An Interdisciplinary Study of Leptospirosis Surveillance Systems in Three Regencies of East Java, Indonesia

  • Bianca van BavelEmail author
  • Fiona Larkan
  • Jarlath E. Nally
  • Armand Purwati
Part of the Law, Governance and Technology Series book series (LGTS, volume 42)


In April–May of 2013, Sampang Regency (Madura Island), experienced extreme seasonal rains, and subsequent flooding, followed by dramatic peaks in reported leptospirosis. Local public health surveillance efforts responded to these events and an investigative regional report was launched by the Centre for Environmental Health Engineering and Disease Control, Sampang Regional Health Office. In light of this outbreak and targeted investigation, this study sought to combine existing surveillance data with descriptive household data to investigate leptospirosis incidence and its associated socio-environmental exposures in Sampang and two neighbouring regencies of Gresik and Surabaya in East Java, Indonesia. 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. Across the nine targeted sample sites, significant discrepancies in surveillance reporting were found between each of the five corresponding 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 public health surveillance systems. 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.


Leptospirosis Environmental risk determinants Social risk determinants Household questionnaires Extreme Rainfall and flooding events Public health surveillance and action East Java Indonesia 



The research was facilitated through extension of an existing academic collaboration between Professor Eric van Gorp (Erasmus Medical Centre, Rotterdam) and Professor Usman Hadi (Dr. Soetomo Teaching Hospital, University of Airlangga, Surabaya). The authors would like to extend special appreciation for the contributions from the community health clinics and regional DKK staff (Dinas Kesehatan Kabupaten, Regional Health Office), as well as the research team from the Institute for Tropical Diseases, Surabaya. Additional thanks to the reviewers for their helpful comments and contributions, which the authors feel have enhanced the manuscript. As well as thanks to our colleague, Angus Naylor (Priestley International Centre for Climate, University of Leeds), for his expertise with mapping. We would also like to acknowledge the passing of our dear co-author and colleague, Fiona Larkan, whose contributions and impact extend far beyond the scope of this work.

This research was conducted in accordance with the Declaration of Helsinki and was granted ethical approval by appropriate regional and local Indonesian authorities, DKPJT, DKK, University of Airlangga Surabaya, as well as the Health Policy and Management and Centre for Global Health Research Ethics Committee, Trinity College Dublin. Informed written consent was obtained from all participants by way of their completion and return of anonymized questionnaires. Participation in this study was completely voluntary and included consenting individuals of 18 years or older. Any further information and documentation that would support these processes and statements will be made available to the Editorial Board upon request.

The authors declare they have no competing interests.

BvB was the principal investigator on the study, designed the study, collected and analysed the data, and wrote the paper. FL assisted in the study design, in particular incorporating mix-methodology, and edited the paper. JEN assisted with background, in-depth analysis, and edited the paper. AP assisted with the design, implementation, and collection of data. All authors read and approved the final manuscript.

Supplementary material


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Bianca van Bavel
    • 1
    • 2
    Email author
  • Fiona Larkan
    • 1
  • Jarlath E. Nally
    • 3
  • Armand Purwati
    • 4
  1. 1.Centre for Global Health, Trinity College DublinDublinIreland
  2. 2.Priestley International Centre for Climate, University of LeedsLeedsUK
  3. 3.Bacterial Diseases of Livestock Research Unit, National Animal Disease Center, Agricultural Research Services, United States Department of AgricultureAmesUSA
  4. 4.Dr. Soetomo Regional General Hospital, Institute of Tropical Diseases, Airlangga UniversitySurabayaIndonesia

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