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      A qualitative exploration of the misconceptions, knowledge gaps and constructs of leptospirosis among rural and urban communities in Malaysia

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          Abstract

          This qualitative study aimed to explore the misconceptions, knowledge gaps and constructs of leptospirosis among 72 respondents from rural and urban districts in two states of Malaysia. We conducted focus group discussions and data were examined using thematic analyses. The layman term of ‘rat urine disease’ contributed the most to the misconceptions regarding leptospirosis. There were gaps in the knowledge among urban and rural respondents in the two states, with the majority of subjects demonstrating a poor understanding of the disease. Construction of knowledge about leptospirosis relied mostly on the information provided by mass and social media; reading materials; word-of-mouth publicity; observations; experiences; and knowledge sharing among families, friends, and communities. The study findings may provide the foundation for the development of educational materials that may reduce the gaps in knowledge, and thereby improve health literacy and enhance preventive health behaviours for avoiding leptospirosis.

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          Most cited references18

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          What about N? A methodological study of sample-size reporting in focus group studies

          Background Focus group studies are increasingly published in health related journals, but we know little about how researchers use this method, particularly how they determine the number of focus groups to conduct. The methodological literature commonly advises researchers to follow principles of data saturation, although practical advise on how to do this is lacking. Our objectives were firstly, to describe the current status of sample size in focus group studies reported in health journals. Secondly, to assess whether and how researchers explain the number of focus groups they carry out. Methods We searched PubMed for studies that had used focus groups and that had been published in open access journals during 2008, and extracted data on the number of focus groups and on any explanation authors gave for this number. We also did a qualitative assessment of the papers with regard to how number of groups was explained and discussed. Results We identified 220 papers published in 117 journals. In these papers insufficient reporting of sample sizes was common. The number of focus groups conducted varied greatly (mean 8.4, median 5, range 1 to 96). Thirty seven (17%) studies attempted to explain the number of groups. Six studies referred to rules of thumb in the literature, three stated that they were unable to organize more groups for practical reasons, while 28 studies stated that they had reached a point of saturation. Among those stating that they had reached a point of saturation, several appeared not to have followed principles from grounded theory where data collection and analysis is an iterative process until saturation is reached. Studies with high numbers of focus groups did not offer explanations for number of groups. Too much data as a study weakness was not an issue discussed in any of the reviewed papers. Conclusions Based on these findings we suggest that journals adopt more stringent requirements for focus group method reporting. The often poor and inconsistent reporting seen in these studies may also reflect the lack of clear, evidence-based guidance about deciding on sample size. More empirical research is needed to develop focus group methodology.
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            Environmental and Behavioural Determinants of Leptospirosis Transmission: A Systematic Review

            Background Leptospirosis is one of the most widespread zoonotic diseases, which is of global medical and veterinary importance, and also a re-emerging infectious disease. The main tracks of transmission are known; however, the relative importance of each of the components and the respective environmental risk factors are unclear. We aimed to assess and specify quantitative evidence of environmental risks of leptospirosis transmission. Methods/findings A database of pre-selected studies, with publication dates from 1970 until 2008, was provided by an expert group. The database has been updated until 2015 using a text mining algorithm. Study selection was based on stringent quality criteria. A descriptive data analysis was performed to calculate the medians of the log transformed odds ratios. From a selection of 2723 unique publications containing information on leptospirosis, 428 papers dealing with risk factors were identified. Of these, 53 fulfilled the quality criteria, allowing us to identify trends in different geo-climatic regions. Water associated exposures were, with few exceptions, associated with an increased leptospirosis risk. In resource poor countries, floods and rainfall were of particular importance, whereas recreational water activities were more relevant in developed countries. Rodents were associated with increased leptospirosis risk, but the variation among studies was high, which might be partly explained by differences in exposure definition. Livestock contact was commonly associated with increased risk; however, several studies found no association. The median odds ratios associated with dog and cat contacts were close to unity. Sanitation and behavioural risk factors were almost always strongly associated with leptospirosis, although their impact was rarely investigated in Europe or North America. Conclusion This review confirms the complex environmental transmission pathways of leptospirosis, as previously established. Although, floods appeared to be among the most important drivers on islands and in Asia, the consistent pattern observed for exposure to rodents and behavioural and sanitation related risk factors indicate potential areas for intervention.
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              Leptospirosis in “Eco-Challenge” Athletes, Malaysian Borneo, 2000

