title: Studying risk factors associated with human leptospirosis.
abstract: BACKGROUND
  Leptospirosis is one of the most under diagnosed and underreported disease in both developed and developing countries including India. It is established that environmental conditions and occupational habit of the individuals put them at risk of acquiring disease, which varies from community to community. Various seroprevalence studies across the world have documented emerging situation of this neglected tropical disease, but limited have probed to identify the risk factors, especially in India.
  
  
  OBJECTIVE
  The objective of this study was to identify the environmental and occupational risk factors associated with the disease in Udupi District.
  
  
  METHODS
  This population-based case-control study was carried out in Udupi, a District in Southern India from April 2012 until August 2012. Udupi is considered to be endemic for Leptospirosis and reported 116 confirmed cases in the year 2011. Seventy of 116 laboratory confirmed cases and 140 sex matched neighborhood healthy controls participated in the study. A predesigned, semi-structured and validated questionnaire was used for data collection through house to house visit and observations were noted about environmental conditions. Univariate analysis followed by multivariate analysis (back ward conditional logistic regression) was performed by using STATA version 9.2 (StataCorp, College Station, TX, USA) to identify potential risk factors.
  
  
  RESULTS
  Occupational factors such as outdoor activities (matched odds ratio [OR] of 3.95, 95% confidence interval [CI]: 1.19-13.0), presence of cut or wound at body parts during work (matched OR: 4.88, CI: 1.83-13.02) and environmental factors such as contact with rodents through using the food materials ate by rat (matched OR: 4.29, CI: 1.45-12.73) and contact with soil or water contaminated with urine of rat (matched OR: 4.58, CI: 1.43-14.67) were the risk factors identified to be associated with disease.
  
  
  CONCLUSIONS
  Leptospirosis is still considered as neglected disease in the district. Early diagnosis and prompt treatment of cases can save many lives. However, there is a need of integrated rodent control measures with great effort to increase awareness and education among subjects in controlling the disease.
authors.affiliation: Department of Public Health, Manipal University, Udupi, Karnataka, India.
authors.forename: Ramachandra
authors.initials: R
authors.lastname: Kamath
authors.affiliation: Indian Institute of Public Health, Bhubaneswar, Odisha, India.
authors.forename: Subhashisa
authors.initials: S
authors.lastname: Swain
authors.affiliation: Department of Public Health, Manipal University, Udupi, Karnataka, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Pattanshetty
authors.affiliation: Department of Statistics, Manipal University, Udupi, Karnataka, India.
authors.forename: N Sreekumaran
authors.initials: NS
authors.lastname: Nair
keywords: Case-control study; India; Leptospirosis; Population
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