Objective: To determine  proportion  of human leptospirosis in the sera of suspected clinical cases acute febrile illness  sent by 5 tertiary care hospitals in Kerala. Methods:  From the Out patient Department  serum samples  of suspected individuals were  sent for confirmation  using the immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) for leptospirosis. Also the number of deaths in this patients were recorded  and proportion of confirmed  causes of death due to Leptospirosis is recorded. Results &conclusions: We found 45.29 %( 95 % CI 43.82 , 46.76) of sero prevalence across the 5 MCH in Kerala.Also proportional death due to Leptospira was 22.62%(95% CI 19.05 , 26.19 ) i.e out of 137 suspected deaths due to Leptospira 31 deaths had serological evidence. Sero prevalence will be  much more in community than this study report. This warrants  for  better diagnostic facilities for better care  . Proper reporting  from all sectors of health to monitor trend of disease and