Behavioral and Environmental Determinants of Leptospirosis: A New Evidence from Klaten, Central Java Using a Path Analysis Model

Background: Leptospirosis is a bacterial disease that affects both humans and animals. Humans become infected through direct contact with the urine of infected animals or with a urine-contaminated environment. The bacteria enter the body through cuts or abrasions on the skin, or through the mucous membranes of the mouth, nose and eyes. Person-to-person transmission is rare. Leptospirosis a global public health issue, with an estimated annual incidence of 0.1 to 1 case/100,000 population in moderate non-endemic area, and 10 to 100 cases/100,000 population in humid and tropical endemic areas. Indonesia is the third country in the world with the highest Leptospirosis-attributable mortality. Its fatality rate ranged from 2.5% to 16.45% with an average of 7.1%. This study aimed to analyze the risk factors of Leptospirosis in Klaten, Central Java. Subjects and Method: This was a case control study conducted in Klaten, Central Java, from October to November, 2017. A sample of 49 Leptospirosis cases and 101 non-diseased controls were selected for this study by fixed disease sampling. The independent variable were employment status, history of cuts, history of water excursion, use of personal protective equipment (PPE), house condition, environmental condition, presence of mouse or cattle, history of rain or flood. The dependent variable was Leptospirosis. The data were collected by questionnaire and analyzed by path analysis. Results: The determinants that increased the risk of Leptospirosis were history of cuts (b= 1.64; 95% CI= 0.40 to 2.87; p= 0.009), history of water excursion (b= 1.98; 95% CI = 0.52 to 3.43; p= 0.008), poor house condition (b= -1.92; 95% CI = -3.08 to -0.77; p= 0.001), and poor environmental condition (b= -2.35; 95% CI= -3.48 to -1.23; p<0.001). History of cuts increased with cattle-related work (b= 1.79; 95% CI = 0.86 to 2.72; p<0.001) and absence of PPE (b= -2.54; 95% CI= -3.49 to -1.60; p<0.001). Conclusion: The behavioral and environmental determinants that increase the risk of Leptospirosis are history of cuts, history of water excursion, poor house condition, and poor environmental condition. Keywords: determinants, behavioral, environmental, leptospirosi

The Relationship of Residential Environment with The Risk of Leptospirosis in Sleman Regency

The effort of leptospirosis prevention in Sleman currently only limited to counseling and treatment of the patient, while the patient search, ways of transmission of leptospirosis from rats to humans, have never implemented in an integrated manner. The study aimed to investigated the relationship between the environmental residential condition with the risk of leptospirosis in Sleman Regency. The research used a survey method Â&nbsp;with case control study design. The results showed that environmental factors, which are not proved to have a relationship with the risk of leptospirosis were residential condition ({p=0,108} OR=3,818 {95%CI:0,922–15,811}), the trash bin condition ({p=1,000} OR=1,138 {95%CI:0,420–3,081}) and the sewer condition ({p=0,415} OR=0,551 {95%CI:0,187–1,624}). Environmental factors that associated with the risk of leptospirosis was the presence of rats ({p=0,001} OR=13,594 {95%CI:2,754–67,107}). The effort should be made in order to prevent the increasement of Leptospirosis cases by sanitation improvement and avoiding direct contact with rats as well as it litter. The Government should be pay more attention in the vector control programs, especially in leptospirosis prone areas so the prevention effort to be able run effectively and efficiently

The Relationship of Residential Environment with The Risk of Leptospirosis in Sleman Regency

The effort of leptospirosis prevention in Sleman currently only limited to counseling and treatment of the patient, while the patient search, ways of transmission of leptospirosis from rats to humans, have never implemented in an integrated manner. The study aimed to investigated the relationship between the environmental residential condition with the risk of leptospirosis in Sleman Regency. The research used a survey method  with case control study design. The results showed that environmental factors, which are not proved to have a relationship with the risk of leptospirosis were residential condition ({p=0,108} OR=3,818 {95%CI:0,922–15,811}), the trash bin condition ({p=1,000} OR=1,138 {95%CI:0,420–3,081}) and the sewer condition ({p=0,415} OR=0,551 {95%CI:0,187–1,624}). Environmental factors that associated with the risk of leptospirosis was the presence of rats ({p=0,001} OR=13,594 {95%CI:2,754–67,107}). The effort should be made in order to prevent the increasement of Leptospirosis cases by sanitation improvement and avoiding direct contact with rats as well as it litter. The Government should be pay more attention in the vector control programs, especially in leptospirosis prone areas so the prevention effort to be able run effectively and efficiently