Knowledge, attitude and practice about leptospirosis prevention among town service workers in northeastern Malaysia: a cross sectional study.

INTRODUCTION: Many efforts have been done to reduce leptospirosis infections in Malaysia especially among high risk groups including town service workers. Town service workers are more likely to be exposed to the leptospiral infection resulting from their occupational activities. METHODS: A cross sectional study was conducted in northeastern Malaysia involving 321 town service workers who were subjected to answer an interviewer-guided validated questionnaire which consists of sociodemographic, knowledge, attitude and practice information. Data were entered and analyzed using SPSS Version 20. RESULTS: All of the respondents were Malay with mean (SD) age of 40.6 (10.28) years old. The mean (SD) duration of employment was 12.1 (9.62) years. Fifty four respondents (16.8%) had never heard of leptospirosis. Among the respondents, 215 (67.0%) of them had poor knowledge on leptospirosis. Meanwhile, 167 (52.0%) and only 128 (39.9%) of them had satisfactory attitude and practice respectively. It was found that knowledge on risk factors for leptospirosis was lacking. There were high risk attitudes such as drinking habit and protective equipment used during working with the favourable answers ranged from 67.3% to 89.1%. The weakest area identified in their practice was also on the use of protective equipment. CONCLUSIONS: The workers' level of knowledge and practice were relatively poor despite an overall good practice on leptospirosis. This finding might expose them to an increased risk of contracting leptospirosis. Identified weak areas in their knowledge, attitude and practice will assist the policy makers to develop a focused and well-directed intervention program on leptospirosis infection.

A hospital-based study on seroprevalence of leptospirosis among febrile cases in northeastern Malaysia.

OBJECTIVE: To determine the seroprevalence of leptospirosis among febrile inpatient cases in northeastern Malaysia. METHODS: A hospital-based cross-sectional study was conducted among 999 febrile cases admitted to 10 hospitals in northeastern Malaysia. A survey using a proforma sheet was used to obtain sociodemographic and occupational information. Serum samples were screened for leptospirosis by IgM enzyme-linked immunosorbent assay test (IgM ELISA) and confirmed by microscopic agglutination test (MAT). RESULTS: There was an equivalent distribution of males and females in the 999 respondents enrolled in the study. The majority were Malay (94.7%) and their mean age was 39.4 (standard deviation 17.6) years. The overall seroprevalence of leptospirosis was 8.4% (95% confidence interval (CI) 6.8-10.3) (n=84). The high-risk occupational group was found to have a higher seroprevalence, which was 56% (95% CI 45.3-66.1) (n=47). The predominant serogroup was Sejroe (82.1%, 95% CI 72.6-88.8) (n=69). CONCLUSIONS: This study revealed a possible high seroprevalence of leptospirosis among febrile cases, indicating the need to review the importance of adding leptospirosis to the case investigation of febrile illness, especially among high-risk occupational groups in Malaysia, as well as in other endemic countries.

Risk factors of leptospirosis among febrile hospital admissions in northeastern Malaysia.

BACKGROUND: Leptospirosis is a worldwide zoonotic disease. Risk factors for the disease may vary among countries. OBJECTIVE: This study was conducted to determine the risk factors of leptospirosis among febrile cases. MATERIALS AND METHODS: A hospital-based cross-sectional study was conducted among 999 febrile patients admitted to 10 hospitals in northeastern Malaysia, from August 2010 to February 2011. An interviewer-guided proforma sheet on sociodemography, type of occupation and social history data was distributed to all adult patients with fever on admission. Serum sample for leptospirosis was screened by IgM Enzyme-linked Immunosorbent Assay (IgM ELISA) test and confirmed by Microscopic Agglutination Test (MAT). The cut-off point for positive MAT was ≥ 1:400 titer in single acute specimens. RESULTS: Seroprevalence of leptospirosis was 8.4% (95% CI: 6.8, 10.3) (n=84/999) by MAT. Multiple logistic regression analysis showed that the high risk occupation group (OR: 1.95, 95% CI: 1.22, 3.13) (p=0.005) and history of recent recreational activity (OR: 2.36, 95% CI: 1.46, 3.85) (p<0.001) were significant associated factors for leptospirosis. CONCLUSION: This study shows a relatively high seroprevalence of leptospirosis in northeastern Malaysia. Identification of high risk occupational group and history of recent recreational activity will help to increase the index of suspicion to diagnose leptospirosis among febrile inpatients due to its mimicking other common febrile illnesses in Malaysia.

Detection of Cryptosporidium parvum in HIV-infected patients in Malaysia using a molecular approach.

This cross-sectional study determined the prevalence of cryptosporidiosis in HIV-infected patients using polymerase chain reaction (PCR). Stool specimens were collected from HIV infected patients who were admitted to Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia, for various indications from December 2004 to December 2005. A modified acid-fast stain was performed on the direct stool smears, then the stool specimens were further tested using nested PCR targeting the 18S rRNA gene of Cryptosporidium parvum, with a built-in internal control (IC). Out of 59 samples, 11 were positives. Nested PCR identified a total of nine samples (16%) compared to microscopy, which identified only three samples. All PCR negative results showed IC amplicons, suggesting that these samples were true negatives and were not due to inhibition of PCR. This study highlights the importance of molecular diagnosis in determining the true prevalence and epidemiology of C. parvum.