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E3S Web of Conferences 31, 06003 (2018)


Mapping Of Leptospirosis Environmental Risk Factors and
Determining the Level of Leptospirosis Vulnerable Zone In
Demak District Using Remote Sensing Image
Siti Rahayu1, Mateus Sakundarno Adi2, and Lintang Dian Saraswati1*
Department Epidemiology and Tropical Diseases, Public Health Faculty, Diponegoro University, Semarang, Indonesia, 50275
Master Program of Epidemiology, School of Postgraduate Studies Diponegoro University, Semarang, Indonesia

Abstract. Leptospirosis, a zoonotic disease, transmitted to human trough contact with contaminated
animal urine and contaminated environment. Demak District is an endemic area where cases increased in
the past 2 years. The aim of the study was to map environmental risk factor of Leptospirosis and to
determine Leptospirosis vulnerable zone using cross-sectional study design. There were 42 cases mapped
by GPS and overlaid using remote sensing (Quickbird image) by using ArcView program then interpreted
by Spatial Feature and Spatial Analyses. Leptospirosis cases were spread out and grouped in Demak Sub
District area. More cases were males (61.9%), 21-50 years old age group (59.3%) and farmers (40.4%).
Spatial analyses showed that all the leptospirosis cases took place in the area with low plain <47 msl,
rainfall ≥220 mm/month (64.7%), clay soil (100%), buffer river <50 m (71.4%), presence of rat (100%),
wastewater disposal (100%), waste disposal facilities (97.7%), flood’s profile (28.6%), tidal inundation’s
profile (7.1%), vegetation (59.5%). Leptospirosis high-risk zone was in 37,801.8 ha (41.32%), moderate
risk zone was 43,570.23 ha (48.55%), and low-risk zone was 9,090.96 ha (10.13%). Densely populated
housing, bad environment condition, and the presence of rat and puddles that were contaminated by rat’s
urine were risk factors of Leptospirosis cases in Demak District.

1 Introduction population per year, whereas in tropical countries it
ranges from 10-100 incidence per 100,000 population
Leptospirosis is a worldwide public health problem, per year [1]. Indonesia as a tropical country becomes
especially in tropical and subtropical countries with one of them. The International Leptospirosis Society
high rainfall, and is also a major problem in temperate states that Indonesia is one of the tropical countries
regions [1]. Leptospirosis, caused by pathogenic with relatively high leptospirosis death cases, ranging
spirochetes belonging to the genus Leptospira, is a from 2.5%-16.45% or an average of 7.1% and is
zoonosis that has important impacts on human and ranked third in the world. Leptospirosis cases in
animal health worldwide [2]. Transmission to Indonesia in 2012 among 239 patients, 29 people died
mammals occurs via direct contact with leptospira- (CFR 12.13%), in 2013 there are an increasing number
infected urine or tissues or indirectly through contact of Leptospirosis cases with 640 patients, 60 people
with contaminated soil or water. Although infection died (CFR 9.38%). Leptospirosis cases in 2014 slightly
may take place through unbroken skin after prolonged decreased by 519 patients, 61 people died (CFR
immersion, Leptospira sp usually gain entry to the host 11.75%) [1], [8].
via abrasions or cuts in the skin or through exposed Demak District is one of the endemic areas of
mucosae (eyes, nose, etc.). Incidence is seasonal, Leptospirosis in Central Java Province with a mortality
peaking in summer and fall in temperate climates and rate of Leptospirosis exceeding the national average
during the rainy season in tropical areas, mirroring the (7.1%). According to Health Office of Demak District
ability of the bacteria to survive in the external in 2015, there are 13 patients of Leptospirosis cases
environment. Soil [3], [4], mud [5], and surface waters and 2 people died in 2012 (CFR 15.3%). In 2013, there
contaminated with urine from chronically-infected are 17 patients of Leptospirosis cases and 2 people died
reservoir hosts remain important sources of human (CFR 11.7%), in 2014 it’s increased by 30 patients and
leptospirosis transmission worldwide [6]–[8]. 5 people died (CFR 16.6%), and in 2015 there are 12
The incidence of Leptospirosis in subtropical patients and 1 person died (8.3%).
countries is in the range of 0.1-1 incidence per 100,000

