Environmental and behavioural factors related to leptospirosis outbreak in Pacitan Regency East Java, Indonesia 2023

국문 초록 (Abstract)

배경: 렙토스피라증은 인도네시아에서 여전히 풍토병인 소외열대질환으로
2022 년에 1613 건의 사례가 기록되었으며 148 명(CFR 9.18%)이 사망했습니다.
방법: 인도네시아의 국가 감시 시스템 및 역학 조사 보고서에서 얻은 Pacitan Regency
내 지역 보건소에서 기록된 렙토스피라증 의심 사례에 대한 2 차 데이터. 데이터를
후향적으로 분석하고, 카이제곱 및 회귀 분석을 사용하여 렙토스피라증과 관련된
요인을 식별했으며, 다변량 로지스틱 회귀 분석의 홀수 비율(OR)을 사용하여 환경
요인과 행동 요인 간의 연관성을 추정했습니다.
결과: 연구 기간 동안 449 건의 사례가 보고되었으며 383 개의 샘플에서
렙토스피라증 양성 반응이 나타났습니다. 교육 수준, 직업, 홍수 지역 내 거주, 하수도
상태, 집안 내 쥐 유무, 가축 소유, 수원, 논 또는 정원 가꾸기 활동, 비누로 씻기, 생식
재고는 각각 렙토스피라증 사례에서 통계적으로 유의했다(p-값<0.05). 이 연구에서
가장 높은 홀수 비율은 농부로서의 직업[6.25 (95% CI 2.98-13.12)], 집에 쥐가 있는
경우[16.97 (95% CI 8.70-33.10)], 가축 소유[5.19 (95% CI 2.99-8.99)], 집에 생식이 있는
경우[7.10 (95% CI 3.91-12.90)]였습니다.
결론: 이 연구는 환경 및 행동 변수가 렙토스피라증의 지속적인 위험에 기여한다는
것을 발견했습니다. 렙토스피라증에 필요한 위험인, 잘 준비된 의료진 및 필수
물품에 대한 표적 교육은 발병 대응의 핵심이며 렙토스피라증의 발병률과 사망률을
최소화합니다.

다국어 초록 (Multilingual Abstract)

Background: Leptospirosis is a neglected tropical disease that is still endemic in Indonesia, recorded 1613 cases, with 148 deaths (CFR 9.18%) in 2022.

Methods: Secondary data on suspected leptospirosis cases recorded in community health centres within Pacitan Regency obtained from Indonesia’s national surveillance system and epidemiology investigation report. The data were retrospectively analysed, factors associated with leptospirosis were identified using chi-square and regression analysis while the odd ratio (OR) from the multivariate logistic regression was used to estimate the association between environmental and behavioural factors.

Result: During the study period, 449 cases were reported, and 383 samples tested positive for leptospirosis. Education level, occupation, living within flood area, sewerage condition, presence of rats in the house, livestock ownership, source of water, rice field or gardening activity, washing with soap, and raw food stock were statistically significant with leptospirosis cases respectively (p-value<0.05). Among the highest odd ratios from the study were occupation as a farmer [6.25 (95% CI 2.98-13.12)], presence of rat in the house [16.97 (95% CI 8.70-33.10)], livestock ownership [5.19 (95% CI 2.99-8.99)] and having raw food stock at home [7.10 (95%CI 3.91-12.90)].

Conclusion: This study found that environmental and behavioural variables contribute to the ongoing danger of leptospirosis. Targeted education of persons at risk, well-prepared healthcare staff and essential commodities required for leptospirosis are key for outbreak response, minimize incidence and fatality of leptospirosis.

목차 (Table of Contents)

• TABLE OF CONTENTS
• TABLE OF CONTENTS.............................................................................................. i
• LIST OF TABLES...................................................................................................... iii
• LIST OF FIGURES.................................................................................................... iv
• LIST OF ACRONYMS ................................................................................................v
• ABSTRACT............................................................................................................... vi
• I. INTRODUCTION.....................................................................................................1
• 1. Background ..............................................................................................................1
• 2. Statement of the Problem..........................................................................................2
• 3. Significance of the Study..........................................................................................3
• 4. Purpose.....................................................................................................................4
• 5. Hypothesis................................................................................................................5
• 6. Operational Definitions ............................................................................................5
• II. LITERATURE REVIEW.........................................................................................7
• 1. Etiology of Leptospirosis..........................................................................................7
• 2. Epidemiology of Leptospirosis.................................................................................8
• 3. Reservoirs and Transmission of Leptospirosis........................................................11
• 4. Factors related to Leptospirosis Incidence..............................................................13
• 5. Surveillance System of Leptospirosis in Indonesia.................................................17
• 6. Conceptual Framework...........................................................................................21
• ii
• III. METHODOLOGY ...............................................................................................22
• 1. Study Design ..........................................................................................................22
• 2. Study Setting ..........................................................................................................22
• 3. Study Subjects........................................................................................................24
• 4. Measures ................................................................................................................26
• 5. Data Collection.......................................................................................................30
• 6. Data Analysis..........................................................................................................30
• 7. Ethical Statement ...................................................................................................31
• IV. RESULT ...............................................................................................................32
• 1. Prevalence of Leptospirosis Cases from January-July 2023 ...................................32
• 2. Characteristic of Participants..................................................................................34
• 3. Association between Variables and Leptospirosis...................................................37
• 4. Association between Leptospirosis Cases and Selected Factors .............................40
• V. DISCUSSION........................................................................................................43
• 1. Association between Environmental Factors and Leptospirosis .............................44
• 2. Association between Behavioural Factors and Leptospirosis..................................46
• 3. Study Limitations ...................................................................................................47
• VI. CONCLUSION ....................................................................................................48
• 1. Conclusion..............................................................................................................48
• 2. Policy Implication .................................................................................................50
• REFERENCES