Introduction

Dengue Hemorrhagic Fever (DHF) is an infectious disease caused by the Dengue virus that can
be transmitted through the bite of female mosquitoes, Aedes degypti and Albopictus types, both
mosquitoes are the main vectors that can cause DHF in several countries in the world [1].
Several factors that can affect transmission. Dengue virus, namely: 1) Vector: Vector
development, biting habits, vector density, vector behavior; 2) recipient: the presence of sufferers
in the environment, mobilization, and exposure to mosquitoes, age, and sex of species; 3)
environment: rainfall, temperature, and population density. Aegypti mosquitoes have
anthropophilic and multiple feeding properties, therefore they can transmit the virus to more than
one person. In addition, the mosquito's flight distance is relatively short, around 50-100 meters,
except in the wind (maximum 200 meters).[2]

The cause of dengue fever which is related to environmental problems comprises settlement
density (population density and area of settlement), the mosquito population density, then rainfall
and environmental conditions. Those factors let mosquito breed and can be a perfect ground for
mosquito to develop. Environmental factors are considered to have an important effect on the
increase and transmission of dengue disease because the densely populated residential
environment can support dengue transmission. The more densely populated the easier the Aedes
Sp transmits the virus from one person to another. [3] Humans are the main carriers of the
dengue virus. Countries affected by dengue generally have a rapid increase in population. Thus,
humans will carry more viruses. Improved transportation is a sign of intense mobility and finally
transfers the virus from dengue area to the non-dengue or the other way around. This population
density will facilitate the transmission of the dengue virus due to the multiple bites. [4]

Indonesia is a country with the highest rate of DHF cases in Southeast Asia in 1968 until 2009.
There was an increase from cases, from 58 cases to 158,912 cases. Until now, Indonesia is still a
DHF endemic country. The DHF incidence (IR) reported in 2013 was 45.85 / 150,000 residents.
[5] The incidence of DHF has grown dramatically throughout the world in the last few decades.
More than 2.5 billion people or more than 40% of the world's population are now suffering from
DHF.[6]
WHO estimates that currently there may be 50-100,000,000 dengue infections worldwide each
year. Most of 500,000 cases of DHF requiring hospitalization each year are children with 2.5%
deaths. World Health Organization (WHO) noted that Indonesia is the country with the highest
DHF cases in Southeast Asia. This situation is closely related to the increase in population
mobility in line with the increasing transportation and the spread of the Aedesaegypti dengue
virus and mosquitoes at various regions of Indonesia. Indonesia is one of the endemic countries
of Dengue Fever that every year there are KLB in various cities and every 5 years there is KLB
in a high rate.[4]

Population density can affect the number of DHF events. A large number of individuals in a
certain area will facilitate the spread of dengue disease because it will facilitate and accelerate
the transmission of dengue virus from the vector. Occupant density is one of the assessments of
healthy living. Based on health standards, the width of the house is 10 m2 per occupant, the wider
the area of the house, the greater the house. [7] Population density results in overcrowding. Thus,
the spread of DHF is faster. The growth of population without specific patterns has led to the
emergence of slums with poor sanitation infrastructure and systems which is resulting in
breeding sites for mosquitoes. This review aims to summarize previous research that outlines the
relationship between population density and the incidence of DHF in Indonesia. The purpose of
this study is to develop ideas for adaptation strategies to reduce dengue fever in the future.

Method
Search strategy

Google and Google Scholar are the main sources of data accessed in September 2019 to translate
the research published in English and discusses it in the Indonesian context. A set of keywords
and a combination are: "Dengue Haemorrhagic Fever", "Population Density and Dengue Fever",
"Occupancy Density" which is for articles. I looked at research papers published during 2014-
2019. Keyword titles and abstracts are filtered for the first step for relevant articles. A full paper
inclusion criteria is included in the analysis.
Inclusion criteria

1. The article must assess the impact of high population growth on the transmission of
dengue fever which is spread by the distance of adjacent houses, urbanization.
2. Articles must use epidemiological designs such as actual analysis and descriptive studies
to identify the relationship between population density variables for dengue transmission.
3. Articles must discuss an Indonesian case and be published in 2014-2019.

