Multilevel Analysis: Determinants of Dengue Hemorraghic Fever in Bantul, Yogyakarta

Nurkhairani1), Setyo Sri Rahardjo2), Bhisma Murti1)


1)Masters Program in Public Health, Universitas Sebelas Maret

2)Faculty of Medicine, Universitas Sebelas Maret



Background: Dengue is an important mosquito-borne disease in the world in terms of mor­bi­dity, mortality and economic costs. The factors responsible for dengue hemor­r­hage fever (DHF) incidence are complex, including socio-demographic and en­vi­ron­mental factors. However, studies into the contextual effect of village on DFH are scarce. This study aimed to examine the determinants of dengue hemorraghic fever in Bantul, Yog­yakarta, using multilevel analysis.

Subjects and Method: A case control study was carried out at 25 villages in Bantul, Yog­ya­karta, Indonesia. A sample of 250 study subjects was selected by fixed disease sam­­pling. The de­pen­dent variable was DHF. The independent variables were Maya index (MI), density figure (DF), dwelling density, knowledge, mosquito nests eradi­ca­tion, use of mosquito repellent, and village. The data were collected by questionnaire and analyzed by a multiple logistic regression.

Results: High MI (b= 1.62; 95% CI= 0.87 to 2.37; p<0.001), high DF (b= 1.39; 95% CI= 0.65 to 2.13; p<0.001), dense dwelling (b= 0.64; 95% CI= -0.94 to 1.37; p= 0.087), poor knowledge (b= 1.08; 95% CI= 0.34 to 1.81; p= 0.004), poor mosquito nest eradi­ca­tion (b= 1.13; 95% CI= 0.38 to 1.87; p= 0.003), did not use mosquito repellent (b= 1.19; 95% CI= 0.37 to 1.86; p= 0.003) in­crea­sed the risk of DHF. Village had contextual ef­fect on the incidence of DHF with ICC= 17.34%.

Conclusion: High MI, high DF, dense dwelling, poor knowledge, poor mosquito nest era­di­ca­tion, did not use mosquito repellent increases the risk of DHF. Village has con­tex­tual effect on the incidence of DHF.

Keywords: dengue hemorrhagic fever, Maya index, density figure, mosquito nest era­di­cation, vil­lage

Correspondence: Nurkhairani. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: Nkhairaniskm@gmail.­com. Mobile: +6285229185896.


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