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as well as the magnitude of leptospirosis population is larger than male. [27]. River. Altitude. extreme weather events The result of this study indicates that more than half of such as cyclones and floods occurring in recent years respondents are male by 61. There were 42 b.6 effective data source for urban environment analysis e. activities. where the female incidence.1 or events. Percetg. b. and Environment [9]–[11].The distance between River 2 Methods and House a. Student 1 2. Primary a. adverse environmental conditions that allow the environment to be a suitable place to live and develop Table. but The high prevalence rate of Leptospirosis in men are at greater risk for Leptospirosis infection due tropical and subtropical climates can be attributed to to several things. which are definable in space as point. Housewife 7 16. Education of Leptospira bacteria [5]. Our previous study Level. Occupation System is a special case where database consist of a. of environmental factors and distribution of The agent of Leptospirosis disease is Leptospira Leptospirosis cases with overlay process to determine bacteria [12]. a. Sex incidence of Leptospirosis [20].6 was used for mapping environmental risk factors and c. and Occupation (n=42) showed mapping and analysis of environmental Characteristics of conditions are needed to determine the picture of Frequency Percentage (%) Respondents environmental factors existed and have a risk for the 1. Host. [22].3 b. Female 16 38. Soil a.7 a. Remotely sensed imagery is an d.1 Characteristic of Respondents by Sex. Poor with Quickbird image. Good Mobile Topographer with the ArcView program built 1 2.The presence of Rats number of leptospirosis cases and digital SHP map of a. Civil Servant 1 2.18]. <220 mm/month 15 36. Recently. cats. [12].7 location point using GPS. Good 42 100 Texture. may The result is different from the condition of the potentially result in an upsurge in the disease population in Demak District.5 time at various spatial and temporal scales without h. Road. The accidental host is human [14]. Secondary data were a 4. Flood Area.Topography a. Present 42 100 b. Land Use. 50-300 m = moderate 12 28.3 being in contact with it [23]–[25]. the use of GIS and Table.3 data were an environmental risk factor and coordinate b.E3S Web of Conferences 31. and Rainfall). 06003 (2018) https://doi.9 The mapping can be done by utilizing Geographic b. [15].1051/e3sconf/20183106003 ICENIS 2017 The occurrence of infectious diseases is influenced by environmental risk factors. such as dogs.000 scale (Administration 5.Rainfall using remote sensing image in Demak District. <50 m = at risk 30 71.3 or areas [21]. Pedicab Driver 1 2. i. [13]. Geographic Information 2. ≥220 mm/month 27 64.2 Frequency Distribution of Leptospirosis Cases in spatial representation of various health issues make Leptospirosis Case Area in Demak District in 2014-2015 professionals arrive at conclusions in a faster and better way in the field of both public health and decision.5 observations on spatially distributed features.Wastewater Disposal Facility Border. Scavenger 2 4. [13]. ≥47 masl 0 0 2. The use of these systems has a wide impact on (%) the public health and lots of studies are based on them 1. b. with increasing frequency and greater intensity. c. After visual interpretation and screen digitalization to visual identification of 2 . Male 26 61.1 Information System (GIS). such as activity and occupation.9% or as many as 26 cases.Waste Disposal Facility The data obtained was mapped with the GPS 41 97. Spatial modeling analysis three factors: Agent.7 Both technologies are very useful in the j. Contour.3 management of spatial information of earth surface condition [26]. In the tropical climatic zone. PooR 0 0 leptospirosis cases.7 urban land cover characteristics and their changes over g. Fisherman 2 4. >300 m = good 0 0 determining the level of Leptospirosis vulnerable zone 3. where environmental conditions are 3 Results and discussions most favorable for survival of Leptospira and the highest morbidity is noted. lines. and cows [2]. The main hosts are rats and pets the level of Leptospirosis vulnerable zone. Both men and women outbreaks [16]–[18]. Labor 3 7. 6.4 An observational study with the cross-sectional design [19]. <47 masl 42 100 [17. None 0 0 Demak District in 1:25.4 that is inherently suited to provide information on f. Farmer 17 40. are equally at risk to be infected by leptospirosis. Entrepreneur 4 9. Variable Frequency making. Merchants 4 9.

