copyrightpsasir.upm.edu.my/id/eprint/70986/1/fpsk(m) 2017 16 ir.pdf · 2019. 8. 8. · gardening...
TRANSCRIPT
-
© CO
PYRI
GHT U
PM
UNIVERSITI PUTRA MALAYSIA
KNOWLEDGE, ATTITUDE AND PREVENTIVE PRACTICE TOWARDS LEPTOSPIROSIS AND SEROPREVALENCE OF LEPTOSPIRA
ANTIBODIES AMONG MARKET WORKERS IN SELANGOR, MALAYSIA
SUHAILAH BINTI SAMSUDIN
FPSK(M) 2017 16
-
© CO
PYRI
GHT U
PMKNOWLEDGE, ATTITUDE AND PREVENTIVE PRACTICE TOWARDS LEPTOSPIROSIS AND SEROPREVALENCE OF LEPTOSPIRA ANTIBODIES AMONG MARKET WORKERS IN SELANGOR, MALAYSIA
By
SUHAILAH BINTI SAMSUDIN
Thesis Submitted to the School of Graduate Studies, Universiti Putra Malaysia, in
Fulfilment of the Requirements for the degree of Master of Science
March 2017
-
© CO
PYRI
GHT U
PM
i
All material contained within the thesis, including without limitation text, logos, icons,
photographs and all other artwork, is copyright material of Universiti Putra Malaysia
unless otherwise stated. Use may be made of any material contained within the thesis for
non-commercial purposes from the copyright holder. Commercial use of material may
only be made with the express, prior, written permission of Universiti Putra Malaysia.
Copyright © Universiti Putra Malaysia
-
© CO
PYRI
GHT U
PM
i
Abstract of thesis presented to the Senate of Universiti Putra Malaysia in fulfillment of
the requirement for the degree of Master of Science
KNOWLEDGE, ATTITUDE AND PREVENTIVE PRACTICE TOWARDS
LEPTOSPIROSIS AND SEROPREVALENCE OF LEPTOSPIRA ANTIBODIES
AMONG MARKET WORKERS IN SELANGOR, MALAYSIA
By
SUHAILAH BINTI SAMSUDIN
March 2017
Chairman : Associate Professor Malina Binti Osman, MD Faculty : Medicine and Health Sciences
Objective: The aim of this thesis is to identify and investigate the knowledge, attitude
and practices towards leptospirosis prevention along with seroprevalence of leptospira
antibodies. Methodology: A cross sectional study was conducted among 120 market
workers in four urban markets in Selangor. Questionnaire surveyed and blood sampled
were two important methods used in the study. A questionnaire consists of respondent’s
background, risk factors, knowledge, attitude and practice questions related with
leptospirosis. The blood sample was collected from market workers with consent in
purpose of seroprevalence study. The sera were obtained and Microscopic Agglutination
Test (MAT) was used to determine seropositivity of leptospira antibodies among market
workers. Validation and reliability of the questionnaire were carried out and proper
procedure in the laboratory was done according to standard protocol. Result: The
result showed majority of respondents have poor knowledge (91.7%), have unacceptable
attitude (60.8%) and have unacceptable practice (72.5%). This study has found that there
are 44.2% serum samples positive of leptospiral antibodies. Regression analysis was
conducted and the result showed that the respondents who were Malaysian and
undertook gardening activity have more likely to have good knowledge. Furthermore,
this study showed that respondents who have formal education, undertook cleaning
outside house, have exposed to contaminated water having more likely to have good
attitude. An adjusted odd ratio shows that respondents who were female, undertook
gardening activity, went for travelling, undertook cleaning of business premises and have
unacceptable practice score have more likely of having seropositive of leptospiral
antibodies. Conclusion: The evidence from this study suggests that comprehensive
health education should be conducted among market workers regarding leptospirosis and
its prevention as majority of them scored poor knowledge, unacceptable attitude and
unacceptable practice.
Keywords : seroprevalence, leptospirosis, knowledge, attitude, practice, market
-
© CO
PYRI
GHT U
PM
ii
Abstrak tesis yang dikemukakan kepada Senat Universiti Putra Malaysia sebagai
memenuhi keperluan untuk ijazah Sarjana Sains
PENGETAHUAN, SIKAP DAN AMALAN PENCEGAHAN TERHADAP
PENYAKIT KENCING TIKUS DAN SEROPREVALEN ANTIBODI
LEPTOSPIRA DI KALANGAN PEKERJA PASAR DI SELANGOR, MALAYSIA
Oleh
SUHAILAH BINTI SAMSUDIN
Mac 2017
Pengerusi : Profesor Madya Malina Binti Osman, MD Fakulti : Perubatan dan Sains Kesihatan
Objektif: Tujuan tesis ini adalah untuk mengenal pasti dan menyiasat pengetahuan,
sikap dan amalan ke arah pencegahan leptospirosis bersama-sama dengan seroprevalen
antibodi Leptospira. Metodologi: Kajian irisan lintang telah dijalankan di kalangan
120 pekerja pasar di empat buah pasar di kawasan bandar di Selangor. Borang soal
selidik dan pengambilan darah adalah dua kaedah penting yang digunakan dalam kajian
ini. Soal selidik mengandungi informasi latar belakang, faktor-faktor risiko, pengetahuan,
sikap dan amalan responden berkaitan dengan leptospirosis. Sampel darah untuk tujuan
kajian seroprevalen telah berjaya dikumpul dengan kebenaran pekerja-pekerja
pasar.Ujian mikroskopik agglutinasi (MAT) telah dijalankan ke atas sera yang telah
diperolehi bagi menentukan seropositif antibodi leptospira di kalangan pekerja pasar.
