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Epidemiology and Society Health Review| ESHR 
 

Vol 2 No1 2020 
 

31 

Research Article 
 
Dengue Risk Factor in Banguntapan III Primary Health 
Centre, Bantul, Indonesia 
 
Devi Stevani1*, Himatul Husna1, Muthia Ardiyanti1, Yuni Andira Sari1, Desi Nurfita1, 
Sugiarto Sugiarto2, Siti Nurkhoiriyah3 
 
 
1Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia 
2District Health Office of Kulonprogo District, Kulon Progo, Indonesia 
3Primary Health Centre of Banguntapan III, Bantul, Indonesia 
 
* Correspondence: devistefani19@gmail.com. Tel: +6281332735218 
 Received 11 March 2020; Accepted 19 April 2020; Published 05 May 2020 
 

ABSTRACT 

Background: Dengue Haemorrhagic Fever (DHF) is an infectious disease caused by Aedes 
aegypti mosquito. DHF is widespread in many regions worldwide, with the number of 
patients continues to increase every year. This study aimed to determine the risk factors for 
DHF include vector control (3M+) program implementation, residential distance, hanging 
clothes habit, napping habit, repellent usage, and sunlight conditions.  
Method: Analytic observational study with a case-control approach was applied in this study. 
Samples divided into case and control. Of 16 cases and 32 controls were participated in this 
study who purposively selected. Data were collected using a questionnaire. Univariate and 
bivariate using chi-square tests were employed to analyze the result.  
Result: Three variables are associated with the dengue incidence in research location: 
napping habit (OR=11.667), residential distance (OR=1.696), and sunlight condition 
(OR=0.0289). 
Conclusions: napping habits, residential distance, and sunlight conditions are the risk factor 
of DHF incidence. 

Keywords: Dengue, behavior, napping habit, residential distance, sunlight conditions 

 

INTRODUCTION 

Dengue Haemorrhagic Fever (DHF) is an infectious disease caused by the dengue virus and 
be transmitted by (Aedes aegypti) (1). Currently, known four dengue virus serotypes: DEN-1, 
DEN-2, DEN-3, and DEN-4. Dengue virus raises some symptoms such as high fever 
accompanied by manifestations of shock and bleeding that could end with death (2). 
Globally, the number of cases and areas infected by dengue continues to increase each 
year (3).  

Dengue Haemorrhagic Fever (DHF) are found in the tropics and sub-tropics area. Dengue 
cases arise throughout the year, especially during the rainy season coincided with the 
optimal conditions for mosquito breeding. At that time, the number of infected people will be 
increasing in the short period (3). Before 1970, only nine countries experienced an outbreak 
of dengue fever. But currently, dengue is endemic in more than 100 countries, including 
Africa, the Americas, the Eastern Mediterranean, Southeast Asia, and the Western Pacific. 



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America, Southeast Asia, and the Western Pacific have the highest number of dengue cases 
meaning that dengue increases not only in terms of the number but also the area infected 
(4). 

Indonesia Ministry of Health reported that the mortality of DHF by 2016 and 2017 was 
reduced three folds from 1,598 and 493, respectively. Dengue was found first time in 
Indonesia in 1968. Since then, DHF spreads across the country. In 2015 showed that 
dengue has spread in 34 provinces in Indonesia (5); one of which is Yogyakarta. There are 
three districts with dengue endemic in Yogyakarta: Yogyakarta, Bantul, and Sleman. Over 
the past two years, the dengue cases in Bantul were increasing significantly, with 62 cases 
in 2014 and 1,417 cases in 2015. Banguntapan sub-district is one of the dengue-endemic in 
this location. 

Based on data from the Bantul District Health Office, there was an increase of dengue 
morbidity in 2014 to 2016, (0.64 ‰), (1.48 ‰), and (2.62 ‰), respectively. The number of 
DHF cases decreased in 2017 (0.55 ‰) and 2018 (0.18 ‰). Banguntapan sub-district 
consists of 8 villages and served by three health centers: Primary Health Centre I, II, and III. 
The population density of 3,984 people / km2. In 2015, the larvae free rate or called Angka 
Bebas Jentik in three PHC were varied, but all of them were below the national standard 
(95%). Banguntapan I, II, and III had 84%, 80%, and 82%, respectively (6).  

