAP score, 62% (n = 370) a medium KAP score and 18% (n = 108) a low KAP score. Among the 119 respondents with good KAP scores, 80% (n = 95) resided in Ambositra district, and 20% (n = 24) resided in Tsiroanomandidy district. According to the health professionals in the two districts, populations in endemic areas are well aware of the plague. There were significant associations (p < 0.05) of not owning a mobile phone, having no contact with a former plague case, and living in Tsiroanomandidy district with a lower KAP score.ConclusionThe results of the study showed the need to adapt plague control interventions to the local context to allow a better allocation of human and financial resources. Doing so would minimize delays in patient management care and increase community resilience to plague epidemics.

Highlights

Plague is endemic to the central highlands of Madagascar
Our results showed that the possibility of having a higher KAP score decreased for an individual without a telephone [adjusted odds ratio ORa = 0.64, p = 0.009] who had never been in contact with a suspected case of plague [ORa = 0.42, p = 0.001] and who lived in Tsiroanomandidy [ORa = 0.37 (95% IC 0.26– 0.52), p < 0.001]
The purpose of the current study was to determine the relationship between KAP related to plague of populations, the sociospatial determinants and the epidemiological features in two plague endemic districts of the central highlands in Madagascar

Summary

Introduction

Plague is endemic to the central highlands of Madagascar. Sporadic human cases or outbreaks can occur annually in these areas. Due to the annual occurrence of human cases and deaths, plague remains a public health problem in Madagascar [7, 8]. Endemic to Madagascar since the end of the nineteenth century, knowledge, attitudes and perceptions about plague remain understudied. These are contributing factors that could potentially be linked to the annual increase in plague cases in endemic areas. It could be a source of delays in care seeking

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