Validasi dan kebolehpercayaan soal selidik telah dijalankan dan prosedur di dalam
makmal mengikut protokol yang ditetapkan. Keputusan: Hasil kajian menunjukkan
majoriti responden mempunyai pengetahuan yang lemah (91.7%), sikap yang kurang
baik (60.8%) dan mempunyai amalan yang kurang baik (72.5%).Kajian ini telah
mendapati bahawa terdapat 44.2% sampel serum positif antibodi Leptospira. Analisis
regresi telah dijalankan dan hasilnya menunjukkan bahawa responden yang
berwarganegara Malaysia dan menjalankan aktiviti berkebun adalah lebih cenderung
untuk mempunyai pengetahuan yang baik. Tambahan pula, kajian ini menunjukkan
bahawa responden yang mempunyai pendidikan formal, menjalankan pembersihan di
luar rumah, terdedah kepada air tercemar mempunyai kecenderungan yang lebih untuk
mempunyai sikap yang baik. Nisbah odds menunjukkan bahawa responden wanita,
menjalankan aktiviti berkebun, pergi melancong, melaksanakan pembersihan premis
perniagaan dan mempunyai skor amalan yang kurang baik mempunyai lebih
kecenderungan dalam mempunyai seropositif antibodi Leptospira. Kesimpulan: Bukti-
bukti daripada kajian ini menunjukkan bahawa pendidikan kesihatan yang komprehensif
hendaklah dilaksanakan di kalangan pekerja pasar mengenai leptospirosis dan
pencegahannya.
Kata kunci: seroprevalen, kencing tikus, pengetahuan, sikap, amalan, pasar
-
© CO
PYRI
GHT U
PM
iii
ACKNOWLEDGEMENTS
Bismillahirrahmannirrahim. Alhamdulillah, thank you to Allah the almighty of the
universe for the entire blessing. I would like to thank my project supervisor, Associate
Profesor Dr Malina Osman for her patiently guidance and supervision to me throughout
the completion of this project. I also give her deepest appreciation of her sincere
helpfulness and co-operation in giving out ideas as well as providing transport and
financial aids.
I would like to extend my sincerest gratitude to my co-supervisor, Dr Siti Norbaya
Masri for sharing ideas, suggestion, financial aids and transportation in order to
complete this project.
I am happy to give my very special appreciation to my beloved parents and family who
always give their blessing, moral support and financial along my journey in this
project. I feel gratitude to have friends (Sakinah, Naqibah, Husna) as they always by
my side as friends make good times better and hard times easier.
Thank you and appreciation are also extended to Kajang Municipal Council, Subang
Jaya Municipal Council and Perbadanan Kemajuan Pertanian Selangor for their
approval and support to carry out research in their area. Lastly, I would like to send my
gratitude to respondents who involved in my study and to people who involved directly
and indirectly throughout my research progress.
-
© CO
PYRI
GHT U
PM
-
© CO
PYRI
GHT U
PM
v
This thesis was submitted to the Senate of Universiti Putra Malaysia and has been
accepted as fulfilment of the requirement for the Master of Science. The members of
the Supervisory Committee were as follows:
Malina Osman, MD
Associate Professor
Faculty of Medicine and Health Sciences
Universiti Putra Malaysia
(Chairman)
Siti Norbaya Masri, MD
Senior Lecturer
Faculty of Medicine and Health Sciences
Universiti Putra Malaysia
(Member)
________________________
ROBIAH BINTI YUNUS, PhD
Professor and Deputy Dean
School of Graduate Studies
Universiti Putra Malaysia
Date:
-
© CO
PYRI
GHT U
PM
vi
Declaration by graduate student
I hereby confirm that:
this thesis is my original work;
quotations, illustrations and citations have been duly referenced;
this thesis has not been submitted previously or concurrently for any other degree at any other institutions;
intellectual property from the thesis and copyright of thesis are fully-owned by Universiti Putra Malaysia, as according to the Universiti Putra Malaysia
(Research) Rules 2012;
written permission must be obtained from supervisor and the office of Deputy Vice-Chancellor (Research and Innovation) before thesis is published (in the form
of written, printed or in electronic form) including books, journals, modules,
proceedings, popular writings, seminar papers, manuscripts, posters, reports,
lecture notes, learning modules or any other materials as stated in the Universiti
Putra Malaysia (Research) Rules 2012;
there is no plagiarism or data falsification/fabrication in the thesis, and scholarly integrity is upheld as according to the Universiti Putra Malaysia (Graduate
Studies) Rules 2003 (Revision 2012-2013) and the Universiti Putra Malaysia
(Research) Rules 2012. The thesis has undergone plagiarism detection software.
Signature: ________________________ Date: __________________
Name and Matric No.: Suhailah binti Samsudin, GS38891
-
© CO
PYRI
GHT U
PM
vii
Declaration by Members of Supervisory Committee
This is to confirm that:
the research conducted and the writing of this thesis was under our supervision;
supervision responsibilities as stated in the Universiti Putra Malaysia (Graduate Studies) Rules 2003 (Revision 2012-2013) are adhered to.
