KAP Surveys and Dengue Control in Colombia: Disentangling the Effect of Sociodemographic Factors Using Multiple Correspondence Analysis

<div><p>During the last few decades, several studies have analyzed and described knowledge, attitudes, and practices (KAP) of populations regarding dengue. However, few studies have applied geometric data analytic techniques to generate indices from KAP domains. Results of such analyses have not been used to determine the potential effects of sociodemographic variables on the levels of KAP. The objective was to determine the sociodemographic factors related to different levels of KAP regarding dengue in two hyper-endemic cities of Colombia, using a multiple correspondence analysis (MCA) technique. In the context of a cluster randomized trial, 3,998 households were surveyed in Arauca and Armenia between 2012 and 2013. To generate KAP indexes, we performed a MCA followed by a hierarchical cluster analysis to classify each score in different groups. A quantile regression for each of the score groups was conducted. KAP indexes explained 56.1%, 79.7%, and 83.2% of the variance, with means of 4.2, 1.4, and 3.2 and values that ranged from 1 to 7, 7 and 11, respectively. The highest values of the index denoted higher levels of knowledge and practices. The attitudes index did not show the same relationship and was excluded from the analysis. In the quantile regression, age (0.06; IC: 0.03, 0.09), years of education (0.14; IC: 0.06, 0.22), and history of dengue in the family (0.21; IC: 0.12, 0.31) were positively related to lower levels of knowledge regarding dengue. The effect of such factors gradually decreased or disappeared when knowledge was higher. The practices indexes did not evidence a correlation with sociodemographic variables. These results suggest that the transformation of categorical variables into a single index by the use of MCA is possible when analyzing knowledge and practices regarding dengue from KAP questionnaires. Additionally, the magnitude of the effect of socioeconomic variables on the knowledge scores varies according to the levels of knowledge, suggesting that other factors might be influencing higher levels of knowledge.</p></div

Profiles of Knowledge and practices.

<p>Profiles of Knowledge and practices.</p

Sociodemographic characteristics of population.

<p>Sociodemographic characteristics of population.</p

Distribution of the scores of knowledge, attitudes and practices.

<p><b>KAP profiles.</b> Box plots of the scores of knowledge, attitudes and practices A. Knowledge profile scores are evenly distributed around the median with few outliers, predominantly below 1.8. B. Attitude scores are skewed to the right and values rages between 1 and 7. C. Practices is also skewed to the right with a range between 1 and 11.</p

Factors associated to low medium and high levels of knowledge, Armenia and Arauca.

<p>Factors associated to low medium and high levels of knowledge, Armenia and Arauca.</p

Understanding Water Storage Practices of Urban Residents of an Endemic Dengue Area in Colombia: Perceptions, Rationale and Socio-Demographic Characteristics

<div><p>Introduction</p><p>The main preventive measure against dengue virus transmission is often based on actions to control <i>Ae</i>. <i>Aegypti</i> reproduction by targeting water containers of clean and stagnant water. Household water storage has received special attention in prevention strategies but the evidence about the rationale of this human practice is limited. The objective was to identify and describe water storage practices among residents of an urban area in Colombia (Girardot) and its association with reported perceptions, rationales and socio-demographic characteristics with a mixed methods approach.</p><p>Methods</p><p>Knowledge, attitudes and practices and entomological surveys from 1,721 households and 26 semi-structured interviews were conducted among residents of Girardot and technicians of the local vector borne disease program. A multivariate analysis was performed to identify associations between a water storage practice and socio-demographic characteristics, and knowledge, attitudes and practices about dengue and immature forms of the vector, which were then triangulated with qualitative information.</p><p>Results</p><p>Water storage is a cultural practice in Girardot. There are two main reasons for storage: The scarcity concern based on a long history of shortages of water in the region and the perception of high prices in water rates, contrary to what was reported by the local water company. The practice of water storage was associated with being a housewife (Inverse OR: 2.6, 95% CI 1.5 -4.3). The use of stored water depends on the type of container used, while water stored in <i>alberca</i> (Intra household cement basins) is mainly used for domestic cleaning chores, water in plastic containers is used for cooking.</p><p>Conclusions</p><p>It is essential to understand social practices that can increase or reduce the number of breeding sites of <i>Ae</i>. <i>Aegypti</i>. Identification of individuals who store water and the rationale of such storage allow a better understanding of the social dynamics that lead to water accumulation.</p></div

Reported KAP variables regarding dengue and <i>Ae</i>. <i>aegypti</i> vector according to water storage, Girardot 2013 (n = 1,721).

<p>^(a) Chi square test.</p><p>^(b) Fisher test.</p><p>Reported KAP variables regarding dengue and <i>Ae</i>. <i>aegypti</i> vector according to water storage, Girardot 2013 (n = 1,721).</p

Plastic bins: Plastic containers with a capacity inferior or equal to 20 liters.

<p>Plastic bins: Plastic containers with a capacity inferior or equal to 20 liters.</p

Tank: Cylindrical structure made of plastic or fibber cement with a capacity superior to 250 liters.

<p>Tank: Cylindrical structure made of plastic or fibber cement with a capacity superior to 250 liters.</p