Environmental and Behavioral Determinants of Leptospirosis in an Endemic Tropical Region: A Case-Control Study in Indonesia
DOI:
https://doi.org/10.53713/htechj.v4i3.721Keywords:
leptospirosis, risk factors, Environment, behavior, Serang RegencyAbstract
Leptospirosis remains an escalating public health challenge in tropical endemic regions, necessitating a deeper understanding of its localized transmission dynamics. This study aimed to identify the specific individual and environmental risk factors significantly associated with leptospirosis incidence in Serang Regency, Indonesia. A quantitative case-control study was conducted involving 62 respondents, comprising 31 confirmed cases and 31 matched controls. Data were analyzed using bivariate Chi-square tests and multivariate logistic regression to determine significant associations and calculate precise odds ratios (OR) with 95% confidence intervals. Multivariate analysis revealed that the non-use of personal protective equipment (PPE) was the most dominant risk factor (p=0.026; OR=10.435), followed by poor handwashing habits (p=0.017; OR=4.444), inadequate house gutter conditions (p=0.032; OR=3.906), the presence of rat footprints (p=0.040; OR=3.385), and residing in flood-prone areas (p=0.040; OR=3.385). Conversely, the conditions of household clean water facilities and trash bins demonstrated no statistically significant association with disease incidence in this cohort. A synergistic interplay of micro-environmental hazards and modifiable behavioral deficits drives leptospirosis transmission in this region. Public health interventions must urgently prioritize targeted PPE distribution, rigorous peri-domestic rodent control, and community-level hygiene education to mitigate future outbreak risks effectively.
References
Afandi, A. T., Kurniyawan, E. H., Nabilah, P., Wanda, I. P., Mauliya, F. R. A., Kurniawan, D. E., & Nur, K. R. M. (2023). Overview of leptospirosis in agricultural settings: A literature review. Health and Technology Journal (HTechJ), 1(5), 547–557. https://doi.org/10.53713/htechj.v1i5.116
Almazar, C. A., Montala, Y. B., & Rivera, W. L. (2026). Leptospirosis in Southeast Asia: Investigating seroprevalence, transmission patterns, and diagnostic challenges. Tropical Medicine and Infectious Disease, 11(1), 18. https://doi.org/10.3390/tropicalmed11010018
Birlutiu, V., & Birlutiu, R. M. (2026). Leptospirosis in Central Romania: A 17-year single-center cohort study of hospitalized adults. Microorganisms, 14(2), 298. https://doi.org/10.3390/microorganisms14020298
Bradley, E. A., & Lockaby, G. (2023). Leptospirosis and the environment: A review and future directions. Pathogens, 12(9), 1167. https://doi.org/10.3390/pathogens12091167
Davignon, G., Cagliero, J., Guentas, L., Bierque, E., Genthon, P., Gunkel-Grillon, P., Juillot, F., Kainiu, M., Laporte-Magoni, C., Picardeau, M., Selmaoui-Folcher, N., Soupé-Gilbert, M. E., Tramier, C., Vilanova, J., Wijesuriya, K., Thibeaux, R., & Goarant, C. (2023). Leptospirosis: Toward a better understanding of the environmental lifestyle of Leptospira. Frontiers in Water, 5, 1195094. https://doi.org/10.3389/frwa.2023.1195094
Ganasen, T., Mohd-Azami, S. N. I., Khoo, J. J., Peng, T. L., Johari, J., Sahimin, N., ... Loong, S. K. (2025). Rodent-borne zoonotic diseases in Southeast Asia: A narrative review. Tropical Biomedicine, 42(2), 100–122. https://doi.org/10.47665/tb.42.2.003
Lennon, L. F., Sahin, O., Batikawai, S., & Reid, S. A. (2026). A One Health approach to water as an ecological enabler for leptospirosis: A system dynamics model. Systems, 14(3), 237. https://doi.org/10.3390/systems14030237
Mekuriaw, A. (2025). Comprehensive epidemiological insights on leptospirosis global health effects and the risk factors for prevention and control. In Infectious diseases. IntechOpen. https://doi.org/10.5772/intechopen.1008181