Signature:
Name of Chairman of
Supervisory
Committee:
Signature:
Name of Member of
Supervisory
Committee:
-
© CO
PYRI
GHT U
PM
viii
TABLE OF CONTENTS
Page
ABSTRACT i
ABSTRAK ii
ACKNOWLEDGEMENT iii
APPROVAL iv
DECLARATION vi
LIST OF TABLES xiii
LIST OF FIGURES xvi
LIST OF ABBREVIATIONS xvii
LIST OF APPENDICES xviii
CHAPTER
1 INTRODUCTION
1.1 Background of study 1
1.2 Problem Statements 2
1.3 Research Justification 3
1.4 Research Objective 3
1.5 Research Hypothesis 4
1.6 Definition of Variables 4
1.7 Conceptual Framework 5
2
LITERATURE REVIEW
2.1 Overview of Leptospirosis
2.1.1 Definition of Leptospirosis 6
2.1.2 Epidemiology of Leptospirosis 8
2.1.3 Signs and Symptoms of Leptospirosis 11
2.1.4 Diagnosis of Leptospirosis 13
2.1.5 Management of Leptospirosis 14
2.1.6 Control and Prevention of Leptospirosis 15
2.2 Demographic and Socio-economic Indicators 15
2.3 Risk Factors of Leptospirosis 17
2.4 Knowledge of Leptospirosis 18
2.5 Attitude towards Leptospirosis Prevention 20
2.6 Practices towards Leptospirosis Prevention 21
2.7 Seropositivity of Leptospira antibodies and Distribution of Serovars 23
3
METHODOLOGY
3.1 Study Design 25
3.2 Study Location 25
3.3 Study Duration 26
3.4 Sampling
3.4.1 Study population 26
3.4.2 Sampling population 26
3.4.3 Sampling frame 27
3.4.4 Sampling method 27
3.4.5 Sample size 27
3.5 Instrument and Data collection
-
© CO
PYRI
GHT U
PM
ix
3.5.1 Instruments 27
3.5.2 Questionnaires 28
3.6 Data Collection
3.6.1 Sample Collection 29
3.6.2 Serology of Leptospira Antibodies by
Microscopic Agglutination Test
30
3.7 Quality Control
3.7.1 Part: Questionnaire 30
3.8 Data Analysis 31
3.9 Study Ethics 31
3.10 Variables 32
4
RESULT
4.1 Response rate 34
4.2 Descriptive of Demographic and Socioeconomic Indicators,
Risk Factors, Knowledge, Attitude and Preventive Practice
Items towards Leptospirosis
4.2.1 Distribution of Demographic and Socioeconomic
Indicators
35
4.2.2 Distribution of Behavioural, Occupational and
Environmental Risk Factors
35
4.2.3 Distribution of Respondents According to Awareness
of Leptospirosis
37
4.2.4 Description of Knowledge Items among Respondents 37
4.2.5 Distribution of Respondents according to Knowledge Score 40
4.2.6 Description of Attitude Items toward Prevention
of Leptospirosis
41
4.2.7 Distribution of Respondents according to Attitude Score 44
4.2.8 Description of Preventive Practice Items among
Market Workers
44
4.2.9 Distribution of Preventive Practice according to
Practice Score
47
4.3 Seropositive of Leptospira Antibody and Distribution of Serovar
Culture
4.3.1 Seropositive of Leptospira Antibody 48
4.3.2 Distribution of Serovar among Seropositive Sera Sample 48
4.3.3 Serovar Positivity among Positive Sera Sample Reaction
to Serovar among Seropositive Respondents
49
4.4 Relationship between Demographic and Socioeconomic Indicators
with Level of Knowledge, Attitude, and Preventive Practice
4.4.1 Association between Demographic and Socioeconomic
Indicators with Knowledge on Causative Agent
of Leptospirosis
50
4.4.2 Association between Demographic and
Socioeconomic Indicators with Knowledge on Modes
of Leptospirosis Transmission
52
4.4.3 Association between Demographic and
Socioeconomic Indicators with Knowledge on Signs,
Symptoms and Complication of Leptospirosis
53
-
© CO
PYRI
GHT U
PM
x
4.4.4 Association between Demographic and
Socioeconomic Indicators with Knowledge on Risk Factors
of Leptospirosis
55
4.4.5 Association between Demographic and
Socioeconomic Indicators with Knowledge on
Treatment, Diagnosis and Prevention
57
4.4.6 Predictor Influencing Knowledge of Respondents
towards Leptospirosis
58
4.4.7 Association between Demographic and
Socioeconomic Indicators with Attitude on Prevention
of Leptospirosis
59
4.4.8 Predictor Influencing Attitude of Respondents
towards Leptospirosis
61
4.4.9 Association between Demographic and
Socioeconomic Indicators with Preventive Practice
on Personal Hygiene
63
4.4.10 Association between Demographic and
Socioeconomic Indicators with Preventive Practice
on Environmental Hygiene
64
4.4.11 Association between Demographic and
Socioeconomic Indicators with Preventive Practice
on Specific Protection
66
4.4.12 Association between Demographic and
Socioeconomic Indicators with Preventive Practice
on Isolation
67
4.4.13 Association between Demographic and
Socioeconomic Indicators with Preventive Practice
on Eradication at Source
68
4.4.14 Predictor Influencing Practice of Respondents
towards Prevention of Leptospirosis
70
4.4.15 Relationship between Knowledge with Attitude
of Leptospirosis
72
4.4.16 Relationship between Knowledge with Preventive Practice
of Leptospirosis
72
4.4.17 Relationship between Attitude and Preventive Practice
of Leptospirosis
73
4.5 Relationship among Demographic and Socioeconomic Indicators,
Risk Factors, Knowledge, Attitude, and Practice with Seropositivity
of Leptospira Antibody
4.5.1 Relationship between Demographic and Socioeconomic
Indicators with Seropositivity of Leptospira Antibody
73
4.5.2 Relationship between Risk Factors (Behavioural Risk,
Occupational Risk, Environmental Risk) with
Seropositivity
of Leptospira Antibody
74
4.5.3 Relationship between Knowledge with Seropositivity of
Leptospira Antibody
77
4.5.4 Relationship between Attitudes with Seropositivity of
Leptospira Antibody
78
-
© CO
PYRI
GHT U
PM
xi
4.5.5 Relationship between Practices with Seropositivity of
Leptospira Antibody
79
4.5.6 Predictor Influencing Seropositivity of Leptospira
Antibody
among Market Workers
81
5
DISCUSSION
5.1 Descriptive of Demographic and Socioeconomic Indicators, Risk
Factors, Knowledge, Attitude, and Preventive Practice Items
towards Leptospirosis
5.1.1 Distribution of Demographic and Socioeconomic
Indicators
83
5.1.2 Distribution of Behavioural, Occupational and
Environmental Risk Factors
84
5.1.3 Distribution of Knowledge regarding Leptospirosis
among Market Workers
84
5.1.4 Distribution of Attitude Regarding Prevention of
Leptospirosis among Market Workers
86
5.1.5 Distribution of Practice Regarding Prevention of
Leptospirosis among Market Workers
90
5.2 Seropositive of Leptospira Antibody and Distribution of Serovar
Strain
5.2.1 Seropositive of Leptospira Antibody and Distribution of
Serovar
91
5.3 Association between Demographic and Socioeconomic Indicators
with Knowledge, Attitude and Preventive Practice
5.3.1 Relationship between Demographic and
Socioeconomic Indicators with Knowledge of
Leptospirosis among Market Workers
93
5.3.2 Predictor Influencing Knowledge of Market Workers
towards Leptospirosis
94
5.3.3 Relationship between Demographic and
Socioeconomic Indicators with Attitude towards
Prevention
of Leptospirosis among Market Workers
95
5.3.4 Predictor Influencing Attitude of Market Workers
towards Leptospirosis
95
5.3.5 Relationship between Demographic and
Socioeconomic Indicators with Practice of Prevention
of Leptospirosis among Market Workers
96
5.3.6 Predictors Influencing Practice of Market Workers
towards Leptospirosis
97
5.3.7 Relationship between Knowledge, Attitude and Preventive
Practice of Leptospirosis among Market Workers
97
5.4 Relationship among Demographic and Socioeconomic Indicators,
Risk Factors, Knowledge, Attitude and Practice with Seropositivity
of Leptospira Antibody
5.4.1 Relationship between Demographic and
Socioeconomic Indicators with Seroprevalence of
Leptospira Antibodies among Market Workers
98
-
© CO
PYRI
GHT U
PM
xii
