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Analysis of Environmental Risk Factors on the Leptospirosis Disease in Klaten, Central Java, Indonesia

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Analysis of Environmental Risk Factors on the Leptospirosis Disease in Klaten, Central Java, Indonesia Journal of Epidemiology and Public Health (2020), 05(02): 158-167 Research Masters Program in Public Health, Universitas Sebelas Maret Analysis of Environmental Risk Factors on the Leptospirosis Disease in Klaten, Central Java, Indonesia Patria Sari Dewi1,2), Setyo Sri Rahardjo3), Bhisma Murti2) 1)Public Health Office (Balkesmas) of Klaten, Central Java 2)Masters Program in Public Health, Universitas Sebelas Maret 3)Faculty of Medicine, Universitas Sebelas Maret, ABSTRACT Background: The number of cases and 95% CI= -3.68 to 0.79; p=0.205) and female mortality rates of Leptospirosis incidences in sex (b= -2.97; 95% CI= -5.52 to -0.42; p= Klaten Regency is increasing from year to year. 0.022). The risk of Leptospirosis was indirectly The study aims to analyze the environmental affected by the presence of mice, presence of risk factors toward Leptospirosis incidences in cattle, flooding area, poor settlement condition, Klaten Regency, Central Java, Indonesia. and poor house physical condition through area Subjects and Method: This was a case- adjacent to a river, and poor physical condition control study conducted in Klaten Regency, of the house, working in the wet area. Central Java. The study sample was all Lepto- Conclusion: The risk of Leptospirosis is spirosis patients who were recorded in Klaten directly increased by the presence of mice and Health Office. The case population was a total flooding area. The risk of Leptospirosis is of 39 people and the control population was a directly decreased by age ≥20 to <60 years and total of 171 people. The dependent variable was: female sex. The risk of Leptospirosis is indirect- Leptospirosis incidences and the independent ly affected by the presence of mice, presence of variables were physical condition of the house, cattle, flooding area, poor settlement condition, environmental condition of the settlement, the and poor house physical condition through area presence of mice, the presence of cattle, adja- adjacent to a river, and poor physical condition cent to a river, flooding area, age, sex category, of the house, working in the wet area and occupation. The study instruments used were questionnaires and checklist. The data Keywords: Leptospirosis, environmental risk were analyzed by path analysis. factors, path analysis Results: The risk of Leptospirosis was directly increased by the presence of mice (b= 7.34; Correspondence: 95% CI= 4.44 to 10.24; p<0.001) and flooding Patria Sari Dewi. Public Health Office (Balkes- area (b= 8.99; 95% CI= 5.02 to 12.96; p mas) of Klaten, Central Java. Email: patria- <0.001). The risk of Leptospirosis was directly [email protected]. Phone: 085643157125. decreased by age ≥20 to <60 years (b= -1.45; Cite this as: Dewi PS, Rahardjo SS, Murti B (2020). Analysis of Environmental Risk Factors on the Leptospirosis Disease in Klaten, Central Java, Indonesia. J Epidemiol Public Health. 05(02): 158-167. https://doi.org/10.26911/je- publichealth.2020.05.02.04. Journal of Epidemiology and Public Healthis licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. BACKGROUND caused by the poor condition of farms and Leptospirosis is a global public health housings and waste disposal, which problem, particularly in tropical and sub- generate a lot of infection sources (WHO, tropical regions (WHO, 2003; WCO India, 2003). 2007). Most of Leptospirosis occurs in Based on data and information on developing countries. Leptospirosis in tro- Indonesian health profile 2018 it is dis- pical and subtropical regions is mostly covered that based on the data of 2016- e-ISSN: 2549-0273 158 Dewi et al./ Environmental Risk Factors on the Leptospirosis 2018 there are 7 provinces with Lepto- incidences in Klaten Regency, Central Java, spirosis. Those 7 provinces namely: Special Indonesia. Capital Region of Jakarta, West Java, Central Java, Special Region of Yogyakarta, SUBJECTS AND METHOD East Java, Banten, and Maluku. Central 1. Study Design Java Province in 2016 had 164 cases of This was a case-control study conducted at Leptospirosis with 30 deaths (CFR 18.29); 21 community health centers in Klaten in 2017 the number of cases was 409 cases Regency, Central Java, Indonesia, from with 65 deaths (CFR 15.89) and in 2018 the December 2019 to February 2020. number of Leptospirosis cases were 427 2. Population and Sample cases with 89 deaths (CFR 20.84) The targetted population of the study was (Kemenkes RI, 2017). all Leptospirosis in Klaten Regency. The Reported in the Pocket Book of source population of the study was all Health Office of Central Java Province Leptospirosis patients recorded in the 2018, the Leptospirosis cases were 427 Health Office of Klaten Regency from cases with 89 deaths. The top three of most January up to June 2019 with a total of 39 Leptospirosis