The Relation of Dengue Hemorrhagic Fever (DHF) Cases and the Climate Variability (Precipitation, Humidity and Temperature)

in East Jakarta Administrative City 2004-2008

Ade Yuniarti
Bachelor in Public Health, University of Indonesia

Intergovernmental Panel on Climate Change in 1996 predicted that DHF incidence in Indonesia would be tripled in 2070. Dengue hemorrhagic fever (DHF) has become endemic in many big cities in Indonesia. Most people predicted that outbreak of DHF happened every year almost in all of in Indonesia has strong relation with climate pattern in South East Asia. The objective of this research is to know correlation DHF cases and pattern of the climate variability in East Jakarta. This research uses the design of ecological time trend study. This research was did on May-June 2009 and located in East Jakarta District with used secondary data. The results indicate that DHF cases had significant related to humidity (pV= 0, 01) and didnt have significant related to precipitation (pV=0, 1) and temperature (pV=0, 28). The conclusion of this study is increasing of humidity can influence the incident of DHF cases. Therefore, cooperation between health department and Geophysics, Climate and Meteorology Board (BMKG) is needed. If the increasing of humidity happened, BMKG is suggested to inform to the health department immediately. In order that health department can be aware and anticipating of DHF cases program can be done immediately by doing preventive program, such as fogging and periodic larva infection. Key words: Dengue hemorrhagic fever (DHF), climate change

Introduction Dengue hemorrhagic fever has been forty years in Indonesia, since 1968 and till today remains one of the important public health problems in Indonesia because it is constantly increasing, both in number and area. The geographical position and tropical climate in Indonesia strongly supports the development of this disease. Dengue has become endemic in large cities in Indonesia. All areas in Indonesia have a risk for infected with dengue fever, because both the virus nor infected mosquitoes already widespread in residents housing and public facilities throughout Indonesia. Until now the number of dengue cases and affected areas are increasing continuousely. Every year dengue outbreaks happened in several provinces.
Dengue hemorrhagic fever is an infectious disease caused by dengue virus with certain signs and transmitted through the bite of a mosquito Aedes aegypti (vector primer), Aedes

albopictus (secondary vector) and Aedes scutellaris (Eastern Indonesia). WHO data (2000) shows the estimated 2.5 to 3 billion world population at risk of dengue virus. Climate change may affect patterns of infectious disease and will increase the risk for both the young and the elderly because of disease agents (viruses, bacteria, or parasites, etc.) and vector (insect or rodensia) are sensitive to temperature, humidity and any other ambient environmental conditions (Sintorini, 2007). Climate change caused mosquitoes could spread to new areas. It's already happened in the year of El Nio 1997 when mosquitoes moved to the highlands in Papua. Higher temperatures also cause some viruses mutate, which seems have occurred in the virus that causes dengue fever, which makes the disease more difficult to be overcome. The spread of the virus was estimated to increase at the turn of seasons is marked by rainfall and high temperatures.

Cases of dengue fever in Indonesia had also been found increasing sharply in the years to La Nia (UNDP, 2007). Intergovernmental Panel on Climate Change of 1996 mentions the incidence of DHF in Indonesia could tripled in the year 2070. Without effective control of Dengue Fever will disrupt the economy of country. Control key of preventive dengue hemorrhagic fever is based on district with control cases and various risk factors simultaneously (Achmad, 2007). DKI Jakarta ranked first as the region most vulnerable to climate change based on a survey of Southeast Asia Economy and Environment Program for Southeast Asia (EEPSEA). Jakarta area is very vulnerable to disasters related to climate change, one consequence of high rates of population density. Almost all DKI Jakarta areas are the most vulnerable region with climate change. From 530 urban areas in seven countries studied, such as Indonesia, Thailand, Cambodia, Laos PDR, Vienam, Malaysia and the Philippines, five areas in Jakarta administrative city in the top 10 cities most vulnerable to climate change.