5.4.2 Relationship between Risk Factors with Seropositivity
of Leptospira Antibody among Market Workers
98
5.4.3 Relationship between Knowledge, Attitude and Practice
with Seroprevalence of Leptospira Antibodies among
Market Workers
99
5.4.4 Predictor Influencing Seropositivity of Leptospira
Antibody
among Market Workers
99
6 SUMMARY, CONCLUSION AND RECOMMENDATIONS
FOR FUTURE RESEARCH
6.1 Summary, Conclusion and Recommendations 101
REFERENCES 104
APPENDICES 109
BIODATA OF STUDENT 129
LIST OF PUBLICATIONS 130
-
© CO
PYRI
GHT U
PM
xiii
LIST OF TABLES
Table Page 2.1 Clinical Manifestation of Leptospirosis among 559 Cases in
Malaysia
12
3.1 Sample size calculation according to objective 27
3.2 Lists of statistical analysis according to objectives 31
3.3 Lists of independent and dependent variables according to
objectives
32
4.1(a) Descriptive of socio demographic and socioeconomic indicators
among market workers in Selangor
34
4.1(b) Descriptive of socio demographic and socioeconomic indicators
among market workers in Selangor
35
4.2 Descriptive of behavioural, occupational and environmental risk
factors exposure among market workers
36
4.3 Distribution of respondents (%) according to level of awareness 37
4.4(a) Description of knowledge items among market workers 39
4.4(b) Description of knowledge items among market workers 40
4.5 Distribution of market workers according to knowledge level 40
4.6 Distribution of respondent (%) according to overall score of
knowledge items
41
4.7(a) Description of attitude items among market workers 42
4.7(b) Description of knowledge items among market workers 43
4.8 Distribution of respondent (%) according to attitude score 44
4.9 Distribution of preventive practice items among market workers 46
4.10 Distribution of preventive practice level within five sections of
items among market workers
47
4.11 Distribution of respondent (%) of practice score on prevention of
leptospirosis
48
4.12 Distribution of respondents according to seropositivity of
leptospira antibody among market workers
48
4.13 Distribution of serovars among seropositive sera sample
obtained from market workers (n= 53)
49
4.14 Serovar positivity among positive sera sample 50
4.15(a) Association between demographic and socioeconomic indicators
with knowledge level on causative agent of leptospirosis among
market workers
51
4.15(b) Association between demographic and socioeconomic indicators
with knowledge level on causative agent of leptospirosis among
market workers
51
4.16(a) Association between demographic and socioeconomic indicators
with knowledge on modes of leptospirosis transmission among
market workers
52
4.16(b) Association between demographic and socioeconomic indicators
with knowledge on modes of leptospirosis transmission among
market workers
53
4.17(a) Association between demographic and socioeconomic indicators
with knowledge on signs, symptoms and complications of
leptospirosis among market workers
54
-
© CO
PYRI
GHT U
PM
xiv
4.17(b) Association between demographic and socioeconomic indicators
with knowledge on signs, symptoms and complications of
leptospirosis among market workers
55
4.18 Association between demographic and socioeconomic indicators
with knowledge level on risk factors among market workers
56
4.19(a) Association between demographic and socioeconomic indicators
with knowledge on treatment, diagnosis and prevention among
market workers
57
4.19(b) Association between demographic and socioeconomic indicators
with knowledge on treatment, diagnosis and prevention among
market workers
58
4.20 Predictor influencing knowledge of respondents towards
leptospirosis
59
4.21 Association between demographic and socioeconomic indicators
with attitude towards leptospirosis prevention among market
workers
60
4.22 Predictors influencing attitude of respondents towards
leptospirosis
62
4.23(a) Association between demographic and socioeconomic indicators
with preventive practice on personal hygiene among market
workers
63
4.23(b) Association between demographic and socioeconomic indicators
with preventive practice on personal hygiene among market
workers
64
4.24 Association between demographic and socioeconomic indicators
with preventive practice on environmental hygiene among
market workers
65
4.25(a) Association between demographic and socioeconomic indicators
with preventive practice on specific protection among market
workers
66
4.25(b) Association between demographic and socioeconomic indicators
with preventive practice on specific protection among market
workers
67
4.26 Association between demographic and socioeconomic indicators
with preventive practice on isolation among market workers
68
4.27(a) Association between demographic and socioeconomic indicators
with preventive practice on eradication at source among market
workers
69
4.27(b) Association between demographic and socioeconomic indicators
with preventive practice on eradication at source among market
workers
70
4.28 Predictors influencing practice of respondents towards
leptospirosis
71
4.29 Relationship between knowledge with attitude of leptospirosis 72
4.30 Relationship between knowledge with preventive practice of
leptospirosis
73
4.31 Relationship between attitude and practice of leptospirosis 73
4.32 Relationship between demographic and socioeconomic
indicators with seroprevalence of leptospira antibody
74
4.33(a) Relationship between risk factors with seropositivity of
leptospira antibody among market workers
75
-
© CO
PYRI
GHT U
PM
xv
4.33(b) Relationship between risk factors with seropositivity of
leptospira antibody among market workers
76
4.33(c) Relationship between risk factors with seropositivity of
leptospira antibody among market workers
77
4.34 Relationship between knowledge with seropositivity of
leptospira antibody
78
4.35 Relationship between attitudes with seropositivity of leptospira
antibody
79
4.36 Relationship between practices with seropositivity of leptospira
antibody
80
4.37 Distribution of predictors influencing seropositivity of leptospira
antibody among respondents
82
-
© CO
PYRI
GHT U
PM
xvi
LIST OF FIGURES
Figure Page
2.1 Leptospira interrogans 7
2.2 Leptospirosis in Malaysia from 2004 – July 2015 9
2.3 Leptospirosis cases in Selangor from year 2005 until year 2015 10
2.4 Leptospirosis cases according to district in Selangor from year 2011
until 2015
10
3.1 Districts in Selangor 25
-
© CO
PYRI
GHT U
PM
xvii
LIST OF ABBREVIATIONS
CDC Communicable Disease Control
CSF Cerebral Spinal Fluid
ELISA Enzyme-linked Immunosorbent Assay
g gram
IMR Institute of Medical Research
kg kilogram
MAT Microscopic Agglutination Test
mg milligram
ml milliliter
PCR Polymerase Chain Reaction
PPE Personal Protective Equipment
RM Ringgit Malaysia
SPFL Severe Pulmonary Hemorrhagic Form Leptospirosis
UPM Universiti Putra Malaysia
WHO World Health Organization
-
© CO
PYRI
GHT U
PM
xviii
LIST OF APPENDICES
Appendix Page
A Definition of Variable 109
B Sample size calculation 113
C Gantt Chart 115
D Ethical Approval Letter 116
E Respondents Information Sheet 118
F Questionnaire 121
G Health Program Poster 126
H Health Program Poster 127
I Data Collection Picture 128
-
© CO
PYRI
GHT U
PM
1
CHAPTER 1
INTRODUCTION
1.1 Background of study
Leptospirosis is an infectious disease caused by pathogenic organisms belonging to the
genus Leptospira, which are transmitted directly or indirectly from animals to humans.
