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Epidemiology and Society Health Review| ESHR 
 

Vol 2, No 2 (2020) 
 

69 

Research Article 
 
Epidemiology of Dengue in Jetis Public Health Centre, 
Yogyakarta 2013-2016 
 
Azip Hasbi Asidik1,2, Rokhmayanti Rokhmayanti1, Sri Supraptiningsih3, Yudha 
Puratmaja4 

 
1 Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia 
2 Master of Public Health Program, Faculty of Medicine, Public Health and Nursing, 
Universitas Gadjah Mada, Yogyakarta, Indonesia 
3 Jetis Primary Health Centre, Yogyakarta, Indonesia 
4 Master of Public Health, Faculty of Public Health, Khon Kaen University, Khon Kaen, 

Thailand  
 
*Correspondence: rokhmayanti@ikm.uad.ac.id. Telp: +6281229517992  
Received 02 June 2020; Accepted 09 July 2020; Published 19 February 2021 
 

ABSTRACT 

Background: Dengue disease is found in tropical and sub-tropical climates worldwide, 
especially in urban and semi-urban areas. Of 70% of actual cases exist in Asia. The incidence 
of DHF in Indonesia during 2018 amounted to 24.73 per 100,000 inhabitants. Yogyakarta City 
is one of the dengue susceptible areas that receive serious attention from the health 
authorities. Jetis Public Health Centres is one of the PHC in Yogyakarta with high dengue 
incidence with one mortality. The purpose of this study was to describe the epidemiology of 
dengue cases based on time, place, people, observe dengue trend, and assess the larva free 
rate target’s achievement. 
Methods: This research was descriptive quantitative using secondary data obtained from Jetis 
Primary Health Centre's health information system, Yogyakarta. Dengue data year 2013-2016 
was analysed using descriptive epidemiology (time, place, and people) to show the dengue 
trend. Last, the larva free rate was compared between targets and achievements.  
Results: In 2016, the dengue case increased from 81 to 104 in 2014 with one mortality. Out 
of 104 cases, 37 cases occurred in the Bumijo village, 33 cases in Cokrodiningratan village, 
34 cases in Gowongan village. 85.58% of DHF cases occur at age ≥ five years, and 57.69% 
happen in women. The achievement of larvae free rate was 67.73% and had not reached the 
determined target. There was a tendency for an increase in dengue cases from May to June 
during the observed year.  
Conclusions: 2016 was the peak of dengue cases during 2013-2016. Women and people 
aged more-equal to five years were the most infected group. Most of the cases were found in 
Bumijo village. Larva's free rate in Jetis was not achieving the target. June was the peak of 
the case in 2016.  

Keywords: Dengue Fever, Dengue Haemorrhagic Fever, Epidemiology, Yogyakarta 

 

 

 



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INTRODUCTION 

Dengue fever is a viral infection transmitted by Aedes aegypti mosquitoes. The latest WHO 
estimates 390 million dengue infections per year, 96 million with severe disease levels. 
Globally, the WHO estimated the prevalence of Dengue fever 3.9 billion people spread over 
129 countries, 70% of the burden was in Asia (1). The disease is found in tropical and sub-
tropical climates worldwide, especially in urban and semi-urban areas (2).  

The climate change phenomenon that changes weather patterns is believed to contribute to 
the death, injury of some infectious diseases (3). Globally, the dengue incident has risen 30 
times over the last 50 years, and the climate is a driving force on the distribution and incidence 
of dengue fever (4). Some literature review discusses the inconsistent relationship between 
climate variability and the transmission of dengue fever and needs advanced research about 
that (5).  

Aedes Aegypti mosquitoes are susceptible to environmental conditions, especially 
temperature, rainfall, and humidity (6)-(7). Previous research indicates there was no 
correlation between precipitation and humidity with dengue fever [6]. Another study has shown 
that dengue fever cases were correlated with rainfall but not the case for temperature (8). 
Research in Indonesia shows that higher temperatures have led to shorter incubation periods 
and virus replication (7). 

These factors affect the pattern of dengue cases, the time of the incident, the number of people 
involved, and the case's location or area. Meteorological and Climatology Agency (BMKG) 
estimates that Indonesia is experiencing an increased rainfall in early February and faces a 
long rainy period in February-March. This situation leads to flooding in some areas, including 
in Yogyakarta (9). Program to preventing outbreaks has been developed through the decree 
of the Indonesia Minister of Health. Its main activity is mosquito nests eradication as part of 
early awareness in society (10). Dengue prevention and control success depends on effective 
vector control measures and sustainable community involvement (11). Besides, it is essential 
to detect the dengue diseases associated with severe dengue fever and access to appropriate 
health care to reduce the mortality rate from severe dengue to below 1% (11) 

Dengue incidence in Indonesia reached 24.73 per 100,000 population in 2018 (12). In 2016, 
90.08% of Indonesia's regions were infected with dengue fever. This number increased to 
84.44% in 2017, and a continuous increase in 2018 with 85.60% with a mortality rate due to 
dengue was 0,70% (12). Five Yogyakarta provinces suffer from dengue every year; one of 
them was Yogyakarta City (12). One of the PHC in Yogyakarta City categorized as high 
dengue incidence in 2016 was Jetis PHC - with 104 dengue cases and one mortality. The 
following year – 2017 and 2018, there were 32 and 5 cases, respectively (13). The purpose of 
this study was to describe the epidemiological of dengue cases based on the time, place 
people, observe the dengue trend and assess the achievement of larva free rate in Jetis PHC 
of Yogyakarta.  

