|VAN BAVEL, BIANCA - University Of Dublin|
|LARKAN, FIONA - University Of Dublin|
|PURWATI, ARMAND - Airlangga University, Indonesia|
Submitted to: Book Chapter
Publication Type: Book / Chapter
Publication Acceptance Date: 7/27/2016
Publication Date: N/A
Interpretive Summary: Pathogenic species of Leptospira cause leptospirosis, a global disease that is transmitted from animals to humans. Leptospires survive in the kidney of domestic and wild animal species, from where they are excreted via urine. Contact with infected urine, or contaminated water can result in disease. Pathogenic leptospires can penetrate breaches of the skin and or mucosal surfaces. In this study, risk factors associated with Leptospirosis in people living in specific areas of Indonesia were investigated. Results identifed an increased risk of infection in households in flood prone areas with a recent history of flooding, close proximity to refuse deposits, performing occupational farming, and using alternative sources of water (artesian wells, rivers and collected rain water). Household access to piped or canalized running water had a negative association with reported leptospirosis outcomes. Results also identifed the need for improved surveillance reporting amongst health clinics. This data will be of interest to public health authorities, particularly those in tropical areas where leptospirosis is a public health problem.
Technical Abstract: Leptospirosis has a complex and variable disease epidemiology. In order to identify environmental and social risk determinants of cases of leptospirosis, a total of 275 household questionnaires were administered across nine targeted sample sites in the Regencies of Gresik, Sampang, and Surabaya East Java, Indonesia. Univariate analysis and binomial logistic regression were used to analyze associations of independent predictor variables with suspected and probable case reporting. Results revealed a history of leptospirosis in 30 respondents. Independent predictors that demonstrated significant association with reported leptospirosis were: living in flood prone areas, recent history of in-house flooding, living in close proximity to refuse deposits, occupational farming, and using alternative sources of water for domestic use (artesian wells, rivers and collected rain water). Household access to piped or canalized running water had a negative association with reported leptospirosis outcomes. The results of the binary logistic regression analysis produced a model with overall fit. Significant discrepancies in surveillance reporting were found between the five health clinics, as well as the three regencies of Gresik, Sampang, and Surabaya, indicating distinct surveillance systems and health responses. While increases in rainfall and flooding events have been well established as determinants, this study highlights two additional key factors attributable to changes in the distribution of leptospirosis: socio-sanitary deprivation, as well as a lack of integrated surveillance. This research reinforces the success of certain local and adaptive surveillance initiatives, and recommends the wider integration of disciplinary efforts and resources across communities, institutions and sectors for effective public health action.