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 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 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.1Journal 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 TYPHOID FEVER.
· 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 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