Spatial Leptospirosis Desy

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Leptospirosis

Text of Spatial Leptospirosis Desy

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    SPATIAL ANALYSIS OF

    LEPTOSPIROSIS AND RISK

    FACTORS IN KLATEN DISTRIC

    Desy Ari Apsari, Setyawan Budiharta, Lutfan Lazuardi

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    Leptospirosis: infectious disease caused by

    Leptospira bacteria, which is transmitted directly/ indirectly from animals to humans.

    Leptospirosis: a zoonotic distributed throughoutthe world, particularly the tropics and subtropics.

    Southeast Asia is an area of endemicleptospirosis, including Indonesia.

    In 2000, the case fatality rate of leptospirosis inIndonesia, the world's third-ranked 16.7%, withan average of 7.1%, with interval 2.5% -16.45%.

    Data from center of zoonois ministry of health inindonesia (2011) mentions CFR leptospirosis in2010 increased to 10% from 6% in the previous

    two years (2009 & 2008).

    Background

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    Regional distribution of leptospirosis in Indonesia:West Java, Central Java, Yogyakarta, Lampung,South Sumatra, Bengkulu, Riau, West Sumatra,North Sumatra, Bali, West Nusa Tenggara, SouthSulawesi, North Sulawesi, East Kalimantan andWest Kalimantan.

    Outbreaks of leptospirosis occurred in Riau1986, Bekasi and Jakarta in 2002 of 138 positivespecimens contained 44.2% infected withLeptospira, Bantul Semarang in 2003 and 2010.

    Central Java in 2010, including a secondcontributor to the number of cases and deathsafter the DI Yogyakarta

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    Leptospirosis outbreak in the district. Klatenoccurred in 2009. In 2010 there were 5 deaths from37 cases of leptospirosis were found in hospitals

    Increased cases of Insist accompanied byexpansion of the spread of leptospirosis.

    Mapping the distribution of leptospirosis isimportant, for the development of area-baseddisease surveillance system.System information about spatial dataleptospirosis incidence and risk factors has notbeen done in the district health office. Klaten.

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    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 ofsanitary 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.

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    Research Methods

    The study design

    - Ecological studies

    - Case-control (matching)

    Sample size

    ,

    2

    21

    2

    P

    PQZZn

    OROR

    P

    1

    - Sampling methods: purposive sampling

    -Sample size: 210 samples

    - Comparison of cases and controls = 1:1

    105: case 105: control

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    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%)

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    Result

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    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 (

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    Citra Satelit

    Gambar Citra Satelit Kluster Primer

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    Citra Satelit

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    Risk Factor Analysis of Leptospirosis

    Characteristics of respondents

    VariabelLeptospirosis Total

    (n=210)Case(n=105) Control(n=105)

    N (%) N (%) N (%)

    Gender

    Male

    Female

    Age

    25 Year

    2635 Year

    3645 Year

    4655 Year

    5665 Year

    6675 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)

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    Multivariabel analysis

    Conditonal Logistic Regression

    Variabel OR 95%CI p-valuePseudo

    R2

    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 -37,038Sanitary 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

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    Spatial Model

    Exposure to risk factors Leptospirosis in Klaten

    ExposureCase

    N %

    Sanitary housing 23 21,90

    Employment 11 10,48Presence 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

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    Distribution of Risk Factors for Leptospirosis in Klaten

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    Disccusion

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    The pattern distribution of leptospirosis in the Klaten district is grouped withthe coordinates of the center of 454,230, 9.15211 UTM zone 49S, a radius of423.86 feet and a p-value 0.017, a total of 12 cases with OR = 2.13 locatedin the Village Ngawen Senden.

    Characteristics of cluster formation region, is an area with a high populationdensity, most of the inhabitants are farmers or farm laborers and thedistance between the houses are very close.

    The neighborhood is very dense slum is one of the risk factors for theincidence of leptospirosis (WHO, 2010).Leptospirosis transmission tends to occur in residential areas with poorsanitary conditions fairly dense residential neighborhood is not good (Macielet al., 2008).

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    Buffer in paddy fields showed that 62.96% of cases of leptospirosis spreadin a radius of 15 m - 50 m from the rice paddies.

    Research Herbreteau et al. (2005) in Phrae Province, Thailand whichstates that 72.9% of cases of leptospirosis were farmers working in the ricefields, especially agriculture. The availability of water in the rice suspectedas the cause of the transmission of leptospirosis in humans.

    Jansen et al. (2005) in his study says that 37% of cases of leptospirosis inGermany in 1997 to 2000 occurred because of exposure to residentialcomprising of whom live in the area of agriculture, plantations and locationof residence, surrounded by mud or water.

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    Buffer road shows 44% of cases of leptospirosis living in a radius of 15-50 mfrom the local / district.50.5% of cases living in a radius of

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    Risk factors associated with the incidence of leptospirosis in Klaten is sanitaryhousing (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 environmentalexposure related to ho