factors associated with the pattern of dengue haemorrhagic fever (dhf) incidence in indonesia ermi...
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FACTORS ASSOCIATEDWITH THE PATTERN OF
DENGUE HAEMORRHAGIC FEVER (DHF) INCIDENCE IN
INDONESIA
ERMI NDOEN1), TITIK RESPATI 1),
PUSPARINI2), ANA M LIMBONG2), BAYU AJI2)
Indonesian Dengue in the Media
175 die from mosquito-borne virus JAKARTA An outbreak of dengue fever has killed at least 175 people as of Thursday, and a health official warned that floods beginning to inundate Jakarta and other cities would worsen the situation.
.The mosquito-borne outbreak has spread to four more provinces and infected 8,735 people in a total of 12 provinces since Jan. 1, said Dr. Mariani Reksoprojo of the Health Ministry, who called the outbreak "extraordinary
175 die from mosquito-borne virus JAKARTA An outbreak of dengue fever has killed at least 175 people as of Thursday, and a health official warned that floods beginning to inundate Jakarta and other cities would worsen the situation.
.The mosquito-borne outbreak has spread to four more provinces and infected 8,735 people in a total of 12 provinces since Jan. 1, said Dr. Mariani Reksoprojo of the Health Ministry, who called the outbreak "extraordinary
Home>>World
Last updated at: (Beijing Time)
Friday, February 27, 2004
Death toll of dengue fever
in Indonesia rises to 267
Death toll of the dengue fever across Indonesia
has risen to 267 people and the sufferers
increased to 15,316 people, an official of the
Health Ministry said Thursday.
Home>>World
Last updated at: (Beijing Time)
Friday, February 27, 2004
Death toll of dengue fever
in Indonesia rises to 267
Death toll of the dengue fever across Indonesia
has risen to 267 people and the sufferers
increased to 15,316 people, an official of the
Health Ministry said Thursday.
Travellers warned
about Dengue
By Zhao Huanxin (China Daily)
Updated: 2004-08-20 01:56
Quarantine authorities are urging travellers to take precautions against the mosquito-borne disease dengue fever after some Southeast Asian countries have reported cases.
Bangladesh, Bhutan, Indonesia and Sri Lanka have recently reported outbreaks of the disease, according to the World Health Organization (WHO).
Travellers warned
about Dengue
By Zhao Huanxin (China Daily)
Updated: 2004-08-20 01:56
Quarantine authorities are urging travellers to take precautions against the mosquito-borne disease dengue fever after some Southeast Asian countries have reported cases.
Bangladesh, Bhutan, Indonesia and Sri Lanka have recently reported outbreaks of the disease, according to the World Health Organization (WHO).
Aim
To examine the associations between DHF Incidence pattern with demographic, environmental factors (climate, land use), and DHF control activities in selected areas in Indonesia
ObjectivesTo describe the fluctuation and spatial distribution of DHF incidence
To examine the association between climatic conditions and DHF incidence
To examine the association between population density, migration, land use with DHF cumulative incidence
To explore the influence of DHF control activities on the DHF incidence
In selected areas.
Areas of Study
Deli SerdangDeli Serdang
JakartaJakarta
Indonesia at a Glance• Area: 1,919.4 sq km• Population (2003): 235 million; • 100 Distinct ethnic groups.
Data collection
1. The monthly data of DHF cases from each sub district collected from DHF surveillance data.
2. The monthly meteorological data (temperature, rainfall, rain day and humidity) obtained from weather monitoring station.
