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Original article Spatial patterns of laboratory-confirmed leptospirosis in northeastern Peninsular Malaysia, 2016–2023
Hazlienor Mohd Hatta1orcid , Kamarul Imran Musa1orcid , Nik Mohd Hafiz Mohd Fuzi2orcid , Paula Moraga3orcid
Epidemiol Health 2025;e2025030
DOI: https://doi.org/10.4178/epih.e2025030 [Accepted]
Published online: May 29, 2025
1Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
2Communicable Disease Control Unit, Disease Control Section, Kelantan State Health Department, Malaysia, Kota Bharu, Malaysia
3Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
Corresponding author:  Kamarul Imran Musa,
Email: drkamarul@usm.my
Received: 3 December 2024   • Revised: 16 April 2025   • Accepted: 13 May 2025
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OBJECTIVES
Leptospirosis presents significant public health challenges in endemic regions such as north-eastern Peninsular Malaysia. Spatial analysis is essential for visualising disease incidence and distribution, assessing vulnerability based on geographical and socio-economic factors, and ultimately informing targeted interventions, optimising resource allocation, and enhancing surveillance strategies. This study aimed to determine the incidence and characterise the spatial distribution of leptospirosis in Kelantan, Malaysia.
METHODS
All laboratory-confirmed leptospirosis cases reported in Kelantan between 2016 and 2023 were extracted from the Communicable Disease Control Information System (CDCIS) e-Notifikasi online database. Spatial analyses were performed using the spatstat, spdep, and ggplot2 packages within the RStudio integrated development environment.
RESULTS
The analysis encompassed 1534 laboratory-confirmed leptospirosis cases. The average crude annual incidence of leptospirosis cases per 1000 population from 2016 to 2023 was 0.101 (95% CI: 0.038, 0.164). Incidence varied considerably across districts and subdistricts, initially higher in the north but declining over time, while consistently high and increasing incidence was observed in the southern region. Significant clustering of leptospirosis cases occurred throughout the studied years, except during the COVID-19 pandemic. Hotspots were initially prevalent in northern areas but later emerged in south-eastern and southern regions. Significant spatial autocorrelation evolved from high-low to high-high clusters, particularly evident in central and southern regions.
CONCLUSIONS
This study provides valuable local epidemiological and spatial insights into the endemicity of leptospirosis. The findings highlight the need for targeted interventions and continued surveillance to effectively mitigate the leptospirosis burden in endemic areas.


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