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Research article - Peer-reviewed, 2022

Why is leptospirosis hard to avoid for the impoverished? Deconstructing leptospirosis transmission risk and the drivers of knowledge, attitudes, and practices in a disadvantaged community in Salvador, Brazil

G. Palma, Fabiana Almerinda; Costa, Federico; Lustosa, Ricardo; Mogaji, Hammed O.; de Oliveira, Daiana Santos; Souza, Fabio Neves; Reis, Mitermayer G.; Ko, Albert I.; Begon, Michael; Khalil, Hussein


Several studies have identified socioeconomic and environmental risk factors for infectious disease, but the relationship between these and knowledge, attitudes, and practices (KAP), and more importantly their web of effects on individual infection risk, have not previously been evaluated. We conducted a cross-sectional KAP survey in an urban disadvantaged community in Salvador, Brazil, leveraging on simultaneously collected fine-scale environmental and epidemiological data on leptospirosis transmission. Residents’ knowledge influenced their attitudes which influenced their practices. However, different KAP variables were driven by different socioeconomic and environmental factors; and while improved KAP variables reduced risk, there were additional effects of socioeconomic and environmental factors on risk. For example, males and those of lower socioeconomic status were at greater risk, but once we controlled for KAP, male gender and lower socioeconomic status themselves were not direct drivers of seropositivity. Employment was linked to better knowledge and a less contaminated environment, and hence lower risk, but being employed was independently associated with a higher, not lower risk of leptospirosis transmission, suggesting travel to work as a high risk activity. Our results show how such complex webs of influence can be disentangled. They indicate that public health messaging and interventions should take into account this complexity and prioritize factors that limit exposure and support appropriate prevention practices.


Leptospirosis; Medical risk factors; Socioeconomic aspects of health; Sewage; Brazil; Psychological attitudes Leptospira Urban environments

Published in

PLOS global public health
2022, volume: 2, number: 12, article number: e0000408

Authors' information

G. Palma, Fabiana Almerinda
Federal University of Bahia (UFBA)
Costa, Federico
Federal University of Bahia (UFBA)
Lustosa, Ricardo
Federal University of Bahia (UFBA)
Mogaji, Hammed O.
Federal University of Bahia (UFBA)
de Oliveira, Daiana Santos
Oswaldo Cruz Foundation (FIOCRUZ)
Souza, Fabio Neves
Federal University of Bahia (UFBA)
Reis, Mitermayer G.
Yale University
Ko, Albert I.
Yale University
Begon, Michael
University of Liverpool
Swedish University of Agricultural Sciences, Department of Wildlife, Fish and Environmental Studies

UKÄ Subject classification

Public Health, Global Health, Social Medicine and Epidemiology

Publication Identifiers

DOI: 10.1371/journal.pgph.0000408

URI (permanent link to this page)