              Adventure travel is becoming more popular, increasing the likelihood of contact with unusual pathogens. We investigated an outbreak of leptospirosis in “Eco-Challenge” multisport race athletes to determine illness etiology and implement public health measures. Of 304 athletes, we contacted 189 (62%) from the United States and 26 other countries. Eighty (42%) athletes met our case definition. Twenty-nine (36%) case-patients were hospitalized; none died. Logistic regression showed swimming in the Segama River (relative risk [RR]=2.0; 95% confidence interval [CI]=1.3 to 3.1) to be an independent risk factor. Twenty-six (68%) of 38 case-patients tested positive for leptospiral antibodies. Taking doxycycline before or during the race was protective (RR=0.4, 95% CI=0.2 to 1.2) for the 20 athletes who reported using it. Increased adventure travel may lead to more frequent exposure to leptospires, and preexposure chemoprophylaxis for leptospirosis (200 mg oral doxycycline/week) may decrease illness risk. Efforts are needed to inform adventure travel participants of unique infections such as leptospirosis.
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                Author and article information

                Contributors
                Role: Formal analysisRole: MethodologyRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Methodology
                Role: Supervision
                Role: Resources
                Role: Project administration
                Role: Conceptualization
                Role: Visualization
                Role: Conceptualization
                Role: Conceptualization
                Role: ConceptualizationRole: Funding acquisitionRole: Project administrationRole: Supervision
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                18 July 2018
                2018
                : 13
                : 7
                : e0200871
                Affiliations
                [1 ] Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
                [2 ] Health Promotion Unit, Penang State Health Department, Bangunan Persekutuan, Jalan Anson, Penang, Malaysia
                [3 ] Department of Medical Microbiology and Parasitology, Faculty of Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
                [4 ] Health Department of Federal Territory Kuala Lumpur and Putrajaya, Jalan Cenderasari, Kuala Lumpur, Malaysia
                Imperial College London, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-0974-7074
                http://orcid.org/0000-0002-7023-9717
                Article
                PONE-D-18-05797
                10.1371/journal.pone.0200871
                6051666
                30021013
                9cc3d5fb-2236-477d-9781-512ba367c219
                © 2018 Sukeri et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 25 February 2018
                : 5 July 2018
                Page count
                Figures: 0, Tables: 1, Pages: 12
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100003093, Ministry of Higher Education, Malaysia;
                Award ID: 203/PPSP/6770003
                Award Recipient :
                The research was funded by the Long-Term Research Grant (203/PPSP/6770003), Ministry of Higher Education Malaysia. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Infectious Diseases
                Bacterial Diseases
                Leptospirosis
                Medicine and Health Sciences
                Tropical Diseases
                Neglected Tropical Diseases
                Leptospirosis
                Medicine and Health Sciences
                Infectious Diseases
                Zoonoses
                Leptospirosis
                Medicine and Health Sciences
                Health Care
                Health Education and Awareness
                Biology and Life Sciences
                Anatomy
                Body Fluids
                Urine
                Medicine and Health Sciences
                Anatomy
                Body Fluids
                Urine
                Biology and Life Sciences
                Physiology
                Body Fluids
                Urine
                Medicine and Health Sciences
                Physiology
                Body Fluids
                Urine
                People and Places
                Geographical Locations
                Asia
                Malaysia
                Biology and Life Sciences
                Veterinary Science
                Veterinary Diseases
                Social Sciences
                Sociology
                Communications
                Social Communication
                Social Media
                Computer and Information Sciences
                Network Analysis
                Social Networks
                Social Media
                Social Sciences
                Sociology
                Social Networks
                Social Media
                Medicine and Health Sciences
                Infectious Diseases
                Zoonoses
                Earth Sciences
                Geography
                Geographic Areas
                Urban Areas
                Custom metadata
                All interview transcripts file is available from the BioStudies database (accession number S-BSST120).

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                Uncategorized

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