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Epidemiology and Society Health Review| ESHR 
 

 
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Review Article 

 

CLIMATE CHANGE and DENGUE in INDONESIA: a 

SYSTEMATIC REVIEW 

 

Fajar Fatmawati
1
 and Sulistyawati Sulistyawati

1* 

 
1 Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia 
*
Correspondence: Email: sulistyawatisuyanto@gmail.com. Tel: +628170402693 

Received 07 August 2019; Accepted 09 September 2019; Published 09 September 2019 

 

ABSTRACT  

Background: Climate change is a global issue because of its impact on 
environmental and human health. No exception for Indonesia, an archipelago state 
with a tropical climate. Climate change potentially influences the mosquitos borne 
disease, including dengue fever, which poses a vulnerability to the Indonesian 
populations. This article aims to review the association and the impact of climate 
change to dengue fever, particularly in Indonesia and to inform the policymaker on 
directing the adaptation option. 

Methods: Of thirteen peer review articles were included in this review sourced from 
google scholar database.  

Results: Climate change affects dengue incidence in Indonesia due to climate 
variability.  

Conclusions: It is essential to Strengthen the surveillance system and provide an 
early warning system (EWS) based on climate information. 

Keywords: Climate change, dengue, Indonesia 

 

INTRODUCTION 

Climate change which is a global phenomenon received attention from many 
countries due to its impact on human and environment. Global temperature surface 
during the decade of 2006-2015 was 0.870C, and between 2030 and 2052 it has 
been predicted that temperature will be 1.5°C. Consequently, the risk of climate 
change to health is expected to be growing (1). Temperature plays a vital role in the 
development, longevity, reproduction and virus transmission of mosquito (2). Climate 
change is suspected to aggravate the risk of mosquito-borne disease, including 
dengue fever. This situation is a global threat, particularly for countries in South Asia 
and Sub-Sahara Africa (3).  
 



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Indonesia is a tropical climate country and archipelagic state.  Accordingly, this 
country is easily affected by climate change such as temperature rising and climate 
shifting that carries some impacts such as drought and failure of harvesting. Climate 
change in Indonesia can be seen from the increasing of the temperature above 
average every year and the decreasing of annual rainfall in some regions. The South 
part of Indonesia tends to have less rain while the north has more rainfall, even it is 
always increasing (4). The temperature average in Indonesia during 1981-2010 was 
27oC. However, in May 2019, it was detected that it was increasing up to 0,9oC (5).   
 
Dengue is a disease that is closely associated with the environmental condition. As a 
result, the changing of environment will lead to a dengue transmission pattern. 
Dengue case in Indonesia in the last 45 years is increasing dramatically with 
intermitted hyperendemic pattern (6) which affected the health of the large 
population. This occurrence predicted the interplay between the disease and climate 
variable. For example, the changing of temperature, humidity and wind speed affects 
the changing of the number of vector population not only for dengue but also for 
some other diseases such as malaria, leptospirosis and filariasis (7).  
 
In 2017, the number of dengue case in Indonesia was decreasing significantly from 
the previous period by having 204.171 cases (8). However, this situation could be 
different in the next coming year due to the changing the environment, such as 
climate changes. Accordingly, a study to summarise the Indonesian situation 
regarding dengue and climate change is essential as a part to prepare adaptation 
strategy to anticipate the worst situation.  
 
This review aims to summarize the previous research that elaborate on the 
relationship between climate change phenomenon and dengue incidence in 
Indonesia. The goal of this review is to develop an idea on an adaptation strategy to 
reduce dengue disease in the future. 

METHODS 

Search Strategy 

Google and Google scholar were used as the main source of database accessed in 
June-July 2019 to extract studies published both in English and Bahasa Indonesia 
that discussed Indonesia context. A set of combination keywords: “Dengue 
haemorrhagic fever”, “dengue fever & climate”, “weather”, “climate change”, “climate 
variability”, “climatic factors”, “temperature”, “rainfall”, “humidity”, “indonesia" were 
used to search the article. We observed research paper published during 2014-2019.  
Title, keyword and abstracts were screened for the first step for the relevant article 
and the full paper that met our criteria inclusion, were included in our analysis.  

Inclusion criteria 

1. Articles must appraise the impact of climate change on dengue transmission 
and spread by discussing climate variables such as temperature, rainfall and 
humidity and disease variables such as incidence and case. 