Leptospirosis is a major direct zoonosis (World Health Organization, 2003).Genus of
Leptospira can be classified into two which are Leptospira interrogans (pathogenic
leptospires) and Leptospira biflexa (saprophytic leptospire). Pathogenic Leptospira
have a potential to cause disease whilst saprophytic Leptospira are free-living bacteria
and do not cause disease (WHO, 2003).
Pathogenic leptospires are survived in the renal tubules and genital tracts of certain
animals which are rodents, cattle, dogs, and pigs appear to be the predominant animal
hosts in many countries (WHO, 2003). In the Asia-Pacific region, countries with high
incidence rates (> 10 per 100,000 populations) are Bangladesh, Cambodia, Fiji, French
Polynesia, the Andaman, and Nicobar Islands in India, Laos, Nepal, New Caledonia,
Sri Lanka, Thailand and Vietnam. Countries like China, mainland India, Malaysia,
New Zealand, the Philippines and Mongolia have moderately high incidence rates (1 –
10 per 100,000 population) while low incidence rates (< 1 per 100,000 population) are
seen in countries like Australia, Hong Kong, Japan, South Korea and Taiwan
(Victoriano, A., Smythe, L., Gloriani-Barzaga, N., Cavinta, L., Kasai, T.,
Limpakarnjanarat, K.,…Adler, B., 2009). In the developing countries of the Asia
Pacific region, leptospirosis is largely a water-borne disease and climate change may
further aggravate the extent of the problem (Lim, J. K., Murugaiyah, V. A., Ramli, A.,
Abdul Rahman, H., Mohamed, N. & Shamsudin, N., 2011).
Leptospirosis occurs in many countries but the incidence varies considerably and
marked underreporting is common. Generally, there is a higher incidence in tropical
countries (Sarkar, Chopra, Katageri, Raj, & Goel, 2012). Persons of all ages and sexes
are susceptible to infection. Besides, it is also considered to be an occupational disease
of individuals, who come in direct contact with infected animals, such as farmers,
veterinarians, and abattoirs workers, and may also affect persons who have contact
with the urine of animals having the disease for example sewer workers and sugarcane
field workers. Occupational exposure towards leptospirosis probably accounts for 30-
50% of human cases ( Sapian, M., Khairi, M. T., How, S. H., Rajalingam, R., Sahhir,
K., Norazah, A.,…Jamaludin, A. R., 2012). The main occupational groups at risk
include farm workers, veterinarians, pet shop owners, field agricultural workers,
abattoir workers, plumbers, meat handlers, coal miners, and workers in the fishing
industry, military troops, and sewer workers (Sapian et al., 2012).
-
© CO
PYRI
GHT U
PM
2
1.2 Problem statements
Market or pasar in Malaysia serves an important role in the modern urban environment
and recreating industry, and has become one of important tourism resources. Night
markets are popular destinations among locals where it can be found easily in almost
every small town and city in every state including Selangor (Aziz, K. A. & Yeng, L.
W., 2011). Other than night market, Malaysia also has a wet market which also known
as a fresh food market. The market is the place which provides a variety of food
although their cleanliness status is well known uncertain. According to a study by
Subramaniam (2011) on rodents and human health risks at the wet market shows the
majority of food workers and hawkers had symptom on health related problem.
Furthermore, the outcome of the study shows about 72% rodent infestation and rodent
species which had been identified exist in the study environment (Subramaniam, Abdul
Hafiz, & Chandrakant, 2011). Wet market workers might pose a risk to acquire
leptospirosis through exposure to Leptospira contaminating watery environment of the
market. Furthermore, the risk not limited to leptospirosis, the previous study showed
that 60 respondents had symptoms of health related problems are reported
(Subramaniam et al., 2011).
Besides in Kuala Lumpur, Selangor also was known has the high-density population,
especially in Klang Valley. Rampant urbanization of cities has been known can lead to
improper garbage management system in urban areas, probably created favourable
conditions for animal carriers (Benacer, D., Woh, P.Y., Mohd Zain, S.N., Amran, F. &
Thong, K.L., 2013).Perhaps the most important animals associated with human
leptospirosis are peridomestic rodents which are rats and mice (Mohan, A. & Chadee,
D., 2011; World Health Organization, 2003). This may pose a health risk for
leptospirosis as infected animals and carriers might contaminate environmental waters
and soils via their excreta and urine (Doudi Benacer et al., 2013).
It is a norm to observe abundant of semi-solid and solid waste left at the site of the
market after their operation ended during that specific day. Variety types of wastes
such as solid, food and sometimes watery waste can be found in market areas when
their closed. This will create favour environment to animal carriers such as rats and
mice. The study shows solid waste accumulations become an important factor for
urban rodent feeding and sheltering strategies. A study from Barcellos and Sabroza in
2011 shows densely populated urban areas displayed an excess of leptospirosis cases
around waste accumulation sites (Barcellos, C. & Sabroza, P. 2001).
