SPATIAL ANALYSIS OF

LEPTOSPIROSIS AND RISK

FACTORS IN KLATEN DISTRIC

Desy Ari Apsari, Setyawan Budiharta, Lutfan Lazuardi

Leptospirosis: infectious disease caused by
Leptospira bacteria, which is transmitted directly
/ indirectly from animals to humans.
Leptospirosis: a zoonotic distributed throughout
the world, particularly the tropics and subtropics.
Southeast Asia is an area of endemic
leptospirosis, including Indonesia.
In 2000, the case fatality rate of leptospirosis in
Indonesia, the world's third-ranked 16.7%, with
an average of 7.1%, with interval 2.5% -
16.45%.
Data from center of zoonois ministry of health in
indonesia (2011) mentions CFR leptospirosis in
2010 increased to 10% from 6% in the previous
two years (2009 & 2008).
Background
Regional distribution of leptospirosis in Indonesia:
West Java, Central Java, Yogyakarta, Lampung,
South Sumatra, Bengkulu, Riau, West Sumatra,
North Sumatra, Bali, West Nusa Tenggara, South
Sulawesi, North Sulawesi, East Kalimantan and
West Kalimantan.
Outbreaks of leptospirosis occurred in Riau
1986, Bekasi and Jakarta in 2002 of 138 positive
specimens contained 44.2% infected with
Leptospira, Bantul Semarang in 2003 and 2010.
Central Java in 2010, including a second
contributor to the number of cases and deaths
after the DI Yogyakarta
Leptospirosis outbreak in the district. Klaten
occurred in 2009. In 2010 there were 5 deaths from
37 cases of leptospirosis were found in hospitals
Increased cases of Insist accompanied by
expansion of the spread of leptospirosis.
Mapping the distribution of leptospirosis is
important, for the development of area-based
disease surveillance system.
System information about spatial data
leptospirosis incidence and risk factors has not
been done in the district health office. Klaten.
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 of
sanitary 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.
Research Methods
The study design
- Ecological studies
- Case-control (matching)
Sample size

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- Sampling methods: purposive sampling
- Sample size: 210 samples
- Comparison of cases and controls = 1:1
105: case 105: control
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%)
Result

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 (<1), so it can be said
that the pattern of distribution of leptospirosis in the district tend to
cluster (cluster)
Citra Satelit
Gambar Citra Satelit Kluster Primer
Citra Satelit

Risk Factor Analysis of Leptospirosis
Characteristics of respondents

Variabel
Leptospirosis Total
(n=210) Case(n=105) Control(n=105)
N (%) N (%) N (%)

Gender
Male
Female

Age
25 Year
26 35 Year
36 45 Year
46 55 Year
56 65 Year
66 75 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)
Multivariabel analysis
Conditonal Logistic Regression
Variabel OR 95%CI p-value
Pseudo
R
2

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 -37,038
Sanitary 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

Spatial Model
Exposure to risk factors Leptospirosis in Klaten
Exposure
Case
N %
Sanitary housing 23 21,90
Employment 11 10,48
Presence 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

Distribution of Risk Factors for Leptospirosis in Klaten

Disccusion

The pattern distribution of leptospirosis in the Klaten district is grouped with
the coordinates of the center of 454,230, 9.15211 UTM zone 49S, a radius of
423.86 feet and a p-value 0.017, a total of 12 cases with OR = 2.13 located
in the Village Ngawen Senden.
Characteristics of cluster formation region, is an area with a high population
density, most of the inhabitants are farmers or farm laborers and the
distance between the houses are very close.
The neighborhood is very dense slum is one of the risk factors for the
incidence of leptospirosis (WHO, 2010).
Leptospirosis transmission tends to occur in residential areas with poor
sanitary conditions fairly dense residential neighborhood is not good (Maciel
et al., 2008).

Buffer in paddy fields showed that 62.96% of cases of leptospirosis spread
in a radius of 15 m - 50 m from the rice paddies.
Research Herbreteau et al. (2005) in Phrae Province, Thailand which
states that 72.9% of cases of leptospirosis were farmers working in the rice
fields, especially agriculture. The availability of water in the rice suspected
as the cause of the transmission of leptospirosis in humans.
Jansen et al. (2005) in his study says that 37% of cases of leptospirosis in
Germany in 1997 to 2000 occurred because of exposure to residential
comprising of whom live in the area of agriculture, plantations and location
of residence, surrounded by mud or water.
Buffer road shows 44% of cases of leptospirosis living in a radius of 15-50 m
from the local / district.
50.5% of cases living in a radius of <50 m of sewer waste water is generally
open.
Sunaryo Research (2009) states that the spread of leptospirosis cases
which form kluter in Semarang due to environmental risk factors that slum
settlements with sewerage systems are bad.
Sarkar et al. (2002) in his study on risk factors for leptospirosis in Salvador,
Brazil said that the residence adjacent to the wastewater sewer leptospirosis
is a risk factor (OR = 5.15 95% CI: 1.80 to 14.74).
Risk factors associated with the incidence of leptospirosis in Klaten is sanitary
housing (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 environmental
exposure related to housing, employment and the sign of the rat.
Research Sarkar et al. (2000) stated that the incidence of leptospirosis caused by
living conditions of poor sanitation such as the collection of garbage, close to the
open sewage and the presence of rats.
Conclusion
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 rat
urine 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.
Recomendation
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


Acknowledge :
Primary health care in Klaten
Klaten Health Office
Faculty of Medicine Gadjah Mada University
Faculty of Veterinary Gadjah Mada University

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


Thank you