Leptospirosis Risk Perception and Associated Behavior in a Region of High Seroprevalence in Iquitos, Peru

BACKGROUND: Iquitos has an ideal environment for Leptospira transmission leading up to endemic leptospirosis. Studies in Belen, an urban slum in Iquitos, indicate seroprevalence as high as 28% with rates higher in flooding and non-flooding areas, and pathogenic Leptospira in floodwater. Public health education efforts to date have failed to reduce prevalence and transmission rates.
OBJECTIVE: Assess the community environment, residents' beliefs and behaviors, and social networks for information exchange to identify opportunities for enhancing public health strategies.
METHODS: The primary researcher collected qualitative data from site observation (approximately 12 hours), 51 interviews, and 4 focus group interviews (n=27). All audio recordings were transcribed verbatim, translated to English, then analyzed and interpreted using NVivo 9.0 (QSR Australia). RESULTS: Roughly half (47%) of participants were familiar with the term "Leptospirosis" or "la enfermedad de la rata" (the rat's disease), but few could report on disease presentation or prevention. Although limited knowledge uptake has hampered prevention efforts, results also demonstrate that high-risk behaviors are closely aligned with environmental conditions, daily living practices, and cultural values, beliefs, and priorities. CONCLUSION: Complex and interconnected social, economical, and cultural conditions make Belen an ideal environment for transmission of leptospirosis. Public health strategies and funding to reduce transmission should target community trash disposal techniques, knowledge of water-borne illness, and modification of education modalities and distribution to leverage community-oriented values and priorities.