































 

 Epidemiology and Society Health Review| ESHR 
Vol. 7, No. 2, 2025, pp. 78-86 ISSN 2656-6052 (online) | 2656-1107 (print) 
      http://journal2.uad.ac.id/index.php/eshr/index                                                   eshr@ikm.uad.ac.id 

 

  

      10.26555/eshr.v7i2.14019   

 
 

78 

 
 

  

 
Review Article  
 
Evaluation of Leptospirosis Surveillance and Response 
Programs: A Systematic Review 
 
Dessy Apriyani1*, Sulistyawati Sulistyawati1, Yuniar Wardani1 

 
1 Faculty of Public Health, Ahmad Dahlan University, Yogyakarta, Indonesia  
 
*Correspondence: dessyapriyani@gmail.com    
 
Received 19 July 2025; Accepted 28 July 2025; Published 02 September 2025 

ABSTRACT 

Background: Leptospirosis is a zoonotic disease that poses a public health problem in 
various tropical countries, including Indonesia. This disease is caused by Leptospira 
bacteria, which can infect humans through contact with the urine of infected animals. 
Method: This study aims to evaluate the effectiveness of surveillance and response 
programs for leptospirosis in Indonesia using a systematic literature review following the 
PRISMA guidelines. The data used were collected from three main databases: Google 
Scholar, Semantic Scholar, and PubMed. Six articles met our criteria and were included in 
this research. 
Results: The results of the study indicate that the surveillance program continues to face 
challenges, including a shortage of trained health workers, suboptimal case reporting and 
recording systems, and inadequate intersectoral coordination. Although the leptospirosis 
mortality rate has decreased, the fluctuating case count underscores the need to improve 
the surveillance system and prevention efforts.  
Conclusion: Increasing the capacity of health workers, optimizing the surveillance system, 
and strengthening coordination between sectors are needed to improve the effectiveness 
of leptospirosis prevention and control programs in Indonesia.  

Keywords: Evaluation; Programs; Surveillance; Leptospirosis 

INTRODUCTION 

Indonesia is a country with various tropical diseases, one of which is leptospirosis.1 
Leptospirosis is a public health problem that is widespread throughout the world, especially in 
tropical and subtropical countries. The risk of leptospirosis in tropical countries is recorded to 
be 1,000 times higher than in subtropical regions.2 Leptospirosis, also known as Weill’s 
Disease, is classified as a zoonotic disease caused by bacteria from the genus Leptospira. 
These bacteria can infect humans and other vertebrates. Clinical symptoms in leptospirosis 
patients include fever, enlarged spleen and liver, jaundice, and impaired kidney function. The 
disease cannot be directly transmitted between humans, but Leptospira bacteria can survive 
and thrive in natural environments.3 

http://journal2.uad.ac.id/index.php/eshr/index
mailto:eshr@ikm.uad.ac.id
https://doi.org/10.26555/eshr.v3i1.3629
https://doi.org/10.26555/eshr.v3i1.3629
mailto:dessyapriyani@gmail.com


 
Apriyani et al. (Evaluation of Leptospirosis Surveillance and Response Programs: A Systematic Review)  

 
 

 
Vol. 7, No. 2, 2025, pp. 78-86 79   10.26555/eshr.v7i2.14019 

  

Leptospirosis is an infection caused by the Leptospira sp. bacterium and can be transmitted 
to humans through direct or indirect contact with the urine of infected animals.4 Water 
contaminated by the urine of reservoir animals serves as the primary medium for the spread 
of pathogenic Leptospira bacteria. Infection in animals or humans can occur through bacterial 
infiltration into the body through open wounds or mucous membranes. The severity of 
Leptospira infection varies, ranging from asymptomatic cases to organ failure and potentially 
life-threatening complications if not properly treated.5 

