Knowledge, Awareness, and Perception on Leptospirosis Infection and its Associated Risk

Factors among Local Villagers Residing in the Two Barangays of Sibagat, Agusan del Sur,

Northeastern Mindanao, Philippines: Implication for Public Health Education

A Research Paper Presented To

Presented to the Faculty of Senior High School Department - Academic Track

Science and Technology, Engineering, and Mathematics (STEM) Strand

In Partial Fulfillment

of the Course Requirements

RESEARCH IN DAILY LIFE 1

Researchers

Mapute, Sophia Angelica A.

Caingles, Stephany

Dela Victoria, Khirt Lourenz C.

Mar, Carah Lesly L.

Pedales, Christian Dave G.

Rosa, Ellyshielynneth Fiona S.

Valmoria, Kyle Angel C.

RAINER P. SULARTE
Research Adviser

February 2024

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 Introduction

Leptospirosis is a common and potentially lethal zoonotic disease that is endemic in

many tropical countries and creates huge outbreaks following severe rains and flooding. Both

humans and animals can contract the bacterial disease leptospirosis. Bacteria belonging to the

genus Leptospira are the cause. Infection occurs through direct or indirect contact with infected

reservoir host animals, which contain the pathogen in their renal tubules and shed harmful

leptospires in their urine. Although numerous wild and domestic animals can act as reservoir

hosts, the brown rat (Rattus norvegicus) is the primary source of human infection (Haake et al.,

2014).

Leptospirosis can cause renal damage, hepatic failure, respiratory distress, meningitis (an

inflammation of the membrane around the brain and spinal cord), and even death if left

untreated. Individuals who live in urban slums with poor sanitation and housing are at greater

risk of contracting leptospirosis from rats. Demographic changes favouring an increase in the

number of urban poor in tropical places vulnerable to intensifying like to storms and urban

floods as a result of climate change are predicted to increase the worldwide burden of

leptospirosis. Findings from prospective surveillance studies indicate that, in endemic locations,

the majority of human leptospiral infections are moderate or asymptomatic (Haake et al., 2014).

In Malaysia, infection and mortality of leptospirosis were primarily linked to water-

related activities, both recreational and non-recreational. In this country, leptospirosis is

endemic, although public awareness, attitudes, and practices are relatively low. Malaysia is

fortunate to have abundant rainfall and high humidity during the northeast monsoon season,

which runs from November to March. After dengue and malaria, leptospirosis is the third most

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deadly infection in Malaysia. The disease has a nearly century-long history there. Leptospirosis

was listed as a disease that needed to be reported in this nation in 2010. Since then, data on the

quantity of cases reported and their fatality have been compiled. Between 2010 and 2019, there

was an increase in leptospirosis cases and deaths, with the highest numbers occurring in 2014

and 2015. It's important to remember that several leptospirosis fatalities in Malaysia included

lung hemorrhage, bloody coughing, and breathing difficulty (K. Ahmed, et al., 2023). The

population of Malaysia as at July 2016 is 30,949,962 (Index Mundi, 39 2016), and based on

statistical estimation of rat population (8 rats per person), the estimated rat population in

Malaysia is 247, 599,696 (Lim 2011).

Leptospirosis in the Philippines is also a serious public health issue. It is seen as a work-

related risk in both urban and rural environments, particularly for sewage workers. The disease is

mostly spread by rodents, particularly rats, who can continuously excrete Leptospira through

their urine, contaminating their surroundings and the workplaces of sewage workers (Jamora et

al., 2022). According to studies, the Philippines sees 680 cases and 40 fatalities from

leptospirosis on average each year10. Nonetheless, since the breakout in 2020, there has been a

growing trend. There were 182 cases recorded in 2020, 1661 cases in 2021, and 2794 cases in

202211, in that order. More than 810 cases were documented between January 1, 2023, and

March 4, 2023, according to recent data. There are 103 instances in the Cagayan Valley Region,

77 cases on the Zamboanga Peninsula, and 176 cases in the Western Visayas Region.

