Abstract

Background:
Leptospirosis remains one of the most significant zoonotic diseases in tropical regions such as Indonesia. It is characterized by high morbidity and mortality rates, with case fatality rates ranging from 5% to 15%, and frequent underreporting due to nonspecific clinical symptoms, which contributes to underdiagnosis in up to 40%–60% of suspected cases. Surveillance at the PHC level is crucial for early case detection and outbreak control in endemic areas.

Aim:
This study aimed to develop and implement a leptospirosis surveillance model at primary health care facilities in two endemic regencies in Central Java, Indonesia, Banyumas and Demak districts to improve early detection, reporting, and response capacity.

Methods:
The research on leptospirosis surveillance by the Public Health care Center (PHC) was conducted from January 2018 to December 2019 in Banyumas and Demak Regencies, Central Java. This research is a time-series study that encompasses case findings, diagnosis, and laboratory detection of leptospirosis. Case findings were carried out both passively (at health centers) and actively (within the community) using the WHO-SEARO clinical symptom criteria.

Results:
In Banyumas Regency, 121 suspects, 106 probable, and 44 confirmed cases of leptospirosis and Demak Regency between 2018 and 2021, 73 cases of leptospirosis were reported, with 22 deaths, resulting in a case fatality rate of 30.1%. A total of 51 patients recovered from the disease. While the hospital reported 63 leptospirosis cases and 9 related deaths, surveillance in Demak Regency identified 72 suspected, 67 probable, and 23 confirmed cases with no reported deaths. However, a Demak hospital recorded 172 cases and 19 deaths. Negative binomial regression revealed a significant negative relationship between cases reported by PHCs and hospitals (coef = -0.050, p = 0.012), along with a decreasing trend in hospital cases over time (coef = -0.010, p = 0.046).

Conclusions:
Leptospirosis surveillance data can be used to identify focal areas of leptospirosis endemicity. The application of the WHO-SEARO (2009) clinical criteria and rapid diagnostic tests (RDTs) supports the identification of suspected and probable cases of leptospirosis at the PHC level.

Key words: Surveillance leptospirosis; Case fatality rate; Public Health Center; Neglected disease; Endemic area.