Rats are the primary reservoir in the transmission cycle of leptospirosis to humans.3 Rats 
belong to the order Rodentia and have distinctive morphological characteristics in their head, 
body, and tail. Rats can adapt to the lifestyle, and the development of rats living around 
settlements differs from that of other wild rats. Rats can adapt to serve as reservoirs for 
Leptospira sp. bacteria due to their extensive range of movement compared to other animals 
such as cattle, cats, and dogs, and they can also act as hosts for Leptospira sp. Bacteria.6 
According to the 2023 Indonesia Health Profile data, there were 2,554 cases of leptospirosis 
spread across 12 provinces, including West Java, Jakarta, Central Java, East Java, 
Yogyakarta, Banten, North Kalimantan, East Kalimantan, Riau Islands, South Sulawesi, Bali, 
and Maluku. Of these cases, 205 deaths were recorded, with a case fatality rate (CFR) of 8%. 
The incidence of leptospirosis in 2023 increased compared to the previous year, although the 
case fatality rate decreased from 9.1% in 2022 to 8% in 2023. Several provinces, such as 
Yogyakarta Special Region, Central Java, East Java, Southeast Sulawesi, South Sulawesi, 
East Kalimantan, and North Kalimantan, reported an increase in the number of cases, while 
West Java, Jakarta Special Region, and Banten saw a decrease in leptospirosis cases.7 
In Indonesia, there are still various obstacles in efforts to combat leptospirosis. Some of the 
main challenges include delays in patients seeking medical treatment, low sensitivity of health 
workers in diagnosing leptospirosis, limited laboratory facilities, and a suboptimal case 
reporting management system.8 

Many cases of leptospirosis go unreported due to difficulties in clinical diagnosis and the 
relatively high cost of diagnostic testing. Other factors contributing to the high incidence of 
leptospirosis include weak surveillance systems, high rat populations as the primary vector, 
and poor environmental sanitation, particularly in flood-prone areas. Therefore, an evaluation 
of the implementation of leptospirosis prevention and control programs is needed to assess 
the effectiveness of program achievements and identify challenges faced in their 
implementation. The evaluation results are expected to provide useful recommendations for 
improving planning and enhancing the effectiveness of leptospirosis prevention and control 
programs in the future. 

 

METHOD 

This study is a literature review using the PRISMA (Preferred Reporting Items for Systematic 
Reviews and Meta-analyses) method, which was applied systematically in accordance with 
the protocol and stages of the study. This method began with a search of scientific literature 
in databases using the keywords evaluation, program, surveillance, and leptospirosis. Article 
searches were conducted in the following databases: Google Scholar, Semantic Scholar, and 
PubMed. Subsequently, the titles and abstracts of each article relevant to the research topic 

https://doi.org/10.26555/eshr.v3i1.3629
https://doi.org/10.26555/eshr.v3i1.3629


 
Apriyani et al. (Evaluation of Leptospirosis Surveillance and Response Programs: A Systematic Review)  

 
 

 
Vol. 7, No. 2, 2025, pp. 78-86 80   10.26555/eshr.v7i2.14019 

  

were reviewed. The inclusion criteria for article selection were that the article addressed the 
topic of evaluating leptospirosis surveillance programs, was freely accessible, available in full 
text, had an ISSN, and was published between 2015 and 2025. Exclusion criteria included the 
absence of full text, literature review articles, paid articles, duplicates, and articles not 
matching the keywords. 

RESULTS 

The search process is described in Figure 1. Based on the search results from several 
databases using predetermined keywords, a total of 417 articles were obtained. After 
screening according to predetermined criteria, six articles that met the criteria were selected 
and included in the analysis. 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 1. PRISMA Literature Review Search 

After an identification and screening process, six articles were found to meet the inclusion and 
exclusion criteria. These were then reviewed by the researchers and summarized in Table 1. 

DISCUSSION  
This research aimed to evaluate the effectiveness of surveillance and response programs for 
leptospirosis in Indonesia using a systematic literature review following the PRISMA 
guidelines. We discuss the evaluation through an input, process, and output approach. We 
discuss the evaluation through an input, process, and output approach.  

