Multilevel determinants of knowledge on TB transmission among women of reproductive age.

BACKGROUND

In Peru, TB remains a leading public health concern, yet knowledge about its transmission among women of reproductive age is poorly characterised. We sought to determine multilevel factors associated with comprehensive TB knowledge in this population.

METHODS

We analysed data from 29,889 women aged 15-49 years across 25 departments using Peru's 2024 Demographic and Health Survey. Comprehensive TB knowledge was defined as correct identification of airborne transmission and rejection of at least three of five common myths. Three-level logistic regression, spatial autocorrelation, and concentration index analyses were used to examine individual, household, and contextual determinants.

RESULTS

Weighted prevalence of comprehensive TB knowledge was 27.5% (95% confidence interval: 26.3-28.6). Education exhibited a dose-response gradient (odds ratio 4.7 for higher vs. no education; 95% confidence interval: 3.30-6.57). The intraclass correlation coefficient was 22.2%, indicating substantial contextual variation. Spatial analysis showed significant clustering (Moran's I = 0.077, P < 0.001), and the concentration index of 0.115 confirmed pro-rich inequality in knowledge distribution.

CONCLUSION

Approximately one in four Peruvian women possess comprehensive TB knowledge, with pronounced socio-economic and geographic inequities. These findings support targeted educational interventions for women with limited schooling in economically disadvantaged communities.