In Philippines, the Department of Health's National Epidemiology Centre received a

report on February 7, 2013, about an increase in leptospirosis infections in Davao City following

the monsoon flooding. There are 64 suspected cases of leptospirosis, six of which were fatal (Ma

Justina Zapanta, et al, 2013).

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 However, in Caraga Region it was reported that leptospirosis cases were roughly 167

between January and May 2018. In the first quarter of 2018, there was an increase in

leptospirosis infections in Surigao del Norte, Surigao City, and certain areas of Agusan del Sur

and Surigao del Sur on rainy days. Additionally, the DOH documented 12 instances of

leptospirosis in May 2018 and 25 cases in April (Radyo Pilipinas Butuan, 2018).

Research Questions

1) What are the common misconceptions about leptospirosis infection among locals in San

Vicente and Ilihan, Agusan del Sur, Northeastern Mindanao, Philippines?

2) What are the dominant and common perceptions about the Leptospirosis infection?

3) How do they perceive the associated risk of the Leptospirosis infection?

Objectives of the Study

This study will evaluate the Knowledge, Awareness, and Perception on Leptospirosis

Infection and its Associated Risk Factors among Local Villagers Residing in the Two Barangays

of Sibagat, Agusan del Sur, Northeastern Mindanao, Philippines: Implication for Public Health

Education.

Specifically, it aims to answer the following questions to:

1. determine the level of knowledge and practices regarding leptospirosis infection;

2. determine level of perception regarding leptospirosis infection among local villagers;

3. survey the associated risk factors on leptospirosis infection among local villagers;

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4. determine the significant difference between the knowledge, awareness, and perception and

socio-demographic profile of the respondents.

Significance of the Study

This research is advantageous since it provides new information and deeper evaluation on

the knowledge, awareness, and perception of Leptospirosis infection among local villagers which

has potential for public health awareness implementation on the said barangays.

Specifically, the results of this endeavor will benefit the following:

Local Villagers. The study can raise correct awareness among local people about the

risks, symptoms, and preventive measures related to Leptospirosis helping them take the right

steps to protect themselves.

Local Government Unit of Sibagat. This research study can serve as a guideline to

know the situation of each barangay which pertains to the awareness of the resident about

Leptospirosis Infection within the municipality of Sibagat.

Department of Health. The research findings can inform DOH's strategies and policies

for better awareness campaigns, and prevention efforts to mitigate Leptospirosis effectively.

Future Researchers. The research can serve as a valuable foundation for future studies on

Leptospirosis perception and awareness, providing insights into the data and analysis techniques.

Scope and Limitation of the Study

This study will assess how people in Barangay Ilihan and Barangay San Vicente, Sibagat,

Agusan del Sur, Northeastern Mindanao, Philippines perceive Leptospirosis. It involves

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surveying 100 local residents in each barangay to understand their knowledge, awareness, and

perception regarding Leptospirosis signs and symptoms, transmission, prevention, and treatment.

The findings may only apply to these specific barangays and may not represent

perceptions in other areas due to differences in geographic factors. Additionally, the sample size

of 100 respondents might not fully represent the diverse views within these communities. The

researchers will only rely on locally-supported survey data that could potentially introduce bias

and other influenced responses.

Conceptual/Theoretical Framework of the Study

PROCESS OUTPUT
INPUT

Making the
Survey
Questionnaires Determination of locals'
knowledge, awareness
Chi- square Test and perception on
Survey leptospirosis infection

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 REVIEW OF LITERATURE

This chapter focuses on literature related to the study and discusses in particular the

relevant topics in the literature. The discussion is divided into four sections: foreign literature,

foreign studies, local literature, and local studies.

A. Foreign Literature

-Zoonosis

According to the world Health Organization (WHO), an infectious disease called zoonosis

has spread from non-human animals to people. Zoonotic infections can infect humans directly or

through food, water, the environment, or other unorthodox means. They can also be bacterial,

viral, parasitic, or involve other unusual agents. Because of our intimate ties to animals in the

natural world, in agriculture, and as companions, they pose a serious threat to global public

health. Zoonosis can also interfere with the commerce and production of animal products used

for food and other purposes. Pathogens known as zoonotic diseases can infect humans at any

moment during interaction with domestic, wild, or agricultural animals. Markets that sell wild

animal meat or byproducts are especially vulnerable since there are so many unknown or

emerging illnesses.