Previous study among local market seller towards leptospirosis showed that majority of
them had moderate knowledge (51.4%), unsatisfactory attitude (90.0%) and
satisfactory practice (64.3%). Thus, it is showed that the sufficient information on
leptospirosis was not made available to the community especially among market
workers (Ismail, Ahmad, Sarker, Lim, Ishak, Husin & Johari, 2016). Furthermore,
previous study only focused on local market seller while recently lots of foreign were
hired to become a worker in the market. This study included both Malaysian and
immigrant workers who involved in this type of occupation.
-
© CO
PYRI
GHT U
PM
3
1.3 Research Justification
Based on statistic cases reported by Jabatan Kesihatan Negeri Selangor (JKNS)
showed there are two districts of Selangor which have a high number of cases in 2015
were Hulu Langat and Petaling. Both districts are located in urban areas of Selangor.
High rodent infestation in urban Selangor causes a high risk of having leptospirosis
among the population. A variety of occupations may easily expose towards
leptospirosis in order to fulfill their job, they need to have contact with the
environment.
Leptospirosis not only infects population who working with infected animals. It also
gives risk to the population who has contact with the urine of animals having the
disease (Shafei, MN., Mohd Rahim, S., Azwany, Y.N., Habsah, H., Zahiruddin, W.M.,
Aziah, B.D.,…Rusli,M.,2012). In an example, markets and hawker centres would
attract rats if the waste is not disposed of properly (Henry, 2013). Thus, working as
market workers and food handlers may pose a risk to have leptospirosis from the
environment.
Market workers have a proneness to have leptospirosis if the location of the market had
precarious sanitation conditions which attract infestation of rats and vulnerable to
flood. Besides, a serious menace at wet markets and food courts was proved as rats are
not just damaging electrical wires and food items but also transmitting dangerous
diseases like leptospirosis (Henry, 2013). Hence, it is importance to have knowledge in
leptospirosis especially on a transmission of the disease, the prevention and also
treatment which can be implemented among market workers to avoid any cases occurs
among them. In order to address this issue, the study of knowledge, attitude and
preventive practice towards leptospirosis and seroprevalence of Leptospira antibodies
among market workers in Selangor is important to be done. Furthermore, the data
from this study will be a good baseline for market workers population to determine the
seroprevalence among them and their level of knowledge, attitude and practices
regarding leptospirosis since there is no study had been done.
1.4 Research Objective
1.4.1 General Objective
To study knowledge, attitude and preventive practice towards leptospirosis along with
seroprevalence of Leptospira antibodies and associations between variables among
market workers.
-
© CO
PYRI
GHT U
PM
4
1.4.2 Specific Objectives
1. To determine demographic (age, gender, race, nationality) and socioeconomic indicators (education level, monthly income), risk factors, knowledge, attitude
and preventive practices distribution towards leptospirosis among market
workers.
2. To determine seropositivity of Leptospira antibodies and distribution of serovars among market workers.
3. To determine associated factors (demographic and socioeconomic indicators) to the level of knowledge, attitude and preventive practices towards
leptospirosis among market workers.
4. To determine associated factors (demographic and socioeconomic indicators, risk factors, knowledge, attitude, and practice) to seropositivity of Leptospira
antibodies among market workers.
5. To determine predictors influencing knowledge, attitude, practice and seropositivity of leptospirosis among market workers.
1.5 Research Hypothesis
1. There is a significant association between associated factors (demographic and socioeconomic indicators) with the level of knowledge, attitude and
preventive practice towards leptospirosis among market workers.
2. There is a significant association between associated factors (demographic and socioeconomic indicators, risk factors, knowledge, attitude and preventive
practice) with seropositivity of Leptospira antibodies among market workers.
3. There is a probability of a predictors is associated with the knowledge, attitude, practice and seropositivity of leptospirosis among market workers.
1.6 Definition of variables
The conceptual definition of variables and operational definition of variables are in
Appendix A.
-
© CO
PYRI
GHT U
PM
5
1.7 Conceptual Framework
Study variable
No study variable
-
© CO
PYRI
GHT U
PM
104
REFERENCES
Abela-Ridder, B., Sikkema, R., & Hartskeerl, R. A. (2010). Estimating the burden of
human leptospirosis. International Journal of Antimicrobial Agents, 36, S5–S7.
http://doi.org/10.1016/j.ijantimicag.2010.06.012
Ahmed, S. M., Haque, R., Haque, U., & Hossain, A. (2009). Knowledge on the
transmission, prevention and treatment of malaria among two endemic
populations of Bangladesh and their health-seeking behaviour. Malaria Journal,
8, 173. http://doi.org/10.1186/1475-2875-8-173
Arbiol, J., Orencio, P., Romena, N., Nomura, H., Takahashi, Y., & Yabe, M. (2016).
Knowledge, Attitude and Practices towards Leptospirosis among Lakeshore
Communities of Calamba and Los Baños, Laguna, Philippines. Agriculture, 6(2),
18. http://doi.org/10.3390/agriculture6020018
Ashford, D. A., Kaiser, R. M., Spiegel, R. A., Perkins, B. A., Weyant, R. S., Bragg, S.
L., … Amador, J. J. (2000). Asymptomatic infection and risk factors for
leptospirosis in Nicaragua. American Journal of Tropical Medicine and Hygiene,
63(5–6), 249–254.
Aziz K A. (2011). Khursiah Binti Abd . Aziz Faculty of Hospitality and Tourism
Management University of Management and Technology ( UMtech ) Malaysia
Lye Wai Yeng Faculty of Hospitality and Tourism Management Universiti Tun
Abdul Razak ( UNIRAZAK ) Malaysia Abstract. International Journal of
Business and Social Science, 2(22), 146–157.
Barcellos, C., & Sabroza, P. C. (2001). The place behind the case: leptospirosis risks
and associated environmental conditions in a flood-related outbreak in Rio de
Janeiro. Cadernos de Saude Publica, 17, 59–67. http://doi.org/10.1590/S0102-
311X2001000700014
Benacer, D., Thong, K. L., Verasahib, K. Bin, Galloway, R. L., Hartskeerl, R. A.,
Lewis, J. W., … Zain, M. (2016). Human Leptospirosis in Malaysia : Reviewing
the Challenges After 8 Decades ( 1925-2012 ).
http://doi.org/10.1177/1010539516640350
Benacer, D., Woh, P. Y., Mohd Zain, S. N., Amran, F., & Thong, K. L. (2013).
