{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T13:51:39Z","timestamp":1784728299543,"version":"3.55.0"},"reference-count":37,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2021,12,14]],"date-time":"2021-12-14T00:00:00Z","timestamp":1639440000000},"content-version":"unspecified","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["19790.01"],"award-info":[{"award-number":["19790.01"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-001754"],"award-info":[{"award-number":["INV-001754"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1084276"],"award-info":[{"award-number":["OPP1084276"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1135288"],"award-info":[{"award-number":["OPP1135288"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["1R01AI147321-01"],"award-info":[{"award-number":["1R01AI147321-01"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","award":["2020\/985800-0"],"award-info":[{"award-number":["2020\/985800-0"]}],"id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["218261\/Z\/19\/Z"],"award-info":[{"award-number":["218261\/Z\/19\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["CCF17-7779"],"award-info":[{"award-number":["CCF17-7779"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/P022081\/1"],"award-info":[{"award-number":["MR\/P022081\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000269","name":"Economic and Social Research Council","doi-asserted-by":"publisher","award":["ES\/P008011\/1"],"award-info":[{"award-number":["ES\/P008011\/1"]}],"id":[{"id":"10.13039\/501100000269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001713","name":"European and Developing Countries Clinical Trials Partnership","doi-asserted-by":"publisher","award":["RIA208D-2505B"],"award-info":[{"award-number":["RIA208D-2505B"]}],"id":[{"id":"10.13039\/501100001713","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,10,28]]},"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Selected Zambian communities formed part of a cluster randomised trial: the Zambia and South Africa TB and AIDS Reduction study (ZAMSTAR). There was wide variability in the prevalence of<jats:italic>Mycobacterium tuberculosis<\/jats:italic>infection and tuberculosis (TB) disease across these communities. We sought to clarify whether specific communities could have been more\/less vulnerable to<jats:italic>M. tuberculosis<\/jats:italic>transmission as a result of sociological variety relevant to transmission efficiency.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>We conducted a mixed methods secondary analysis using existing data sets. First, we analysed qualitative data to categorise and synthesise patterns of socio-spatial engagement across communities. Second, we compared emergent sociological variables with a measure of transmission efficiency: the ratio of the annual risk of infection to TB prevalence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>ZAMSTAR communities in urban and peri-urban Zambia, spanning five provinces.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Fifteen communities, each served by a health facility offering TB treatment to a population of at least 25 000. TB notification rates were at least 400 per 100 000 per annum and HIV seroprevalence was estimated to be high.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Crowding, movement, livelihoods and participation in recreational activity differed across communities. Based on 12 socio-spatial indicators, communities were qualitatively classified as more\/less spatially crowded and as more\/less socially \u2018open\u2019 to contact with others, with implications for the presumptive risk of<jats:italic>M. tuberculosis<\/jats:italic>transmission. For example, watching video shows in poorly ventilated structures posed a presumptive risk in more socially open communities, while outdoor farming and\/or fishing were particularly widespread in communities with lower transmission measures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A dual dynamic of \u2018social permeability\u2019 and crowding appeared relevant to disparities in<jats:italic>M. tuberculosis<\/jats:italic>transmission efficiency. To reduce transmission, certain socio-spatial aspects could be adjusted (eg, increasing ventilation on transport), while more structural aspects are less malleable (eg, reliance on public transport). We recommend integrating community level typologies with genome sequencing techniques to further explore the significance of \u2018social permeability\u2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"ISRCTN36729271\">ISRCTN36729271<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2020-047136","type":"journal-article","created":{"date-parts":[[2021,12,14]],"date-time":"2021-12-14T16:36:18Z","timestamp":1639499778000},"page":"e047136","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Sociological variety and the transmission efficiency of<i>Mycobacterium tuberculosis<\/i>: a secondary analysis of qualitative and quantitative data from 15 communities in Zambia"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3345-2698","authenticated-orcid":false,"given":"Emma J","family":"Murray","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J","family":"Dodd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Marais","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Ayles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwame","family":"Shanaube","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albertus","family":"Schaap","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard G","family":"White","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Bond","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,12,14]]},"reference":[{"key":"2024112512332800000_11.12.e047136.1","unstructured":"World Health Organization . Global tuberculosis report 2020, 2020. Available: https:\/\/www.who.int\/tb\/publications\/global_report [Accessed 22 Oct 2020]."},{"key":"2024112512332800000_11.12.e047136.2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0005602"},{"key":"2024112512332800000_11.12.e047136.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2011.02849.x"},{"key":"2024112512332800000_11.12.e047136.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-017-2345-5","article-title":"The prevalence of HIV among adults with pulmonary TB at a population level in Zambia","volume":"17","author":"Chanda-Kapata","year":"2017","journal-title":"BMC Infect Dis"},{"key":"2024112512332800000_11.12.e047136.