 

https://doi.org/10.26555/eshr.v3i1.3629
https://doi.org/10.26555/eshr.v3i1.3629


 
Apriyani et al. (Evaluation of Leptospirosis Surveillance and Response Programs: A Systematic Review)  

 
 

 
Vol. 7, No. 2, 2025, pp. 78-86 81   10.26555/eshr.v7i2.14019 

  

Table 1. Data from articles included in the review. 

No Author Title Research 
Method 

Goals Results 

1 Fitirana, 
Ahmad and 
Djasri, 
2019.9 

Evaluation of 
one-health-
based 
leptospirosis 
control 
management in 
Boyolali District 

 

Descriptive 
observation 
using 
qualitative 
research 
methods. 

 

To evaluate the 
implementation of 
One Health-based 
leptospirosis control 
management in 
Boyolali Regency. 

 

70% of health workers have 
received training. Rapid 
diagnostic tests (RDT) are not 
available in primary health 
care facilities but are available 
at the Health Office. Data 
collection is reported 
passively. Leptospirosis 
cases in livestock are 
investigated when human 
cases are found. However, 
the main reservoir (rats) is not 
investigated by the Agriculture 
Office. Each case found is 
reported to the Boyolali 
District Health Office and 
receives treatment. 

2. Wikansari et 
al. 2019.10 

Evaluation of 
the Early 
Warning Alert 
and Response 
System 
(EWARS) 
Program in the 
Implementation 
of Surveillance 
in Salatiga City, 
Central Java 
Province. 

 

Qualitative To evaluate the 
Early Warning Alert 
and Response 
System (EWARS) in 
the implementation 
of outbreak 
surveillance in 
Salatiga City, 
Central Java 
Province. 

 

Problems in the input aspect 
include officers who have two 
or more tasks (67%) and 
insufficient funds. In the 
process aspect, challenges 
include target setting and 
planning (50%) and cross-
sector coordination (33%). In 
the output aspect, there are 
delays in the submission of 
reports by staff. Meanwhile, in 
the outcome aspect, although 
Outbreak Events (KLB) can 
be detected early, there is still 
no epidemiological bulletin 
serving as a weekly public 
health information medium. 

3. Saraswati et 
al. 2017.11 

Evaluation of 
Leptospirosis 
Case 
Surveillance 
Implementation 
at the Boyolali 
District Health 
Office. 

 

Descriptive 
with an 
observational 
research 
design. 

 

Conducting an 
evaluation of the 
implementation and 
results of 
leptospirosis case 
surveillance in 
Boyolali District. 

 

The implementation of 
leptospirosis epidemiological 
surveillance in Boyolali 
District has not been optimal. 
Although all respondents 
have collected data, the data 
compilation process has only 
been carried out in 3 of 12 
community health centers and 
at the Health Office. Data 
analysis is limited to the 
Health Office and only covers 
basic analysis related to 
leptospirosis case trends. 
Additionally, information 
dissemination has been 
carried out through reporting 
and feedback mechanisms. 

https://doi.org/10.26555/eshr.v3i1.3629
https://doi.org/10.26555/eshr.v3i1.3629


 
Apriyani et al. (Evaluation of Leptospirosis Surveillance and Response Programs: A Systematic Review)  

 
 

 
Vol. 7, No. 2, 2025, pp. 78-86 82   10.26555/eshr.v7i2.14019 

  

No Author Title Research 
Method 

Goals Results 

4. Depo, 
Pramono 
and 
Aryanto, 
2019.12 

Evaluation of 
the 
Leptospirosis 
Prevention and 
Control 
Program in 
Bantul Regency 
in 2017. 

 

Descriptive 
observational
. 

 

To describe and 
identify factors 
contributing to the 
implementation and 
achievement of the 
leptospirosis control 
program from the 
aspects of input, 
process, output, 
and outcome in 
Bantul Regency. 