Pathogenic and Saprophytic Leptospira Species in Water and Soils from Selected
Urban Sites in Peninsular Malaysia, 28(1), 135–140.
http://doi.org/10.1264/jsme2.ME12154
Bernardo CCM, Y. P. R. E. (2003). Human leptospirosis: a twenty-nine-year
serological study in Sao Paulo, Brazil. Revista Do Instituto de Medicina Tropical
de Sao Paulo, 45(5), 245–248.
CDC. (2009). Leptospirosis (Infection). Centers for Disease Control and Prevention,
(18), 2009. Retrieved from
http://www.cdc.gov/leptospirosis/infection/index.html
-
© CO
PYRI
GHT U
PM
105
Chaudhry, R., Premlatha, M. M., Mohanty, S., Dhawan, B., Singh, K. K., & Dey, A. B.
(2002). Emerging leptospirosis, North India [2]. Emerging Infectious Diseases,
8(12), 1526–1527. http://doi.org/10.3201/eid0812.020052
Communicable Disease Control Unit. (2013). Penyakit leptospirosis. Jabatan Kesihatan
Negeri Perak.
David, A. Haake, Paul N. Levett. (2015). 241-Leptospira Species (Leptospirosis).
Mandell, Douglas and Benett's Principles and Practices of Infectious Diseases
(Eight Edition), 2714-2720. Vol 2. http://doi.org/10.1016/B978-1-4557-4801-
3.00241-1
Draghi, M. G., Brihuega, B., Benítez, D., Sala, J. M., Biotti, G. M., Pereyra, M., …
Guariniello, L. (2011). [Leptospirosis outbreak in calves from Corrientes
Province, Argentina.]. Revista Argentina de Microbiologia, 43(1), 42–44.
http://doi.org/10.1590/S0325-75412011000100009
El Jalii, I. M., & Bahaman, a R. (2004). A review of human leptospirosis in Malaysia.
Tropical Biomedicine, 21(2), 113–119.
Fairuz, A., Rani, B. A., Ayu, M., & Hishamshah, I. (2007). Epidemiology of human
leptospirosis in Malaysia. 17th European Congress of Clinical Microbiology and
Infectious Diseases/25th International Congress of Chemotherapy, S282–S282.
Retrieved from ://000253692401114
Fernandez, E., “Keep clean: Health Ministry advises against patronizing dirty outlets,”
2013, http://www2.nst.com.my/ nation/general/2-775-leptospirosis-cases-23-
deaths-this-year- 1.340149.
Hartskeerl, R. A., Smits, H. L., Korver, H., Goris, M. G. A., & Terpstra, W. J. (2016).
International Course on Laboratory Methods for The Diagnosis of Leptospirosis
(5th Editio).
Henry, B. E. R. (2013). Wet markets and food courts face rat infestations. Retrieved
from http://www.starproperty.my/index.php/articles/property-news/wet-markets-
and-food-courts-face-rat-infestations/
Ismail, N., Ahmad, S., Sarker, M., Lim, A., Ishak, N., Husin, N., & Johari, N. (2016).
Knowledge, Attitude and Practice on Leptospirosis among.
Khairani-Bejo, S. Leptospirosis and Environment. Prosiding Kolokium Leptospirosis
Pendekatan ‘One Health’ Dalam Pengawalan Leptospirosis, PICC,
Putrajaya,Malaysia, 2012.
Levett, P. N. (2001). Leptospirosis. Clinical Microbiology, 14(2), 296–326.
http://doi.org/10.1128/CMR.14.2.296
Lim J K, Murugaiyah V A, Ramli A , Abdul Rahman H , Mohamed N , Shamsudin N,
T. J. C. (2011). A Case Study : Leptospirosis In Malaysia A Case Study :
Leptospirosis In Malaysia Human Leptospirosis in Malaysia. WebmedCentral >
Review Articles.
-
© CO
PYRI
GHT U
PM
106
Mohan, A. R. M., & Chadee, D. D. (2011). Knowledge, attitudes and practices of
Trinidadian households regarding leptospirosis and related matters. International
Health, 3(2), 131–137. http://doi.org/10.1016/j.inhe.2011.03.002
Mohd Nazri, S., Mohd Rahim, S., Azwany, Y., Habsah, H., Zahiruddin, W., Aziah, B.,
… Rusli, M. (2012). Seroprevalence of Leptospirosis among Town Service
Workers in Northeastern State of Malaysia. International Journal of
Collaborative Research on Internal Medicine & Public Health, 4(4), 395–403.
Mohd Rahim, S., Aziah, B., Mohd Nazri, S., Azwany, Y., Habsah, H., Zahiruddin, W.,
… Mohamed Rusli, a. (2012). Town Service Workers ’ Knowledge , Attitude
and Practice towards Leptospirosis. Brunei Darussalam Journal of Health, 1–12.
Musso, D., & La, B. (2013). Laboratory diagnosis of leptospirosis : A challenge. JMII,
46(4), 245–252. http://doi.org/10.1016/j.jmii.2013.03.001
Navaseelan, J. A., & Prakash, S. K. (2010). a Study on Serogroup Profile of
Leptospirosis in Central Chennai. Www.drshivakumar.org Dr.Shivakumar
Academy.