Results
Literature search

The firstly, twelve articles collected from Google scholar. Among these, 1 article did not meet
the inclusion criteria, 4 articles did not have a relationship of population density with the
incidence of DHF, 7 articles had a relationship of population density and the incidence of dengue
and met the inclusion criteria.

All those articles include the study of relationship between population density variables and the
incidence of dengue fever. Several methods are used to determine the relationship between
population density variables and the incidence of dengue fever. Four of the articles used
ecological studies, [4], [1], [8], [5] two of the articles used a descriptive-analytic survey of cross-
sectional [9], [6], study approaches. One article uses Spearman's test and the use of Geographic
Information Systems (GIS). [2] Some studies describe determinants such as larval free rates,
rainfall, humidity, and water storage [1], [9], [5], [8].

Discussion
The relationship between population density variables and the incidence of dengue fever.

Researchers examined most of the endemic research sites studied. Variable population density is
significantly correlated with dengue fever. According to the analysis of almost all articles
reported that population density has a correlation to the transmission of dengue fever, houses that
are close to each other facilitate the transmission of this disease, given the short distance of the
Ae.Aegypti mosquito, which is about 50-100 meters, except if carried by the wind. Ae.Aegypti
mosquitoes can fly a maximum of 200 meters. [4], [1], [9], [8], [2], [6], [5] In other areas, the
population density does not correlate with the incidence of dengue fever perhaps because the
population has good immune status. This is also caused by the area of the house and the number
of residents and residents of the house doing many activities outside the home. [10], [3], [11], [7]
However, dengue infection does not only occur at home but can also be infected with dengue at
school or other public places. [10]

The distribution of DHF events based on population density shows that in the zone of the spread
of DHF cases that are in a radius of fewer than 240 meters can occur in almost all parts of the
area classified as having high population density. Population density is associated with mosquito
flying distances and dengue disease transmission. This is because the more densely populated the
easier it is for DHF transmission. Therefore, the mosquito's fly distance is approximately
50m.[4], [2]
Table 1. Characteristics of Relationships Between Variables Population Density and Occurrence of Dengue Fever

Study & Data collecting Statistic

Study Location Main Result Comment
Language Risk Factor Vektor Method
High population
Ecology study
Bondowoso density and close-
Irma Prasetyo Population and descriptive
Regency, East Dengue Fever between make the
(2015) density analysis scatter
Java spread of DHF
plot analysis
more intensive
- High rainfall
significantly
correlates with
dengue cases.
- Population
Population density and the
Rika Kurniawati Jember Regency density, incidence of DHF
Dengue Fever Ecology Study
et al. (2014) (2014) Rainfall, and are each
ABJ correspond.
-There is a
significant
relationship
between ABJ and
DHF cases
 The distribution of
DHF events based
Agcrista Descriptive on population
permata & Dyah Kedungmundu analysis survey density with buffer
Population
Mahendrasari Health Center Dengue Fever by study cross- analysis shows that
density
(2016) (2016) sectional all villages have
approach the potential to
cause dengue
transmission.
-Population density
affects the
incidence of DHF.
Emilia Chandra -Rainfall affects
(2019) the incidence of
Population
DHF.
density,
Jember (2019) Dengue Fever Ecology study -Humidity is
Rainfall, and
related to the
humidity
incidence of DHF.
-There is a
correlation
between
population density
 and the occurrence
of Dengue Fever
There is a
correlation
Rahmi & Pupita Palu (2010- Population Spearman’s rho between
Dengue Fever
Sari (2017) 2014) density experiment population density
and the occurrence
of Dengue Fever
-The occupancy
density and the
incidence of DHF
Balleangin is significantly
Population
Abd Majdi et al. Village, Balocci Cross Sectional correlated.
Density, Dengue Fever
(2017) District, Design -There is a
Landfill, 3M
Pangkep relationship
between TPA and
the incidence of
dengue fever
Temperature, -The temperature
Masrizal & Tanah Datar
rainfall, could affect the
Nova Permata Regency (2015- Dengue Fever Ecology study
population incidence of
(2016) 2016)
density, and dengue fever.
wind velocity -There is a
relationship of
rainfall with the
incidence of
dengue fever.
-There is a
relationship
between wind
speed and the
incidence of
dengue fever.
- Dense population
density is one of
factors of dengue
fever
Conclusion