 

Challenges in the input aspect 
include limitations in untrained 
human resources, limitations 
in Communication, 
Information, and Education 
(KIE) media, and high 
workloads. Meanwhile, in the 
process aspect, 
Epidemiological Investigation 
and Local Area Monitoring 
(PWS) activities have not 
been implemented optimally, 
and cross-sectoral 
coordination has not yet been 
realized. From the output 
aspect, an Outbreak of 
Leptospirosis (KLB) occurred 
in February and March 2016, 
with the highest trend of 
cases in 2016 occurring in 
Bantul District. From the 
outcome perspective, in 2016, 
cases occurred in Bantul 
District, with an Incidence 
Rate (IR) of 8.9 per 100,000 
population and a Case 
Fatality Rate (CFR) of 5.75%. 

5. Fauziah and 
Handayani, 
2019.13 
 

Leptospirosis 
Control 
Program in 
Semarang City. 

 

Qualitative 
descriptive. 

To evaluate the 
implementation of 
the leptospirosis 
control program in 
Semarang City in 
2018. 

 

The report shows that five 
community health centers 
have implemented 
leptospirosis control 
programs. However, there 
were still obstacles in the 
planning, organization, and 
implementation of these 
programs in 2018. Therefore, 
it can be concluded that the 
implementation of 
leptospirosis control programs 
in Semarang City in 2018 was 
not yet optimal. 

6. Calero and 
Monti, 2022. 
14 

Assessment of 
the Current 
Surveillance 
System for 
Human 
Leptospirosis in 
Ecuador by 
Decision 
Analytic 
Modeling. 

Qualitative To assess the 
sensitivity of 
Ecuador's current 
national 
surveillance system 
for leptospirosis in 
humans as a basis 
for an economic 
evaluation of the 
system. 

The criteria that most influence 
the sensitivity of the system 
are “presence or likelihood of 
going to a health center” and 
likelihood of having symptoms, 
especially in coastal areas and 
Amazonia. 

 
Related to Input, in the leptospirosis surveillance program, these aspects include the 
availability of manpower and supporting facilities. Human resources at local health centers 
indicate that 70% of health workers have undergone training related to leptospirosis, either in 
control programs or zoonosis programs, with the number of training sessions or seminars 
ranging from 1 to 2 times. All leptospirosis control officers have double roles such as 
conducting outreach, advocacy, case detection, risk factor control, technical guidance, and 

https://doi.org/10.26555/eshr.v3i1.3629
https://doi.org/10.26555/eshr.v3i1.3629


 
Apriyani et al. (Evaluation of Leptospirosis Surveillance and Response Programs: A Systematic Review)  

 
 

 
Vol. 7, No. 2, 2025, pp. 78-86 83   10.26555/eshr.v7i2.14019 

  

reporting.9 Research conducted by Wikansari et al. shows that 67% of officers have dual roles, 
which greatly increases their workload as they have to handle more than one program at a 
time. This situation causes the focus on leptospirosis control to be divided, resulting in delayed 
responses to cases, suboptimal surveillance activities, and a decline in program 
implementation quality. Therefore, the limited human resources who are assigned multiple 
tasks can affect the effectiveness of program goal achievement.10 Meanwhile, another 
research identified that input aspects include untrained personnel, limitations in 
communication media, information, and education (KIE), as well as high workloads. This 
shows that weaknesses in human resources and supporting facilities can hamper the 
effectiveness of the program. Untrained officers are at risk of being less accurate in early 
detection and case management. Limitations in communication, information, and education 
(KIE) media have an impact on the low reach and understanding of the community regarding 
leptospirosis prevention. Meanwhile, high workloads, including those resulting from double 
roles, cause the program's focus to be divided, resulting in suboptimal leptospirosis control. 11 
In addition to the availability of labor and facilities, funding and planning are also included in 
the input category. The facilities and tools available for leptospirosis control in Boyolali District 
include technical guidelines, case recording and reporting forms, educational tools, 
communication tools, Leptospirosis Rapid Diagnostic Tests (RDTs), examination support 
tools, and medications. Meanwhile, at the Health Office of Salatiga District, the availability of 
data processing tools is still not optimal, and transportation facilities are insufficient to meet 
the needs.9 Funding sources come from Health Operational Assistance (BOK) for community 
health centers and the State Budget (APBN) for the Health Office. The entire budget is 
sufficient to support control activities.9 