Navegantes de Arau´ jo,W., Finkmoore, B., Guilherme S. Ribeiro, Renato B. Reis,
Ridalva D. M. Felzemburgh, Jose´ E. Hagan, Mitermayer G. Reis, Albert I. Ko,
Costa, F (2013). Knowledge, Attitudes, and Practices Related to Leptospirosis
among Urban Slum Residents in Brazil. Am.J.Trop.Med.Hyg.,88(2),pp,359-363
Ngbede, E., & Raji, M. (2012). Risk practices and awareness of leptospirosis in an
abattoir in northwestern Nigeria. Scientific Journal of …, 1, 65–69. Retrieved
from http://sjournals.com/index.php/SJVA/article/view/131
Picardeau, M. (2013). Diagnosis and epidemiology of leptospirosis. Medecine et
Maladies Infectieuses, 43(1), 1–9. http://doi.org/10.1016/j.medmal.2012.11.005
Picardeau, M. (2013). Diagnosis and epidemiology of leptospirosis. Médecine et
Maladies Infectieuses, 43(1), 1–9. http://doi.org/10.1016/j.medmal.2012.11.005
Picardeau, M., Bertherat, E., Jancloes, M., Skouloudis, A. N., Durski, K., & Hartskeerl,
R. A. (2014). Rapid tests for diagnosis of leptospirosis : Current tools and
emerging technologies. Diagnostic Microbiology and Infectious Disease, 78(1),
1–8. http://doi.org/10.1016/j.diagmicrobio.2013.09.012
Poeppl, W., Orola, M. J., Herkner, H., Müller, M., Tobudic, S., Faas, A., …
Burgmann, H. (2013). High prevalence of antibodies against Leptospira spp. in
male Austrian adults: a cross-sectional survey, April to June 2009. Euro
Surveillance : Bulletin Européen Sur Les Maladies Transmissibles = European
Communicable Disease Bulletin, 18(25). Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/23806296
Sakinah, S., Samsudin, S., Jamaluddin, T., Norbaya, S., & Malina, O. (2015).
Seroprevalence of Leptospiral Antibodies and Knowledge, Attitude and Practices
-
© CO
PYRI
GHT U
PM
107
of Leptospirosis . International Journal of Public Health and Clinical Sciences,
1(1), 92–104.
Samarakoon, Y. M., & Gunawardena, N. (2013). Knowledge and self-reported
practices regarding leptospirosis among adolescent school children in a highly
endemic rural area in Sri Lanka. Rural and Remote Health, 13(4), 2360.
http://doi.org/2360 [pii]
Samsudin, S., Masri, S. N., Maztura, T. Z., Jamaluddin, T., Saudi, S. N. S., Ariffin, U.
K. M., Amran, F., Osman, M. (2015). Seroprevalence of Leptospiral Antibodies
among Healthy Municipal Service Workers in Selangor. Advances in Public
Health, 2015. http://doi.org/208145
Sapian, M., Khairi, M. T., How, S. H., Rajalingam, R., Sahhir, K., Norazah, A., …
Jamalludin, A. R. (2012). Outbreak of Melioidosis and Leptospirosis Co-
infection following a rescue operation. Med J Malaysia., 67(3), 293–297.
Sarkar, J., Chopra, A., Katageri, B., Raj, H., & Goel, A. (2012). Leptospirosis: a re-
emerging infection. Asian Pacific Journal of Tropical Medicine, 5(6), 500–502.
http://doi.org/10.1016/S1995-7645(12)60086-8
Sejvar, J., Bancroft, E., Winthrop, K., Bettinger, J., Bajani, M., Bragg, S., …
Rosenstein, N. (2003). Leptospirosis in “Eco-Challenge” athletes, Malaysian
Borneo, 2000. Emerging Infectious Diseases, 9(6), 702–707.
http://doi.org/10.3201/eid0906.020751
Socolovschi, C., Angelakis, E., Renvoisé, A., Fournier, P.-E., Marié, J. Lou, Davoust,
B., … Raoult, D. (2011). Strikes, flooding, rats, and leptospirosis in Marseille,
France. International Journal of Infectious Diseases : IJID : Official Publication
of the International Society for Infectious Diseases, 15(10), e710-5.
http://doi.org/10.1016/j.ijid.2011.05.017
Subramaniam, K., Abdul Hafiz, M., & Chandrakant, P. (2011). Procedia Social and
Behavioral Sciences. Procedia Social and Baehavioral Sciences, 0.
Sugunan, a. P., Vijayachari, P., Sharma, S., Roy, S., Manickam, P.,
Natarajaseenivasan, K., … Sehgal, S. C. (2009). Risk factors associated with
leptospirosis during an outbreak in Middle Andaman, India. Indian Journal of
Medical Research, 130(July), 67–73.
Suriani, I (2015). Health Promotion Intervention Strategies and Approaches
[Powerpoint Slides].
Vanasco, N. B., Schmeling, M. F., Lottersberger, J., Costa, F., Ko, a. I., & Tarabla, H.
D. (2008). Clinical characteristics and risk factors of human leptospirosis in
Argentina (1999-2005). Acta Tropica, 107, 255–258.
http://doi.org/10.1016/j.actatropica.2008.06.007
Victoriano, A., Smythe, L., Gloriani-Barzaga, N., Cavinta, L., Kasai, T.,
Limpakarnjanarat, K., … Adler, B. (2009). Leptospirosis in the Asia Pacific
-
© CO
PYRI
GHT U
PM
108
region. BMC Infectious Diseases, 9(1), 147. http://doi.org/10.1186/1471-2334-9-
147
Vijayachari, P. (2007). Leptospirosis. World Health Organization.
http://doi.org/10.3109/00313028109086822
Wahab, Z. A. (2015). Epidemiology and Current Situation of Leptospirosis in
Malaysia, (September).
Wasiński, B., Sroka, J., Wójcik-Fatla, A., Zając, V., Cisak, E., Knap, J. P., …
Dutkiewicz, J. (2012). Seroprevalence of leptospirosis in rural populations
inhabiting areas exposed and not exposed to floods in eastern Poland. Annals of
Agricultural and Environmental Medicine : AAEM, 19(2), 285–8.
http://doi.org/1001810 [pii]
Whitney, E. a S., Ailes, E., Myers, L. M., Saliki, J. T., & Berkelman, R. L. (2009).
Prevalence of and risk factors for serum antibodies against Leptospira serovars in
US veterinarians. Journal of the American Veterinary Medical Association,
234(7), 938–944. http://doi.org/10.2460/javma.234.7.938
WHO. (2009). Leptospirosis situation in the WHO South-East Asia Region.
World Health Organization. (2003). Human leptospirosis: guidance for diagnosis,
surveillance and control. WHO Library, 45(5), 1–109.
http://doi.org/10.1590/S0036-46652003000500015
COVERTHESIS HARDBOUND SUE B5 FORMATBlank PageBlank PageBlank PageBlank Page