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IJPHCS International Journal of Public Health and Clinical Sciences Open Access: E-Journal E-ISSN : 2289-7577

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IJPHCS International Journal of Public Health and Clinical Sciences Open Access: E-Journal E-ISSN : 2289-7577 IJPHCS International Journal of Public Health and Clinical Sciences Open Access: e-Journal e-ISSN : 2289-7577. Vol. 3:No. 4 July/August 2016 THE RISE OF LEPTOSPIROSIS IN KELANTAN 2014: CHARACTERISTICS, GEOGRAPHICAL PATTERN AND ASSOCIATED FACTORS Azimullah AZ1, Aziah BD1, Fauziah MN2 1 Department of Community Health, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia. 2 Communicable Disease Centre Unit, Kelantan State Health of Department, 15150 Kota Bharu, Kelantan, Malaysia. *Corresponding author: Dr Aziah Daud, MD(UKM), Master ComMed(USM) Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia. E-mail: [email protected] ABSTRACT Introduction: Leptospirosis is a zoonotic disease largely attributed to climatic and environmental condition. The occurrence signifies the complex interaction between man, animal host and the environment whereby socioeconomic status, occupation, association with animals, recreational activity and climate are all connected with occurrence of leptospirosis. The aim of this study was to determine the sociodemographic characteristics, geographical pattern and associated factors of leptospirosis cases in Kelantan 2014. Methods: This was a cross-sectional study done among leptospirosis cases in Kelantan 2014 based on E-notifikasi database from January 2014 to December 2014. Climate data were taken from National Meteorology Department. The data were analyzed using IBM SPSS 22 and Map Source Version 6 Software. Results: There were 620 confirmed Leptospirosis cases in Kelantan. Majority was Malay (88.7%) and male (63.7%). The mean (SD) age was 33.2 (18.23) years with age range from 2 to 89 years old. Most were in low risk occupational group (61.3%). Multiple logistic regression analysis showed high risk occupation (adjusted OR: 1.671, 95% CI: 1.228, 2.273, p=0.001) and age (adjusted OR: 1.010, CI: 1.003, 1.018, p= 0.008) were the significant associated factors. In relation to rainfall, majority of the cases occur from August to December 2014 with rainfall range from 160.3 mm to 1092.6 mm. Most resided in settlement area (22.9%), followed by plantation (16.1%), rural area (14.4%) and paddy field (13.8%). Conclusions: High risk occupation mostly agricultural workers and food handlers were associated with leptospirosis. Rainfall distribution and type of land were observed to influence number of leptospirosis cases in Kelantan. Combination of these multifactorial factors contributed to leptospirosis in Kelantan 2014. Keywords: Leptospirosis, high risk occupation, rainfall distribution, Kelantan Azimullah AZ, Aziah BD, Fauziah MN 52 IJPHCS International Journal of Public Health and Clinical Sciences Open Access: e-Journal e-ISSN : 2289-7577. Vol. 3:No. 4 July/August 2016 1.0 Introduction The incidence of leptospirosis is ranging from 0.1 to 1 per 100 000 per year in temperate climates to 10 or more per 100 000 per year in the humid tropics and may reach up 100 per 100 000 during outbreaks. The wet and warm climate is favourable conditions for survival of leptospires in environment contributes to the magnitude of the problem in Malaysia. The incidence in Malaysia is estimated between 2 to 5 per 100 000 per year (El Jalii and Bahaman, 2004). The data from Disease Control Division of Ministry of Health generally showed the increasing trend of Leptospirosis in Malaysia from 2009 to 2013 where 1418 cases in 2009 and 4457 cases in 2013 reported. The same goes for Kelantan state in 2014, in which the data from Kelantan State Health Department indicated the case of leptospirosis has increased tremendously up to almost 200 % in year 2014 as compared to 2013 (Kelantan State Health Department,KSHD,2014). Yet, the factors associated to rise of these cases have not yet being described. Therefore this study was conducted to identify the sociodemographic characteristics, geographical pattern related to leptospirosis and the associated factors contributed to the increment of leptospirosis cases in 2014. It is known, leptospirosis closely related with environmental factors and climate changes especially rainfall distribution and temperature however to this date after extensive searching of research in Malaysia there is limited published study about the association of environmental factor with occurrence of leptospirosis diseases. This study is very important to formulate effective strategy for control and prevention of the disease. 