cases in Central Java are people. The study sample was selected by Demak Regency (92 cases 24 deaths), using mixed disease sampling. The number Klaten Regency (67 cases 12 deaths), Sema- of Puskesmas where the sample would be rang City (56 cases 14 deaths). Incidence taken from was 21, with a sample of 10 Rate (IR) of Leptospirosis in Central Java is people for each Puskesmas, that there was a at 1.24 per 100,000 people, whereas based total of 210 study subjects as the sample. on the Leptospirosis IR of Regencies/ Cities 3. Study Variable in Central Java 2018, it discovers the top The dependent variable was Leptospirosis. four of the highest IR. At the top are Demak The independent variables were house Regency at 7.99 per 100,000 people, Klaten physical condition, settlement environmen- Regency at 5.72 per 100,000 people, tal condition, the existence of mice, the Banyumas Regency at 3.33 per 100,000, existence of cattle, area adjacent to river and the City of Semarang at 3.14 per basin, flooding area, age, sex, and 100,000 people. occupation. According to diseases data from the 4. Operational Definition of Variables Health Office of Klaten Regency 2018, it is Leptospirosis was defined as patients discovered that Leptospirosis in Klaten who were diagnosed by a doctor at a hos- Regency keeps on increasing from year to pital/ Puskesmas through clinical and labo- year. In 2018 the number of Leptospirosis ratory examination during the month of cases is 67 people with 12 deaths. It January to June 2019 and recorded by the increases from 2017 with the number of Health Office of Sleman Regency. cases is 47 people and 7 deaths. From House physical condition was defined January to April 2019, it is discovered there as permanent wall, plastered or tile floor, are 22 cases with 4 deaths. Leptospirosis with a ceiling, the roof is not made into incidences in Klaten Regency evenly occur mice' nest, kitchen's and house's cleanliness in every sub-district. is maintained, at least 2 weeks before The study aimed to analyze environ- Leptospirosis incidence mental risk factors toward Leptospirosis Settlement environmental condition was a condition of settlement environment www.jepublichealth.com 159 Dewi et al./ Environmental Risk Factors on the Leptospirosis that consisted of sewerage, condition of 6. Data analysis sewerage which did not well-up, condition The direct and indirect effects between of sewerage that was not potentially passed variables were analyzed by path analysis by mice, condition of trash which was not run on Stata 13. scattered about, closed trash bin, the 7. Study Ethics distance between the house and trash This study has been approved permits by disposal area >100 meters, there was no informed consent, anonymity, confiden- puddle around the house, 2 weeks before tiality, had obtained ethical clearance from Leptospirosis incidence at the very least. KEPK No.: 1.392/ XII/HREC/ 2019 of Dr. The existence of mice was the presence Moewardi Regional Hospital, Surakarta, or absence of mice inside or around the Central Java, Indonesia. house of study subjects which was marked by mice’ droppings, mice’ footprints, mice’ RESULTS smear marks, gnaw marks, mice’ nest, and 1. Study Subject Characteristics mice’ burrow. Study subject characteristics are presented The existence of cattle was the presence in Table 1. or absence of cattle inside and around the 2. Path analysis house discovered from the result of The purpose of path analysis is to give the interviews with the study subjects. estimated quantity and statistical signifi- The area adjacent to the river basin cance of causal associations which are was an area of study subjects' dwelling hypothesized among several variables. places that were 0 – 100m distance away Figure 1 depicted path diagram of environ- from the river was categorized as close to mental risk factors variable toward Lepto- the river. An area that was >100 m distance spirosis incidences. Table 2 reported the away from the river was categorized as far results of path analysis on the risk factors of from the river. Leptospirosis. Table 2 indicated: Flooding area was the residence of the 1. The effect of the presence of mice study subjects that was flooded when it was toward Leptospirosis incidences raining or there were a lot of puddles, 2 Leptospirosis incidences were directly and weeks before Leptospirosis incidence at the positively affected by the presence of mice. very least. The presence of mice inside or around the Age was study subjects who were 5 years house held a higher risk of Leptospirosis by older or younger than study subjects in the 7.34 units than the house without the case group. presence of mice (b= 7.34; 95% CI= 4.44 to The occupation was the main activities 10.24; p<0.001). conducted by study subjects to met their 2. The effect of flooding area toward daily needs, that was at risk of contracted Leptospirosis incidences Leptospirosis, 2 weeks before Leptospirosis Leptospirosis incidences were directly and incidence at the very least.
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