Study of Factors Caused Dengue Haemoragic Fever

Case study: Jember, East Java-Indonesia

Mochammad Sholehhudin


Department of Environmental Health and Safety
Faculty of Public Health, University of Jember, East Java - Indonesia
Abstract. DHF is one of communicable diseases that occurs in almost 40% of the world population. DHF
cases which in city of Jember, Indonesia becomes attention caused by the largest number of cases and the
outbreaks of DHF area (KLB). This study aims to describe the situation of DHF cases in Jember and factors
affecting DHF cases. This study is using descriptive method. Samples were taken from the 10 sub-districts
which accumulated of the highest DHF cases from 2008-2012. Researcher discovering the last trend of the
cause DHF cases in 2012. Researcher is using a text descriptive analysis with frequencies form and crosstabs.
This study has been showed that the 10 highest sub-district DHF cases from 2008-2012, DHF trend factors in
2012 showed the number of density low categories correlated 60% with the low category of DHF cases, the
low category of healthy house 0% correlated, low category of household with PHBS 0% correlated, and low
categories ABJ 0% correlated with high category of DHF cases. The conclusion show up the population
density according to the theory of DHF transmission, while the other variables do not fit up with the theory.
Keywords: DHF, Jember, factors, and population density.
1. Introduction
Today about 2.5 billion people, or 40% of the worlds population, live where in there is a risk of dengue
transmission [1]. The World Health Organization (WHO) estimates that 50 to 100 million infections occured
yearly, including 500,000 DHF cases and 22,000 deaths, mostly among to the children. Dengue and dengue
haemoragic fever are present in urban and suburban areas in America, South-East Asia, the Eastern
Mediterranean and the Western Pacific and dengue fever is mainly present in rural areas in Africa [2].
Most of the regions in Indonesia have tropical climate and sub-tropics. These circumstances make
Indonesia as one of the DHF endemic countries in south east asia. DHF has been known in Indonesia since
1968 by the name of dengue fever (DBD). The disease was first reported in Surabaya, East Java [3]. Since
then, DHF spread to the whole of Indonesia district. During the years 1996-2005, it has been recorded that
334 685 cases of DHF, with the number of died patients are 3,092 people [4]. In 2006, Indonesia contributes
the highest number of dengue cases in the Region, with 125 045 cases each year [5]. While the year 2010,
Indonesia became the highest rank in ASEAN of DHF cases [6] with the number of deaths until 1,317 people.
Data in East Java showed up as that there are 26,059 cases and 233 deaths which occur in almost all
regions, amounting to 80% of contracted dengue. In 2012, there are 7 cities in East Java which is included in
the city of DHF outbreaks, one of them is Jember. Since 2008-2012, the number of DHF cases in Jember
increased except in 2011.
Jember conditions in 2008, there were 780 cases and increasing in 2009 by 983 cases. In 2010, there was
an outbreak with 1,494 the number of cases, so thats made whole of the health workers seriously controlling
the DHF cases. In 2011, DHF been in good condition due to a significant decline and only 77 cases occur.
However, in 2012 this disease became increase by 260 cases. In 2013, the condition of DHF cases have

Corresponding author. Tel: + 6285749700702.

