Valuing human leptospirosis prevention using the opportunity cost of labor

Global, regional, and country-level cost of leptospirosis due to loss of productivity in humans

BACKGROUND

Leptospirosis, a prevalent zoonotic disease with One Health priority and a disease of poverty, lacks global economic burden estimates. This study aims to determine the global, regional, and country-level cost of leptospirosis due to loss of productivity.

METHODOLOGY/PRINCIPAL FINDINGS

The cost of leptospirosis due to loss of productivity (referred to as productivity cost hereafter) was estimated by converting the disability-adjusted life years (DALYs) lost due to leptospirosis to a monetary value using the per capita gross domestic product (GDP). The country-specific DALYs lost were obtained from the global burden of leptospirosis study published previously. Non-health GDP per capita (GDP- per capita health expenditure) was used for the cost conversion of DALYs. Country-specific GDP and health expenditure data were obtained from the World Bank data repositories. Estimates were done using both nominal and international dollars. The estimated global productivity cost of leptospirosis in 2019 was Int$ 29.3 billion, with low and high estimates ranging from Int$ 11.6 billion to 52.3 billion. China (Int$ 4.8 billion), India (Int$ 4.6 billion), Indonesia (Int$ 2.8 billion), Sri Lanka (Int$ 2.1 billion), and the United States (Int$ 1.3 billion) had the highest productivity cost due to leptospirosis. Eight out of 10 countries with the highest burden were in the Asia-Pacific region. In addition, lower-middle-income countries had an annual productivity cost of Int$ 13.8 billion, indicating that the disease is poverty-related.

CONCLUSION

Although significant, the cost estimate due to loss of productivity is merely a fraction of the overall economic burden of this disease, which also includes other direct, indirect, and intangible costs. The existing partial estimates of the different components of economic cost suggest a profound economic burden that demands the inclusion of leptospirosis in the global health agenda for comprehensive disease control and prevention efforts, including vaccine development.

A Multi-landscape Assessment of Leptospira Prevalence on a Diversity of Small Mammals

Leptospirosis is a major zoonotic disease, especially in the tropics, and rodents were known to be carriers of this bacterium. There was established information on Leptospira prevalence among animal reservoirs in human-dominated landscapes from previous literature. However, there was very little focus given comparing the prevalence of Leptospira in a wide range of habitats. An extensive sampling of small mammals from various landscapes was carried out, covering oil palm plantations, paddy fields, recreational forests, semi-urbans, and wet markets in Peninsular Malaysia. This study aims to determine the prevalence of pathogenic Leptospira in a diversity of small mammals across different landscapes. Cage-trapping was deployed for small mammals' trappings, and the kidneys of captured individuals were extracted, for screening of pathogenic Leptospira by polymerase chain reaction (PCR) using LipL32 primer. Eight microhabitat parameters were measured at each study site. Out of 357 individuals captured, 21 (5.9%) were positive for pathogenic Leptospira of which recreational forest had the highest prevalence (8.8%) for landscape types, whereas Sundamys muelleri shows the highest prevalence (50%) among small mammals' species. Microhabitat analysis reveals that rubbish quantity (p < 0.05) significantly influenced the Leptospira prevalence among small mammals. Furthermore, nMDS analysis indicates that the presence of faeces, food waste, and exposure to humans in each landscape type also were linked with high prevalence of pathogenic Leptospira among the small mammals. This study supplements previous studies on pathogenic Leptospira prevalence across different landscape types, and the major microhabitat factors associated with Leptospira prevalence. This information is crucial for epidemiological surveillance and habitat management to curb the possibility of the disease outbreaks.

Determinants of COVID-19 Prevention Behavior in School Students - A Cross-sectional Study

Background: The status of global pandemic that has been going on for more than one year has forced countries around the world to adopt new habitual adaptations, including Indonesia. The application of new norm adjustments is applied in all areas that intersect with the public, such as public transportation, places of worship, offices, supermarkets, inns and restaurants. Control of the spread of Covid-19 is carried out by the government with various efforts so its spread can be controlled but in reality on the ground it is increasingly rampant, controlling the spread of Covid-19 can be successful if the entire community participates in taking precautions for its spread. Aims: Research objective was to determine the relationship between knowledge, attitude and behavior of SMKN I students in efforts to prevent Covid-19. Methods: The type of this research was processed using descriptive correlative method which described the relationship between knowledge, attitude and behavior of students in efforts to prevent Covid-19. The population in this research were students that majoring in Pharmacy and Computer and Network Engineering Departments of SMKN 1 Garut, the sample was using total sampling technique as many as 160 respondents, the instrument in this research was questionnaire. Data analysis used chi-square. Results: The result showed that the level of students' knowledge about the efforts to prevent Covid-19 was in the sufficient category (72%). Most of the students' attitude about the prevention of Covid-19 was in the sufficient category (74%). Most of the sufferers' behavior regarding the prevention of Covid-19 was in the good category (79%). Based on the result of statistical tests using Chi Square, the result showed that there was a relationship between students' knowledge and behavior in efforts to prevent Covid-19 (p value = 0.63) and there was a relationship between students' attitude and behavior in efforts to prevent Covid-19 (p value = 0.83). The conclusion was that there was a relationship between knowledge, attitude and behavior of students in efforts to prevent Covid-19.