3. The population density, land use and dwellings type data data obtained from The Indonesian Statistics Bureau (BPS).
4. Type of water containers obtained from DHF survey in in selected areas.
Data Analysis
Statistical analysis included:
• Descriptive analysis : Time series graphs,
Frequency distributions Test of normality
• The independent t-test
• Chi Square analysis
• A correlations analysis
Spatial Analysis
To show the spatial distribution and the variation
of DHF incidence at study areas
ClimateTemperature, Humidity,
Rainfall, Rain day, Precipitation and Extreme weather
events
EcologyVegetation, Soil
moisture, and Land use
Transmission BiologyVector reproduction/
movement
Social FactorsVector control,
Travel/migration, Behavior, Population,
Basic sanitation
Disease OutcomeRate of transmission,
Incidence Rate
THEORITICAL FRAMEWORK
Research Framework
Weather condition: Land Use
– Rainfall– Temperature – Humidity
DHF Cumulative
Incidence
Demographic condition:
- Population density
- Migration
Control Activity
Number of DHF Cases and Infected Areas in Indonesia (1968 –2003)
IR p
er 1
00,0
00
No
of C
ity/D
istr
icts
Inf
ecte
d
Incidence Rate (IR)No of Infected Areas
Dengue (DHF) Outbreak in Indonesia (2004)
Outbreak areas
Potential Outbreak areas
The Spatial Distribution DHF
Incidences in West Jakarta
The Spatial Distribution of DHF Incidence in Central Jakarta
1
84
7
2
9
6 203
40
15
5
16
13
23
41
33
18
37
14
43
10
24
27
1231 29
39
17
32
28
2126
19
38
11
22
35
30
3634
25
4244
1
84
7
2
9
6 203
40
15
5
16
13
23
41
33
18
37
14
43
10
24
27
1231 29
39
17
32
28
2126
19
38
11
22
35
30
3634
25
4244
1
84
7
2
9
6 203
40
15
5
16
13
23
41
33
18
37
14
43
10
24
27
1231 29
39
17
32
28
2126
19
38
11
22
35
30
3634
25
4244
1
84
7
2
9
6 203
40
15
5
16
13
23
41
33
18
37
14
43
10
24
27
1231 29
39
17
32
28
2126
19
38
11
22
35
30
3634
25
4244
119979 7 1998
1999 2000
1
84
7
2
9
6 203
40
15
5
16
13
23
41
33
18
37
14
43
10
24
27
12
31 2939
17
32
28
2126
19
38
11
22
35
30
3634
25
42
44
1
84
7
2
9
6 203
40
15
5
16
13
23
41
33
18
37
14
43
10
24
27
12
31 2939
17
32
28
2126
19
38
11
22
35
30
3634
25
42
44
1
84
7
2
9
6 203
40
15
5
16
13
23
41
33
18
37
14
43
10
24
27
1231 29
39
17
32
28
2126
19
38
11
22
35
30
3634
25
4244
220011 220022
2003
Category: Low Middle High Very High
1998
1999 2000
2003
Climate Factors and DHF Incidence (West Jakarta)
Climate Factors Spearman R Square P ValueCoefficient correlation
Average Temperature -0.075 0.0056 0.573Relative Humidity 0.468** 0.219 0.000
Number of rainy days 0.436** 0.1901 0.001Average Daily Rainfall 0.469** 0.2200 0.000
.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
100.00
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
0
5
10
15
20
25
30
DHF Incidence Temperature Relative Humidity No. of Rainy Day Daily Rainfall
Rainfall, rainy days & humidity had positive relationship with DHF incidence
Temperature had no significance relationship with DHF incidence
Population Density and DHF Incidence (West Jakarta)
(< 13568 people/km2)
(-48.32 – 27.66) 96.672. Low
0.585-10.329(> 13568 people/km2)
86.341. High
Mean Diffe-rence
Mean
P value (95% CI)
DHF Cum IncCategory of Population
Density Area
Land Use and DHF (West Jakarta)
(-25.69 – 14.71) 66.35 - Low (< 0.095%)0.588-5.4960.86 - High (> 0.095%)
3. Free & Agriculture
(-34.62 – 5.08) 70.99 - Low (< 11.17%)
0.142-14.7756.22 - High (> 11.17%)
2. Office & Industry
(-5.83 – 33.95) 56.57 - Low (< 72.32%)0.16214.0670.63 - High (> 72.32%)
1. Residential
Mean Diffe-rence
MeanLand Use AreaP value
(95% CI)
DHF Cum IncidenceCategory of
Dwellings Type and DHF (West Jakarta)
(-39.53 – -0.52) 73.61 - Low (< 9.25%)
0.071-20.0253.59 - High (> 9.25%)
3. Temporary
(-13.64 – 26.71) 60.34 - Low (< 24.87%)
0.5196.5366.87 - High (> 24.87%)
2. Semi Permanent