2. The article should employ epidemiology design such as actual analysis, 
Spatio-temporal and descriptive study for identifying the relationship between 
climate variable versus dengue transmission and spreading 

3. The article should discuss Indonesia and published in 2014-2019 



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Figure 1.  Flow chart of article review 

Results 

Literature search 

Two hundred and sixty-one articles were collected from Google scholar in the first 
step. Among them, 240 articles were excluded since they did not meet the title and 
keyword, while 21 articles were included. In terms of the full paper, 16 articles were 
included, and at the final stage, 13 articles met our inclusion criteria. Methodology 
and main finding of the 13 articles are summarised in Table 1. The study took place 
in Sleman (n=2), North Minahasa District, Ternate City, Limboto subdistrict, Jakarta 
City, Sulawesi Tenggara Province, Surabaya City, Medan City, Banjarmasin City, 
Cirebon District, Kolaka District and Indonesia.  
 
All of the included articles were studying the association between climate variable 
and dengue incidence. Some methods were used to determine the relationship 
between the climate variable and dengue incidence. Three of them employed a 
descriptive study through ecologic approach (9),(13),(18). Correlation and multiple 
regressions (Poisson), path analysis which is an extension from linear regression 
also used as an approach 18. Three articles used time series (12),(16),(21), one 
article employed time series decomposition analysis with Loess (STL) model and 
one article used smoothing (19). Only one article used ecology proxy indicators such 
as Normalized Difference Vegetation Index (NDVI), Moran's I analysis, and LISA 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Studies were selected for 
more detailed evaluation (full-
text articles were retrieved, 
and abstracts were read) 
(n=16) 

 

 

3 articles did not meet inclusion criteria: 
- Discussing climate change and dengue 
fever 
- Discussing Indonesia 
- Research paper 
- Published  in 2014-2019  

 

 

240 articles were excluded because the 
title and keywords were not relevant 

 

Potentially relevant studies 
were identified by searching in 
Google Scholar database 
(n=261). 

 
 
 
 
 
 

Studies were selected by title 
and keywords (n=21) 

 

 

Potentially relevant studies 
(n=13) 

 



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analysis (19). Some research elaborated the determinants such as attitude and 
behaviour, environmental, land cover type, and altitude (11), (14), (15). GAM model 
was used to express the non-linear relationship and non-monotonic between the 
response variable and predictor (17). Four articles reviewed the use of Geographic 
Information System (GIS) to create a risk map based on vector distribution 
(12),(17),(19),(21). 
 
 
DISCUSSION 

Association between climate variable and dengue incidence  

In most of the endemic research location studied, climate variable was significantly 
correlated to dengue cases. Temperature, humidity, and rainfall were the standard 
variables associated with dengue incidence. To identify climate risk factor to dengue 
incidence in Indonesia, research had been done to seek the relationship between 
meteorological variable and dengue (9-21).  

According to the analysis, almost all of the article reported that temperature had a 
correlation to dengue transmission from low to medium power. In Ternate, monthly 
temperature average is 24.8oC-29.0oC. The highest temperature occurred in 2009 
(29oC). At that moment, dengue incidence was increasing from January, and the 
peak occurred in March (10). This occurrence was probably associated with 
mosquito longevity which is at 27oC, so the increase of the temperature influences 
the dengue virus. In other areas, the temperature did not have a correlation with 
dengue incidence, possibly due to the low temperature in that location. Such as in 
Sleman-Yogyakarta, the monthly temperature average is 22,8oC-27,2oC, meaning 
that it tends to be cold for the maturation of mosquito egg.  

Low temperature shortens the incubation period and prolongs the mosquito 
reproduction cycle as well as reduces mosquito biting (22). Large differentiating 
temperature influences the number of female mosquitos, meaning that the number of 
blood-sucking mosquitoes for transmitting the virus is decreasing (11). Meanwhile, in 
Gamping subdistrict-Godean-Sleman District, Medan City and Kolaka District, the 
differences of maximum-minimum of the temperature were associated with dengue 
incidence (11), (17), (20). The high disparity of minimum and maximum temperature 
impacts on the low of dengue incidence (11). 



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Table 1. Studies characteristic discussed the association between climatic variables and dengue 

Study & 
Language 

Study area & 
period 

Data Collection Statistical 
Methods Main findings Comments 

Risk factors Disease/
vector 

   

Lasut et al. 
(2017) 
Indonesian 
(9) 

North Minasaha 
District 2014-
2016 

Temperature, 
humidity, wind 
speed, rainfall 
and number of 
days with rain 

Case 
counts 

- Quantitative by 
using an 
ecology study 
design 

- Correlation test 
- Linear 

regression 
 
 

- A positive correlation was found 
between temperature, humidity, 
wind speed and dengue incidence 

- Rainfall and number of day rain 
were not associated with dengue 
incidence 

- A three-year short study period 
 
 

Tomia et 
al. (2016) 
Bahasa 
Indonesian 
(10) 

