Spatial Leptospirosis Desy

5/23/2018 Spatial Leptospirosis Desy

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SPATIAL ANALYSIS OF

LEPTOSPIROSIS AND RISK

FACTORS IN KLATEN DISTRIC

Desy Ari Apsari, Setyawan Budiharta, Lutfan Lazuardi


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Leptospirosis: infectious disease caused by

Leptospira bacteria, which is transmitted directly/ indirectly from animals to humans.

Leptospirosis: a zoonotic distributed throughoutthe world, particularly the tropics and subtropics.

Southeast Asia is an area of endemicleptospirosis, including Indonesia.

In 2000, the case fatality rate of leptospirosis inIndonesia, the world's third-ranked 16.7%, withan average of 7.1%, with interval 2.5% -16.45%.

Data from center of zoonois ministry of health inindonesia (2011) mentions CFR leptospirosis in2010 increased to 10% from 6% in the previous

two years (2009 & 2008).

Background


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Regional distribution of leptospirosis in Indonesia:West Java, Central Java, Yogyakarta, Lampung,South Sumatra, Bengkulu, Riau, West Sumatra,North Sumatra, Bali, West Nusa Tenggara, SouthSulawesi, North Sulawesi, East Kalimantan andWest Kalimantan.

Outbreaks of leptospirosis occurred in Riau1986, Bekasi and Jakarta in 2002 of 138 positivespecimens contained 44.2% infected withLeptospira, Bantul Semarang in 2003 and 2010.

Central Java in 2010, including a secondcontributor to the number of cases and deathsafter the DI Yogyakarta


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Leptospirosis outbreak in the district. Klatenoccurred in 2009. In 2010 there were 5 deaths from37 cases of leptospirosis were found in hospitals

Increased cases of Insist accompanied byexpansion of the spread of leptospirosis.

Mapping the distribution of leptospirosis isimportant, for the development of area-baseddisease surveillance system.System information about spatial dataleptospirosis incidence and risk factors has notbeen done in the district health office. Klaten.


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Research Objectives

General

Knowing the pattern of spread of leptospirosis incidence and determine the risk

factors associated with the incidence of leptospirosis in the district of Klaten.

Specially

Knowing the distribution pattern of the incidence of leptospirosis in the district of

Klaten.

Knowing the spread of leptospirosis around the paddy fields, rivers and roads.

Analyzing the characteristics of the individual associations consisting of income,

employment and education with incidence of leptospirosis.

Analyzing the environmental conditions of housing associations consisting ofsanitary homes, residential density, the presence and location of the rat cage

with the incidence of leptospirosis.

Analyze the association between the incidence of leptospirosis distribution

patterns with environmental factors.


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Research Methods

The study design

- Ecological studies

- Case-control (matching)

Sample size

,

2

21

2

P

PQZZn

OROR

P

1

- Sampling methods: purposive sampling

-Sample size: 210 samples

- Comparison of cases and controls = 1:1

105: case 105: control


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analysis of data

1. Spatial analysis of leptospirosis

- Average nearest neighboor

- Purely spatial analysis Bernoulli

- Overlay & buffer

2. Analysis of risk factors for leptospirosis

- Analysis bivariable: Mc.Nemar, the significance level of 5% (CI: 95%)

-Multivariable Analysis: coditional logistic regression, the significance

level of 5% (CI: 95%)


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Result


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Analisis Spasial Leptospirosis

The analysis showed that the index of the nearest neighbor (nearest

neighbor ratio) from the point of the case is 0.7 (


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Citra Satelit

Gambar Citra Satelit Kluster Primer


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Citra Satelit


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Risk Factor Analysis of Leptospirosis

Characteristics of respondents

VariabelLeptospirosis Total

(n=210)Case(n=105) Control(n=105)

N (%) N (%) N (%)

Gender

Male

Female

Age

25 Year

2635 Year

3645 Year

4655 Year

5665 Year

6675 Year

> 75 Year

Education

no school

NotFinished ES

ES

JuniorSchool

Hight School

College

Job

Farmers

Employee

Private Employee

Entrepreneurial

Goverment/Retired

Others

Income

< Rp. 766.022,-

Rp. 766.022,-

83 (79,05)

22 (20,95)

7 (6,67)

16 (15,24)

21 (20,00)

24 (22,86)

16 (15,24)

13 (12,38)

8 (7,62)

10 (9,52)

4 (3,81)

38 (36,19)

23 (21,90)

27 (25,71)

3 (2,86)

51 (48,57)

23 (21,90)

0 (0,00)

21 (20,00)

3 (2,86)

7 (6,67)

76 (72,38)

29 (27,62)

83 (79,05)

22 (20,95)

7 (6,67)

14 (13,33)

21 (20,00)

29 (27,62)

14 (13,33)

12 (11,43)

8 (7,62)

2 (1,90)

2 (1,90)

33 (31,43)

20 (19,05)

32 (30,48)

16 (15,24)

30 (28,57)

17 (16,19)

5 (4,76)

30 (28,57)

16 (15,24)

7 (6,67)

46 (43,81)

59 (56,19)

166 (79,05)

44 (20,95)

14 (6,67)

30 (14,29)

42 (20,00)

53 (25,24)

30 (14,29)

25 (11,90)

16 (7,62)

12 (5,71)

6 (2,86)

71 (33,81)

43 (20,48)

59 (28,10)

19 (9,05)

81 (38,57)

40 (19,05)

5 (2,38)

51 (24,29)

19 (9,05)

14 (6,67)

122 (58,10)

88(41,90)