2.0 Materials and Methods This was a cross – sectional study done among leptospirosis cases in Kelantan in year 2014. All confirmed leptospirosis cases were taken from E-notifikasi database from first January 2014 to 31st December 2015. Leptospirosis cases with coinfection with other diagnosis such as Dengue fever and incomplete data were excluded in the study. No sampling method applied as all eligible cases were included. The information obtained from E- notifikasi database includes sociodemographic data, geographical location based on latitude and longitude and occupational history. The geographical location of leptospirosis cases from E- notifikasi database were transferred to Map Source software version 6 for mapping, geographical distribution and to determine type of land resided by the cases. Data for rainfall distribution and temperature were obtained from National Meteorology Department from first January 2014 to 31st December 2014 for Kelantan state. The data was analyzed using the IBM SPSS 22. All continuous variables were described using mean (SD) and/ or median (IQR) whereas for categorical data as frequency (%). The Azimullah AZ, Aziah BD, Fauziah MN 53 IJPHCS International Journal of Public Health and Clinical Sciences Open Access: e-Journal e-ISSN : 2289-7577. Vol. 3:No. 4 July/August 2016 continuous variables were age while categorical variables were sex, race, citizenship, and occupational classification. At univariate analysis, simple logistic regression was used to compare the sociodemographic characteristics, occupational classification and confirmed leptospirosis. The results of simple logistic regression, crude odd ratio (OR), p- value, and 95% confidence interval (CI) were recorded for each variable. p – Value of <0.05 (two sided) was taken as significant at 95% confidence interval. Multiple logistic regression model was performed to predict factors associated with the leptospirosis cases in Kelantan 2014. All the variables were tested whether there is an association between factors and confirmed leptospirosis case in Kelantan 2014. The final model was presented with adjusted odds ratio and 95% confidence interval (CI), Wald statistics and p- value. The level of significance was set at p- value less than 0.05. 3.0 Result 3.1 Socio demographic characteristics of confirmed leptospirosis cases in Kelantan 2014 There were 620 confirmed Leptospirosis cases in Kelantan in year 2014. Majority of leptospirosis cases were Malay (88.7%) and male cases contributed about 63.7% outnumbered female cases (36.3%), non-Malaysian contributed 7.9 % of the leptospirosis cases in Kelantan. The mean (SD) age was 33.2 (18.23) years with range from 2 years old to 89 years old. Majority of the leptospirosis cases were in low risk occupational group (61.3%). Table 1 shows the sociodemographic characteristics of confirmed leptospirosis cases in Kelantan in year 2014. Table 1: Sociodemographic characteristics of confirmed leptospirosis cases Variable Mean(sd) n (%) Age (year) [range:2-89] 33.2(18.23) Gender Female 225 (36.3) Male 395 (63.7) Race Malay 550 (88.7) Non Malay 70 (11.3) Citizenship Malaysian 571(92.1) Non-Malaysian 49 (7.9) Occupation High risk 240 (38.7) Low risk 380 (61.3) Azimullah AZ, Aziah BD, Fauziah MN 54 IJPHCS International Journal of Public Health and Clinical Sciences Open Access: e-Journal e-ISSN : 2289-7577. Vol. 3:No. 4 July/August 2016 3.2 Type of occupation for confirmed leptospirosis in Kelantan 2014 The highest percentage of confirmed leptospirosis case was students which contributed 26.9% followed by agriculture worker 22.1%, housewife 11.8% and unemployed 9.8%. High risk occupation such as outdoor worker, food handler medical personnel, and military contributed 7.1%, 5.5 %, 2.4% and 1.8% respectively. Figure 1 shows the proportion of confirmed leptospirosis according to type of occupation Figure 1: The proportion of confirmed leptospirosis according to type of occupation 3.3 Distribution of leptospirosis cases based on district in Kelantan 2014 Leptospirosis cases were distributed in all districts throughout the state with the highest number was in Pasir Mas (153), followed by Kota Bharu ( 94), Kuala Krai (88), Gua Musang ( 88), Machang ( 63 ), Tumpat ( 48 ), Jeli ( 29 ), Bachok (25), and the lowest number were Tanah Merah (16) and Pasir Puteh ( 16 ). Table 2 shows the proportion of confirmed leptospirosis cases and the outcome in Kelantan 2014. Table 2: Proportion of confirmed leptospirosis cases based on districts in Kelantan 2014 (n = 620) District Cases, n (%) Pasir Mas 153(24.7) Kota Bharu 94 (15.2) Gua Musang 88 (14.2) Kuala Krai 88 (14.2) Machang 63 (10.2) Tumpat 48 (7.7) Bachok 25 (4.0) Jeli 29 (4.7) Pasir Puteh 16 (2.6) Tanah Merah 16 (2.6) Total 620 Azimullah AZ, Aziah BD, Fauziah MN 55 IJPHCS International Journal of Public Health and Clinical Sciences Open Access: e-Journal e-ISSN : 2289-7577. Vol. 3:No. 4 July/August 2016 3.4 Type of land resided by leptospirosis in Kelantan 2014 In relation to type of land resided by leptospirosis cases in Kelantan state, Most of the confirmed leptospirosis in Kelantan 2014 resided in settlement area (22.9%), followed by plantation (16.1%), rural area (14.4%) and paddy field (13.8%). Table 3: Type of land in relation to number of leptospirosis cases in Kelantan 2014 Type of land use Leptospirosis case Frequency % Settlement area 141 22.9 Plantation 99 16.1 Rural area 89 14.4 Paddy field 85 13.8 Forest 73 11.9 Urban area 65 10.6 Others 62 10.4 3.5 Climatological Data in Kelantan 2014 The rainfall pattern from January to December 2014 indicates variation of distribution over the Kelantan.
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