About process, we discuss this item following planning, implementation, and partnership. First 
is planning, leptospirosis control planning includes target setting and mapping, which covers 
monitoring endemic areas, detecting cases in animals, and mapping regions. Based on the 
results of observations, 60% of community health centers and health offices have set targets 
for observing endemic areas.9 However, not all community health centers have optimally 
implemented the Early Warning Alert and Response System (EWARS) planning.10 Data was 
collected by identifying cases of leptospirosis, with most cases in Boyolali Regency being 
found in hospitals.12 
Related to implementation, the identification of leptospirosis cases is carried out passively 
through data collection based on reports from hospitals. Leptospirosis diagnosis is confirmed 
through Rapid Diagnostic Test or RDT.15 The implementation of the Early Warning Alert and 
Response System (EWARS) at the community health center level includes early detection of 
extraordinary events (KLB), meetings at the community health center level, cross-program 
and cross-sector meetings, monitoring of local areas, reporting and recording, and 
identification and follow-up of issues in the EWARS program. However, not all PHC carry out 
all these stages comprehensively.10 The data collection process begins with the identification 
of leptospirosis cases. To date, most cases of leptospirosis for example (for example) in 
Boyolali District have been detected in hospitals. Routine reports from community health 
centers are submitted through the Integrated Community Health Center Recording and 
Reporting System (SP2TP), and since leptospirosis is classified as a potential epidemic 
disease, weekly reports (W2) are required. Reported cases include suspected cases and 
confirmed cases, which are then recorded in the register based on reports from community 
health centers and hospitals.11 According to the Indonesian Ministry of Health, data processing 
is a stage that is carried out to facilitate data analysis. This stage is intended to prepare data 
so that it can be easily handled during analysis and is free from errors. In general, data 

https://doi.org/10.26555/eshr.v3i1.3629
https://doi.org/10.26555/eshr.v3i1.3629


 
Apriyani et al. (Evaluation of Leptospirosis Surveillance and Response Programs: A Systematic Review)  

 
 

 
Vol. 7, No. 2, 2025, pp. 78-86 84   10.26555/eshr.v7i2.14019 

  

