Dengue Hemorrhagic Fever in Indonesia: Identifying Provincial Trends and Clusters of High Disease Incidence Within A Vast Tropical Archipelago

Abstract

Anthropogenic processes have a profound impact on environmental health, and by extension, on human health. This thesis uses the sporadic emergence of dengue fever (DF) to explore how ecological transformation influences human vulnerability to infections. Urbanization, changing land use, and the resulting environmental destruction are likely drivers of increasing dengue hemorrhagic fever (DHF) throughout Indonesia, a tropical archipelago whose unique geography causes its population to be particularly susceptible to global climate change. This paper analyzes the number of reported DHF cases, DHF incidence rate per 100,000, DHF case fatality rate, and total DHF fatalities for 33 provinces in Indonesia. The most densely populated and urbanized areas of Indonesia––West Java, Central Java, and East Java––are experiencing the highest number of DHF cases and fatalities. Cluster analyses show that DHF is aggregating on provinces in Kalimantan, the Indonesian section of the island of Borneo, which are suffering greatly from changing land use, drought, and forest fires. Incidence rate analysis supports this association by showing that major outbreaks in these areas are occurring in the years directly following damaging forest fires. General upward trends of DHF incidence rates on Sumatra and Sulawesi suggest the potential influence of a warming climate. This research indicates that the rising prevalence of DHF in Indonesia is likely associated with anthropogenic activities and could potentially be curtailed with increased environmental precautions. Ultimately, as Earth experiences a Third Epidemiological Transition fueled by profound anthropogenic ecological transformation, humanity risks experiencing an intensifying disease burden.