Geophysics, Climate and Meteorology Board (BMKG) Kemayoran Jakarta. This study used secondary data. Dependent variable data is suspect cases of dengue fever in East Jakarta City Administration for five periods (2004-2008). This data sourced from the section of Infectious Diseases at the Public Health Office of East Jakarta. Case report is the result of a recapitulation of the entire district starting from January 2004 through December 2008. While the independent variable data are precipitation data, humidity and temperature in East Jakarta Administrative City in the same period (2004-2008). The data collection of air quality measurements were taken from Geophysics, Climate and Meteorology Board (GCMB) Meteorological Station in Jakarta Kemayoran. Data used are monthly reports of air quality over the past five years (January 2004-December 2008). Furthermore analysis of the correlation has been done by using simple correlation analysis method to analyze the degree or strength of the relationship between climatic factors of precipitation, temperature, humidity with dengue cases and to know what kind of relation between two variables used simple linear regression analysis

Method This study used ecological study based on time. Ecological study based on time is to observe number of cases (incidence) in one or more groups within a certain period (Noor, 2008). Data collection was collected on MayJune 2009 and located in 10 districts in the area of East Jakarta Administrative City. The choice of location was based by several considerations are the East Jakarta Administrative City is a dengue endemic area, where the number of dengue cases was relatively higher than other areas in DKI Jakarta and the recording and reporting of cases are relatively better.
The population in this study were all residents with suspected cases of dengue fever on January 2004 to December 2009 in East Jakarta Administrative City recorded in Public Health Office of East Jakarta Administrative City and the measurement of precipitation, humidity and temperature on January 2004 to December 2009 in East Jakarta Administrative City recorded at meteorological stations

Results During the study period, dengue cases decreased from 572 cases in year 2004 to 561 cases

Fluctuation of DHF Cases Graph of DHF cases in the area of East Jakarta Administrative City in the period 2004-2008 shows two things: (a) Average DHF cases for the period 2004-2008 begin increasing on January-February, then decreases in July and reached its lowest point on SeptemberNovember and begin rising up on January (Figure 1). (b) When compared with 2004, number of DHF cases has decreased in 2005, but after that in the following years (20062008) the number of DHF cases is increasing each year.
The highest incidence rate (IR) of dengue cases over the past five years (2004-2008)

occurred in 2007 is 445.13 per 100,000 population and lowest IR is in 2005, 317.36 per 100,000 populations. While Case Fatality Rate (CFR) for five years (2004-2008) are decrease continuously. The highest CFR of DHF during the five years (2004-2008) occurred in 2004 is 3.49 per 1,000 populations and lowest CFR occurred in 2008, is 0.54 per 1,000 populations.

Climate Factor Test result of the relation humidity test showed that there was a significant correlation with the incidence of dengue fever during the period 2004-2008 with a value of r 0.32 (pV = 0.01). And there is no significant correlation with precipitation and temperature with a value of r and pV respectively 0.21 pV (pV = 0.1); 0.14 (pV = 0,28). Precipitation and DHF Average precipitation during the period 20042008 in the East East Jakarta Administrative City has increased on January and the highest occurred on February and then had fluctuations continuously and precipitation started to decrease on March and the lowest occurred on September. If precipitation compared with cases of DHF, it appears that there is trend when cases begin increasing, precipitation tends increasing too and the opposite when the cases begin decrease, precipitation tends decreased. Bivariate data analysis shows that rainfall did not affect the cases of DHF were significantly (p = 0.1) (Figure 2) Humidity and DHF Humidity is relatively constant each year, the humidity begin increasing when the end of the year, around November and December through January and February. If the humidity compared with cases of DHF, it appears that there is a trend when cases of DHF begin increasing, the humidity tends to decrease and the opposite when the cases of DHF begin to decrease, humidity tends to increase, although this trend did not occur in almost every case. Because the trend when the humidity increasing and relatively constant, cases is decrease.
The result of bivariate analysis between the humidity with the number of dengue cases in the period 2004-2008 showed that there was a

significant correlation between the humidity with the incidence dengue in East Jakarta Administrative City in 2004-2008 (pV = 0.01). It proves that the changes of humidity during the period 2004-2008 give a significant effect on the incidence of DHF, with value of 0.1 means that the coefficient of determination, obtained by the regression line equation can explain 10% variation of dengue cases and the positive relation that is followed by increased humidity increase in the number of dengue incidence in East Jakarta City administrative. (Figure 3)