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-017-4836-0","article-title":"Tuberculosis among older adults in Zambia: burden and characteristics among a neglected group","volume":"17","author":"Coffman","year":"2017","journal-title":"BMC Public Health"},{"key":"2024112512332800000_11.12.e047136.6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0119861"},{"key":"2024112512332800000_11.12.e047136.7","doi-asserted-by":"publisher","DOI":"10.1002\/casp.893"},{"key":"2024112512332800000_11.12.e047136.8","doi-asserted-by":"crossref","DOI":"10.3912\/OJIN.Vol11No01Man03","article-title":"The impact of tuberculosis on Zambia and the Zambian nursing workforce","volume":"11","author":"Chanda","year":"2006","journal-title":"Online J Issues Nurs"},{"key":"2024112512332800000_11.12.e047136.9","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czs072"},{"key":"2024112512332800000_11.12.e047136.10","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir229"},{"key":"2024112512332800000_11.12.e047136.11","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0135179","article-title":"A century of tuberculosis epidemiology in the Northern and southern hemisphere: the differential impact of control interventions","volume":"10","author":"Hermans","year":"2015","journal-title":"PLoS One"},{"key":"2024112512332800000_11.12.e047136.12","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61131-9"},{"key":"2024112512332800000_11.12.e047136.13","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwv160"},{"key":"2024112512332800000_11.12.e047136.14","doi-asserted-by":"publisher","DOI":"10.1177\/1740774508094747"},{"key":"2024112512332800000_11.12.e047136.15","doi-asserted-by":"publisher","DOI":"10.1186\/1745-6215-9-63"},{"key":"2024112512332800000_11.12.e047136.16","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0007749"},{"key":"2024112512332800000_11.12.e047136.17","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1177\/1049732318809940","article-title":"Value and limitations of broad brush surveys used in Community-Randomized trials in southern Africa","volume":"29","author":"Bond","year":"2019","journal-title":"Qual Health Res"},{"key":"2024112512332800000_11.12.e047136.18","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-021-05352-z"},{"key":"2024112512332800000_11.12.e047136.19","doi-asserted-by":"crossref","unstructured":"Bond V . Terrains and Tuberculosis: The Model Applied in Urgent Public Health Settings. In: Wallman S , ed. The capability of places: methods for modelling community response to intrusion and change. London, UK: Pluto Press, 2011: 80\u2013110.","DOI":"10.2307\/j.ctt183p4gp.8"},{"key":"2024112512332800000_11.12.e047136.20","unstructured":"Murray EJ . The Social Terrain of Endemic Tuberulosis in and around Cape Town [MPhil dissertation]. Faculty of Health Sciences, Stellenbosch University, South Africa, 2010. Available: http:\/\/hdl.handle.net\/10019.1\/5387 [Accessed 22 Oct 2020]."},{"key":"2024112512332800000_11.12.e047136.21","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jix362"},{"key":"2024112512332800000_11.12.e047136.22","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.06.037804"},{"key":"2024112512332800000_11.12.e047136.23","unstructured":"Simwinga M . Exploring the role of community participation in research studies: the case of two Community Advisory Boards in Zambia [doctoral dissertation]. United Kingdom: London School of Hygiene and Tropical Medicine, 2015."},{"key":"2024112512332800000_11.12.e047136.24","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0077740","article-title":"Association between socioeconomic position and tuberculosis in a large population-based study in rural Malawi","volume":"8","author":"Odone","year":"2013","journal-title":"PLoS One"},{"key":"2024112512332800000_11.12.e047136.25","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kws331"},{"key":"2024112512332800000_11.12.e047136.26","doi-asserted-by":"publisher","DOI":"10.1098\/rsos.170726"},{"key":"2024112512332800000_11.12.e047136.27","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiu138"},{"key":"2024112512332800000_11.12.e047136.28","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0096334","article-title":"Shared air: a renewed focus on ventilation for the prevention of tuberculosis transmission","volume":"9","author":"Richardson","year":"2014","journal-title":"PLoS One"},{"key":"2024112512332800000_11.12.e047136.29","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-11-156"},{"key":"2024112512332800000_11.12.e047136.30","doi-asserted-by":"crossref","first-page":"S644","DOI":"10.1093\/infdis\/jix354","article-title":"Drivers of tuberculosis transmission","volume":"216","author":"Mathema","year":"2017","journal-title":"J Infect Dis"},{"key":"2024112512332800000_11.12.e047136.31","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0039246"},{"key":"2024112512332800000_11.12.e047136.32","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0067338"},{"key":"2024112512332800000_11.12.e047136.33","doi-asserted-by":"publisher","DOI":"10.1016\/j.tube.2010.12.002"},{"key":"2024112512332800000_11.12.e047136.34","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1016\/j.apjtb.2016.06.015","article-title":"Tuberculosis in the mines of Zambia: a case for intervention","volume":"6","author":"Chanda-Kapata","year":"2016","journal-title":"Asian Pac J Trop Biomed"},{"key":"2024112512332800000_11.12.e047136.35","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2009.175646"},{"key":"2024112512332800000_11.12.e047136.36","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02730-6"},{"key":"2024112512332800000_11.12.e047136.37","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0251806"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-047136","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T20:33:50Z","timestamp":1732566830000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-047136"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":37,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12,14]]},"published-print":{"date-parts":[[2021,12]]}},"alternative-id":["10.1136\/bmjopen-2020-047136"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-047136","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]}}}