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Multivariabel analysis

Conditonal Logistic Regression

Variabel OR 95%CI p-valuePseudo

R2

Log

Likelyhood

Model 1

0,4920 -36,974

Sanitary housing 6,25 1,70-22,90 0,006

Employment 4,26 1,59-11,42 0,004

Presence of rats 3,38 1,22-9,32 0,019

Density residential 3,15 0,30-32,75 0,337

Education 1,65 0,60-4,52 0,328

Cage of location 1,64 0,65-4,12 0,288

Income 0,81 0,25-2,57 0,722

Model 2

0,4728 -37,038Sanitary housing 7,89 2,68-23,21 0,000

Employment 3,77 1,49-9,54 0,005

Presence of rats 3,58 1,35-9,49 0,010


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Spatial Model

Exposure to risk factors Leptospirosis in Klaten

ExposureCase

N %

Sanitary housing 23 21,90

Employment 11 10,48Presence of rats 5 4,76

Sanitary housing & employment 16 15,24

Sanitaty housing & presence of rats 5 4,76

Sanitary housing, employment & presence of

rats

3 2,86

Risk factor outside of model 42 40,00


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Distribution of Risk Factors for Leptospirosis in Klaten


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Disccusion


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The pattern distribution of leptospirosis in the Klaten district is grouped withthe coordinates of the center of 454,230, 9.15211 UTM zone 49S, a radius of423.86 feet and a p-value 0.017, a total of 12 cases with OR = 2.13 locatedin the Village Ngawen Senden.

Characteristics of cluster formation region, is an area with a high populationdensity, most of the inhabitants are farmers or farm laborers and thedistance between the houses are very close.

The neighborhood is very dense slum is one of the risk factors for theincidence of leptospirosis (WHO, 2010).Leptospirosis transmission tends to occur in residential areas with poorsanitary conditions fairly dense residential neighborhood is not good (Macielet al., 2008).


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Buffer in paddy fields showed that 62.96% of cases of leptospirosis spreadin a radius of 15 m - 50 m from the rice paddies.

Research Herbreteau et al. (2005) in Phrae Province, Thailand whichstates that 72.9% of cases of leptospirosis were farmers working in the ricefields, especially agriculture. The availability of water in the rice suspectedas the cause of the transmission of leptospirosis in humans.

Jansen et al. (2005) in his study says that 37% of cases of leptospirosis inGermany in 1997 to 2000 occurred because of exposure to residentialcomprising of whom live in the area of agriculture, plantations and locationof residence, surrounded by mud or water.


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Buffer road shows 44% of cases of leptospirosis living in a radius of 15-50 mfrom the local / district.50.5% of cases living in a radius of


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Risk factors associated with the incidence of leptospirosis in Klaten is sanitaryhousing (OR = 7.89, 95% CI: 2.68 to 23.21, p = 0.000), employment (OR = 3.77,95% CI: 1 , 49 to 9.54, p = 0.005) and the presence of rats (OR = 3.58, 95% CI:1.35 to 9.49, p = 0.010).

Reis et al. (2008) mentions that Leptospira infection caused by environmentalexposure related to housing, employment and the sign of the rat.

Research Sarkar et al. (2000) stated that the incidence of leptospirosis caused byliving conditions of poor sanitation such as the collection of garbage, close to theopen sewage and the presence of rats.


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Conclusion


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1. Distribution of leptospirosis incidence in Klaten District are clustered.

2. Incidence of leptospirosis in Klaten scattered in a radius of 15-30 meters

around the field, 30-50 meters around the local / district and less than 50

meters around the river.

3. Work as farmers / farm workers and jobs that allow a person exposed to raturine contaminated water increases the risk of transmission of leptospirosis.

4. Poor sanitary and the number of mice around the home increases the risk

of transmission of leptospirosis.

5. The pattern of distribution of leptospirosis in Klaten associated with

environmental factors. Risk factors for sanitary home, where rats and

residential density is the dominant risk factor clusters in the region

leptospirosis.


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Recomendation


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1. Klaten District Health Office through health centers working to increase public

participation in the control of risk factors for leptospirosis in both cluster and

non-cluster areas

2. Klaten District Health Office should improve coordination with community

health centers in the implementation of leptospirosis surveillance and

monitoring systems of mice, primarily in the area or cluster and dense

residential areas and close to agricultural areas (rice fields) and the river.

3. There needs to be more research to determine the severity level of

endemicity or distribution of leptospirosis in the region Klaten


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Acknowledge :Primary health care in Klaten

Klaten Health Office

Faculty of Medicine Gadjah Mada University

Faculty of Veterinary Gadjah Mada University

Reference


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Reference

Vanasco, N. B., Schmeling, M. F., Lottersberger, J., Costa, F., Ko, A. I., &

Tarabla, H. D. (2008). Acta Tropica Clinical characteristics and risk factors of

human leptospirosis in Argentina ( 1999 2005 ).Acta Trop., (107) : 255-258.

doi: 10.1016/j.actatropica.

Victoriano, A. F. B., Smythe, L. D., Gloriani-barzaga, N., Cavinta, L. L., Kasai,

T., Limpakarnjanarat, K., et al. (2009). Leptospirosis in the Asia Pacific region.BMC Infectious Diseases, (9) : 1-9. doi: 10.1186/1471-2334-9-147.

WHO. (2007). Leptospirosis (Laboratory Manual). (P. Vijayachari, Ed.). New

Delhi: Regional Medical Research Center.

WHO, (2006), Guideline for Prevention and Control of Leptosirosis, Zoonosis

Division, National Institute of Communicable Diseases, New Delhi


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Thank you

Documents

Spatial Leptospirosis Desy