METHODS 

Quantitative descriptive was applied in this research. We used tables and graphs to present 
our analysis. Secondary data set (2013-2016) from SIMPUS (information system 
management system) in the health centre, manual report and case registry were obtained 
from the Jetis Primary Health Centre, Yogyakarta City. The data was collected from residence 
who diagnosed with dengue positive in Jetis health center during that periods. Data was 
analyzed using descriptive epidemiology (time, place, and people), trend, and comparative 
analysis.  



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RESULTS 

Epidemiology descriptive 
1) Case distribution by time 

Based on the case report, Dengue disease in the work area of Jetis PHC occurs every 
year. In 2013 dengue case in this area was 56, and in 2014 was 19 cases. However, in 
2015 there was an increase in the case of more than twice higher compare with last year 
(81 cases). 2016 was the year with the highest cases compared to the previous 2 years 
(Figure. 1 and 2).   
 

 
 

Figure 1. Number of dengue case in Jetis PHC, 2013 - 2016 

During 3 years of observations, most dengue cases occurred in 2016, with 1 case of 
death in January. The dengue case peak occurred in June that increased significantly 
from 2 cases in June to 21 in June. (Figure. 2). 
 
 
 

Figure 2.   Number of the monthly case and mortality Jetis PHC year 2016 

 
Time-based analysis can be seen from trends using maximum and minimum patterns during 
the 3-years of data set. The year 2013 - 2015, the increase of dengue cases occurred in April, 
and the peak was in June. Then it decreased and fluctuated in the following month. The same 
happened in 2016, where there was an increase in the case after April to June (Figure 3). 

 

56

19

81

104

65

0

20

40

60

80

100

120

2013 2014 2015 2016

N
um

be
r o

f c
as

e 
(n

)

Year

Cases Mean

5 4

8

2

18

21

3

11 11

8 7
5

1 0 0 0 0 0 0 0 0 0 0 0

9

0

5

10

15

20

25

Jan Feb Mar Apr May Jun Jul Aug Sep Okt Nov Des

N
um

be
r o

f c
as

e 
(n

)

Case

Death

Mean



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Figure 3. Dengue case trend in Jetis PHC, during 2013-2016 

2) Case distribution by place 

 
Figure. 4. Dengue case per village in Jetis PHC year 2016 

 
Jetis District is part of the City of Yogyakarta, located near the Code River. The Jetis 
Community Health Center's work area consists of three villages: Bumijo, 
Cokrodiningratan, and Gowongan. Of the 104 DHF cases in 2016, the highest case 
occurred in Bumijo Village (Figure 4).  
 

3) Case distribution by people  
Most of the dengue cases in the research area occurred in people aged ≥ five years 
(85.58%). More than half of the dengue cases were infecting women (57.69%) (Table 
1). 
 

 
 
 
 

Jan Feb Mar Apr Mei Jun Jul Agu Sept Okt Nov Des
Minimal 2 4 1 4 1 2 0 1 0 0 0 0
Maksimal 6 14 5 12 15 18 8 6 6 6 1 2
Diamati (2016) 5 4 9 2 18 21 3 11 11 8 7 5

0

5

10

15

20

25

37

33

34

31

32

33

34

35

36

37

38

Bumijo Cokrodiningratan Gowongan

D
en

gu
e 

ca
se

 n
um

be
r (

n)



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Table 1. Dengue case distribution by sex in Jetis, 2016 

Age  
Sex 

N (%) Male Female 
< 5 years 7 8 15 (16,42) 
≥ 5 years 37 52 89 (85,58) 
N (%) 44 (42,31) 60 (57,69) 104 (100) 

 

Comparative analysis 

One indispensable indicator in dengue prevention is larva-free rate (ABJ). Jetis PHC targeted 
the ABJ coverage of ≥ 95%. However, the implementation merely reached up 67.73% or still 
under the target (Figure 5). 

 
Figure 5. Comparison between target and achievement of larva free rate  

DISCUSSIONS 

This research discusses the epidemiology of dengue cases in Jetis PHC, Yogyakarta City by 
time, place, and people during 2013-2016, followed by trend and comparative analysis for 
larva free rate for 2016.   

Case distribution by time 

Dengue cases were increasing during the three years of observation in the research area 
(2013-2016). Most cases occurred in 2016 (104 cases), most of which occurred in June. 
Several previous types of researchers observed the relationship between the dengue 
increases and the rain intensity that potentially raises Aedes’ aegypti breeding habitat, such 
as puddles (14)-(15). A high mosquito population supported with proper air humidity increases 
people's risk of contact with the mosquito (16). Dengue peak in Jetis PHC, which occurred in 
June, is following literature that reported in some big cities in Indonesia dengue transmission 
season occurred in March to August with peak happened in June (16). However, a previous 
study showed the relationship between the dengue case and the climatic variable was not 
consistent (5). In 2017 and 2018, dengue cases in Jetis PHC were declining from 32 to 5 
cases. The decline of dengue cases in the period is probably related to the decrease of vector 
existence because of the development of larva free rate achievement (13). 