1051/e3sconf/20183106003 ICENIS 2017 Percetg.7%). None 13 31 the rat droppings while searching for rubbish in the 8.5 .org/10. Scavengers are at risk of direct contact with b. b. A flood occurs due to the overflow of contaminant environment even larger.331 mm/year. a. ≥3 types 25 59. The habit of throwing rubbish in the river Occupation of the respondents is also at risk to make the volume of river shrinks so water will be exposure to contaminants or animals infected with overflowed when the water debit start to increase. The condition of Demak District which is mostly lowland so more than half of its area is used for As of the case in Demak District.5 areas with high rainfall ≥220 mm/month (64.E3S Web of Conferences 31. Present 29 69 cement.e. the result of this study also indicates that the research that the characteristic of the occupation of respondents are living in housing with poor sewerage respondents is labor farmer. are at risk to the rice fields contaminated with Fig. and scavenger. during stirring of a.3 transmission occurred when looking for rubbish. i. Construction laborers Variable Frequency (%) are at risk to the dirty water contaminated by 7.7 Demak District is an area with high rainfall that is 10. Semarang City is one of the endemic 9. as rats often roam for food in the trash. Present 12 28. b.Vegetation 534-3. 06003 (2018) https://doi. Present 6 14.The presence of Pet Leptospira when working. river water. The existence of large river or men who will directly clean the environment after river irrigation becomes a strong factor of flood during flood causes the possibility of exposure to the rainy season. Farmers conditions and poor waste disposal facilities. Leptospirosis from rat droppings. It can be seen from the result of this addition. None 30 71. so there is a high possibility of a.6 Respondents’ location to look for rubbish is in b.1 The Incidence of Leptospirosis Cases in Demak District Every Month in 2014-2015 3 .Flood History trash. None 36 85.Tidal Flood History areas of Leptospirosis.4 Semarang City. More than half of cases occur in a. <3 types 17 40. the activity of irrigation rice field. In Leptospirosis.

And respondents who use vegetables ate events that cause the widespread formation of water by rodents have 4.5. However.1051/e3sconf/20183106003 ICENIS 2017 The incidence of Leptospirosis in Demak District in distribution of cases.3. especially when the pH is slightly Mranggen Sub-district and Karangawen Sub-district alkaline [13]. [31]. years [20]. from whose proximal renal tubules Leptospira 2011. [32]. This Flooding and heavy rainfall have been associated with can be seen from the results of this research showing an increase of leptospirosis in specific in Albania. except for half of long periods of time. that occurred 7 cases water can stagnate longer [3]. 06003 (2018) https://doi. The primary source is the excretor 000 in 2005 toward 1. Respondents claimed to have seen rats teritory of the country with increase of incidence either inside or outside the house. Tidal flood and flood are the same in their house. between the distribution of cases in the area with flood February) and still occurred during low rainfall. Sayung Subdistrict there are only Leptospirosis cases spreading. there appears to be a difference 2014-2015 is increasing during high rainfall (January.1%). in particular drying. The most affected areas are traces in the house or rat droppings inside the house. As for the area with tidal flood history The altitude from sea level is an important variable for in Monosari Village. The basic factor for the possible survival and spread of level of incidence has been increased from 0. [29]. Dissemination of Leptospirosis Cases Fig.3-8. Rats are the primary reservoir that has ≥47-100 masl animals in Leptospirosis cases in Demak District.9%) Leptospira sp survive in moist soil and fresh water for Demak District area is lowland. after the flood.6 times greater risk of minimum once in 2 years occurred in 3 respondents Leptospirosis compared to those who do not have rats houses (7. Mostly (98. there are a lot of cases occurred supported by clay soil type in Demak District. the flooded areas of Shkoder. Altitude condition is 2 cases. Respondents with rats in incidence in Demak District shows that flood history their house have 22. Fig. Climate change and floods may potentially result sp are excreted into the environment with urine. whereas pathogenic permanent water logging [30].6 times greater than who don’t use puddles that last for a long time. Land Use and Leptospirosis Cases Dissemination 4 . In the distribution of cases in the formation of puddles.E3S Web of Conferences 31.5 cases/ 10 000 in 2010 and rodent. from the vegetables ate by rodents [29]. to have seen rat’s during the last two years. This is possible because the pH of tidal flood strongly associated with flood area and the location of water ranges from 8. they can survive for long periods Distribution of tidal flood history in Leptospirosis in water and wet soil [18]. so the in Mangunjiwan Village area. The the presence of rats either inside or outside the house of study showed that Leptospirosis is spread in 47% all respondents.2. Fier and Lezha and also The renal carrier state of rodents still remains a Berat and Tirana with single cases in other cases/10 Leptospira sp. in an upsurge in the disease incidence over the last Although they are susceptible to environmental factors. High history and the distribution of cases in the area with rainfall is the cause of flood and resulted in the tidal flood history. The presence of puddles is area with flood history.8 -2.