processing can be done manually or computerized using software according to user needs.13 
Data analysis and interpretation of results are essential to complement the objectives of case 
reporting and monitoring of prevalence cases. Collected data must be analyzed and 
interpreted immediately because the purpose of surveillance is not only to calculate the 
incidence of disease but also to identify problems quickly so that intervention efforts can be 
carried out immediately to reduce further risks.14 Leptospirosis surveillance includes data 
collection, recording, compilation, analysis, and interpretation, as well as the dissemination of 
epidemiological information. 
Regarding supervision, the purpose of supervision is to conduct continuous monitoring of the 
implementation of the P2 Leptospirosis program, which includes planning, patient care, 
recording and reporting, as well as the provision and distribution of RDT. Supervision by the 
District/City Health Office of community health centers is conducted three times a year, 
conjunction with other programs.11 Supervision activities aim to improve staff performance 
through maintaining competence and enhancing work motivation. Supervision is a crucial 
element in the guidance and control of the program. However, the EWARS program only 
receives supervision once a year or during an Extraordinary Event (KLB). This situation 
indicates limitations in terms of resources, both human and financial, which prevent 
supervision activities from being carried out optimally and continuously. In fact, regular 
supervision is very important to ensure data quality, reporting compliance, and early response 
to potential outbreaks. As a result, monitoring activities rely more on weekly routine reports 
from community health centers, while field supervision is considered sufficient on an annual 
basis or when there is a spike in cases. However, this pattern has the potential to weaken the 
early detection function because infrequent supervision can reduce opportunities to identify 
technical problems, provide direct guidance, and strengthen the capacity of field officers.12 
The implementation of monitoring and evaluation of the leptospirosis control program in 
Semarang City in 2018 has been applied in every health center with varying schedules. Some 
health centers conduct evaluations every month, every three months, and some only when 
cases arise. These differences occur because each health center adapts to internal policies, 
resource limitations, and the workload of staff who often juggle other programs. As a result, 
monitoring and evaluation have not been carried out uniformly, so the effectiveness of the 
program may vary between health centers.15  Evaluation of the surveillance system needs to 
be carried out as a complementary strategy by public health workers and stakeholders.16 
The last point is about partnership, collaboration between the Health Office and the Agriculture 
Office has not been optimally established, so information related to leptospirosis has not been 
fully conveyed to the Agriculture Office.9 Leptospirosis control should be based on the One 
Health concept, which emphasizes multidisciplinary collaboration to achieve the best health 
for humans, the environment, and animals. Efforts to address and intervene in leptospirosis 
should be focused on areas with moderate to high risk levels.17About Output, in general the 
output aspect shows that a reporting and recording system is already in place, but the quality, 
timeliness, and completeness of information remain major challenges. Program output should 
not only consist of administrative reports, but also include in-depth epidemiological analysis, 
regular publication of epidemiological bulletins, and policy recommendations that can be 
immediately followed up. Thus, the success of the output is not only measured by the number 
of reports submitted, but also by the extent to which these reports provide a solid basis for 
rapid response, prevention, and control of leptospirosis in endemic areas.  
 
 
 

https://doi.org/10.26555/eshr.v3i1.3629
https://doi.org/10.26555/eshr.v3i1.3629


 
Apriyani et al. (Evaluation of Leptospirosis Surveillance and Response Programs: A Systematic Review)  

 
 

 
Vol. 7, No. 2, 2025, pp. 78-86 85   10.26555/eshr.v7i2.14019 

  

CONCLUSION 

Based on a review of relevant studies, surveillance and response programs for leptospirosis 
in Indonesia still face various challenges. Input aspects show limitations in trained health 
personnel, maximum availability of diagnostic facilities, and human resources with multiple 
workloads. In terms of process, the planning and implementation of leptospirosis control 
programs are still not optimal, especially in terms of cross-sector coordination, more proactive 
data collection, and more systematic dissemination of epidemiological information. In terms of 
output, a system for reporting and recording leptospirosis cases is in place, but it still faces 
problems related to timeliness, completeness, and quality of reports. Delays in report 
submission and limited epidemiological analysis result in suboptimal information for decision-
making. In addition, the publication of epidemiological bulletins and dissemination of 
surveillance results are still inconsistent, limiting their use as a source of information and as a 
basis for public health policy. 

Declarations 

Authors' contribution 

SS and YW were designing the idea. DA was doing data collection, analysis, and writing the 
rough draft of the article. SS and YW were reviewing the article.  

Funding statement 

This publication for this research is funded by Universitas Ahmad Dahlan through the master’s 
thesis research with contract number PTM-042/SP3/LPPM-UAD/XII/2024.  

Conflict of interest 

There is no conflict of interest in this research.  

REFERENCES 

1.  Dewi HC, Yudhastuti R. Risk factors for leptospirosis incidents in Gresik Regency (2017-
2018). J Keperawatan Muhammadiyah. 2019;4. [in Indonesian] 

2.  Zukhruf IA, Sukendra DM. Spatial analysis of leptospirosis cases based on 
epidemiological factors and environmental risk factors. Higeia J Public Heal Res Dev. 
2020;4:587–98. [in Indonesian] 

3.  Ahmadi H, Chusna D, Syafriadi M. Determinants of environmental aspects that risk the 
transmission of Leptospira sp bacteria from rats confirmed in Bondowoso Regency. J 
Kesehat Lingkung Indones. 2023;22:1–12. [in Indonesian] 