The study notes that a dense population corresponds with the incidence of Dengue Fever.
Population density requires special attention from the government regarding the feasibility of
human life, especially due to unpredicted and controlled urbanization. Therefore, the information
is needed to present the geographical distribution of population that allows the government to
overcome the problem of the population density. Information about population density is
certainly very influential, in particular on health interests.

References

1. Rika Kurniawati, D.M.W., Analisis Spasial Sebaran Kasus Demam Berdarah Dengue
(DBD) di Kabupaten Jember Tahun 2014. Artikel Ilmiah Hasil Penelitian Mahasiswa,
2015: p. 1-7.
2. Rahmi A.R, P.S., Hubungan Kepadatan Penduduk dengan Kejadian Demam Berdarah
Dengue (DBD) di Kota Palu. Jurnal Ilmiah Kedokteran 2017. 4(1): p. 49-58.
3. Suhermanto, S., Demam Berdarah Dengue Berdasarkan Kepadatan Penduduk dan
Curah Hujan. Jurnal Bahana Kesehatan Masyarakat ISSN, 2017. 1(1): p. 75-86.
4. Prasetyowati, I., Kepadatan Penduduk dan Insiden Rate Demam Berdarah Dengan
(DBD) Kabupaten Bondowoso,Jawa Timur. The Indonesian Journal Of The Health
Science, 2015.
5. Masrizal, N.P.S., Analisis Kasus DBD Berdasarkan Unsur Iklim dan Kepadatan
Penduduk Melalui Pendekatan GIS di Tanah Datar. Jurnal Kesehatan Masyarakat
Andalas, 2016: p. 166-171.
6. Abd. Majid HR. Lagu, D.S.D., Hubungan Jumlah Penghuni, Jumlah Tempat
Penampungan Air dan Pelaksanaan 3M Plus dengan Keberadaan Jentik Nyamuk Aedes
sp di Kelurahan Balleangin Kecamatan Balocci Kabupaten Pangkep. ISSN, 2017. 3(1):
p. 23-29.
7. Agustina Ratri M, N.E.W.d.R.M., Hubungan Kepadatan Penduduk dengan Kejadian
Demam Berdarah Dengue di Semarang. Jurnal Kesehatan Masyarakat (e-Journal), 2017.
5(5): p. 434-440.
8. Chandra, E., Pengaruh Faktor Iklim Kepadatan Penduduk dan Angka Bebas Jentik (ABJ)
Terhadap Kejadian Demam Berdarah Dengue (DBD) di Kota Jambi. Jurnal
Pembangunan Berkelanjutan eISSN, 2019. 1(1): p. 1-15.
9. Agrista Permata Kusuma, D.M.S., Analisis Kejadian Demam Berdarah Dengue
Berdasarkan Kepadatan Penduduk. Unnes Journal of Public Health, 2016: p. 48-56.
10. Adi Septian1), M.C.A., Marsum, Studi Korelasi Beberapa Faktor yang Mempengaruhi
Kejadian Demam berdarah Dengue di Kabupaten Banyumas 2015.
11. Sri Handayani, P.F., Analisis Spasial Temporal Hubungan Penduduk Dan Ketinggian
Tempat Dengan Kejadian DBD. Jurnal Kesehatan Medika Saintika, 2015. 8(1): p. 25-33.