Research Article

Conceptualizing One Health governance for leptospirosis control through a bivariate spatial analysis of risk factors in East Java province, Indonesia

Volume: 24 Number: 1 October 16, 2026

Conceptualizing One Health governance for leptospirosis control through a bivariate spatial analysis of risk factors in East Java province, Indonesia

Abstract

Objective: Effective management requires a One Health strategy integrating epidemiological and environmental data to guide intersectoral coordination. This study aimed to analyze local spatial associations between leptospirosis and risk factors using the Bivariate Local Indicator of Spatial Association (BiLISA) and to develop a One Health Cooperation Map for targeted control. 
Methods: An ecological cross-sectional study was conducted across 38 regencies/cities in East Java using 2024 data. Variables included leptospirosis incidence, climate, flooding, agriculture, and socio-demographics. Global Moran’s I and BiLISA were used to identify spatial clusters. Significant clusters were mapped to construct a governance framework assigning intervention responsibilities to relevant non-health sectors.
Results: Global spatial autocorrelation was weak, but BiLISA revealed significant local heterogeneity. The analysis distinguished "hotspots" (High-Low) from critical "silent risk" areas (Low-High)-regions where low reported cases coexist with high environmental vulnerability (e.g., Sidoarjo, Lamongan). Nineteen priority regencies were identified. These findings were translated into a One Health Governance Map, explicitly linking specific spatial risks to mandated actions for agencies such as Public Works and Housing. 
Conclusion: Leptospirosis in East Java exhibits distinct local clustering driven by specific determinants. By translating statistical evidence into a practical governance tool, this study operationalizes One Health. This shift from siloed approaches to determinant-led collaboration enables policymakers to prioritize "silent risk" areas and implement targeted infrastructure-based prevention strategies.

Keywords

One Health, Leptospirosis, Spatial Analysis

Supporting Institution

The authors declare that they have no funding support

Ethical Statement

This research received ethical approval with number: 1586/FTMK/EP/IX/2025 from BHAKTA Institut Ilmu Kesehatan Faculty of Technology and Health Management Ethics Commission.

Thanks

We acknowledge the support of the Provincial Health Office (Dinas Kesehatan Provinsi) Jawa Timur, especially Ms. Ika Puspitasari, S.ST., M.KL, for her feedback, which helped improve the analysis and making one health cooperation map . The authors did not receive any funds for this study.

References

  1. Goarant C. Leptospirosis : risk factors and management challenges in developing countries Leptospirosis : risk factors and management challenges in developing countries. Res Reports Trop Med I. 2016;7:49-62.
  2. Arent Z, Gilmore C, Pardyak L, Dubniewicz K, Mcinerney B, Ellis W. The serological and genetic diversity of the Leptospira interrogans Icterohaemorrhagiae serogroup circulating in the UK. J Vet Res. 2023;67(4):529-36.
  3. Setyaningsih Y, Bahtiar N, Kartini A, Pradigdo SF. The presence of Leptospira sp . and leptospirosis risk factor analysis in Boyolali district. J Public health Res. 2022;11(2144).
  4. Wicaksono SF, Rahardjo SS, Murti B. Meta-Analysis The Effect of Skin Wound on The Risk Of Leptospirosis Infection. In: The 9th International Conference on Public Health. Solo: Masters Program in Public Health, Graduate School, Universitas Sebelas Maret Public Health; 2022.
  5. Mwachui MA, Crump L, Hartskeerl R, Zinsstag J. Environmental and Behavioural Determinants of Leptospirosis Transmission : A Systematic Review. PLoS Negl Trop Dis. 2015;9(9):1-15.
  6. Alcayna T, Fletcher I, Gibb R, Tremblay L, Funk S, Rao B, et al. Climate-sensitive disease outbreaks in the aftermath of extreme climatic events: A scoping review. One Earth [Internet]. 2022;5(4):336-50.
  7. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-dewan S, et al. The Lancet Global Health Commission High-quality health systems in the Sustainable Development Goals era : time for a revolution. Lancet Glob Heal Comm High Qual Heal Syst SDG Era. 2018;6(November):1196-252.
  8. Mackenzie JS, Jeggo M. The One Health Approach - Why Is It So Important ? Trop Med Infect Dis. 2019;4(88):5-8.
  9. Ghai RR, Wallace RM, Kile JC, Shoemaker TR, Vieira AR, Negron ME, et al. OPEN A generalizable one health framework for the control of zoonotic diseases. Sci Rep [Internet]. 2022;12(8588):1-11.
  10. Antoniolli A, Guis H, Picardeau M, Goarant C, Flamand C. One Health Field Approach Applied to Leptospirosis : A Systematic Review and Meta-Analysis Across Humans , Animals and the Environment. Open Forum Infect Dis [Internet]. 2024;12(1):1-17.
APA
Sidjabat, F. N., & Tersandy, N. F. (2026). Conceptualizing One Health governance for leptospirosis control through a bivariate spatial analysis of risk factors in East Java province, Indonesia. Turkish Journal of Public Health, 24(1). https://doi.org/10.20518/tjph.1910351
AMA
1.Sidjabat FN, Tersandy NF. Conceptualizing One Health governance for leptospirosis control through a bivariate spatial analysis of risk factors in East Java province, Indonesia. TJPH. 2026;24(1). doi:10.20518/tjph.1910351
Chicago
Sidjabat, Forman Novrindo, and Nanda Ferlyansin Tersandy. 2026. “Conceptualizing One Health Governance for Leptospirosis Control through a Bivariate Spatial Analysis of Risk Factors in East Java Province, Indonesia”. Turkish Journal of Public Health 24 (1). https://doi.org/10.20518/tjph.1910351.
EndNote
Sidjabat FN, Tersandy NF (October 1, 2026) Conceptualizing One Health governance for leptospirosis control through a bivariate spatial analysis of risk factors in East Java province, Indonesia. Turkish Journal of Public Health 24 1
IEEE
[1]F. N. Sidjabat and N. F. Tersandy, “Conceptualizing One Health governance for leptospirosis control through a bivariate spatial analysis of risk factors in East Java province, Indonesia”, TJPH, vol. 24, no. 1, Oct. 2026, doi: 10.20518/tjph.1910351.
ISNAD
Sidjabat, Forman Novrindo - Tersandy, Nanda Ferlyansin. “Conceptualizing One Health Governance for Leptospirosis Control through a Bivariate Spatial Analysis of Risk Factors in East Java Province, Indonesia”. Turkish Journal of Public Health 24/1 (October 1, 2026). https://doi.org/10.20518/tjph.1910351.
JAMA
1.Sidjabat FN, Tersandy NF. Conceptualizing One Health governance for leptospirosis control through a bivariate spatial analysis of risk factors in East Java province, Indonesia. TJPH. 2026;24. doi:10.20518/tjph.1910351.
MLA
Sidjabat, Forman Novrindo, and Nanda Ferlyansin Tersandy. “Conceptualizing One Health Governance for Leptospirosis Control through a Bivariate Spatial Analysis of Risk Factors in East Java Province, Indonesia”. Turkish Journal of Public Health, vol. 24, no. 1, Oct. 2026, doi:10.20518/tjph.1910351.
Vancouver
1.Forman Novrindo Sidjabat, Nanda Ferlyansin Tersandy. Conceptualizing One Health governance for leptospirosis control through a bivariate spatial analysis of risk factors in East Java province, Indonesia. TJPH. 2026 Oct. 1;24(1). doi:10.20518/tjph.1910351