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

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.Author Summary: Local vector control programs, as part of their routine activities, often use Knowledge Attitudes and Practices (KAP) surveys to guide their dengue control strategies. Usually, these questionnaires are extensive and result in a large amount of data that is difficult to analyze and summarize. This study uses an analytical approach to summarize the results of these types of questionnaires about dengue and subsequently assesses the effect of sociodemographic factors. Our results suggest that Multiple Correspondence Analysis is a useful statistical technique to summarize KAP survey information. Age and higher levels of education are related to more reported knowledge about dengue, but these effects are seen only among people in groups with low and middle knowledge of dengue, according to their KAP knowledge scores. Finally, when decisions about the family healthcare are made jointly by male and female members of the household, knowledge about the disease and means of transmission improves at all levels of knowledge (low, medium, high). Preventive practices regarding dengue, specifically against adult and immature forms of the mosquito that transmit the disease do not seem to be related to sociodemographic factors. This study provides an alternative way to more effectively analyze the results of KAP in a routine setting.