Liberty University Master of Public Health Health 625 Prevention and Control of Infectious Diseases STUDYING RISK FACTORS ASSOCIATED WITH HUMAN LEPTOSPIROSIS (Kamath R et al.): AN ARTICLE REVIEW IMA STUDENT ID: XOXOXO November 4, 2014 Words: 951 Article: Kamath R, Swain S, Nair SN, Pattanshetty S. Studying risk factors associated with human Leptospirosis. J Glob Infect Dis.2014; 6(1): 3–9. doi:10.4103/0974-777X.127941. I. SUMMARY The article presents the findings of a matched case-control study conducted to identify the occupational and environmental risk factors of Leptospirosis in India. The study was conducted from April 2012 to August 2012 with a total of 70 cases and 140 sex matched controls belonging to the same neighborhoods as cases. Data collection on occupational and environmental risk factors was achieved through semi-structured questionnaires and researcher observation. The study revealed that certain occupational and environmental factors were significantly associated with Leptospirosis and were therefore risk factors for this disease. Of all risk factors, the presence of a wound or cut in the skin while working was found to have the strongest association with Leptospirosis. This was followed by contact with soil contaminated with infected rodent urine. Occupations involving outdoor activities were significant risk factors for Leptospirosis compared to those involving indoor tasks. Other significant risk factors were the presence of drainage or sewage within a 15m radius from the home as well as the ingestion of inadequately cooked or raw vegetables with rat bites. II. ARTICLE REVIEW This article review examines the research methodology, study findings as well as the limitations of the study. Findings are analyzed using evidence from similar studies and recommendations are provided to address the identified limitations. Review of Methodology The case-control approach was used to determine risk factors of Leptospirosis. While this method is not very rigorous compared to other study designs, it is useful in the study of outbreaks and rare or neglected diseases such as Leptospirosis. This method is also appropriate where the small sample size and inadequate resources limit the use of more rigorous designs. The control of confounders was achieved by matching cases and controls according to gender, age and geographic location. 1 While researchers identified the three main confounders, confounding by religion was not controlled, in fact majority of participants belonged to one religion. This may have been a result of selecting cases and controls from the same neighborhood. Religion may be a risk factor of Leptospirosis especially if it involves rituals or practices where members come in contact with contaminated rivers, water or soil. Data collection was done through the use of semi-structured questionnaires and researcher observation. 1 While semi-structured questionnaires allow researchers to obtain substantial in ...

1. Liberty University
Master of Public Health
Health 625
Prevention and Control of Infectious Diseases
STUDYING RISK FACTORS ASSOCIATED WITH HUMAN
LEPTOSPIROSIS (Kamath R et al.):
AN ARTICLE REVIEW
IMA STUDENT
ID: XOXOXO
November 4, 2014
Words: 951
Article: Kamath R, Swain S, Nair SN, Pattanshetty S. Studying
risk factors associated with human Leptospirosis. J Glob Infect
Dis.2014; 6(1): 3–9. doi:10.4103/0974-777X.127941.
I. SUMMARY
The article presents the findings of a matched case-control
study conducted to identify the occupational and environmental
risk factors of Leptospirosis in India. The study was conducted
from April 2012 to August 2012 with a total of 70 cases and 140
sex matched controls belonging to the same neighborhoods as
cases.
Data collection on occupational and environmental risk factors
was achieved through semi-structured questionnaires and
researcher observation.

2. The study revealed that certain occupational and environmental
factors were significantly associated with Leptospirosis and
were therefore risk factors for this disease. Of all risk factors,
the presence of a wound or cut in the skin while working was
found to have the strongest association with Leptospirosis. This
was followed by contact with soil contaminated with infected
rodent urine. Occupations involving outdoor activities were
significant risk factors for Leptospirosis compared to those
involving indoor tasks. Other significant risk factors were the
presence of drainage or sewage within a 15m radius from the
home as well as the ingestion of inadequately cooked or raw
vegetables with rat bites.
II. ARTICLE REVIEW
This article review examines the research methodology, study
findings as well as the limitations of the study. Findings are
analyzed using evidence from similar studies and
recommendations are provided to address the identified
limitations.
Review of Methodology
The case-control approach was used to determine risk factors of
Leptospirosis. While this method is not very rigorous compared
to other study designs, it is useful in the study of outbreaks and
rare or neglected diseases such as Leptospirosis. This method is
also appropriate where the small sample size and inadequate
resources limit the use of more rigorous designs.
The control of confounders was achieved by matching cases and
controls according to gender, age and geographic location. 1
While researchers identified the three main confounders,
confounding by religion was not controlled, in fact majority of
participants belonged to one religion. This may have been a
result of selecting cases and controls from the same

