An Interdisciplinary Study of Leptospirosis Surveillance Systems in Three Regencies of East Java, Indonesia
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.
KeywordsLeptospirosis 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.
- 2008. Economic impacts of sanitation in Indonesia: a five country study conducted in Cambodia, Indonesia, Lao PDR, the Philippines, and Vietnam under the Economics of Sanitation Initiative (ESI). In: Pacific WASPEAAT (ed) Economics of sanitation initiative. World Bank, JakartaGoogle Scholar
- 2012. Human Development Index (HDI) by Province and National: 1996–2012. Badan Pusat Statistik, Indonesia. http://sp2010.bps.go.id/. Accessed 30 Nov 2017
- 2014. Buletin Epidemiologi Jawa Timur. In: Timur DKPJ (ed) IndonesiaGoogle Scholar
- Biggs HM, Bui DM, Galloway RL, Stoddard RA, Shadomy SV, Morrissey AB, Bartlett JA, Onyango JJ, Maro VP, Kinabo GD, Saganda W, Crump JA (2011) Leptospirosis among hospitalized febrile patients in Northern Tanzania. Am J Trop Med Hyg 85(2):275–281. https://doi.org/10.4269/ajtmh.2011.11-0176 CrossRefGoogle Scholar
- Biggs HM, Hertz JT, Munishi OM, Galloway RL, Marks F, Saganda W, Maro VP, Crump JA (2013) Estimating leptospirosis incidence using hospital-based surveillance and a population-based health care utilization survey in Tanzania. PLoS Negl Trop Dis 7:e2589. https://doi.org/10.1371/journal.pntd.0002589 CrossRefGoogle Scholar
- BPS (2010) Sensus Penduduk 2010. Badan Pusat Statistik. http://sp2010.bps.go.id/. Accessed 30 Nov 2017
- Cook GC, Zumla A (2009) Manson’s tropical diseases, 22nd edn. Saunders Elsevier, PhiladelphiaGoogle Scholar
- Creswell JW (2013) Research design: qualitative, quantitative, and mixed methods approaches. Sage Publications, Incorporated, Thousand OaksGoogle Scholar
- Felzemburgh RDM, Ribeiro GS, Costa F, Reis RB, Hagan JE, Melendez AXTO, Fraga D, Santana FS, Mohr S, Dos Santos BL, Silva AQ, Santos AC, Ravines RR, Tassinari WS, Carvalho MS, Reis MG, Ko AI (2014) Prospective study of leptospirosis transmission in an urban slum community: role of poor environment in repeated exposures to the Leptospira agent. PLoS Negl Trop Dis 8:e2927. https://doi.org/10.1371/journal.pntd.0002927 CrossRefGoogle Scholar
- Githeko AK, Lindsay SW, Confalonieri UE, Patz JA (2000) Climate change and vector-borne diseases: a regional analysis. Bull World Health Organ 78(9):1136–1147Google Scholar
- Goeijenbier M, Wagenaar J, Goris M, Martina B, Henttonen H, Vaheri A, Reusken C, Hartskeerl R, Osterhaus A, van Gorp E (2013) Rodent-borne hemorrhagic fevers: under-recognized, widely spread and preventable – epidemiology, diagnostics and treatment. Crit Rev Microbiol 39(1):26–42. https://doi.org/10.3109/1040841X.2012.686481 CrossRefGoogle Scholar
- Halliday J, Daborn C, Auty H, Mtema Z, Lembo T, Bronsvoort BMD, Handel I, Knobel D, Hampson K, Cleaveland S (2012) Bringing together emerging and endemic zoonoses surveillance: shared challenges and a common solution. Philos Trans Roy Soc Lond B: Biol Sci 367(1604):2872–2880. https://doi.org/10.1098/rstb.2011.0362 CrossRefGoogle Scholar
- Manock SR, Jacobsen KH, De Bravo NB, Russell KL, Negrete M, Olson JG, Sanchez JL, Blair PJ, Smalligan RD, Quist BK, Espín JF, Espinoza WR, MacCormick F, Fleming LC, Kochel T (2009) Etiology of acute undifferentiated febrile illness in the Amazon Basin of Ecuador. Am J Trop Med Hyg 81(1):146–151. https://doi.org/10.4269/ajtmh.2009.81.146 CrossRefGoogle Scholar
