Spatial analysis of pulmonary tuberculosis in Antananarivo Madagascar: tuberculosis-related knowledge, attitude and practice.
BACKGROUND
Tuberculosis infection may remain latent, but the disease is nevertheless a serious public health issue. Various epidemiological studies on pulmonary tuberculosis have considered the spatial component and taken it into account, revealing the tendency of this disease to cluster in particular locations. The aim was to assess the contribution of Knowledge Attitude and Practice (KAP) to the distribution of tuberculosis and to provide information for the improvement of the National Tuberculosis Program.


METHODS
We investigated the role of KAP to distribution patterns of pulmonary tuberculosis in Antananarivo. First, we performed spatial scanning of tuberculosis aggregation among permanent cases resident in Antananarivo Urban Township using the Kulldorff method, and then we carried out a quantitative study on KAP, involving TB patients. The KAP study in the population was based on qualitative methods with focus groups.


RESULTS
The disease still clusters in the same districts identified in the previous study. The principal cluster covered 22 neighborhoods. Most of them are part of the first district. A secondary cluster was found, involving 18 neighborhoods in the sixth district and two neighborhoods in the fifth. The relative risk was respectively 1.7 (p<10-6) in the principal cluster and 1.6 (p<10-3) in the secondary cluster. Our study showed that more was known about TB symptoms than about the duration of the disease or free treatment. Knowledge about TB was limited to that acquired at school or from relatives with TB. The attitude and practices of patients and the population in general indicated that there is still a stigma attached to tuberculosis.


CONCLUSIONS
This type of survey can be conducted in remote zones where the tuberculosis-related KAP of the TB patients and the general population is less known or not documented; the findings could be used to adapt control measures to the local particularities.
Département de géographie, Faculté des Lettres et Sciences humaines, Université d' Antananarivo, Antananarivo, Madagascar.
Sitraka
S
Rakotosamimanana
Institut National de Santé Publique et Communautaire, Antananarivo, Madagascar.
Vatsiharizandry
V
Mandrosovololona
Institut National de Santé Publique et Communautaire, Antananarivo, Madagascar; Etablissement Universitaire de Soins de Santé Publique d'Analakely, Antananarivo, Madagascar.
Julio
J
Rakotonirina
Département de géographie, Faculté des Lettres et Sciences humaines, Université d' Antananarivo, Antananarivo, Madagascar.
Joselyne
J
Ramamonjisoa
Institut National de Santé Publique et Communautaire, Antananarivo, Madagascar.
Justin Rasolofomanana
JR
Ranjalahy
Institut Pasteur, Antananarivo, Madagascar.
Rindra Vatosoa
RV
Randremanana
Institut Pasteur, Antananarivo, Madagascar.
Fanjasoa
F
Rakotomanana
D016000:Cluster Analysis; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008270:Madagascar / Q000453:epidemiology; D011156:Population Density; D012306:Risk; D012923:Social Class; D062206:Spatial Analysis; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000635:transmission