Application of leptospirosis surveillance study at primary health care center in Banyumas and Demak, Central Java,...

Leptospirosis remains one of the most significant zoonotic diseases in tropical regions such as Indonesia. It is characterized by high morbidity and mortality rates, with case fatality rates ranging from 5% to 15%, and frequent underreporting due to nonspecific clinical symptoms, which contributes to underdiagnosis in up to 40%-60% of suspected cases. Surveillance at the Public Health Care Center (PHC) level is crucial for early case detection and outbreak control in endemic areas.

This study aimed to develop and implement a leptospirosis surveillance model at primary health care facilities in two endemic regencies in Central Java, Indonesia, Banyumas and Demak districts, to improve early detection, reporting, and response capacity.

The research on leptospirosis surveillance by the PHC was conducted from January 2018 to December 2019 in Banyumas and Demak Regencies, Central Java. This research is a time-series study that encompasses case findings, diagnosis, and laboratory detection of leptospirosis. Case findings were carried out both passively (at health centers) and actively (within the community) using the WHO-SEARO clinical symptom criteria.

In Banyumas Regency, 121 suspects, 106 probable, and 44 confirmed cases of leptospirosis and in Demak Regency between 2018 and 2021, 73 cases of leptospirosis were reported, with 22 deaths, resulting in a case fatality rate of 30.1%. A total of 51 patients recovered from the disease. While the hospital reported 63 leptospirosis cases and 9 related deaths, surveillance in Demak Regency identified 72 suspected, 67 probable, and 23 confirmed cases with no reported deaths. However, a Demak hospital recorded 172 cases and 19 deaths. Negative binomial regression revealed a significant negative relationship between cases reported by PHCs and hospitals (coef = -0.050; p = 0.012), along with a decreasing trend in hospital cases over time (coef = -0.010; p = 0.046).

Leptospirosis surveillance data can be used to identify focal areas of leptospirosis endemicity. The application of the WHO-SEARO (2009) clinical criteria and rapid diagnostic tests supports the identification of suspected and probable cases of leptospirosis at the PHC level.