Spatial and Temporal Disparities of Leptospirosis Transmission in Sarawak (Malaysia), 2011-2018

Keywords: Leptospirosis, Local Indicator of Spatial Association (LISA), Moran's Global Index, Sarawak, spatial analysis


This study is to analyse the spatial distribution of leptospirosis and identify its high and low incidence clusters in Sarawak. The annual incidence rate at the district level was calculated using confirmed report of leptospirosis cases from year 2011 to 2018. Empirical Bayes estimation smoothing of relative risks was used to display the spatial distribution of leptospirosis across the study region. Moran's Global Index and Local Indicators of Spatial Association (LISA) were used to analyse the existence of global and local spatial autocorrelation. Data were analysed using ArcGIS and Geoda software at the district level. The annualised average incidence reported during the study period was 20.83 per 100,000 population, with the highest cases reported in year 2018 (n = 870). The Global Moran's Index revealed spatial clustering of leptospirosis incidence in 2012 (Moran's I: 0.23), 2013 (Moran's I: 0.33), and 2014 (Moran's I: 0.45), while 2011 (Moran's I: -0.01), 2015 and 2016 (Moran's I: 0.09), 2017 (Moran's I: 0.13), and 2018 (Moran's I: 0.04) showed random patterns. High incidence clusters of leptospirosis were primarily congested in the Southeast of Sarawak, involving districts such as Kapit, Belaga, Song, Tatau and Lubok Antu. Spatial and temporal patterns of leptospirosis incidence were heterogeneous across Sarawak. This study facilitates the implementation of targeted interventions and control measures for leptospirosis in Sarawak by identifying spatial cluster and outliers.


Anselin, L. (1995). Local indicators of spatial association - LISA. Geographical Analysis, 27(2): 93-115.

Anselin, L., Syabri, I. & Kho, Y. (2006). GeoDa: An introduction to spatial data analysis. Geographical Analysis, 38(1): 5-22.

Areas, G.A. (2012). GADM database of Global Administrative Areas, version 2.0. Berkeley, CA: University of Berkeley.

Bahaman, A.R. & Ibrahim, A.L. (1988). A review of leptospirosis in Malaysia. Veterinary Research Communications, 12(2-3): 179-189.

Barragan, V., Olivas, S., Keim, P., & Pearson, T. (2017). Critical knowledge gaps in our understanding of environmental cycling and transmission of Leptospira spp.. Applied and Environmental Microbiology, 83(19): e01190-17.

Benacer, D., Thong, K.L., Min, N.C., Bin Verasahib, K., Galloway, R.L., Hartskeerl, R.A., Souris, M., & Mohd Zain, S.N. (2016). Epidemiology of human leptospirosis in Malaysia, 2004-2012. Acta Tropica 157: 162-168.

Cardoso, D.T., de Souza, D.C., de Castro, V.N., Geiger, S.M., & Barbosa, D.S. (2019). Identification of priority areas for surveillance of cutaneous leishmaniasis using spatial analysis approaches in Southeastern Brazil. BMC Infectious Diseases, 19(1): 318.

Chou, Y.L., Chen, C.S., & Liu, C.C. (2008). Leptospirosis in Taiwan, 2001-2006. Emerging Infectious Diseases, 14(5): 856.

Department of Statistics Malaysia (2019). Current Population Estimate Malaysia 2018. Department of Statistics Malaysia Official Portal the Source of Malaysia's Official Statistics. https://newss. Downloaded on 21 September 2018.

Dhewantara, P.W., Mamun, A.A., Zhang, W.Y., Yin, W.W., Ding, F., Guo, D., Hu, W. & Magalhães, R. (2018). Geographical and temporal distribution of the residual clusters of human leptospirosis in China, 2005-2016. Scientific Reports, 8(1): 16650.

Dhewantara, P.W., Lau, C.L., Allan, K.J., Hu, W., Zhang, W., Mamun, A.A. & Soares Magalhães, R.J. (2019). Spatial epidemiological approaches to inform leptospirosis surveillance and control: A systematic review and critical appraisal of methods. Zoonoses Public Health, 66(2): 185-206.