Topography and Leptospirosis Cases Dissemination Fig.6. Waste Water Disposal Facilities 5 .9. River Buffer and Leptospirosis Cases Dissemination Fig.8. Garbage Disposal Facilities Fig. Rainfall and Leptospirosis Cases Dissemination Gig.5. 06003 (2018) Web of Conferences 31.1051/e3sconf/20183106003 ICENIS 2017 Fig.4. Type of Soil and Leptospirosis Cases Dissemination Fig.

10. Mapping of Leptospirosis Vulnerable Zone in Demak District 6 . History of Flood Fig.11.13.15.E3S Web of Conferences 31.1051/e3sconf/20183106003 ICENIS 2017 Fig. Presence of Rodents Fig.12. The presence of Potential Pests As Reservoir Fig. 06003 (2018) https://doi. Vegetation Number History of Tidal Fig.

6 times greater be known that the number f maximum value is 53 and than who don’t use vegetables ate by rodents [29]. 06003 (2018) https://doi. and low risk zone is 9. 12 Leptospirosis high risk zone in Demak district is 1. the number of minimal value is 21. Mark. a small river. and vegetation. Dry field Leptospirosis risk zone in Demak is spread evenly in 3: <50 m 5 15 all of Demak area. 6 Tegalan. It is caused by the area of Demak 2.1051/e3sconf/20183106003 ICENIS 2017 This can be seen from the results of this research Final scoring of all environmental parameters showing the presence of rats either inside or outside the procured from a score of environmental parameter mark. The primary source is the excretor rodent. leptospirosis vulnerable rate is using Sturgess method as they can survive for long periods in water and wet soil reference. Rainfall 1: <220 mm/month 3 moment that raining. 2 32-42 Risk Zone Environmental 3 21-31 Low-risk Zone Score Mark Value Parameters 3: Housing 6 18 2: Rice field. The who do not have rats in their house. All of it is not leptospirosis high-risk zone.23 ha 1: Fishpond. River Buffer 2: 50-300 m 10 district which has low plain exploited as rice field. from After scoring. in particular drying. and value can who use vegetables ate by rodents have 4. to have seen environmental parameters. Loam. Scoring and marking of all variables were based on Classification = (53-21)/3 variable influence great or environmental variable Classification = 10 toward leptospirosis incident. >300 m 5 leptospirosis high-risk zone spreads in all of Demak 2: ≥3 Types 4 8 district area with forming a pattern on the river current 3.32%).743 ha which has 14 leptospirosis vulnerable zone is divided 3 class which are subdistricts and 243 villages.570.E3S Web of Conferences 31.3 Class of Leptospirosis Vulnerable Zone the modification. Topography 2% 1: >47 masl and>2% 1 7 . house of all respondents. Vegetation because Demak district is the area which has many big 1: <3 Types 4 Respondents with rats in their house have 22. Land Use Swamp 37. Handling determining and leptospirosis intervention is prioritized at a specific zone that is risk zone. and low-risk zone. marking. Silt 2 4 crowd and dirt housing which has near a location with 5. 1 2 6.090. of class river buffer. determination of classification leptospirosis into the environment with urine. Basic of scoring and marking are the result of first research and the result of Table. sp. Plantation. risk zone is 43. Making of leptospirosis vulnerable zone be based on Classification = (The number of maximal value – The leptospirosis vulnerable zone which is determined by number of minimal value) /The number environmental parameters that are land use. Leptospirosis high-risk zone is 2: Clay. Spatial classification of susceptible to environmental factors. the 1.96 ha (10. Class Interval Zone Table. It divides the result of the number of maximal [18].801.8 ha (41. Dissolve at the end of overlay rat’s traces in the house or rat droppings inside the executed with the aim to agglomerate the final result that house. marking and value each environmental whose proximal renal tubules Leptospira sp are excreted parameters. (48. type of soil.13%). Although they are vulnerable zone is determined. Type of soil 1: Sand 2 river and rice field. 2: <47 masl and 0. risk zone.55%). Classification of Demak District is 89. topography. and irrigation that can cause flood 2: ≥220 mm/month 3 6 or puddle when the river water overflowing at the 4. rainfall. risk zone. and Value at Environmental Parameters 1 43-53 High-Risk Zone of Determining of Leptospirosis vulnerable zone in Demak District. has the same value at each environmental parameters so The renal carrier state of rodents still remains a basic class-wide of leptospirosis vulnerable zone can be factor for the possible survival and spread of Leptospira calculated. And respondents determination result of scoring. woods.2 Score.6 value decrement with the number of minimal value be times greater risk of Leptospirosis compared to those based on the number of the class wanted. Respondents claimed to have Overlay executed after summing the value from each seen rats either inside or outside the house.

