Kembhavi Ravindra S, Velhal Gajanan D, Shah Anuradha K
Department of Community Medicine, Seth G. S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India.
J Family Med Prim Care. 2021 Sep;10(9):3361-3367. doi: 10.4103/jfmpc.jfmpc_674_21. Epub 2021 Sep 30.
Leptospirosis is emerging as one of the growing public health problems in many parts of India. It can occur in both rural and urban areas with varied risk factors. This study was taken up in three districts of Maharashtra namely-Mumbai, Ratnagiri, and Sindhudurg to understand the determinants of leptospirosis in both the urban and rural areas and look for differences if any.
This cross-sectional study was carried out during the year 2017. A pretested validated questionnaire was used to collect data. Field observations were made. Eighty-seven cases from Sindhudurg and 14 from Ratnagiri and 307 cases from Mumbai were included in the study.
A total of 408 cases were included in the study. A total of 63 (62.4%) were males and 38 (37.6%) were females. Most cases belonged to the 20-35 year age group (37%). In rural areas, 32.7% of them visited government facilities first, whereas, in the urban areas, it was 73.9% ( = 0.006). Headache, myalgia, and prostration were more common in cases from rural areas ( = <0.05). Skin rash was found to be associated with urban cases of leptospirosis. The presence of rodents, cattle sheds, pets, and working in paddy fields were common environmental risks in rural areas, and using water for recreational activities were common in urban areas ( < 0.001).
Context-specific risk factors were found significantly associated with the cases. No important difference was found in the epidemiology of leptospirosis in the urban and rural areas except the source of infection.
钩端螺旋体病正成为印度许多地区日益严重的公共卫生问题之一。它可发生在农村和城市地区，危险因素各不相同。本研究在马哈拉施特拉邦的三个地区——孟买、拉特纳吉里和辛杜尔古尔进行，以了解城乡钩端螺旋体病的决定因素，并寻找其间可能存在的差异。
本横断面研究于2017年开展。使用经过预测试验证的问卷收集数据，并进行实地观察。研究纳入了来自辛杜尔古尔的87例病例、来自拉特纳吉里的14例病例以及来自孟买的307例病例。
本研究共纳入408例病例。其中男性63例（62.4%），女性38例（37.6%）。大多数病例属于20 - 35岁年龄组（37%）。在农村地区，32.7%的患者首先前往政府医疗机构就诊，而在城市地区这一比例为73.9%（P = 0.006）。头痛、肌痛和全身乏力在农村地区的病例中更为常见（P <0.05）。皮疹被发现与城市钩端螺旋体病病例相关。农村地区常见的环境危险因素包括有啮齿动物、牛棚、宠物以及在稻田工作，而城市地区常见的危险因素是将水用于娱乐活动（P < 0.001）。
发现特定背景下的危险因素与病例显著相关。除感染源外，城乡钩端螺旋体病的流行病学未发现重要差异。