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-Leptospirosis

A journal from PubMed Central in 2019 stated that a zoonotic infection with a

worldwide distribution is leptospirosis. Even though the majority of infections are minor and

self-limiting, the illness is thought to claim the lives of almost 60,000 individuals annually. In 5–

15% of instances, severe illness manifests as multiorgan failure, acute kidney injury (AKI), or

pulmonary hemorrhage. Severe leptospirosis can have a case-fatality rate of as low as 6% if

vasopressors, renal replacement therapy (RRT), and mechanical breathing are administered

promptly. However, if these supportive measures are not provided right away, the rate can

increase to more than 50%.

-Leptospira

According to Thomas Albrecht, PhD, with his co-authors of the Medical

Microbiology 4th edition book, it was said that Leptospira interrogans are responsible for

causing leptospirosis, a typically mild feverish condition that can lead to liver or kidney failure.

Leptospira, Borrelia, and Spirillum are associated with illnesses characterized by stages of

remission and exacerbation. Leptospira organisms, characterized by their unique flexuous

motility, are thin, tightly coiled, obligate aerobic spirochetes. The genus comprises two species:

pathogenic leptospires (L. interrogans) and free-living leptospires (L. biflexa). Serotypes of L.

interrogans cause leptospirosis, primarily affecting wild and domestic animals, leading to

significant economic losses in the meat and dairy industry. While humans can contract the

disease, they are accidental hosts, and the severity of the illness varies. Although initially

described in 1886 as a severe icteric illness known as Weil's disease, most human cases are

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nonicteric and not life-threatening, typically resolving with the appearance of specific antibodies.

Leptospira enters the host through mucosa and broken skin, causing bacteremia, and then

multiplies in various organs, particularly the central nervous system, kidneys, and liver.

Although cleared by the immune response from most tissues, they persist and multiply in kidney

tubules, eventually being shed in urine. The precise mechanism of tissue damage remains

unknown.

B. Foreign Studies

-Determining Leptospirosis in Australia

It can be challenging to identify the patients who are most likely to acquire a serious

illness. Various studies have indicated that the presence of a range of clinical symptoms, results

from laboratory tests, and images and electrocardiograms can be beneficial. These methods

might be less useful in low- and middle-income countries (LMIC), where the disease burden is

disproportionately higher, even though they might be beneficial in settings with adequate

resources and access to cutting-edge laboratory and radiological assistance (B. Delmas, 2018). A

retrospective analysis was conducted at Cairns Hospital, a tertiary referral hospital with 531 beds

located in tropical northern Australia. Together with 16 smaller community hospitals, Cairns

Hospital serves a 380,000 km2 population of about 280,000 people with medical services.

Between January 1998 and May 2016, every leptospirosis case in the area was recorded using the

regional electronic pathology reporting system (AUSLAB).

When one or more of the following conditions were met by adult patients (≥16 years old), it was

considered that they had confirmed leptospirosis: (1) Leptospires isolated from blood culture; (2)

Microscopic agglutination test (MAT) single titre of ≥ 1:400; (3) Fourfold rise in MAT antibody

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titres; and (4) Polymerase Chain Reaction (PCR) detection of Leptospira in blood.( S. Smith, et

al, 2019).

-Risk factors gathered in India

A study involving 70 confirmed cases and 140 healthy neighborhood controls found

that the Leptospirosis disease is most prevalent during rainy seasons in tropical regions and late

summer to early fall in temperate regions. The majority of cases were aged 41-50 and 21-30

years, which is a productive age group. Risk factors for the disease include the presence of cuts

or wounds, outdoor occupation, contact with rodents through contaminated food materials,

contact with contaminated soil, and presence of drainage within 15 meters of the home.