Temperature and DHF Figure 4 shows the fluctuations in air temperature is relatively constant each year, such as humidity, air temperature begin increasing when the end of the year, around November and December and then decrease on January to February. If the temperature compared with cases of DHF, it appears that there is a trend when cases begin increasing, temperatures tend to decrease and the contrary when the cases of DHF begin to decrease, temperatures tend to increase, although this trend did not occur in almost every case. Because there is a trend when the temperature is increase and relatively constant, cases is decrease. Based on the analysis of data between the air temperature with the number of dengue cases in the period 2004-2008, obtained the value of correlation (r = 0.14) and pV= 0.28 there was no significant correlation between air temperature with dengue cases in the East Jakarta Administrative City in 5-year period (2004-2008). Discussion Dengue cases always happened all year in the East Jakarta Administrative City and always the highest cases compared with other areas of Jakarta and accompanied by death. Its because the area of East Jakarta Administrative City is largely endemic areas. East Jakarta ranks second with 14 red-zone areas are Jatinegara, Milling, Pulo Gebang, Ciracas, Duren Sawit, Klender, Pondok Bambu, Pondok Kelapa, lote China, Rawa Bunga, Cawang, Napier, Pekayon, and Wood White (http: / www.republika.co.id)
In addition, in East Jakarta vegetation found relatively more than the other five areas of

Jakarta. Therefore beside Ae. aegypti, Ae. albopictus is more like habitats in the garden is also suspected as the source transmitters. The crowded residential areas with low social class causes more rapid infection, because Ae. aegypti has a habit of sucking blood repeatedly until a full stomach filled with blood (multiple bites) in one cycle gonotropik so it is very effective as transmitters of disease (Christopher in Sungkar). In addition, the density of mosquito populations consistent with population density and the environment are not well maintained and low social class are not identical with the environment clean and well maintained. While the distribution of monthly dengue cases in 2004-2008 showed that the highest mean of dengue cases occurred on March (1315 cases) and the lowest occurred in September (260 cases) (table 5.4). This is in accordance with climatic conditions, especially precipitation in East Jakarta City Administration, on October the mean of precipitation is high and fluctuated in the following months and reached the highest point on February (549.52 mm) and the lowest occurred in on September (70.82 mm). High precipitation on February caused to the increasing mosquito breeding places. With relatively high precipitation, it will allow places to be filled by rain water so it can become a breeding place for mosquitoes (MOH, 1992) and Aedess eggs could be hatching faster in fluoded water (Sungkar, 2005). So the number of cases has increased on March. The result of bivariate analysis of variable precipitation with dengue cases in the East Jakarta Administrative City in the period 2004-2008 wasnt statistically significant (p = 0.21, r = 0.05). However, if analyze annual data, in 2004 there was statistically significant related to dengue cases (p = 0.01) and a strongly degree of correlation (r = 0.7) with coefficient 0.5, which means that 50% variations in the proportion of incidence cases of DHF can be described by precipitation. The remaining 50% are described by other factors, such as the activity of mosquitoes, mosquito metabolism, air temperature, air humidity, the activity of individual human beings, knowledge, attitudes and behavior of people, vegetation, building density, topography, or

other infrastructure that a limitation of the study.

Conclusion Mean of dengue cases increasing continuously every year. In the period year 2004-2008 is 672 cases or equivalent to the rate of 31 per 100.000 populations. During the study mean of dengue cases begin increasing on JanuaryFebruary, then decrease on July and reached its lowest point on September-November and begin rising up again on January. This study found that mean humidity was statistically significant related to the increases of dengue cases in East Jakarta Administrative City. This study showed positive association, the increasing of humidity followed by increasing of cases. But precipitation and temperature wasnt statistically significant related to the dengue cases in East Jakarta Administrative City. Recommendation Increasing of humidity followed by an increasing the dengue cases. Therefore, the eradication and prevention of dengue fever need more attention to the impact of humidity changes. For example with building and improving communication networks with related sectors, such Climatology Meteorology and Geophysics Board (BMKG) and Regional Environmental Management Board (BPLHD). Measurement and monitoring of the climate need to be done continuously, constantly and continuously, not only for record, but also it must be informed to the local health department. If there is an increasing in humidity BMKG is advised to immediately inform to the health department, so health department could be aware and immediately execute activities to anticipate the incidence of dengue cases by doing preventive activities, such as fogging and periodic inspection of larvae. Precipitation also influenced the dengue cases, dengue cases increases during the rainy season, the season of transition and after the rainy season or early dry season. During five years (2004-2008) on February and March have the highest mean dengue cases, so that monitoring should be more intensive from the others month. Therefore, the awareness to dengue should be increased at those times. Priority interventions of mitigation and

prevention, such as eradication of mosquito breeding and periodic larvae inspection should be done continuously and comprehensive before these months. And it needs cooperation between regions to do both these activities, because the spread of mosquitoes do not recognize administrative boundaries. Negligence of a region in conducting these activities maybe harmful to other areas around it. It also can be the basis for the filing of a joint program funds by the planners of each program area.