Hyg. vol. Johnson et al. pp. Woods. More than half of the respondents are male with 10. Vet. (2009). 21. vol. 290–302. Public Health. 28. no. Monahan.. vol. pp. O. (2003). J. Geospat. Ntherlands: Elsevier Scientific leptospirosis : guidance for diagnosis. no. 6. and S. Mesev. Schwartzman. P. 3. no. P. A. vol. R. 251–259. 2. Nally. Asia. risk occupations are a farmer. 175–187. Dec. P. pp. 10. 6. vol. Mcbride. T. Human 22. 5. B. 1. L. 4. 4. Udiyono. Prev. Haq. Sp. 135–141..-W. G.. vol. (2003). Biosci. 8 . Appl. A. S. Dis. 22–3. Vet. Cooperate with sectoral agencies regarding the vol. de la Peña Moctezuma. Trop. Remote Sens. pp. D. Microbes Environ. 3. (2017). e228. Shabbir. pp. Egypt. K. Ahmad. smoothly during the rainy season. puddles. M. Ns. Isaac. (2005). 71. 43. Brenner. Soc. in Molecular medical microbiology. K. vol. pp. pp. 6 References Aziz. 631–638. Environ. 4. Oct. 2. no. P. (2003). Liu. no. Athanazio. Dis.. J. rainfall attributed to the occurrence of flood and 2. M. Raghavan.. vol. Garg. vol. no. S. shallowing rivers so the water will flow 1. and J. Eds. 12. Sci. 1. A. Nair. 18. (2002). (2014). Geoinf. McEwen. vol. B. low rainfall or dry season (June and July) 12. Lau. 94 27. 28. and D. K. M. India. J. 8. vol. Microbiol. Harrington. Appl. 3. constructing a healthy sewer in residential 19. D. vol. p. Harkin. Leptospirosis Curr. 37S–46S. D. Sep. C. Maycock. pp. Smythe. 716. S. Ann Trop Med Parasitol. Carvalho. functions of the river and digging the Vijayachari. Natl. Health Organization. F. vol. 1. Vet. Microbiol.. pp. Sugunan. (2012). 1. C. Vet. 7. May (1997). 28. Jan. surveillance and control. no. (1995). and P. R. Sakundarno. no. 3–4. Health. Dis. Wilcock. J. (2009).E3S Web of Conferences 31. P. 15–32.. pp. 14. André-Fontaine. no. pp. S. pp. Public 29. high rainfall (January and February) and during 103. pp. no. Ko. The condition of Demak District which has (2010). Pattanshetty. 10. 169–82. N. laborers. 5. Infect. Vijayachari. F.. Amran. 4. 15. 955–61. and R. 25. J. E. vol. construction 2nd Ed. 7. lowland area with clay soil type and high 13. and A. Dhaliwal. Rats are the main reservoir of Leptospirosis 15. 1973–1990. Jun. 104. Can. D. Levett. Spickett. although the rain intensity is lower. Dec. Higgins.. L. Butt. no. Asia. E. J. Cooperate with relevant cross-sectoral agencies Shriram. and J. 3. I. 2. Clin. 557–69. Can. B. Suppl. vol. (2013). no. P. 757–771. Kamath. vol. Elsevier. Y.. B. M. Jun... 4 Conclusions I. J. A. 173–182. R. 140. J. Egypt. S. Pac.. pp. cases in Demak District. 