(-13.75 – 26.60) 60.39 - Low (< 65.52%)
0.5266.4366.81 - High (> 65.52%)
1. Permanent
Mean Difference
MeanDwelling TypeP value (95% CI)
DHF Cum IncidenceCategory of
Most DHF cases occurred in unplanned housing areas (Central Jakarta)
Gelora
GambirCideng
Menteng
Pasar Baru
Senen
Kenari
Kebon Sirih
Cikini
Sumur Batu
Johar Baru
Pegangsaan
Paseban
Kramat
Duri Pulo
KaretTengsin
Serdang
Bendungan Hilir
Cempaka Baru
Kebon Melati
Gn.Sahari Utara
Cemp. Putih Timur
Rawa Sari
Kebon Kelapa
Kampung Bali
Petojo Utara
Kartini
Petamburan
Cemp. Putih Barat
Gondangdia
Mangga 2 Selatan
Gn.Sahari Selatan
Kwitang
Petojo Selatan
Karang Anyar
Kebon Kosong
Tanah Tinggi
Bungur
Galur
Kebon Kacang
Utan Panjang
Harapan Mulia
Kemayoran
Kampung Rawa
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Cumulative Incidence 30 - 6768 - 9293 - 123124 - 174175 - 256
In Central Jakarta Control Activity (Fogging) was found to be ineffective in preventing DHF outbreak
0
5
10
15
20
25
30
35
40
45
50
Jan-
99
Mar
-99
May
-99
Jul-9
9
Sep
-99
Nov
-99
Jan-
00
Mar
-00
May
-00
Jul-0
0
Sep
-00
Nov
-00
Jan-
01
Mar
-01
May
-01
Jul-0
1
Sep
-01
Nov
-01
Jan-
02
Mar
-02
May
-02
Jul-0
2
Sep
-02
Nov
-02
Jan-
03
Mar
-03
May
-03
Jul-0
3
Sep
-03
Nov
-03
Month
DH
F C
I
Another Control Strategy for Combating DHF is Mosquito Breeding Site Eradication
Program (MBSEP)
“…to encourage communities in the eradication of dengue, especially in removing mosquito larvae, so the
infection by the disease can be prevented… ”
The Way of Executing Mosquito
Breeding Site Eradication Program
• Cleaning water containers
• Covering water containers
• Burying discarded containers
• Other activities such as changing water regularly in flower pots and bird feeding cups, etc
Typical water containers in Indonesia that can be potential breeding place for
dengue mosquitoes
Typical Water Containers in Rural Area
MBSEP of Respondents in two areas in Deli Serdang District
39%
17%
61%
83%
Urban Rural
Participated Not participated
(2 = 12.6; df = 1; p = 0.00; = 0.1) = Significant
MBSEP = Mosquito Breeding Site Eradication Program
Education No Variable High Low
P Value
OR (CI)
Comment
High 105
(80 %) 44
(63 %)
Low 25 (20 %)
26 (27 %)
1.
Knowledge
Total 130 (100 %)
70 (100 %)
0. 006 2.482 (1.764 - 4.764)
Significant
Good 85
(65 %) 40
(57 %)
Poor 45 (35 %)
30 (42 %)
2. Attitude
Total 130 (100 %)
70 (100 %)
0.251 1.417 (0.781 – 2.570)
Not Significant
Participated 43 (33 %)
14 (20 %)
Not Participated
87 (67 %)
56 (80 %)
3. Practice
Total 130 (100 %)
70 (100 %)
0.051 1.977 (0.991 – 3.943)
Significant
Education No Variable High Low
P Value
OR (CI)
Comment
High 105
(80 %) 44
(63 %)
Low 25 (20 %)
26 (27 %)
1.
Knowledge
Total 130 (100 %)
70 (100 %)
0. 006 2.482 (1.764 - 4.764)
Significant
Good 85
(65 %) 40
(57 %)
Poor 45 (35 %)
30 (42 %)
2. Attitude
Total 130 (100 %)
70 (100 %)
0.251 1.417 (0.781 – 2.570)
Not Significant
Participated 43 (33 %)
14 (20 %)
Not Participated
87 (67 %)
56 (80 %)
3. Practice
Total 130 (100 %)
70 (100 %)
0.051 1.977 (0.991 – 3.943)
Significant
The Relationship between Respondents’ Level of Education with Knowledge, Attitude and Practice in
Mosquito Breeding Site Eradication Programs (MBSEP)
Occupation No Variable Employed Unemployed
P Value
OR (CI)
Comment
High 57 (77 %)
92 (73 %)
Low 17 (23 %)
34 (27 %)
1.
Knowledge
Total 74 (100 %)
126 (100 %)
0. 530
1.239
(0.634 – 2.420)
Not Significant
Good 56 (75 %)
69 (55 %)
Poor 18 (25 %)
57 (45 %)
2. Attitude
Total 74 (100 %)
126 (100 %)
0.003
2.570
(1.360 – 4.857)
Significant
Participated 23 (31 %)
34 (27 %)
Not Participated
51 (69 %)
92 (73 %)
3. Practice
Total 74 (100 %)
126 (100 %)
0.535
1.220
(0.650 – 2.292)
Not Significant
Occupation No Variable Employed Unemployed
P Value
OR (CI)
Comment
High 57 (77 %)
92 (73 %)
Low 17 (23 %)
34 (27 %)
1.