Disease Control Division, Department of Pub¬lic Health, Ministry of Health Malaysia. (2011). Guidelines for the diagnosis, management, prevention and control of leptospirosis in Malaysia. Ministry of Health. pp 6-10.

Garba, B., Bahaman, A.R., Bejo, S.K., Zakaria, Z., Mutalib, A.R. & Bande, F. (2018). Major epidemiological factors associated with leptospirosis in Malaysia. Acta Tropica, 178: 242-247.

Goarant, C. (2016). Leptospirosis: Risk factors and management challenges in developing countries. Research and Reports in Tropical Medicine, 7: 49-62.

Goris, M.G., Boer, K.R., Duarte, T.A., Kliffen, S.J. & Hartskeerl, R.A. (2013). Human leptospirosis trends, the Netherlands, 1925 - 2008. Emerging Infectious Diseases, 19(3): 371-378.

Haake, D.A., Dundoo, M., Cader, R., Kubak, B.M., Hartskeerl, R.A., Sejvar, J.J. & Ashford, D.A. (2002). Leptospirosis, water sports, and chemoprophylaxis. Clinica Infectious Diseases: An official publication of the Infectious Diseases Society of America, 34(9): e40-3.

Hinjoy, S. (2016). Epidemiology of leptospirosis from Thai national disease surveillance system, 2003-2012. Outbreak, Surveillance and Investigation Reports, 7(2): 1-5.

Jones, B.A., Grace, D., Kock, R., Alonso, S., Rushton, J., Said, M.Y., McKeever, D., Mutua, F., Young, J., McDermott, J. & Pfeiffer, D.U. (2013). Zoonosis emergence linked to agricultural intensification and environmental change. Proceedings of the National Academy of Sciences of the United States of America, 110(21): 8399-8404.

Kawaguchi, L., Sengkeopraseuth, B., Tsuyuoka, R., Koizumi, N., Akashi, H., Vongphrachanh, P., Watanabe, H. & Aoyama, A. (2008). Seroprevalence of leptospirosis and risk factor analysis in flood-prone rural areas in Lao PDR. The American Journal of Tropical Medicine and Hygiene, 78(6): 957-961.

Mayfield, H.J., Lowry, J.H., Watson, C.H., Kama, M., Nilles, E.J. & Lau, C.L. (2018). Use of geographically weighted logistic regression to quantify spatial variation in the environmental and sociodemographic drivers of leptospirosis in Fiji: A modelling study. Lancet Planet Health, 2(5): e223-e232.

Mohammadinia, A., Alimohammadi, A. & Saeidian, B. (2017). Efficiency of geographically weighted regression in modeling human leptospirosis based on environmental factors in Gilan Province, Iran. Geosciences, 7(4): 136.

Mohd Radi, M.F., Hashim, J.H., Jaafar, M.H., Hod, R., Ahmad, N., Nawi, A.M., Baloch, G.M., Ismail, R. & Ayub, N.I. (2018). Leptospirosis outbreak after the 2014 major flooding event in Kelantan, Malaysia: A spatial-temporal analysis. The American Journal of Tropical Medicine and Hygiene, 98(5): 1281-1295.

Moore, D.A. & Carpenter, T.E. (1999). Spatial analytical methods and geographic information systems: use in health research and epidemiology. Epidemiologic Reviews, 21(2): 143-161.

Moran, P.A.P. (1948). The interpretation of statistical maps. Journal of the Royal Statistical Society. Series B, Statistical Methodology,10(2): 243-251.

Philip, R.R., Indu, P.S., Anish, T.S., Shrinivasa, B.M., Joy, T.M. & Sujina, C.M. (2013). Occupational and environmental risk factors of leptospirosis: A case control study in a tertiary care setting in Kerala, India. Health Sciences 2(1): JS005A.