1. Craig. no. Benacer. 2. Int. Rev. Med. (2006). 26. 707– May (2013). Khare. 18. and A. Fajriyah. I. Tang. (2008). vol. 25. S... J. 2. 7. Microbiol. J. Paras. J. (2010). D. 117. 647–51. vol. D. Reis et al. sewerage and poor waste disposal facility. Sugunan. D. vol. J. Co. Swain. 20509. Sussman. 15. Prescott. Fraga. The respondents’ Barbosa. Saraswati. A. M. Poeppl et al. Dec. and J. no. A. Opin. Muhammad. Microbiol. 3. 3–4. and K. Sehgal. given the fact that rats are present in all areas of 20. Vet. (2008). 1. pp. and scavengers.1051/e3sconf/20183106003 ICENIS 2017 9. (2005). Apr. 3–4.. pp. Comput. in rejuvenating the function of sewer and Nov. Dueker.. and B. areas. vol. Leptospirosis cases. pp. pp. 135–40. 33. 10. Benacer et al. p. vol. R. S. IOP Conference Series: Earth and Environmental Science. no. vol. A. pp. L. J. PLoS Negl. J. p. N. Poxton. Akhtar. Dec. P. J. (2001). 5 Suggestions 16. S. Oct. (1979). World Health Organization. no. S.. same pattern of cases that are occurring during 11. J. 1. Pac. Leptospirosis cases in 2014 and 2015 have the pp. vol. Remote Sens. no. J. Sci. Bertolatti. and A. A. no. Earth Obs. no. no.. J.. Pub. Feb. Geneva: World 23. Bharti et al. 6. J. P. May (2016). Dis. vol. 1. Rahmatullah. vol. Hunter. pp. B. Mohd Zain. Lancet Infect. M. pp. N. Oct. no. R.. Microbiol. Health.. 21. K. p. Craig et al. R. and L. S. Berke.. Eurosurveillance. 18. 296–326. Med.. Trans. Thong. Dis. L. Conducting efforts to eradicate rats. S. (2015). prevention of flood by rejuvenating the 17. A. Abrams-Ogg. K. Sp.. A. no. Appl. 24. M. 2. R. Trop. 18.(2013). 1016–22. 4. (2004). 1. no. M. Glob. V. 19–24. Med. and P. Jan. (2008). 376–386. Infect. N.. 287–96. Woh. 55. and K. Jat. Taylor. M. The condition is exacerbated by poor 14. 2. Adler and A. Emerg. no. 06003 (2018) https://doi. no. J. Urban Syst. and N. Weinstein. K. W. average age of 44 years old. 26–43. Infect. (2014). = La Rev. 26. Y. 107. Miller. 12. S.

. A. PLoS One. J. (2000) 9 . Barcellos and P. 06003 (2018) https://doi. e39672. Kupek. 30. vol. 17 Suppl. Jul.. M. pp. 7. Cad.1051/e3sconf/20183106003 ICENIS 2017 3. and J. vol. C. Sabroza. de Sousa Santos Faversani. 7. (2012). M. no. 131–4. Dechet et al. (2014). no. 31. 59–67. vol. Infect. Jan. C. pública. de Souza Philippi.E3S Web of Conferences 31. saúde Dis. pp. M. C. 4. E. 32. p. Jun. (2001). Braz.