Murray, M. H., Buckley, J. Y., Byers, K. A., German, D., Sancha, N. U., Mehta, S., ... Magle, S. B. (2024). Urban rats (Rattus norvegicus) through a One Health lens: Social and ecological factors promote opportunities for urban leptospirosis in rats, dogs, and people. One Health Cases, 2024, ohcs20240001. https://doi.org/10.1079/onehealthcases.2024.0001
Nurfauzia, E. N., Adi, M. S., & Widjanarko, B. (2025). Socio-environmental determinants of zoonotic disease and cardiovascular risk: A leptospirosis case-control study in an endemic area of Indonesia and its implications for hypertension prevention. Revista Latinoamericana de Hipertensión, 20(9). https://doi.org/10.5281/zenodo.17314794
Nurfitri, N., Sukesi, T. W., & Mulasari, S. A. (2025). Risk factor analysis of leptospirosis incidence in endemic areas. Advances in Healthcare Research, 3(2), 297–313. https://doi.org/10.60079/ahr.v3i2.543
Palma, F. A. G., Costa, F., Lustosa, R., Mogaji, H. O., de Oliveira, D. S., Souza, F. N., ... Khalil, H. (2022). Why is leptospirosis hard to avoid for the impoverished? Deconstructing leptospirosis transmission risk and the drivers of knowledge, attitudes, and practices in a disadvantaged community in Salvador, Brazil. PLOS Global Public Health, 2(12), e0000408. https://doi.org/10.1371/journal.pgph.0000408
Sandoval, K. L., Cada, K. J. S., Dimasin, R. V. D., & Labana, R. V. (2025). A One Health approach to the prevention, control, and management of leptospirosis: A scoping review. Discover Public Health, 22(1), 108. https://doi.org/10.1186/s12982-025-00489-7
Scherer, J. N., Dipp, T., Schaefer, R., Mosmann, C. P., & Ornell, F. (2025). Insights on health burden, needs, and prevention strategies after the flood catastrophe in Southern Brazil. Journal of Prevention, 46(4), 639–665. https://doi.org/10.1007/s10935-025-00839-w
Soni, N., Eyre, M. T., Souza, F. N., Diggle, P. J., Ko, A. I., Begon, M., Pickup, R., Childs, J. E., Khalil, H., Carvalho-Pereira, T. S., Pertile, A. C., Carvalho, M., Oliveira, D. D., Nery, N., Giorgi, E., & Costa, F. (2024). Disentangling the influence of reservoir abundance and pathogen shedding on zoonotic spillover of the Leptospira agent in urban informal settlements. Frontiers in Public Health, 12, 1447592. https://doi.org/10.3389/fpubh.2024.1447592
Sykes, J. E., Reagan, K. L., Nally, J. E., Galloway, R. L., & Haake, D. A. (2022a). Role of diagnostics in epidemiology, management, surveillance, and control of leptospirosis. Pathogens, 11(4), 395. https://doi.org/10.3390/pathogens11040395
Sykes, J. E., Haake, D. A., Gamage, C. D., Mills, W. Z., & Nally, J. E. (2022b). A global One Health perspective on leptospirosis in humans and animals. Journal of the American Veterinary Medical Association, 260(13), 1589–1596. https://doi.org/10.2460/javma.22.06.0258
Tazerji, S. S., Nardini, R., Safdar, M., Shehata, A. A., & Duarte, P. M. (2022). An overview of anthropogenic actions as drivers for emerging and re-emerging zoonotic diseases. Pathogens, 11(11), 1376. https://doi.org/10.3390/pathogens11111376
Temporada, K., Quinto, L., Tarraya, D. A., Sison, F. C., Marfil, J. F., Ramirez, C., & Ng, W. J. (2025). Awareness and preventive practices on leptospirosis in flood-prone communities of Marikina City, Philippines. International Journal of Health & Business Analytics, 1(1). https://doi.org/10.65166/x71zvx65
Wijayanto, R., Zilfiarani, C. N., & Fahlefi, M. I. R. (2026). Ecological determinants of pathogenic Leptospira survival: Microbial interactions, environmental stressors, and One Health perspectives. Media Kedokteran Hewan, 37(1), 114–127. https://doi.org/10.20473/mkh.v37i1.2026.114-127
Ziliotto, M., Chies, J. A., & Ellwanger, J. H. (2024). Extreme weather events and pathogen pollution fuel infectious diseases: The 2024 flood-related leptospirosis outbreak in Southern Brazil and other red flags. Pollutants, 4(3), 424–433. https://doi.org/10.3390/pollutants4030028