Pui, C.F., Bilung, L.M., Su'ut, L. & Apun, K. (2015). Prevalence of Leptospira species in environmental soil and water from national parks in Sarawak, Malaysia. Borneo Journal of Resource Science and Technology, 5(1): 49-57.

Pui, C.F., Bilung, L.M., Apun, K. & Su'ut, L. (2017) Diversity of Leptospira spp. in rats and environment from urban areas of Sarawak, Malaysia. Journal of Tropical Medicine, 2017: 3760674.

Pui, C.F., Bilung, L.M., Su'ut, L., Chong, Y.L. & Apun, K. (2017). Detection of Leptospira spp. in selected national service training centres and paddy fields of Sarawak, Malaysia using polymerase chain reaction technique. Pertanika Journal of Tropical Agricultural Science, 40(1): 99-109.

Sejvar, J., Bancroft, E., Winthrop, K., Bettinger, J., Bajani, M., Bragg, S., Shutt, K., Kaiser, R., Marano, N., Popovic, T., Tappero, J., Ashford, D., Mascola, L., Vugia, D., Perkins, B. & Rosenstein, N. (2003). Leptospirosis in "eco-challenge" athletes, Malaysian Borneo, 2000. Emerging Infectious Diseases, 9(6):702.

Su'ut, L., Mazlan, M.N., Arif, M.T., Yusoff, H., Abdul Rahim, N.A., Safii, R. & Suhaili, M.R. (2016). Serological prevalence of leptospirosis among rural communities in the Rejang Basin, Sarawak, Malaysia. Asia Pacific Journal of Public Health, 28(5): 450-457.

Su'ut, L., Mazlan, A., Arif, M.T., Katip, T., Nor Aliza, A.R. & Haironi, Y. (2018) Serovar diversity of Leptospira sp. infecting wild rodents in Sarawak, Malaysia. Tropical Biomedicine, 35(1): 252-258.

Tan, W.L., Soelar, S.A., Mohd Suan, M.A., Hussin, N., Cheah, W.K., Verasahib, K. & Goh, P.P. (2016). Leptospirosis incidence and mortality in Malaysia. The Southeast Asian Journal of Tropical Medicine and Public Health, 47(3): 434-450.

Thayaparan, S., Robertson, I.A., Amraan, F., Su'ut, L. & Abdullah, M.T. (2013). Serological prevalence of leptospiral infection in wildlife in Sarawak, Malaysia. Borneo Journal of Resource Science and Technology, 2(2):79-82.

Trueba, G., Zapata, S., Madrid, K., Cullen, P. & Haake, D. (2004). Cell aggregation: A mechanism of pathogenic Leptospira to survive in fresh water. International Microbiology: The Official Journal of the Spanish Society for Microbiology, 7(1):35-40.

Vega-Corredor, M.C. & Opadeyi, J. (2014). Hydrology and public health: Linking human leptospirosis and local hydrological dynamics in Trinidad, West Indies. Earth Perspectives 1:3.

Widayani, P., Gunawan, T., Danoedoro, P. & Mardihusodo, S.J. (2016). Application of geographically weighted regression for vulnerable area mapping of leptospirosis in Bantul District. The Indonesian Journal of Geography 48:168.

World Health Organization (WHO) (2015). Leptospirosis Burden Epidemiology Reference Group (LERG). /diseases/lerg/en/index2.html. Downloaded on 15 September 2018.

Wynwood, S.J., Graham, G.C., Weier, S.L., Collet, T.A., McKay, D.B. & Craig, S.B. (2014). Leptospirosis from water sources. Pathogens and Global Health 108(7):334-338.

How to Cite
ROSDI KIRA, LESLEY MAURICE BILUNG, ROMANO NGUI, KASING APUN, & LELA SU’UT. (2022). Spatial and Temporal Disparities of Leptospirosis Transmission in Sarawak (Malaysia), 2011-2018. Borneo Journal of Resource Science and Technology, 12(2), 1-10.