SETTING: Access to information about tuberculosis (TB) is vital to ensure timely diagnosis, treatment, and control among vulnerable communities. Improved approaches for distributing health education materials to remote populations are needed.OBJECTIVE: To evaluate the impact of two comprehensive video training curricula in improving patient, community member, and community health worker knowledge of TB in a remote area of Madagascar.DESIGN: A pre-test/post-test design was used to measure knowledge acquisition. Educational videos were short, culturally appropriate films presented at critical moments in the TB cascade of care.RESULTS: Of the total 146 participants, 86 (58.9%) improved their score on the post-test, 50 (34.2%) obtained the same score, and 10 (6.8%) received a worse score. A statistically significant difference was observed between the pre- and post-test scores, wherein scores increased by a median of 10.0% (interquartile range 0.0–20.0) after viewing the videos (P < 0.001). There was a significant difference between the number of correct answers on the pre-test and the number of correct answers on the post-test (P < 0.001).CONCLUSION: Educational videos were found to significantly improve TB knowledge among a low-literacy, remote population in Madagascar. Our findings suggest educational videos could be a powerful, low-cost, and sustainable tool to improve access to TB education materials globally.

In many rural farming societies, wild plant foods (WPFs) continue to play an important role in everyday diets as well as in coping with hunger during food shortages. However, WPF collection and consumption may pose challenges to biodiversity conservation efforts (e.g., in protected areas), and some “famine foods,” foods not typically eaten under normal conditions, may have deleterious health impacts. Using data from a cross-sectional survey of 328 smallholder farmers and fisherfolk living in 15 villages surrounding Manombo Special Reserve on the southeastern coast of Madagascar, we examine the relationship between food security, dietary diversity, and consumption of WPFs, specifically giant aquatic arrowhead or via (Typhonodorum lindleyanum) and Polynesian arrowroot or tavolo (Tacca leontopetaloides), during the region's main lean season. We complement survey findings with focus group interviews to document traditional ecological knowledge and perceptions of these WPFs, including how tavolo and via are rendered edible, as well as human health effects from collecting, preparing, and eating them. Using multilevel logistic regression modeling, we found that consumption of these WPFs were significantly associated with inadequate nutrition among farmers. Wealthier households were less likely to consume these WPFs as a coping strategy during food insecure periods, while larger and more food insecure households were more likely to consume them. These findings reaffirm the importance of access to natural areas and support the design of protected area conservation strategies that honor local foodways and consider WPFs that serve as food safety nets for more vulnerable populations.

Background Understanding latent Mycobacterium tuberculosis infection (LTBI) prevalence is crucial for the design of TB control strategies. There are no data on LTBI in rural Madagascar. Methods Tuberculin skin tests were performed in 98 adults aged &gt;15 y in five rural villages in the Ifanadiana district, Madagascar. Results Of adults, 78.6% were positive for LTBI, ranging between 28.6% and 95.0% among villages. The majority (65.3%) showed an induration reaction of &gt;15 mm. Conclusions LTBI prevalence is high in rural Madagascar. Long-term TB control strategies including LTBI testing and treatment must account for high and heterogeneous prevalence in remote, underdeveloped areas.

Background Quality surveillance data used to build tuberculosis (TB) transmission models are frequently unavailable and may overlook community intrinsic dynamics that impact TB transmission. Social network analysis (SNA) generates data on hyperlocal social-demographic structures that contribute to disease transmission. Methods We collected social contact data in five villages and built SNA-informed village-specific stochastic TB transmission models in remote Madagascar. A name-generator approach was used to elicit individual contact networks. Recruitment included confirmed TB patients, followed by snowball sampling of named contacts. Egocentric network data were aggregated into village-level networks. Network- and individual-level characteristics determining contact formation and structure were identified by fitting an exponential random graph model (ERGM), which formed the basis of the contact structure and model dynamics. Models were calibrated and used to evaluate WHO-recommended interventions and community resiliency to foreign TB introduction. Results Inter- and intra-village SNA showed variable degrees of interconnectivity, with transitivity (individual clustering) values of 0.16, 0.29, and 0.43. Active case finding and treatment yielded 67%–79% reduction in active TB disease prevalence and a 75% reduction in TB mortality in all village networks. Following hypothetical TB elimination and without specific interventions, networks A and B showed resilience to both active and latent TB reintroduction, while Network C, the village network with the highest transitivity, lacked resiliency to reintroduction and generated a TB prevalence of 2% and a TB mortality rate of 7.3% after introduction of one new contagious infection post hypothetical elimination. Conclusion In remote Madagascar, SNA-informed models suggest that WHO-recommended interventions reduce TB disease (active TB) prevalence and mortality while TB infection (latent TB) burden remains high. Communities’ resiliency to TB introduction decreases as their interconnectivity increases. “Top down” population level TB models would most likely miss this difference between small communities. SNA bridges large-scale population-based and hyper focused community-level TB modeling.