1. CASE STUDY OF LEPTOSPIROSIS: USING AN ECOHEALTH APRROACH FOR BETTER MANAGEMENT OF LEPTOSPIROSIS IN KULONPROGO DISTRICT, YOGYAKARTA SPECIAL PROVINCE, INDONESIA EHRC UGM Dyah Ayu Widiasih Presented on EcoHealth-One Health Short Course, Hanoi 27-30 May 2013

2. Background In 2009, there were outbreaks of leptospirosis in Yogyakarta Leptospirosis = ZEID NEED NEW APPROACHES FOR BETTER CONTROLLING Priority of controlliing EID Ministry of Agriculture INTEGRATIVE RESEARCH Priority zoonoses in Indonesia: Leptospirosis 3 rank (MOH) ECOHEALTH CONCEPT APPROACHES

3. EcoHealth Approaches to Solve Risk Factors of Leptospirosis Progo river

4. EcoHealth Aspects of Leptospirosis Research Focus on the following: Collaboration with transdisciplinary team Articulation of an EcoHealth conceptual framework Understanding Leptospirosis risk factors & policy issues Understanding cultural landscape & policy context of Leptospirosis Engaging in regional exchange /work on Leptospirosis

5. The problem: Leptospirosis in Yogyakarta Public health authorities (municipal health services) Livestock services Head of District Farmers (dairy cattle, goat, sheep) & pet owners UGM (implementing the project) 7 faculties: Vet Med, Animal Science, Social Science (Anthropology) & Medicine, Geography, Biology, Groups involved - Framework

6. Some faculties at UGM Municipal Health of Yogyakarta Special Province Livestock services of Yogyakarta Special Province Community Boundary Partners

7. Phase 1 Surveillance and screening agents from animals Questionnaires for demographic data and potential risks from animals Spatial analysis Phase 2 Exploring risk factors: Knowledge of zoonotic diseases & leptospirosis Behavior of people Control & prevention Stakeholder policy Materials and Methods

8. -Cattle sera: -Sampling design Kulon Progo district High human cases area along the watershed of Progo River Kulon Progo, Bantul, Sleman Leptospirosis prevalence Risk factors: hosts environments socio-economics Mapping disease Materials and Methods (Phase 1)

9. Prevalence observed: 1.Cattle: 10% (out of 500 cattle sera analyzed so far 50 have been tested positive) 1.Sheep & goat: 1.6% (1/60) 2.Dog & cat : 0% (0/60) Preliminary Results – Leptospirosis Serology Preliminary Results – Leptospirosis Serology

10. Leptospirosis serovars Preliminary Results – Leptospirosis Serology Preliminary Results – Leptospirosis Serology

11. No.SubdistrictNo. of casesSerovars 1Seworan, Triharjo, Wates7Leptospira serovar hardjo 1Leptospira serovar icterohaemorrhagiae 2Block IV, Karangwuni, Wates1Leptospira serovar hardjo 3Kriyanan, Wates, Wates11Leptospira serovar hardjo 1Leptospira serovar javanicae, L. celledoni 4X, Pleret, Panjatan3Leptospira serovar icterohaemorrhagiae 5Bojong 3, Bojong, Panjatan1Leptospira serovar celledoni 6Temben, Ngentakrejo, Lendah1Leptospira serovar icterohaemorrhagiae 2Leptospira serovar hardjo 1Leptospira serovar battaviae 1Leptospira serovar tarrasovi 7Kutogiri, Sidomulyo, Pengasih1Leptospira serovar hardjo 8Mrungi, Sendangsari, Pengasih3Leptospira serovar hardjo 1Leptospira serovar battaviae 9Kisik, Banjarasri, Kalibawang2Leptospira serovar icterohaemorrhagiae 1Leptospira serovar rachmatie 1Leptospira serovar hardjo 10Krikil, Pendoworejo, Girimulyo1Leptospira serovar battaviae 6Leptospira serovar rachmatie 1Leptospira serovar hardjo 1Leptospira serovar javanicae 1Leptospira serovar icterohaemorrhagiae 11Wiyu, Kembang, Nanggulan1Leptospira serovar icterohaemorrhagiae 12Duwet, Purwoharjo, Samigaluh1Leptospira serovar icterohaemorrhagiae 2Leptospira serovar rachmatie 2Leptospira serovar hardjo 1Leptospira serovar pomona Positive Areas Based on MAT Analysis

12. Age Education Occupation Results - Demographic Data of Farmers Involved in the Study (QX)

13. Potential Human - Risk Factors for Leptospirosis

14. Grazing at pasture Bath in the river Work in the rice field Feed (grass) from the field have many wild mice Many mice at the ware house Number of sick cattle and tested positive for leptospirosis (MAT currently applied) Potential Risk Factors for Leptospirosis in Animals

15. The distribution of leptospires in Kulon Progo in animals. Positive cases distributed around the river and carried buffer (distance positive leptospirosis cases with watershed) : 1. At a distance of 50 meters 2. At a distance of 100 m 3. At a distance of 200 m 4. Distances greater than 300 m

16. Phase 2: Results of FGD and IDI Knowledge of zoonotic disease and leptopsirosis Behaviour of people Control and measure Stake holder policy

17. Knowledge of Zoonotic Disease and Leptospirosis Mostly people understand Familiar zoonotic disease: AI, Rabies Rat disease Distribution

18. Behaviour of People Unhealthy behaviour  through garbage outside house, no washing hand No protective cloth (boot, etc) during work Ignore to the death rats

19. Control and Prevention Natural predator: snake, owl, garangan (Herpertes javanicus) Killing Burning Bombing (being burned by traditional fireworks)

20. Control and Prevention  Obstacles : The natural predators are caught and sold by people The boots often stuck in the mud of paddy field makes the farmers not eager to wear them The rats ate motorcycles and other various cables

21. Stakeholder Policies Socialization Free medication service program Eradication program

22. CONCLUSION The synthesis from the qualitative & quantitative surveys data will contribute to a better integrated understanding of disease emergence and the basis for a more effective addressing of public health policy concerns in order to better management of the disease.

23. Acknowledgement This work was supported by International Livestock Research Institute (ILRI) and International Development Resource Centre (IDRC). We are grateful to all ILRI representatives in South East Asia, the head of Kulon Progo districts and all staff of Kulon Progo Livestock Services and Municipal Health Services of Kulon Progo for providing the fascilities and secondary data. The grateful thanks to all member of Working Group of EHRC- UGM for being a good collaboration team in this study. For more information please visit: www.ilri.org/ecozd www.ilriasia.wordpress.com/tag/ecozd www.ecohealth.fkh.ugm.ac.id

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