 

67,73%

95%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

An
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Be

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Je
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Target CapaianAchievement 

La
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a 
Fr

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 R

at
e 



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Trend analysis 
During 2013-2016, dengue cases occurred throughout the year that mostly dengue peaks 
occurred in June, then decreasing and ups-down in the following month. Some references 
reported the association between dengue and rainfall (14)-(15). Climate change means 
changing climate pattern is recognized as a factor that leads to death, injury, and fatality for 
some climate-sensitive infectious diseases (3) 

Indonesia is experiencing high rainfall intensity from February to March and potential flooding 
in some areas, including Yogyakarta (9). Yogyakarta has a dengue transmission season from 
March to August, and usually, the peak occurred in June (16). This situation is following the 
case that happened in the work area of Jetis PHC. However, the literature indicates no direct 
correlation between monthly dengue cases with monthly rainfall and the average temperature 
(17). Therefore, it is necessary to maximize the early warning system and conduct appropriate 
studies to reduce future cases. Literature mentions that proper Bayesian Spatio-temporal 
models allow the identification of various regional groups and climate covariate impact. 
Prediction of high-risk areas and the mutual influence between areas, climate variables, and 
temporal data will help policymakers retrieve dengue prevention measures (18).  

Case distribution by place  
The increasing dengue case could be associated with the rising vector existence, closely 
related to human risk factors such as population density, mobility, and housing (19). In 2016, 
population densities in Jetis PHC were 16,074 per km2, categorized as high density (20). Rapid 
urban population growth, population mobilization, and low population control allow the dengue 
outbreak to increase the probability of more fabulous mosquito presence in populated areas, 
with habitat expansion in the future (21). Jetis sub-district is among five other subdistricts in 
Yogyakarta City with a high dengue case (13) because it has increased population density 
and is located on the riverbank. 
 
Case distribution by the people 
Dengue disease in the Jetis Health Center area mainly attacks people aged over five years 
(85.58%). Literature states that there has been a change in dengue patterns from children 
under 5 to all age groups, even more in the productive age or adolescent and adult groups 
(22). Changes in dengue epidemiology are also influenced by environmental health factors 
(16). Our research also found that most of the dengue cases occur in the female of 57.69%, 
it might be because women spend more time with their domestic affairs than men who 
primarily work out the region.  

Comparative analysis 
The dengue transmission dengue is closely related to vector control measures implemented 
to speed up community participation (23). The process requires persistence of patience, and 
effort to continuously provide understanding and motivation to individuals, groups, and society. 
A study showed that the public's counselling does not affect the community's behaviour in 
vector control activities (PSN) because the community has various characteristics that 
potentially influence their understanding, making them unable to implement dengue vector 
control (22 independently. As a result, PSN activities need to be run maximally with guidance 
from the key stakeholders, such as the primary health centre.  
 
On vector control (PSN), education and economic status are important factors that influence 
community participation. Education and financial situation have a positive correlation to the 
prevention behaviour of dengue (24). Moreover, the family size, the adults, the income, and 
perception are significantly associated with reducing dengue cases (25). People who have 
suffered from dengue fever are very likely to use adaptation measures than people who do 
not experience dengue fever. Noting that factors may be beneficial to public health authorities 



Epidemiology and Society Health Review| ESHR 
 

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to develop an awareness of dengue fever in the community and population sensitivity to use 
measures adaptation (25). 
 
Mosquito-nest eradication (PSN) is part of the dengue early warning system under the health 
regulation ministry (10). Labours in improving dengue early warning systems and control need 
to be improved, especially on systematic surveillance of diseases and vectors in PHC, 
city/district, provincial, and central government levels. Cooperation across sectors requires 
finding a proper approach aimed to reach a broader community (26). 

CONCLUSIONS 

Dengue case in 2016 was the highest case during 2013-2016, with a peak that occurred in 
June. Most of the dengue cases happened in women and people aged ≥ five years. Bumijo 
was the hotspot of dengue during that period. Larva free rate (ABJ) in the Jetis sub-district 
has not reached the target. Active early warning systems between primary health center staff 
and the community need to be done to achieve ABJ targets and maximize efforts to prevent 
and reduce dengue cases. 

Authors’ Contribution 

AHA contributed to the data collection, data analysis, report writing, and manuscript 
publication, RR contributed to licensing, data analysis, and report writing. SS participated as 
a provider of data and information, data analysis, and report writing. YP participated in data 
analysis and writing. 

Funding 

This research has not received external funding.  

Acknowledgments 

Thanks to Jetis Primary Health Center, Yogyakarta City, which has provided the study's data 
and information. 

Conflict of Interest 

There are no conflicts of interest. 

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