Ternate City 
2007-2014 

Rainfall, 
temperature and 
humidity  

The 
monthly 
incidenc
e of 
dengue 

-Pearson 
correlation 

- Temperature and dengue incidence 
were found correlate 

- Rainfall and humidity were not 
associated with dengue incidence 

 
 
 
 

- Employed correlation 
- Added other variables such as habitat 

characteristic, larvae free number and 
community participation on breeding 
site habitat cleaning movement (PSN) 

- Lag times of climatic factors were 
analysed 

 
Kesetyanin
gsih et al. 
(2017) 
English 
(11) 

Sleman District 
2008-2013 

Monthly 
minimum-
maximum 
temperature 

Monthly 
incidenc
e of 
dengue 

-Linear 
regression  

- Temperature variability was found to 
be associated with dengue 
incidence 

 
 

- The only temperature included 
- Explaining other factor such as host 

factors and the environmental factors 
 

Pakaya, 
Ririn 
(2015) 
English 
(12) 

Limboto, 
Gorontalo 2012-
2015 

Precipitation, 
temperature, 
humidity and wind 
speed 

Case 
counts 

-Cross sectional 
-Spearman 
correlation 
- Poisson 
regression 
-GIS 

- The association between humidity 
and dengue incidence was found to 
be significantly negative  
 

- A four-years short study period 
 

Hasannah Jakarta 2008- Temperature, Case - Descriptive with - Strong correlation was found - Relative long study period 



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& Dewi 
Susanna 
(2019) 
English 
(13) 

2016 rainfall, and 
humidity 

counts ecology study 
design  
-Correlation test  

between humidity and dengue 
incidence 

- -Medium correlation was found 
between temperature and dengue 
incidence 

- Rainfall had weak correlation to 
dengue incidence 

 
Kesetyanin
gsih et al. 
(2018) 
English 
(14) 

Sleman District 
2008-2013 

Humidity, land 
cover, altitude, 
rainfall and 
temperature 

Monthly 
incidenc
e of 
dengue 

-Spatial test 
-Spearmen 
correlation test 
-Pearson 
correlation 
 

- Humidity has medium correlation to 
dengue incidence 

- Land cover, altitude, rainfall had 
weak correlation with dengue 
incidence 

- Temperature was not associated 
with dengue incidence 

- All climate parameter did not 
influence dengue incidence in 
sporadic area  

 

- Case number per month was absence  

Tosepu et 
al. (2018) 
English 
(15) 

Kendari, 
Southeast 
Sulawesi 2010-
2015 

Temperature, 
rainfall and 
humidity  

Monthly 
incidenc
e of 
dengue 

-Spearmen test 
-Time-series 
Poisson 
regression 
multivariate 
 
 

- Temperature has positive 
association with dengue incidence 

- Rainfall did not associated with 
dengue incidence  

- Humidity did not associated with 
dengue incidence 

 
 

- Geographical conditions and behaviour 
were explained 

Tang et al. 
(2019) 
English 
(16) 

Surabaya City 
2009-2017 

Temperature 
average, rainfall 
and humidity   

Monthly 
incidenc
e of 
dengue 

-One-Sample 
Kolmogorov 
Smirnov Test 
- Spearman 
correlation 

- Rainfall and humidity were 
associated to dengue incidence 

- Temperature average did not 
associate with dengue incidence  

 
 

- One city was included 
- Difficult to observe the influence of 

temperature because of the lack of 
seasonal variation of temperature in 
Surabaya 

- Lack of mosquito data 
 

Setiawati, 
et al. 
(2017) 

Medan 2002-
2016 

Average 
temperature, 
max-min 

Case 
counts 

-Compile data 
base 
-GAM model 

-  Rainfall, humidity, rainfall, maximum 
temperature influenced dengue 
incidence 

- Several statistical methods were applied 



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English 
(17) 

temperature, 
relative humidity, 
precipitation 

-Design  
vulnerability 
Index & 
Generate in GIS 
 

- Climate variability influenced 74.8% 
of dengue incidence 

 

Ishak et al. 
(2018) 
English 
(18) 

Banjarmasin, 
South 
Kalimantan 
2012-2016 

Temperature, 
humidity, wind 
speed, rainfall 

Monthly 
incidenc
e of 
dengue 

- Quantitative 
descriptive with 
ecological time 
trend 
- Path analysis 

-  the only variable that shown positive 
correlation between dengue 
incidence and rainfall  

 

- Relative short study period 

Astuti et al. 
(2019) 
English 
(19) 

Cirebon, West 
Java 2011-2017 

Rainfall, 
temperature, 
humidity and 
NDVI 

Monthly 
incidenc
e of 
dengue 

-Spearman 
correlation 
-Poisson (GLM) 
-Spatial analysis 
-Time series 
(decomposition 
analysis with 
STL) 
- Moran’s I 
analysis 
- LISA analysis 
 

