1

HEALTH SERVICES DELIVERY

1.4

DISEASE CONTROL PROGRAMME

1.4.2.j.1

Communicable Diseases Control: Leptospirosis Prevention and Control (as

of March 2008)

A Focal Point
B Implementing Agencies

C Target Areas & Beneficiaries

Epidemiology Unit
Epidemiology Unit
Provincial Director of Health Services
Regional Director of Health Services
Medical Officers of Health
The total population of the country

Project Summary:
Leptospirosis is emerging in Sri Lanka and has been identified as a potential public health
issue in the country. Therefore it is important to focus on following activities to control and
prevent leptospirosis in the country:
Establish a National Programme on Control and Prevention of Leptospirosis in Sri
Lanka
Assess burden of leptospirosis in the country
Strengthen laboratory and epidemiological surveillance of leptospirosis
Improve facilities for case detection and proper clinical management at the medical
institutions
Strengthen environmental measures including occupational health activities
Provide chemoprophylaxis to high-risk occupational groups
Health promotion and health education
Promote intersectoral coordination

1. Justification:
Leptospirosis is one of the notifiable diseases in Sri Lanka. It is an endemic in many parts of
Sri Lanka and occurs throughout the year. The actual incidence of leptospirosis is likely to be
more than the hospital admission figures, as a large number of patients with mild form of
disease do not seek treatment at all or are being treated by private practitioners or at the OPD
of government hospitals, therefore not reported to the Epidemiology Unit.
During the last decade, there has been an increase in the number of leptospirosis cases
reported from 167 cases (0.96/100,000) in 1991 to 2194 cases (11/100,000) in 2007. This
increase may be due to the occurrence of outbreaks of leptospirosis in some districts and, also
due to improved case detection and notification.
Most of the affected were in the age group of 24-45 years indicating increased risk among
physically active working population. Paddy cultivation takes place in most of the endemic
areas and the peak incidence is seen either during rainy or harvesting seasons. During these

periods, there is an increase in the rodent population in and around the fields or they tend to
come out from their burrows and drains due to flood water. Further, due to population
migration and urbanization, there is an increase in the rodent population in and around urban
areas.
There is no National Programme for prevention and control of leptospirosis and only ad-hoc
programs are carried out by the interested public health workers at the divisional level.
Prevention and control of leptospirosis needs to be addressed at all levels by health
authorities. It is also important to highlight, that the activities for prevention and control of
leptospirosis should necessarily be carried out with the active support and participation of
other sectors such as agriculture, livestock, irrigation and local government.
2.

Important Assumptions/ Risks/ Conditions:

Government commitment for prevention and control of leptospirosis will remain. There will
be active participation and commitment from the Ministry of Health and other sectors, such as
Ministries of Agriculture, Irrigation and Livestock, and local government authorities for
prevention and control of leptospirosis. Public will support the planned activities by actively
participating in those whenever necessary.
.
3. Project Objective:
Objective
Indicators
Prevention and control of Morbidity and mortality
leptospirosis in Sri Lanka
rates of leptospirosis

4.

Means of Verification
Notification data, Review
of Medical Statisticians and
health care institution records /
community surveys

Project Output/ Product:

Outputs
Indicators
Leptospirosis morbidity and Hospital admission rate
mortality reduced
of leptospirosis
No. of notifications from
MOH
No. of outbreaks of
leptospirosis
Improved
patient
care Number of institutions
management facilities at the with all basic facilities for
government institutions
the management of
leptospirosis
Case Fatality Rate of
leptospirosis at institutional
level
Leptospirosis surveillance Notification rate of
including laboratory and leptospirosis
veterinary
surveillance Timeliness of notification

Means of Verification
Review data at
Epidemiology Unit and
Medical Statistician records

IMMR
Review Medical Statistician
and Register General records
Annual Health Bulletin
DGHS Annual Report

Review data at
Epidemiology Unit and
Medical Statistician records

strengthened

Chemo
prophylactic
treatment for high-risk
groups provided

Public awareness improved

Social
programme
established

Timeliness and
completeness of special
investigations
Notification of
leptospirosis from private
sector
No of veterinary reports
available
Number of persons
getting chemoprophylaxis
Morbidity rates in areas
where prophylaxis is given
Number of MOH offices
institution with uninterrupted
chemo-prophylaxis supplies
% of budget allocation by
RDHS for chemoprophylaxis
Number of educational
programmes conducted
Number of people aware
of leptospirosis
Number of MOH areas
with established SMB

mobilization
(SMP)

MOH/ RDHS data

IMMR

MOH data
Community survey

Reports

5. Related Projects:
Project No.

6.

Project Title
Leptospirosis Surveillance Network
Leptospirosis Burden Study
Provision of laboratory facility at the Provincial / district level (base
hospitals and above) for leptospirosis investigations
Awareness programme
Chemoprophylaxis programme for high risk groups

Relevant Agencies to be Coordinated:

Ministry of Agriculture, Ministry of Livestock, Ministry of Irrigation, Ministry of Local

Government and Public Administration, All Provincial Councils and other related agencies
7. Monitoring & Evaluation:
1.

Who?

Director General of Health Services and Epidemiology Unit

2. When? Quarterly
3.

What actions to be taken based on results of monitoring & evaluation?

Continue reviews with Provincial/ District/ Divisional Health Authorities
Periodical reviews with other relevant agencies to be coordinated
Workshops and other means of imparting technical input

8. Activities:
Activities
1

2
3

Expected Results

Process Indicators

Establish a National Task Force/ Policy formulated

Programme for Control and Coordination
at
Prevention of Leptospirosis
national level
Monitoring
and
evaluation carried out
Carry out Leptospirosis Burden Disease
burden
of disease study
identified
Conduct awareness programme Awareness
among
among high risk groups and people at risk and heath
health workers
workers created
Provide laboratory facility at the Laboratory surveillance
Provincial/ District level (at base strengthened
hospitals
&
above)
for
leptospirosis investigations

Regular quarterly meeting

Strengthen
surveillance

Notification rate
Timeliness & completeness
of special investigation
forms
% of outbreaks predicted
% of outbreaks investigated

Final report to be made

available
Number of programmes
conducted

No. of hospitals with

laboratory facilities
> 50% reported cases
confirmed by laboratory
tests
Un-interrupted supply of drugs People at high risk % coverage of chemo
for chemoprophylaxis at MOH received
chemo prophylaxis among people
level
prophylaxis
at high risk
leptospirosis Improved notification
of leptospirosis
Outbreaks
timely
predicted
All
outbreaks
investigated
Special investigation
forms
sent
from
sentinel hospitals
Enhance veterinary services to Survey
on
animal
support disease control
reservoirs done

Final report to be made

available