Economic benefit of leptospirosis prevention in Kelantan, Malaysia: Willingness-to-contribute approach

Leptospirosis is an endemic disease in Malaysia. Despite the increasing incidence rate, knowledge on the economic assessment of preventing leptospirosis is still limited. This paper introduces the willingness-to-contribute (WTC) method for estimating the economic benefit of preventing leptospirosis. A cross-sectional study using the WTC method was applied to measure how much time respondents in Kelantan were willing to contribute toward preventing leptospirosis. Study respondents were wet market traders aged 18 years old and above who were fluent in the Malay language. The average WTC value was multiplied by the population of Kelantan to derive the monetary value of preventing leptospirosis. Two hundred and fifty respondents participated in the study. The mean time contribution was 6.68 hours (SD9.01) per month. The average WTC corresponded to a monthly cost savings of US$4.94 per person. Approximately between US$106.7 million to US$315 million per annum can be saved through the prevention of leptospirosis in Kelantan. Preventing leptospirosis is beneficial to Kelantan and would bring major economic savings. The findings are intended to help policy makers in the planning and management of leptospirosis policies and interventions.

Exploring governance for a One Health collaboration for leptospirosis prevention and control in Fiji: Stakeholder perceptions, evidence, and processes

Fiji has a high burden of leptospirosis, with endemic infection and epidemic outbreaks with high mortality, often associated with flooding and cyclones. As a zoonosis, leptospirosis control requires interventions in sectors beyond the usual control of health-in Fiji, the dairy and sugar industries, and water and sanitation and rodent control in communities. This paper presents the findings of qualitative research to inform policy around governance for a One Health multisectoral approach to leptospirosis control.

METHODS

Key informants from relevant government agencies and industry organizations were interviewed in late 2014, and the interviews analyzed and triangulated with documentary analysis.

FINDINGS

The analysis identified 5 themes: perceptions of the impact of leptospirosis, governance processes, models for collaboration, leptospirosis control, and preferred leadership for leptospirosis management. Data were limited, with poor communication between ministries, and limited awareness of leptospirosis outside outbreaks. Collaboration during outbreaks was positive but not sustained in endemic periods. Mechanism for enhanced collaboration was developed for endemic and outbreak situations.

CONCLUSION

The findings informed a One Health governance approach to leptospirosis, framed within a National Strategic Plan, with a specific National Action Plan for Leptospirosis. The process provides a research based One Health template for application to other zoonotic diseases.

Development and validation of a new knowledge, attitude, belief and practice questionnaire on leptospirosis in Malaysia

Background

In Malaysia, leptospirosis is considered an endemic disease, with sporadic outbreaks following rainy or flood seasons. The objective of this study was to develop and validate a new knowledge, attitude, belief and practice (KABP) questionnaire on leptospirosis for use in urban and rural populations in Malaysia.

Methods

The questionnaire comprised development and validation stages. The development phase encompassed a literature review, expert panel review, focus-group testing, and evaluation. The validation phase consisted of exploratory and confirmatory parts to verify the psychometric properties of the questionnaire. A total of 214 and 759 participants were recruited from two Malaysian states, Kelantan and Selangor respectively, for the validation phase. The participants comprised urban and rural communities with a high reported incidence of leptospirosis. The knowledge section of the validation phase utilized item response theory (IRT) analysis. The attitude and belief sections utilized exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).

Results

The development phase resulted in a questionnaire that included four main sections: knowledge, attitude, belief, and practice. In the exploratory phase, as shown by the IRT analysis of knowledge about leptospirosis, the difficulty and discrimination values of the items were acceptable, with the exception of two items. Based on the EFA, the psychometric properties of the attitude, belief, and practice sections were poor. Thus, these sections were revised, and no further factor analysis of the practice section was conducted. In the confirmatory stage, the difficulty and discrimination values of the items in the knowledge section remained within the acceptable range. The CFA of the attitude section resulted in a good-fitting two-factor model. The CFA of the belief section retained low number of items, although the analysis resulted in a good fit in the final three-factor model.

Conclusions

Based on the IRT analysis and factor analytic evidence, the knowledge and attitude sections of the KABP questionnaire on leptospirosis were psychometrically valid. However, the psychometric properties of the belief section were unsatisfactory, despite being revised after the initial validation study. Further development of this section is warranted in future studies.

Using discrete choice modeling to evaluate the preferences and willingness to pay for leptospirosis vaccine

Leptospirosis is highly endemic in the Philippines and a serious concern to public health. Local research on candidate vaccine is moving through the development pipeline. The availability of vaccines alone does not guarantee acceptance because individuals' vaccination choice decision is influenced by several factors. This study assessed how vaccine attributes and socio-demographic factors affect the acceptability of leptospirosis vaccine; and estimated individuals' willingness to pay for leptospirosis vaccine. A discrete choice experiment was conducted among leptospirosis and non-leptospirosis case respondents (n = 342) living in Metro Manila. Random Parameters Logit model was used to estimate the relative importance of vaccine attributes and socio-demographic variables on respondents' leptospirosis vaccination choice decision. The estimated model coefficients were used to derive implicit prices and willingness to pay for leptospirosis vaccine. Both case respondents preferred leptospirosis vaccine with 70-100% efficacy, mild to moderate risk of side-effects, given in a single shot, and at a lower price. Non-leptospirosis case respondents preferred a vaccine with 7 to 10 y of protection, while leptospirosis case respondents preferred a vaccine with 10 y protection. The probability of leptospirosis vaccination acceptance was affected by respondents' age, education, family size and income, proximity of home to rivers and sewers, and leptospirosis awareness level. Respondents' willingness to pay for leptospirosis vaccine (US$ 31.14-US$ 65.89) was higher than the Japanese retail price (US$ 21.60-US$ 24.00). Our findings indicated significant potential for introducing leptospirosis vaccine in the Philippine vaccine market. Delivery strategies to ensure equitable access to future leptospirosis vaccine are recommended.