Knowledge
Total 74 (100 %)
126 (100 %)
0. 530
1.239
(0.634 – 2.420)
Not Significant
Good 56 (75 %)
69 (55 %)
Poor 18 (25 %)
57 (45 %)
2. Attitude
Total 74 (100 %)
126 (100 %)
0.003
2.570
(1.360 – 4.857)
Significant
Participated 23 (31 %)
34 (27 %)
Not Participated
51 (69 %)
92 (73 %)
3. Practice
Total 74 (100 %)
126 (100 %)
0.535
1.220
(0.650 – 2.292)
Not Significant
Relation between Occupation and KAP
Economic No Variable High Low
P Value
OR (CI)
Comment
High 111 (76 %)
38 (70 %)
Low 35 (24 %)
16 (30 %)
1.
Knowledge
Total 146 (100 %)
54 (100 %)
0. 415
1.335 (0.665 – 2.680)
Not Significant
Good 93 (63 %)
32 (59 %)
Poor 53 (37 %)
22 (41 %)
2. Attitude
Total 146 (100 %)
54 (100 %)
0.565
1.206 (0.637 – 2.286)
Not Significant
Participated 45
(30 %) 12
(22 %) Not Participated
101 (70 %)
42 (78 %)
3. Practice
Total 146
(100 %) 54
(100 %)
0.232
1.559 (0.750 – 3.241)
Not Significant
Relation Between Economic Status and KAP
Health Promotion
No
Variable Had ever
heard
Never heard
P
Value
OR (CI)
Comment
High 44 (83 %)
105 (71 %)
Low 9 (17 %)
42 (29 %)
1.
Knowledge
Total 53 (100 %)
147 (100)
0. 097
1.956
(0.877 – 4.358)
Significant
Good 38 (71 %)
87 (59 %)
Poor 15 (29 %)
60 (41 %)
2. Attitude
Total 53 (100 %)
147 (100)
0.107
1.747
(0.883 – 4.456)
Not Significant
Participated 16
(30 %) 41
(27 %) Not Participated
37 (70 %)
106 (73 %)
3. Practice
Total 53 (100 %)
147 (100)
0.751
1.118
(0.562 – 2.225)
Not Significant
Relationships Between Health Promotion and KAP
TV
TV
RadioRadio
Health Worker
Health Worker
News paper
News paper
0%
10%
20%
30%
40%
50%
60%
70%
80%
Kenangan Tembung
The Preferences of Health Promotion Media for DHF in Deli Serdang District, North
Sumatera - Indonesia
(Urban area) (rural area)
Conclusions1. Dengue Haemorrhagic Fever (DHF) is one of the most important
communicable diseases occurs in urban areas such as Jakarta.
2. DHF incidence is associated with relative humidity, number of
rainy days and average daily rainfall.
3. Analysis of population density and DHF incidence at sub-district
level indicates that DHF incidence was high in low population
density areas.
4. DHF incidence tended to be higher where residential buildings
occupied a high percentage of land, whereas areas with high
proportion of ‘office and industrial’ and ‘free space and
agriculture’ land use had lower incidence of DHF.
• Respondents with higher education level tend to be more involved in MBSEP.
• The economic status of respondents had no relationship with their participation in the MBSEP.
• Occupation was found to have no correlation with the participation level of the MBSEP
5. In areas of permanent and semi-permanent dwellings,
DHF incidence was higher than in the temporary
dwellings areas.
6. Water containers inside and around the houses are
important factors in DHF transmission due to the
abundance of vectors.
7. Education and Socio-economic Factors in Relation
to The Mosquito Breeding Site Eradication Program
• Health promotion campaigns have a relationship with the level of knowledge in the MBSEP.
• Respondents with low education level prefer greater consultation with health workers.
• Knowledge of the MBSEP has no relationship with respondent participation in the program.
• Respondents attitudes have no relationship towards their participation in the MBSEP.
• More respondents in urban area participated more than in the rural area for MBSEP .
Knowledge, Attitude, Practice (KAP) in the MBSEP
Health Promotion in Mosquito Breeding Site
Eradication Program
Media in health promotion in Mosquito
Breeding Site Eradication Program
Recommendations1. The information of seasonal patterns of DHF
incidence can be useful in preparing of DHF control programs to prevent an outbreak.
2. It is necessary to strengthen socio-environmental intervention through several efforts as follows:– Healthy housing condition with sufficient water
supplies and solid waste disposal. – Use biological control– Intensive health promotion program that
emphasises and encourages people to participate in preventive programs such as the “3M Plus” reduction of mosquito breeding sites program (PSN)
Recommendations
Collaboration is needed between health sectors, other institutions and the community targeted by the MBSEP activities
Further studies: more comprehensive study designs taking into account the location of water containers inside or around the house and the abundance of dengue vectors in the wet and dry seasons. Other climate factors such wind, heat and lighting (sun) should be considered in future research.
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