title: Knowledge, perceptions, and environmental risk factors among Jamaican households with a history of leptospirosis.
abstract: BACKGROUND
  Leptospirosis is a globally important zoonotic disease caused by pathogenic Leptospira, and outbreaks typically follow heavy rainfall and flooding. This study examined the knowledge and perceptions concerning leptospirosis, factors associated with environmental hygiene and sanitation, and the presence of Leptospira in water samples from households with or without a history of the disease in the parish of St. Mary, Jamaica.
  
  
  METHODS
  The study employed a cross-sectional design in 43 communities within the parish of St. Mary, Jamaica between September 2008 and March 2009. Households that had at least one confirmed case of leptospirosis during the 2005 or 2007 outbreaks were assessed for living conditions, environmental hygiene, and for knowledge and risk perceptions about leptospirosis. A parallel sampling scheme was used for households with no reported cases during the outbreak years.
  
  
  RESULTS
  Almost 97% of the participants reported having heard of leptospirosis; however, less than 40% of respondents from households with a history of leptospirosis agreed that leptospirosis was a problem in the parish. Among households without a history of leptospirosis, this perception was greater in urban/peri-urban households than in rural households (59% vs. 21%; p=0.04). Risk behaviors or living conditions were common; however, there was a high level of awareness about the health risks associated with flooding. Among households with history of leptospirosis, the perception that nothing can be done to control rodents was significantly higher (p<0.04) in rural (50%) than in urban/peri-urban (17.6%) households. Nine (4%) water samples were positive for Leptospira; 56% of these were from water stored for domestic purposes. Overall, residence in rural communities, presence of a garbage dump, and leptospiral DNA in water samples correlated with households with the history of the disease (p<0.01).
  
  
  CONCLUSIONS
  Education of rural communities regarding leptospirosis and its prevention through proper waste disposal and rodent control should be urgently initiated.
authors.affiliation: Division of Environmental Health, School of Public Health, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN 55455, United States.
authors.forename: Paul
authors.initials: P
authors.lastname: Allwood
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. Second Street, Suite 300, Minneapolis, MN 55454, United States.
authors.forename: Claudia
authors.initials: C
authors.lastname: Muñoz-Zanzi
authors.affiliation: Division of Environmental Health, School of Public Health, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN 55455, United States.
authors.forename: Martin
authors.initials: M
authors.lastname: Chang
authors.affiliation: Department of Basic Medical Sciences, University of West Indies, Mona, Kingston 7, Jamaica. Electronic address: paul.brown@uwimona.edu.jm.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D003430:Cross-Sectional Studies; D004197:Disease Reservoirs; D005191:Family Characteristics; D005192:Family Health; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007563:Jamaica; D007922:Leptospirosis / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012377:Rodentia; D014871:Water Microbiology; D055815:Young Adult; D015047:Zoonoses / Q000453:epidemiology* / Q000517:prevention & control*
keywords: KAP (knowledge, attitude, perception); Leptospirosis; Prevention and control; Public health