E-mail address:mssholhud@gmail.com.
2013 2nd International Conference on Environment, Chemistry and Biology
IPCBEE vol.59 (2013) (2013) IACSIT Press, Singapore
DOI: 10.7763/IPCBEE. 2013. V59. 25
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being worried. Start from the early years to 29 January 2013, the case reached 152 cases of DHF and 1
toddler died [7].
DHF cases occur due to multiple factors. Studies of dengue fever have been carried out, both related to
the etiologic factors, diagnostic and also prognostic of the disease. Several etiologic factors were found be
associated with dengue fever is a host of factors (age, gender, mobility), environmental factors (housing
density, the breeding places of mosquitoes, mosquito resting place, the density of mosquito larvae-free
numbers, rainfall), behavioral factors (sleep patterns, activities eradication of mosquito breeding, drain,
dispose/ bury mosquito) [8]. It also can be influenced by the demographic factors (population density,
population mobility, knowledge, income, and livelihood).
Based on these factors, there are several important factors that are considered for high DHF cases in
Jember. These factors include the demographic factors of population density, in terms of behavioral factors
of that households clean and healthy living behavior (PHBS), as well as environmental factors are seen from
the density of larvae (ABJ) and healthy house state.
This study aims to describe the situation of DHF cases in Jember and the factors that influence, including
overcrowding or population density, healthy housing conditions, household clean and healthy living behavior
(PHBS), and larvae-free numbers (ABJ). The result of this study is expected to be a reference for the
development of policy and management control of DHF in Jember, in according to the trends and patterns of
DHF development.
2. Material and Method
2.1. Study Area
The research was conducted in the city of Jember, East Java, Indonesia. Area of Jember about 3,293 km
2
.
Jember is a city which has big population after Surabaya dan Malang in East Java Province. The population
in Jember at 2004 about 2,136,999 people, composed from 1,040,207 man and 1,096,792 woman.
2.2. Population and Sampling Method
The study population used all of the sub-districts in Jember. Samples have taken from 10 sub-districts
with the highest DHF cases. Cases where in the data were accumulated from 2008 to 2012. The sampling
results are shown in Table 1.
2.3. Method Design and Procedure
This research is a descriptive study which uses secondary data by Health Office of Jember. The
procedure begin with accumulating the research across DHF cases from 2008-2012 based on the sub-district.
Then the data are being ranked highest to get the sub 10 DHF cases. The 10 sub-districts data which being
the sample be mapped with all of the variables to see the variables change in each sub-district from 2008-
2012. The variables are including of all variables, population density, healthy house, household PHBS, and
larvae-free numbers (ABJ) then being categorized into some categories such as low, medium, and high. DHF
cases low category 15, medium 16-30, high > 30. Category of low population density 1000 person/km
2
,
being 1,001-2,000 people/km
2
, and high > 2,000 people/km
2
. While the category of a healthy house,
household within PHBS, and larvae-free numbers (ABJ) be assessed by percentage, low 40 %, medium 41-
75 %, high > 75 %. After be categorized based on the reference category, researchers analyze the DHF cases
variable with all of the factors causing DHF by descriptive text analysis in the form of frequencies and
crosstabs in SPSS.
3. Result and Discussion
The results of this study comprise:
Based on the accumulated number of DHF cases that occurred during 2008-2012, there were 10 sub-
districts of 31 sub-districts that have the highest DHF cases, shown in Table 1.
It is known that the development of population density in each sub-district fluctuate in 2008-2012. It
means that the density will be always evolve erratic positive or negative each year, as shown in figure 1.
132
Contrary to the healthy house development which the percentage was increased and it can be seen in 2010
and 2011. However, in 2012 the downward trend occurred in all districts as shown in figure 2.
On figure 3, the household within PHBS development were not so good. Attainment percentage figures
shown are not too high in each year, unless the Kaliwates and Sumbersari sub-district in 2008. In fact the
achievement of more over sub-district is only in the range of less than 80 % in each year.

Table 1: 10 Sub-district with Highest DHF Cases in Jember at 2008-2012.













Fig. 1: Development Chart of Population Density Fig. 2: Development Chart of Healthy House (%)


Fig. 3: Development Chart of Household within PHBS (%) Fig. 4: Development Chart of ABJ (%)

No Sub-district Case
1. SUMBERSARI 596
2. KALIWATES 584
3. PATRANG 315
4. PUGER 193
5. UMBULSARI 153
6. AJUNG 136
7. WULUHAN 134
8. BALUNG 122
9. KENCONG 116
10. GUMUKMAS 109
133
The growth of ABJ data is shown up to figure 4. Majority, sub-districts are achieving decreased free
numbers larvae in 2009. Then being increased again in 2010-2011. However, the majority of districts fell
back below 80 % reached in 2012.
Based on Table 1, have been known that there is a correlation between the density of population with
DHF cases. The low category of density allows for low category of DHF cases by 60 %. This value is the
highest value of the other categories of DHF cases. The condition is according to the WHO theory.
Population growth and urbanization, patterns of unplanned and uncontrolled is one of the factors that play a
role in the re-emergence of dengue disease outbreaks [9]. However there is small discrepancy at high density
correlated only 33 % of cases with high DHF category.