4.  Kemenkes RI. Indonesia's health profile in 2023. Jakarta: Kementerian Kesehatan RI; 
2024. [in Indonesian] 

5.  Joharina AS, Pujiyanti A, Nugroho A, Martiningsih I, Handayani FD. The role of rats as 
leptospira reservoirs in three ecosystems in Bantul Regency, Yogyakarta. Bul Penelit 
Kesehat. 2019;47:191–8. [in Indonesian] 

6.  Husni SH, Martini M, Suhartono S, Budiyono B, Raharjo M. Environmental factors 
influencing the presence of rats and the identification of Leptospira sp. bacteria in 
settlements around Semarang City markets in 2022. J Kesehat Lingkung Indones. 
2023;22:134–41. [in Indonesian] 

7.  Relica C, Mariyati. The role of micronutrients in preventing Covid-19. Jurnal Ilmiah 

https://doi.org/10.26555/eshr.v3i1.3629
https://doi.org/10.26555/eshr.v3i1.3629


 
Apriyani et al. (Evaluation of Leptospirosis Surveillance and Response Programs: A Systematic Review)  

 
 

 
Vol. 7, No. 2, 2025, pp. 78-86 86   10.26555/eshr.v7i2.14019 

  

Permas: Jurnal Ilmiah STIKES Kendal. 2024;14:75–82. [in Indonesian] 
8.  DIRJENP2P. Technical guidelines for leptospirosis control. Kementerian Kesehatan 

Republik Indonesia. 2017. [in Indonesian] 
9.  Fitriana V, Ahmad RA, Djasri H. Evaluation of one-health-based leptospirosis control 

management in Boyolali Regency. Ber Kedokt Masy. 2019;35:283–9. [in Indonesian] 
10.  Wikansari NW, Santoso DB, Pramono D, Widarsih DW. Evaluation of the early warning 

alert and response system (EWARS) program in the implementation of outbreak 
surveillance in Salatiga City, Central Java Province. J Manaj Inf dan Adm Kesehat. 
2019;2:9–17. [in Indonesian] 

11.  Depo M, Pramono D, Aryanto S. Evaluation of the leptospirosis prevention and control 
program in Bantul Regency in 2017. J Inov Kesehat. 2019;1:1–10. [in Indonesian] 

12.  Saraswati LD, Nuraini S, Adi MS, Setyawan H. Evaluation of the implementation of 
leptospirosis case surveillance at the Boyolali District Health Office. Unnes J Public Heal. 
2017;6:92. [in Indonesian] 

13.  Pelaksanaan E, Kewaspadaan S, Dan D, Skdr R, Rifai A, B WA. Evaluation of early 
warning alert and respons system (SKDR) as an effort to detect outbreak (KLB ). 
2025;1:103–11.  

14.  Dian Saraswati L, Ginandjar P, Udijono A, Arie Wuryanto M, Sakundarno Adi M, 
Kusariana N. Community-based leptospirosis surveillance training for the PKK Group in 
Sambiroto Tembalang village. Semin Nas Pengabdi Kpd Masy UNDIP 
2020. 2020;1:189 96. [in Indonesian] 

15.  Fauziah TH, Handayani OWK. Leptospirosis control program in Semarang City. HIGEIA 
(Journal Public Heal Res Dev. 2019;3:612–24. [in Indonesian] 

16.  Calero ML, Monti G. Assessment of the current surveillance system for human 
leptospirosis in ecuador by decision analytic modeling. Front Public Heal. 2022;10:1–15.  

17.  Arsyad AS, Kusnanto H. Mapping of leptospirosis disease vulnerability areas using the 
geographically weighted zero inflated Poisson regression method. BKM Ber Kedokt 
Masy . 2018;34:257 62. [in Indonesian] 

 

 

 

https://doi.org/10.26555/eshr.v3i1.3629
https://doi.org/10.26555/eshr.v3i1.3629