Dengue disease transmits through mosquito bites that contain the virus on their saliva. On 
the other hand, dengue is an environmental disease because environmental conditions 
influence mosquito development. Dengue disease is as well as influenced by socio-
ecological factors (7). Some previous research revealed that environmental factors and 
people's habits strongly influence the increase in dengue incidence. The determinant of 
dengue fever, namely gender, home environment, mobility, not using mosquito repellent, 
house walls, dug wells, and the residential density is a risk factor getting dengue infections. 
Besides, people's knowledge, attitudes, and practice are the risk factors for dengue 
hemorrhagic fever (8–10). Research related to a dengue risk factor is essentials to support 
policymaker in developing dengue prevention efforts. 

METHODS 

This study is observational analytic with a case-control design to study the relationship 
between risk factors of dengue incidence. The case was defined as people who diagnosed 
with DHF in Puskesmas (PHC) Banguntapan III from January-November 2019. There were 
30 cases during that period, and we did total sampling to recruited the respondent. Control 
was defined as people who not diagnosed with DHF in the same period with the case.  
 
Sampling for case and control were selected by purposive sampling with inclusion and 
exclusion criteria. Inclusion criteria for the case are the person recorded in the PHC 
information system as DHF positive and willing to participate in this study. We did a 
matching with 1:2 ratio case vs. control. Control should live in the same neighbourhood as 
the case. Exclusion criteria for case and control were someone moves to another place, so it 
cannot be interviewed. 
 
We used a questionnaire to collect the data. Data were analyzed using univariate and chi-
square tests in bivariate.  

RESULTS 

In total, 48 respondents were participated in this study, consist of 16 cases and 32 
controls. The characteristic respondent is presented in Table 1. Most of the respondents are 



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in the 20-29 years and 40-49 years. The majority of the respondent is female (60.4%), and 
the majority of respondents are holding university education (39.6%). 

Table 1. Characteristics of Respondents 

Characteristics of Respondents Frequency  Percentage  
 n % 
Age group   
20-29  12 25.0 
30-39  11 22.9 
40-49 12 25.0 
50-59  6 12.5 
60-69  5 10.4 
70-79  2 4.2 
Gender   
Male 19 39.6 
Female 29 60.4 
Education   
Primary School 7 14.6 
Secondary School 11 22.9 
High School 11 22.9 
University 19 39.6 

 
Chi square analysis shows, there were three variables associated with dengue incidence: 
residential distance (p value = 0,020), napping habit (p value = 0,021), and sunlight condition 
(p value = 0,032) (Table 2).   
 

Table 2. Dengue Risk Factors Analysis in Banguntapan III PHC, Bantul 
 

Risk Factors DBD  P-value OR  
Confidence Interval 

(CI) 
Lower Upper 

Vector Control (3M) Implementation 0.918 1.296 0.379 4.434 
Residential Distance 0.020 1.696 1.305 2.203 
The habit of Hanging Clothes 1.000 1.140 0.332 3.916 
Napping Habit 0.021 11.667 1.371 99.294 
Repellent Usage 0.460 0.429 0.800 2.308 
Sunlight Conditions  0.032 0.289 0.183 0.457 

 

DISCUSSIONS 

Our research revealed, the current vector control program called 3M (Menutup, Menguras, 
and Mengubur), meaning covering of water containers, cleaning of water containers, and 
burying of discarded containers (11), is not associated with dengue infection. Our finding is 
different from other research previously in Pare PHC, who stated that vector control had a 
significant association with dengue incidence (12). Other studies mentioned that vector 



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control contributed positively to the prevention of dengue outbreaks in Mataram (p <0.05) 
(8). Vector control is the most appropriate approach to prevent and control dengue 
outbreaks. Vector control can be well implemented when the community has good behavior 
on dengue prevention. But, in Banguntapan III, PHC found that the implementation of vector 
control is quite low. Likewise, WHO (2000) stated that the elimination of the Aedes mosquito 
larvae with a grain Temephos with a dose of 1 ppm with the residual effects for three months 
is quite effective to reduce Aedes mosquito populations or increase the number of larvae 
free, also reduce the risk of dengue outbreaks (13).  