3. neighborhood. Religion may be a risk factor of Leptospirosis
especially if it involves rituals or practices where members
come in contact with contaminated rivers, water or soil.
Data collection was done through the use of semi-structured
questionnaires and researcher observation. 1 While semi-
structured questionnaires allow researchers to obtain substantial
information, they are prone to researcher bias during analysis
and are therefore less reliable. Data collection through
observation introduces bias especially when each observation
involves a single researcher. Using more than one researcher for
each observation may help minimize bias.
Exposure to risk factors was determined retrospectively thus
increasing the possibility of recall bias.
Review of Findings
The study identified the occupational and environmental factors
that were significantly associated with Leptospirosis. Of all risk
factors identified, the presence of a wound or cut in the skin
during work had the strongest association with Leptospirosis.1
A similar observation was made in a systematic review of risk
factors of Leptospirosis which indicated that skin wounds were
significantly associated with Leptospirosis infection.2 Contact
with soil contaminated with rodent urine was also determined to
be significantly associated with Leptospirosis infection.1 This
is consistent with findings from other studies that have reported
an increased incidence of Leptospirosis in individuals who have
contact with contaminated soil or mud when farming without
protective equipment.2,3,4,
In addition to the two significant findings described above,
outdoor activities were significant risk factors for
Leptospirosis. Occupations involving contact with mud, water,
rivers and domestic animals were significantly associated with
Leptospirosis.1 Other studies found that rural based
occupations, water recreation activities and outdoor activities
such as agriculture, farming and fishing significantly increased

4. exposure to contaminated water and soil thus placing
individuals at high risk for Leptospirosis.2, 3,4,5 The risk is
even higher for individuals working with wounds or cuts or for
those without protective equipment such as gloves and
boots.1,2,4
It was further observed that the presence of drainage within a
15m radius from the home significantly contributed to the
incidence of Leptospirosis.1 Other studies have linked the
presence of stagnant waters and flooding to Leptospirosis
infection.2, 4,5,6
Though not reported by previous studies, the ingestion of raw or
inadequately cooked vegetables with rodent bites was
significantly associated with Leptospirosis.1
A secondary observation made in this study and similar studies
was that individuals in the productive age group (21-50 years
old) were more likely to be exposed to contaminated water or
soil and to subsequently become infected with Leptospirosis.1,
5 These individuals are more likely to be involved in high risk
occupations such as agriculture, fishing or farming where they
are frequently exposed to contaminated water or soil.6
Recommendations
The study was successful in achieving its objective of
identifying the risk factors of Leptospirosis. The following
recommendations serve as a guide for future research on this
topic.
Since ethical constraints may limit the use of intervention
studies, meta-analyses or systematic reviews and cohort studies
are useful methodologies for future research. This case-control
study can be replicated in different settings using a larger
sample. It is important to assign more than one control to each
identified case to reduce confounding; controls may come from
different geographical locations.
Data requiring observation should be collected by more than
one individual in order to minimize bias. Researchers may use a
standardized form or checklist to record their observations.

5. Findings from this study demonstrate the importance of using
protective equipment when performing high-risk tasks. This
suggests the need for policymakers and Public Health
professionals to develop guidelines that protect individuals at
high risk for Leptospirosis. Policymakers may consider
establishing regular screening and prophylaxis for individuals
with high-risk occupations. Health education on environmental
sanitation, vector control and personal hygiene is also important
to minimize exposure to contaminated water and soil.
References
1. Kamath R, Swain S, Nair SN, Pattanshetty S. Studying risk
factors associated with human Leptospirosis. J Glob Infect
Dis.2014; 6(1): 3–9. doi:10.4103/0974-777X.127941
2. Sakundarno M, Bertolatti D, Maycock B. et al. Risk factors
for Leptospirosis infection in humans and implications for
public health intervention in Indonesia and the Asia-Pacific
region. Asia Pac J Public Health. 2014;26(1):15-32.
doi:10.1177/1010539513498768
3. Rafizah AA, Aziah BD, Azwany YN et al.Risk factors of
leptospirosis among febrile hospital admissions in northeastern
Malaysia. Prev Med. 2013;57(1):S11-13.
doi:10.1016/j.ypmed.2012.12.017

6. 4. Prabhakaran SG, Shanmughapriya S, Dhanapaul S et al. Risk
factors associated with rural and urban epidemics of
leptospirosis in Tiruchirappalli District of Tamilnadu, India. J
Public Health. 2014;22(4):323-333. doi:10.1007/s10389-014-
0611-1.
5. Vanasco NB, Schmeling MF, Lottersberger J et al. Clinical
characteristics and risk factors of human leptospirosis in
Argentina (1999–2005). Acta Trop. 2008;107(3):255-8.
doi:10.1016/j.actatropica.2008.06.007
6. Heymann DL. Control of Communicable Diseases Manual.
Washington, DC: American Public Health Association;
2008:643-644.
3
HLTH 625
Journal Article Reviews Instructions
Review and analyze a recent journal article (published within
the last 5 years) from a peer-reviewed publication (e.g The
Journal of Infectious Diseases) about a CHLAMYDIAL
INFECTIONS
· You must evaluate the chosen paper against at least 4 other
peer-reviewed sources.
· You may cite your text; however, it does not count as one of
your peer-reviewed sources.
· For each review, you will select an article about a topic from

7. the required readings between each review assignment
submission.
· You will then compose a 4 -page paper, not including the
cover page and references, on your topic of choice.
· The goal of the assignment is to help link the current best
practices identified in your text and the ongoing developments
of research reflected in the peer-reviewed literature in support
of learning outcomes A and B.
· You should, therefore, choose articles related to current
epidemiologic trends for infectious diseases and/or the impact
of the diseases and of the control measures on global
populations. Special attention should be devoted to
understanding the role of infectious agents as causes of
morbidity and mortality in the context of economically
developing nations.
Be sure to include the following elements:
· A clearly documented reference to best practices or standard
of care
· Reported findings are completely and fairly assessed and
critiqued
· A summary of the principal contents of the article under
review
· Adequate information to understand the central themes and
recommendations
· Paper, references, and citations all consistently follow current
AMA formatting