Zoonotic transmission risk in flood-prone river basins: community knowledge and behavioral determinants of leptospirosis in eastern Ethiopia

Abstract

BACKGROUND: Leptospirosis is a neglected zoonotic disease with a rising incidence in flood-prone tropical regions. In the Shabelle River Basin of eastern Ethiopia, recurrent flooding combined with close human-animal contact creates conditions conducive to transmission. However, community knowledge, attitudes, and behaviors related to leptospirosis remain poorly characterized, limiting effective prevention efforts. METHODS: A community-based cross-sectional study was conducted in flood-affected districts of Mustahil and Fer Fer in eastern Ethiopia. Adult household heads or primary caregivers were selected using multistage sampling with systematic random sampling within flood-affected kebeles. Data on knowledge, attitudes, and preventive practices regarding leptospirosis were collected through a structured interviewer-administered questionnaire. Descriptive statistics and logistic regression analyses were used to identify factors associated with high-risk behaviors. RESULTS: Of the 422 respondents, only 15.2% had heard of leptospirosis, and 99.1% demonstrated poor knowledge of its transmission, symptoms, and prevention. Although 60.2% recognized flooding as a serious hazard, only 30.3% acknowledged the risk posed by rodents. High-risk behaviors were prevalent, including floodwater farming (73.0%), barefoot irrigation (64.9%), and sharing water sources with livestock (52.8%). Livestock ownership was strongly associated with high-risk practices (adjusted odds ratio [AOR] = 16.96), whereas the presence of rodents in households was inversely associated (AOR = 0.31). Higher risk perception modestly reduced engagement in risky behavior (AOR = 0.90). No significant associations were found with other sociodemographic factors. CONCLUSIONS: This study highlights critical gaps in community knowledge and widespread high-risk behaviors contributing to leptospirosis transmission in flood-prone areas of eastern Ethiopia. The inverse association between rodent presence and high-risk behaviors likely reflects behavioral adaptations rather than a biological protective effect. Integrated One Health interventions are urgently needed, focusing on culturally appropriate community education, enhanced rodent control through environmental management, improved water and sanitation infrastructure, and increased access to protective equipment. Strengthening health system capacity for leptospirosis diagnosis and surveillance will support timely detection and response. Embedding leptospirosis prevention within existing flood response and zoonotic disease frameworks can enhance resilience to climate-sensitive health risks in vulnerable pastoralist populations. TRIAL REGISTRATION: Not applicable.