Table 2: Cross tabulation of population density with DHF cases at 2012

Table 3: Cross tabulation of healthy house with DHF case at 2012
Case Total
Healthy House Low Medium High
Low % within Healthy House 4 (66.7%) 2 (33.3%) 0 (.0%) 6 (100.0%)
Medium % within Healthy House 2 (50.0%) 0 (.0%) 2 (50.0%) 4 (100.0%)
Total % within Healthy House 6 (60.0%) 2 (20.0%) 2 (20.0%) 10 (100.0%)

In Table 2 shown that healthy houses are correlated in the case of DHF. Number of healthy houses with
low category had a correlation of 0% in the high category of DHF cases. This is not consistent with the
objectives of national healthy houses program. One of the components which in a healthy house must exist is
the prevention of vector, one of which is Aedes aegepty sp. If the percentage is low, mosquitoes should be in
that house and DHF cases be increasing, but the different conditions are shown in Jember.

Table 4: Cross tabulation of household within PHBS with DHF case at 2012

The similar circumstances also have been shown by the household clean and healthy living behavior
(PHBS). On the number of household within PHBS low category, DHF cases correlated to the occurrence of
high category 0%. It means that PHBS have no value to the DHF cases. In addition, the number of household
within PHBS high category only correlated 25 % with low category of DHF cases. This figure does not
correspond to the results of research fathi et al. [10], states that measures 3M (draining, burying and closing)
and are included in PHBS Abatization serves to reduce and prevent the risk of DHF transmission.
Case Total
Population Density Low Medium High
Low % within Population density
3 (60.0%) 1 (20.0%) 1 (20.0%) 5 (100.0%)
Medium % within Population density
2 (100.0%) 0 (.0%) 0 (.0%) 2 (100.0%)
High % within Population density
1 (33.3%) 1 (33.3%) 1 (33.3%) 3 (100.0%)
Total % within Population density
6 (60.0%) 2 (20.0%) 2 (20.0%) 10 (100.0%)
Case Total
HH-PHBS Low Medium High
Low % within RT-PHBS
1 (100.0%) 0 (.0%) 0 (.0%) 1 (100.0%)
Medium % within RT-PHBS
4 (80.0%) 0 (.0%) 1 (20.0%) 5 (100.0%)
High % within RT-PHBS
1 (25.0%) 2 (50.0%) 1 (25.0%) 4 (100.0%)
Total % within RT-PHBS
6 (60.0%) 2 (20.0%) 2 (20.0%) 10 (100.0%)
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Based on Table 4 it can be known that there is correlation between each variable. But the number of
larvae-free number (ABJ) on the low category correlates of 0% to the number of DHF case high category. It
means that when a place is not being the larva-free location then it has no chance to making the proficiency
level of DHF cases be decreased. ABJ is the parameter of mosquito density. However, these conditions are
not in accordance with previous investigators. Research conducted by the previous researchers who stated
that the high density of the vector will be also increase the risk of transmission of dengue disease [9].

Table 5: Cross tabulation of ABJ with DHF Cases at 2012

4. Conclucion
The conclusion of this study indicate that the population density variable accordance to the theory of
transmission DHF disease. While the other variables such as healthy house, household within PHBS, and
larvae-free numbers (ABJ) have no correspondence between the events on the field with the theory.
The condition may occur due to possible presence of other factors that influence the occurrence of DHF
in the city of Jember. Another factor thought to play a role is the management factor. In addition it is also
possible discrepancy due to the researcher inaccuracies of the data analysis.
DHF management programs that have been implemented include counseling DHF, fogging and mosquito
breeding program. The program should be implemented and maintained to the level of the lowest areas, such
as a village. In addition it must be executed by every household and every family makes good DHF response.
Beside there all of surveyor in collecting the data must be more carefully.
5. Acknowledgement
This study was conducted and support by Faculty of Public Health and University of Jember. The author
grateful to parents, Dr. Isa Marufi, S.KM, M.Kes., and all of friends who give contribution to this study.
6. References
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2013]
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Case Total
ABJ Low Medium High
Low % within ABJ 2 (66.7%) 1 (33.3%) 0 (.0%) 3 (100.0%)
Medium % within ABJ 2 (50.0%) 0 (.0%) 2 (50.0%) 4 (100.0%)
High % within ABJ 2 (66.7%) 1 (33.3%) 0 (.0%) 3 (100.0%)
Total % within ABJ 6 (60.0%) 2 (20.0%) 2 (20.0%) 10 (100.0%)
135
2, Agustus 2010.
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136