- Rainfall, temperature and humidity 
were associated to dengue 
incidence  

- One city was included 
- Several statistical methods were applied 
- Ssocioeconomic factors were 

Considered 
- Spatial-temporal analysis 

Tosepu et 
al. (2018) 
English 
(20)  

Kolaka, 
Southeast 
Celebes 2010-
2015 

Rainfall, 
humidity, 
temperature 
average, 
minimum-
maximum 
temperature 

Monthly 
incidenc
e of 
dengue 

-Regression 
linear 
-Spearman 
correlation 
-Poisson 
distribution 
 
 

- All climate variables investigated 
were associated with dengue 
incidence  

 
 
 
 
 
 
 
 
 

 

- Various meteorological variables were 
considered 



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Haryanto. 
Budi 
(2016) 
English 
(21) 

Indonesia 1980-
2010 

Temperature and 
rainfall 

Case 
counts 

-Ecological 
time-series 
study design 
-Vulnerability 
Analysis of the 
IPCC 2001 
-Correlation and 
regression 
analysis 
-GIS 

- High intensity of rainfall had 
weak association in 11 districts in 
Indonesia 

- Rainfall and temperature in other 
city were not associated with 
dengue incidence 

 

- Long-term data from a thirty years 
period 

 

 
 

 



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The impact of rainfall to dengue incidence was recognised in most of the analysed 
research (13-21). Research in Jakarta by using 9 years of data set (2008-2016) 
shows dengue incidence was significantly associated with rainfall about 254-667mm 
then followed by high dengue incidence in 0-3 month in the beginning of the year 
(13). Temporal relationship between rainfall and dengue incidence was identified as 
linear between the increase of 10mm of the rainfall and 1% increase of dengue 
incidence in three months (23). In another research, it was mentioned that the 
increase of the rainfall led to the increase of the mosquito breeding place (9). While 
in North Minahasa and Ternate City, rainfall and dengue were not associated 
(9),(10). According to PLUM model aimed to evaluate the high rainfall intensity and 
larva flush from the breeding place, it shows that rainfall and dengue were not 
associated (24). High of precipitation makes larvae transported and sometimes dies 
due to continues water stream and the absence of puddle for the mosquito breeding 
site (9). 
 
Humidity sometimes caused by high intensity of rainfall, make the environment 
suitable for Aedes life (11),(13). The relationship between humidity and dengue 
incidence occurred in some areas of Indonesia was reported by some researches 
(9),(12),(13),(14),(16),(17),(19),(20) , while the rest of the research did not involve 
humidity as research variable. A research in Jakarta shows that humidity was a 
meteorological variable that is strongly associated with dengue incidence compared 
to temperature and rainfall (13). Likewise, a research in Singapore reported that 
humidity was the most climate variable that influenced dengue incidence (25). 
Humidity is a suitable condition for mosquito reproduction. High humidity affects the 
high dengue incidence as occurred in North Minahasa. In that place, dengue 
incidence was high in January 2015 in 89% of humidity (9). When humidity is lower 
than 60% it will shorten the mosquito age; consequently, mosquito cannot continue 
its reproduction cycle (18). 
 
In North Minahasa, the relationship between wind speed and dengue transmission 
was identified. It could be seen from the increase of dengue case along with the 
decrease of wind speed 1 knot in May 2015. Wind speed influences the mosquitos 
flight range; accordingly, the decrease in wind speed is followed by the dengue 
incidence (9). However, research in Limboto Sub-district and Banjarmasin City 
reported that there was no relationship between wind speed and dengue incidence 
(12),(18). 

CONCLUSIONS 

The impact of climate change and dengue incidence have been discussed on this 
review. Protection and adaptation to this situation are critical to overcoming dengue 
risk in society. Early warning system (EWS) development based on climate 
information can be one alternative solution to inform the community that when 
climate variables are changing it would potentially influence the dengue 
transmission. Holistic work by involving the associated office such as Meteorological, 
Climatological and Geophysical Agency (BMKG) is recommended. EWS based on 
climatic information has been done in Jakarta province and expected to be extended 



Epidemiology and Society Health Review| ESHR 
 

 
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in other regions in Indonesia. This effort aimed to give information to the population 
according to the present climate situation. Accordingly, there would be follow up 
actions such as epidemiological assessment, counselling, environment refinement, 
selective and mass larvaciding, and fogging (26). Other efforts such as mosquito’s 
breeding site elimination or called PSN and health services should be improved and 
scaled up 

AUTHORS’ CONTRIBUTION 
SS Designed the study, writing the manuscript. FF conducted a literature search and 
writing the result.  
 
FUNDING 
This research did not receive external funding 
 
Conflict of interest 
There are no conflicts of interest 

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