Estimating the burden of leptospirosis: global lessons from Sri Lanka
Janith Warnasekara, Shalka Madushan Srimantha, Suneth Agampodi
Abstract
### Summary box Health planning requires a comprehensive understanding of the health needs of a population.1 Assessments of the actual burden of diseases, including mortality, morbidity and major risk factors, should be a primary concern for decision-making and implementing health policies in the countries.1 As a result, assessing the actual burden of many diseases, including leptospirosis, remains a challenge, especially in lower and middle-income countries (LMIC).2 The published global disease burden of leptospirosis suffers from a lack of data in various geographical regions and does not have age and sex-disaggregated data.3 In addition, the majority of these studies have sampling bias, leading to an underestimation of the true disease burden. Therefore, we discuss the different elements that need to be addressed to properly estimate the burden of leptospirosis using Sri Lanka as an example. Disease burden estimates heavily rely on routine reporting. Hospital information systems are not digitalised in many LMICs. Thus, routine reporting is a tedious manual procedure that is a ‘burden’ to treating physicians. Deficiencies in or incomplete reporting/notification represent a significant underlying factor for underestimation.4 Reporting is sometimes hampered because the available diagnostic tools are neither perfect nor effective for the early …