Based on the bivariate analysis, there is no relationship between the residential distance and 
DHF incidence, with the Odds Ratio (OR) of 1.696 with a confidence interval (CI) from 1.305 
to 2.203 and p = 0.02. It means a person who lives within the adjacent house had 1,696 
times greater risk for DHF compared with people who have space between the house. This 
factor related to the mosquito flight range that is 100 meters. Accordingly, when the distance 
between the house less than 100 m, it could be easy for the mosquito to reach other homes 
to find people or breeding places. Moreover, it will be exacerbated if people have poor 
behavior, particularly when they less paying attention to the house condition.  Our result 
does not correspond to a survey conducted by Astuti and Lustiyati (2018), who stated that 
there was no significant relationship (p = 0.662) between the distance of the building with 
dengue incidence of dengue (14). 

The bivariate test shows there is no relationship between habits of hanging clothes with the 
incidence of DHF. This result is different from Amrieds et al., who stated that there was a 
relationship between the practice of hanging clothes with the incidence of dengue in 19 
November village, Wundulako District of Kolaka in 2016 (15). The WHO says that the 
mosquito Aedes aegypti prefers to rest in a dark place, moist, hidden area of the building, 
including a bed, toilet, bathroom, and kitchen. This mosquito seldom found rest outside the 
house, such as in the plantation or shelter (13). In this study, many respondents use 
mosquito repellent (79.2%) that could influence the presence of mosquito inside the house. 

The person who has napping habit,11.667 times greater risk for DHF compared with people 
who do not have napping habit. To see the significance of the coefficient by comparing the 
value of significance with alpha (5%), the value of significance is 0,021 less than the alpha 
0.05, which means that the variable habit of napping is statistically significant with DHF. 
These findings are consistent with Amrieds et al., which states that there was a relationship 
between napping habits with dengue incidence in Wundulako District of Kolaka 2016 with p-
value = 0.001. It could happen because Aedes has biting time in the early morning and late 
afternoon when residents nap. Accordingly, people who have napping habit without 
protection: mosquito nets or repellent is at risk of being bitten by mosquitoes Aedes while 
respondents were not napping. People also could be bitten by mosquitoes when they are 
working (15).  

We found that there is no relationship between the use of insect repellent with the incidence 
of DHF. These findings are consistent with research conducted by Riana sari et al., who 
stated that there was no correlation between the use of anti-mosquito habits with the 
incidence of dengue in Mustikajaya village with p = 0.066 (p≤0,05) (16). Use individual 
protection protects people from mosquito bites. These efforts have been undertaken by most 
of the respondents (79.2) in both the case and control groups. So that in this study, we found 
no correlation between the use of insect repellent with the incidence of DHF. 

The results showed that among the 48 respondents, most respondents (93.8%) have a 
home with proper sunlight conditions, while three respondents (6.3%) had insufficient 
sunlight. Based on the bivariate analysis, it shows there is a relationship between sunlight 
condition and dengue incidence. But light is rolled as a protective factor for dengue 



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incidence. This research is in line with research Wijirahayu and Sukesi (2019), who stated 
that no statistical relationship between variable sunlight with dengue incidence (p = 0.39). 
Houses with insufficient sunlight, high-density family member, and poor behavior of 
sanitation contributed to the proliferation and spread of the mosquito Aedes aegypti. 

CONCLUSIONS 

From the results known that residential distance, napping habit, and sunlight conditions are 
the most potential risk factor in the research location. 

 

Authors’ Contribution 

DS, HH, MA, and YA are responsible for data collection and manuscript preparation. DN 
contributed to research permits, data analysis, and manuscript preparation. SS conducted a 
literature review.  SN did research permit application and data collection.  

Funding 

Universitas Ahmad Dahlan funded this research. 

Conflict of Interest 

There are no conflicts of interest. 

 

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