Risk practices and awareness of leptospirosis amongst residents of Zaria, Nigeria

This study evaluated the level of risk practices and awareness of leptospirosis among residents of Zaria, Nigeria. A pre-tested questionnaires were administered via face-to-face interview to 100 residents. The data was analyzed using chi-square and multivariate analysis to identify risk factors for leptospirosis. The demography showed that the majority of the respondents were male, aged 21–40 years, and majorly crop farmers. The risk factors identified showed that males were 4.14 times more likely to be affected by leptospirosis (OR 4.14, 95% CI [1.93–5.37], p = 0.02) and the source of animal’s water was 5.56 times more likely to be contaminated by Leptospira spp. (OR 4.14, 95% CI [2.88–8.03], p = 0.01) and these relationships were significant. The majority of respondents were not aware of the disease (OR 1.87, 95% CI [1.22–4.57], p = 0.01) with 78% of the respondents not sure of which of the animal species leptospirosis affected (OR 1.67, 95% CI [1.07–2.62], p = 0.02). This study has demonstrated the existence of risk behaviors, and paucity of knowledge about leptospirosis in the study area. It is therefore recommended to organize an enlightenment program and the need for protective clothing for individuals occupationally at risk of infection by Leptospira spp.

Leptospirosis is an important zoonotic disease and poses a serious threat to public health and animal health worldwide.They represent about 70% of the number of emerging infectious diseases in recent times 1,2 .Humans living in high-risk areas, occupationally risk individuals such as farmers, veterinarians, and abattoir workers constitute a major group at risk of infection with Leptospira spp, due to the close contact that exists between them and animals/tissue or excreta in soil 2 .An estimated 320,000 occupationally related deaths from infectious diseases are reported yearly worldwide 3 .Occupation, migratory behaviour, gender, and age are all significant risk factors for leptospirosis 4 .In the past, leptospirosis was first considered as an occupational disease, whereby coal miners were the first occupational risk groups to be documented in the literature 5,6 .
Leptospirosis has a global distribution and is one of the leading causes of reproductive failure in cattle 7 .Tropical countries with significant rainfall and humidity, as well as marshy soil and paddy-growing areas, are more prone to the disease 8 .Leptospirosis is an infectious zoonotic disease of veterinary and public health importance caused by pathogenic bacteria belonging to the genus Leptospira.The disease is transmitted via contact with tissue or urine of infected animal reservoirs such as cattle, sheep, pigs, dogs, and rodents.Transmission occurs via direct contact of the mucous membrane or broken skin with the urine or tissue of infected animals or indirectly with a contaminated environment, especially water contaminated with the urine of infected animals 9,10 .
Therefore, an important factor affecting the risk of infection and the transmission of leptospirosis in Zaria Kaduna State, Nigeria is the attitude, knowledge, and practices of residents, especially occupationally risk individuals such as farmers, miners, hunters, veterinarians, and abattoir workers.Understanding the Knowledge and awareness of leptospirosis existence creates a platform for behavioural changes that will help in the prevention of leptospirosis 11 .This will also help in resource prioritization and dedication to the prevention and control of leptospirosis by the government 2 .

Data analysis
Discrete data obtained from the questionnaire were entered into Microsoft Excel® sheets and the frequencies were converted to percentages and presented in the form of tables.Chi-square and multivariate analysis were used to check for association between variables.Statistical Package for Social Science (SPSS) version 21 was used for data analysis, values of p < 0.05 were considered significantly different.

Demographic features of respondents
The demography showed that the majority of the respondents were male, aged 21-40 years, and majorly crop farmers (Table 1).

Risk factors
The results showed that the major risk factors observed in the study area were sex, occupation, outdoor activities around water bodies, flooding, and consumption of rodents.The risk factors identified showed that males were 4.14 times more likely to be affected by leptospirosis (OR 4.14, 95% CI [1.93-5.37],p = 0.02) and the source of animal water was 5.56 times more likely to be contaminated by Leptospira spp.(OR 4.

Discussion
The risk factors for leptospirosis in humans identified in the study area were middle-aged males between the ages of 21 to 40 years.Many of them were crop farmers (60%) and were not aware of leptospirosis.Also, 36% were animal health professionals who did not consider leptospirosis as a differential diagnosis of the disease.The finding agrees with the report of Ngbede 2 who also highlighted that the majority of the respondents in the study area were not aware of leptospirosis and this puts them at risk of infection.Precautionary steps to prevent infection by the organism are often neglected by Zaria locals, as the majority of those surveyed were unaware of the disease.Lack of formal education by respondents in the study area as well as the lack of awareness of the disease can be linked to the absence of a local name for the disease in the study area 2 .Also, the reason for this finding on middle-aged males may not be unconnected with the fact that the study area had lots of persons within the age group of 21 to 40 years, also in their productive years of life, and were mostly crop farmers who were always in direct exposure to outdoor settings of farms and water bodies possibly contaminated with rodent urine.Furthermore, despite Udechukwu 14 establishing a high prevalence in the study area, there may have been insufficient active surveillance of Leptospira spp.by local public health authorities and researchers within the study location, which could have contributed to the lack of awareness about leptospirosis in this study.We postulated that the nonspecific clinical signs and the possibility of leptospirosis mimicking other febrile illnesses may be responsible for the low level of consideration of leptospirosis as a differential diagnosis by clinicians.The findings on the occupation and educational status of the respondents agree with the report of Buchanan 5 who stated that occupation, education, gender, and age are significant risk factors for leptospirosis.This study showed that males are at higher risk of infection than females as the males in the study location were more prone to occupational exposure and outdoor exposure than females 15 .This may be connected with the sociocultural and www.nature.com/scientificreports/religious practices in some parts of Northern Nigeria where uneducated young women are not allowed to either interact or work outside their homes with their husbands 16 .The results are in agreement with the report of the Leptospira Burden Epidemiology Reference Group 15 which states that men are likely to become more infected with Leptospira spp, than women as they are more prone to exposure in outdoor settings.Activities near water bodies, flooding, and rodent proliferation were also highlighted in this study as risk factors in the study area.This may have been because of the unhygienic practices that have been observed in the area, which may have increased the likelihood that water bodies within the study area will become contaminated during rainfall and flooding 17 , leading to an increase in the prevalence of Leptospira spp.Water from the well is the major source of drinking water in the study area and can easily be contaminated with flooded water contaminated with rodent urine, with consequent increase in the risk of Leptospira spp.burden in the study area as also reported by WHO 15 .

Conclusion
This study has shown that the residents of Zaria, Kaduna State Nigeria are at risk of infection with Leptospira spp.due to the low level of awareness of the disease.It is therefore recommended to organize an enlightenment program on the implication of contact with animals/or their tissues without adequate protection and the need for the use of such protective clothing for individuals occupationally at risk of infection by Leptospira spp.

Table 2 .
Risk factors associated with leptospirosis.

Table 3 .
Knowledge, attitude and practice of respondents.*Value of p ≤ 0.05 is considered significant.