- Marmot M, Steptoe A (2007) Whitehall II and ELSA: integrating epidemiological and psychobiological approaches to the assessment of biological indicators. Biosocial Surveys. National Research Council of the National Academies Washington DC, Chapter 2. https://www.ncbi.nlm.nih.gov/books/NBK62431/. Accessed 30 Nov 2017
- Paul RC, Rahman M, Gurley ES, Hossain MJ, Diorditsa S, Hasan AM, Banu SS, Alamgir A, Rahman MA, Sandhu H, Fischer M, Luby SP (2011) A novel low-cost approach to estimate the incidence of Japanese Encephalitis in the catchment area of three hospitals in Bangladesh. Am J Trop Med Hyg 85(2):379–385. https://doi.org/10.4269/ajtmh.2011.10-0706 CrossRefGoogle Scholar
- Penyakit BBTKLDP (2014) Laporan Investigasi Potensi Risiko Kesehatan Akibat Bencana Banjir Di Kabupaten Sampang. In: Sampang DKK (ed) Sampang, IndonesiaGoogle Scholar
- Picardeau M, Bertherat E, Jancloes M, Skouloudis AN, Durski K, Hartskeerl RA (2014) Rapid tests for diagnosis of leptospirosis: current tools and emerging technologies. Diagn Microbiol Infect Dis 78(1):1–8. https://doi.org/10.1016/j.diagmicrobio.2013.09.012 CrossRefGoogle Scholar
- Reis RB, Ribeiro GS, Felzemburgh RDM, Santana FS, Mohr S, Melendez AXTO, Queiroz A, Santos AC, Ravines RR, Tassinari WS, Carvalho MS, Reis MG, Ko AI (2008) Impact of environment and social gradient on Leptospira infection in urban slums. PLoS Negl Trop Dis 2:e228. https://doi.org/10.1371/journal.pntd.0000228 CrossRefGoogle Scholar
- Sarkar U, Nascimento SF, Barbosa R, Martins R, Nuevo H, Kalofonos I, Kalafanos I, Grunstein I, Flannery B, Dias J, Riley LW, Reis MG, Ko AI (2002) Population-based case-control investigation of risk factors for leptospirosis during an urban epidemic. Am J Trop Med Hyg 66(5):605–610CrossRefGoogle Scholar
- Sarosa W (2006) Indonesia. In: Roberts BH, Kanaley T (eds) Urbanization and sustainability in Asia: case studies of good practice. Asian Development Bank, ManilaGoogle Scholar
- Thriemer K, Ley B, Ame S, von Seidlein L, Pak GD, Chang NY, Hashim R, Schmied WH, Busch CJ-L, Nixon S, Morrissey A, Puri MK, Ali M, Ochiai RL, Wierzba T, Jiddawi MS, Clemens JD, Ali SM, Deen JL (2012) The burden of invasive bacterial infections in Pemba, Zanzibar. PLoS ONE 7:30350. https://doi.org/10.1371/journal.pone.0030350 CrossRefGoogle Scholar
- Torgerson PR, Hagan JE, Costa F, Calcagno J, Kane M, Martinez-Silveira MS, Goris MGA, Stein C, Ko AI, Abela-Ridder B (2015) Global burden of leptospirosis: estimated in terms of disability adjusted life years. PLoS Negl Trop Dis 9:e0004122. https://doi.org/10.1371/journal.pntd.0004122 CrossRefGoogle Scholar
- Vinetz JM, Wilcox BA, Aguirre A, Gollin LX, Katz AR, Fujioka RS, Maly K, Horwitz P, Chang H (2005) Beyond disciplinary boundaries: leptospirosis as a model of incorporating transdisciplinary approaches to understand infectious disease emergence. EcoHealth 2(4):291–306. https://doi.org/10.1007/s10393-005-8638-y CrossRefGoogle Scholar
- WHO (2003) Human leptospirosis: guidance for diagnosis, surveillance and controlGoogle Scholar
- WHO (2008) Leptospirosis in South-East Asia: the tip of the iceberg? World Health Organization Regional Office for South-East Asia (SEARO), New DelhiGoogle Scholar
- WHO (2009) Leptospirosis situation in the WHO South-East Asia region. World Health Organization Regional Office for South-East Asia (SEARO), New DelhiGoogle Scholar
- WHO UNICEF (2017) Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and SDG Baselines. World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), Geneva. Licence: CC BY-NC-SA 3.0 IGOGoogle Scholar