The strongest risk factor identified was the presence of wounds or cuts in the skin

during work, which could be due to the tradition of agriculture in India, where people carry out

cultivation barefoot and hand with animals, increasing the risk of injury and direct contact with

contaminated mud. Contact with contaminated soil around the home was the second highest risk

factor, and the presence of contaminated soil and contaminated materials during work further

increased the risk of infection.

Environmental sanitation and hygiene are also a proven factor responsible for the

disease, with the presence of drainage within 15 meters of the home being a risk factor (R.

Kamath, 2014).

-Travel associated case of Leptospirosis in Malaysia

While past studies have shed light on transmission within nations and regions, few

have delved into transmission across international borders. Our review aimed to assess the

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influence of human travel and migration on the resurgence of Leptospirosis. Findings indicate

that alongside local environmental and occupational exposure, international travel now presents a

significant independent risk factor for contracting the disease. Travel-associated cases can

account for up to 41.7% of total cases in some countries. Longitudinal data in certain countries

shows a notable increase in the proportion of travel-associated Leptospirosis over time.

Reporting patterns indicate a substantial underestimation of the disease due to limited diagnostic

capabilities. The surge in global travel and eco-tourism has profoundly altered the epidemiology

of Leptospirosis (B. Garba,et. al.,2017).

- Presence of Leptospira among cats in Italy

Leptospirosis is a common zoonotic illness that affects both people and animals

globally. The feline panleukopenia virus, Leptospira interrogans serogroup Australis ST 24, was

first detected in Europe in a young outdoor cat with significant comorbidity, according to a study

conducted in Europe. A seroprevalence of 10.5% among outdoor cats in Northeast Italy was also

observed by the study. The antigens from the serovars Grippotyphosa, Bratislava,

Icterohaemorrhagiae, and Copenhageni were highly matched to the MAT titres of symptomatic

cats. The frequency of Leptospirosis-related blood antibodies in cats that roam freely indicates

that healthy cats are naturally resistant to developing clinical leptospirosis. More research is

required to fully comprehend the pathophysiology of feline leptospirosis (W. Ellis, 2014).

- Perception on Leptospirosis infection in Malaysia

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 The perceived severity of leptospirosis infection did not differ between rural and urban

respondents, with mixed responses from low to highly severe. Urban households without a

history of leptospirosis had a higher perception of the severity. The majority of respondents

perceived leptospirosis as severe and highly severe, based on poor disease prognosis, lack of a

cure, rapid deterioration rate, and mortality risk. This finding aligns with Rosenstock's postulated

perception of health problems in terms of clinical consequences and potential death. Death was

considered synonymous with leptospirosis in Malaysia due to viral reports and high-profile

cases, creating the "social amplification of risk." (S. Sukeri, et al, 2020).

C. Local literature

-Knowledge, Attitude and Practices towards Leptospirosis among Lakeshore Communities of

Calamba and Los Baños, Laguna, Philippines

The study analyzed the knowledge, attitudes, and prevention practices of leptospirosis

among agricultural and non-agricultural workers in lakeshore communities in the Philippines.

Although both groups had positive attitude scores, their knowledge and practice scores were

lower than in the literature. Community-based health education and promotion activities are

needed to increase knowledge about leptospirosis and improve prevention practices. Strategies

could include using broadcast media to disseminate disease prevention messages and improving

local government health units' capacity to conduct health promotion activities. Targeting younger

and low-income male non-agricultural workers and less-educated male agricultural workers is

also crucial. Health communications should be designed for agricultural workers with low

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literacy and strengthened occupational health and safety entities in the agricultural sector (J.

Arbiol, 2016).

D. Local Studies

- Leptospirosis cases in Philippines

According to a study by Abubakar Nazir in 2023, the Philippines sees 680 cases and 40

fatalities from leptospirosis on average each year. Nonetheless, since the breakout in 2020, there

has been a growing trend. There were 182 cases recorded in 2020, 1661 cases in 2021, and 2794

cases in 202211, in that order. More than 810 cases were documented between January 1, 2023,

and March 4, 2023, according to recent data. There are 103 instances in the Cagayan Valley

Region, 77 cases on the Zamboanga Peninsula, and 176 cases in the Western Visayas Region.

- Diversification of Philippine endemic rodents

The Philippine Islands boast 22 genera and 64 species of rodents, mainly endemic to the

region, making them ideal for studying diversification in island systems. Although the reasons

behind this diversity are unclear, our phylogenetic analysis of these endemic rodents, along with

those from outside the archipelago, suggests multiple colonization events. These events likely

occurred in two stages, approximately 15 million years ago and later 8 to 12 million years after,

contributing to both "Old" and "New" endemic rodent faunas. Our findings indicate that most

diversification happened within the Philippines, with Luzon being a significant area of

colonization for older endemic species and Mindanao or Luzon for newer ones. While combining

mitochondrial and nuclear data improves phylogenetic resolution, it can affect estimates of

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ancient divergence times, especially when using specific methods that consider rate

heterogeneity among genes (S. Jansa, et al, 2006).

CHAPTER 3

METHODOLOGY

This chapter will present the research method. It focuses on the method to be used in

conducting this research, which covers research design, research locale, research respondents and

samples, ethical considerations, data gathering method and data analysis.

3.1 Research design

In this study, a qualitative approach will be employed to explore the knowledge,

awareness, and perception of leptospirosis infection and its associated risk factors among local

villagers in the two barangays, San Vicente and Ilihan, of Sibagat, Agusan del Sur, Northeastern

Mindanao, Philippines. This approach will allow the researchers to explore the underlying

factors influencing knowledge, awareness, and perception, which may not be adequately

captured through quantitative measures alone. Utilizing a survey questionnaire as the data

collection tool, 100 respondents will be selected from each barangay, totalling 200 participants.

Thematic analysis will be conducted on the collected data to identify key themes and patterns in

respondents' perceptions, understanding, and awareness of leptospirosis.

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3.2 Research Locale

This study will be conducted in the lowland barangays San Vicente and Ilihan in the

municipality of Sibagat, Agusan del Sur, Northeastern Mindanao, Philippines. Since higher

concentrations of human activity, such as urbanization, farming, and fishing, are typically found

in lowland locations. These activities may raise your chance of coming into contact with polluted

soil or water, which are the primary ways that leptospirosis is spread.

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Figure 1: Location of barangay Ilihan

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Figure 2: Location of barangay San Vicente

3.3 Participants of the Study

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 The participants of the study will be the locals of the stated barangays. The researchers

will survey 100 respondents from the barangay of San Vicente as well as the barangay of Ilihan,

totalling 200 participants. In order to provide a more representative sample of the population and

improve the findings' reliability and generalizability, 200 people will be polled.

3.4 Sampling size and sampling techniques

The study will involve 200 people, according to the researcher. They will employ random

sampling, which gives every person of the population an equal chance of being chosen for the

study. By doing this, bias in the selection process is reduced and the sample is guaranteed to be

representative of the greater population.

3.5 Ethical consideration

Prior to the conduct of the study, the researchers will ensure that both the barangay heads

and study participants are provided with clear explanations about the study and give their

consent. There won't be any leaks of private information obtained from the survey of the data

that was gathered, the researchers will not be partial or include the researchers' personal

viewpoint of the study's outcome.

3.6 Data gathering

In gathering the data, the researchers will be conducting a survey to be more in-depth

using with both structured Likert scale questions and open-ended questions.

3.7 Flowchart of the Study.

Step 1. Step 3. sStep 4.

Step 2.
The researchers will
After the confirmation,
write the consent letters,
the reseachers will roam
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The premade survey The data collected will
questionnaires will be be analyzed.
 around and will start to

3.9 Statistical Analysis

The researcher will use a survey questionnaire with Likert scale responses (such as

"strongly agree," "agree," "disagree," and "strongly disagree") to assess the knowledge,

awareness, and perception of Leptospirosis and its associated risk factors in two lowland areas.

The Chi-square test will also be utilized to determine potential associations between

demographic variables (e.g., age, gender), to compare the perceptions between the two areas, to

identify any significant differences and the themes identified in the qualitative data. This

approach will provide valuable insights into the level of understanding and awareness of

Leptospirosis and its risk factors in the respective communities.

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