2009, and 2012; in Padang Pariaman Regency in 2008, 2011, and 2012; in the city of Padang. Panjang in 2007 and 2008; in the city of Denpasar in 2006, 2009 ...
DENGUE HEMORRHAGIC FEVER VULNERABILITY TO CLIMATE IN INDONESIA: ASSESSMENT, PROJECTION AND MAPPING Paper Presented on International Conference on Innovative Trends In Multidisciplinary Academic Research (ITMAR), Istanbul – Turkey, 20-21 October 2014 Budi Haryanto Department of Environmental Health – University of Indonesia
ABSTRACT A change in temperature, humidity, and wind speed, are contributing to the increase in vector population, increasing their life-span and also widen their spread. This in turn may intensify the occurrence of vector-related communicable diseases such as leptospirosis, malaria, dengue hemorrhagic fever (DHF), yellow fever, schistosomiasis, filariasis and plague. In Indonesia, there is an increase of risks for certain populations who are more susceptible to damages caused by climate change, such as the poor and the very poor (45.2% from 105.3 million), coastal community (64% of people in Java Island live in coastal areas), children and the elderly, farmers, traditional community, people living in small islands (17,500 islands). Climate change is definitely and causing negative impacts on the community, with the worse to expect. There is a need to have an accurate and reliable data on human health vulnerability and maps of diseases areas induced by climate change. The objective of this study is to develop a model of climate change projection linked with incidence of DHF and Malaria complemented with distribution maps for each of 20 cities/districts in 5 provinces: West Sumatera, DKI Jakarta, East Java, Bali and Central Kalimantan in 2013. Ecological time-series study design was used to quantify the relationships between exposure and response for a range of climate-sensitive diseases by using time-series data climate of temperature, rainfall, and relative humidity 1980-2010 and data incidence/prevalence of Dengue Hemorrhagic Fever and Malaria 1980-2010. The projection model analysis was developed up to year 2030. Vulnerability and Risk model of the IPCC AR4 was used to identify and quantify the vulnerable population to the disease outcome. Spatial mapping distribution on malaria’s and dengue’s breading places including its radius coverage of flying distance were developed in regard to identify current and future populations at risk. Mapping was developed at the local scale, with linkage to census-derived small area indicators, or at a larger scale to show geographical areas distribution risk to Malaria and DHF. The expected finding will enhance the national efforts to develop the health adaptation strategy and action accurately. Keywords: Dengue Haemorrhagic Fever (DHF), Climate, Indonesia INTRODUCTION Located between 06o 08’ North – 11o 15’ South and 94o 45’ - 14o 05’ East, Indonesia is known as the biggest island country in the world which consists of five main islands and 30 smaller island groups including 17,500 islands. The total area of Indonesia comprise 3.1 million KM2 of ocean 73-1
(62% of the total area) and approximately 2 million KM2 of land (38% of total area), with a coastal line that extend to 81,000. If the economic exclusive zones of 2.7 million KM2 included the total jurisdiction area of Indonesia is no less than 7.8 million KM2 . Indonesia’s geographic and geological characteristics are also easily affected by climate change, natural disasters (earthquakes and tsunamis), and extreme weather (long drought and floods). Its urban areas also have high pollution levels. Climate change is a serious challenge currently facing, as the impacts are already happening. Much evidence can be seen, ranging from an increase in global temperature, variable season changes, extremely long droughts, high incidence of forest fires, and crop failures. In Indonesia, climate change can be detected from an increase in temperature at a rate of 0,03 o C and an increase in rainfall of 2-3% per year (Hulme and Sheard, 1999), as well as a change in ENSO (El Nino Southern Oscillation) to 2-5 years from what was normally 3-7 years (Ratag, 2001). This affects not only the environment, but also public health in a global scale, both directly and indirectly. A drop in rainfall due to climate variability or seasonal change combined with a rise in temperature has significant effects on water supply (El Nino effect). A rise in seawater temperature has contributed to the spread of diseases such as malaria, dengue fever, diarrheal, cholera, and other vector-related diseases (La Nina years). A change in temperature, humidity, and wind speed, are also contributing to the increase in vector population, increasing their lifespan and also widen their spread. This in turn may intensify the occurrence of vector-related communicable diseases such as leptospirosis, malaria, dengue fever, yellow fever, schistosomiasis, filariasis and plague. Extreme occurrences influenced by climate change in Indonesia, such as floods, hurricanes, tidal waves, landslides, droughts, and forest fires, are happening more often than before. There are 300 events of extreme occurrences from January to August 2008, resulting in 263 deaths, 1927 critically injured, 66,988 with mild injuries, 7 missing, and 92,210 refugees. Those refugees are susceptible to easily spreading communicable diseases, even worsened by unpredictable climate. The health risks to the community due to climate change include the spread of diseases such as malaria, dengue fever, diarrhoea, cholera, and other vector-related diseases. There is an increase of risks for certain populations who are more susceptible to damages caused by climate change, such as the poor and the very poor (45.2% from 105.3 million), coastal community (64% of people in Java Island live in coastal areas), children and the elderly, farmers, traditional community, people living in small islands (17,500 islands). Climate change is definitely and causing negative impacts on the community, with the worse to expect (Ministry of Health Republic of Indonesia, 2011). The availability of relevant hydro-meteorological, socioeconomic and health data is limited and available data are often inconsistent and seldom shared in an open and transparent manner. Furthermore, there is insufficient capacity for assessment, research and communication on climate-sensitive health risks in Indonesia, as well as insufficient capacity to design and implement mitigation and adaptation programs. However, in Indonesia, the urgent need to incorporate health concerns into the decisions and actions of other sectors has been recognized since the last couple years. In which a scenario to mitigate and adapt to climate change, to ensure that these decisions and actions also enhance health, had been developed.
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DENGUE HAEMORRHAGIC FEVER (DHF) IN INDONESIA Changes in climate that can affect the potential transmission of vector-borne infectious diseases include temperature, humidity, altered rainfall, soil moisture and rising sea level. The factors responsible for determining the incidence and geographical distribution of vector-borne diseases are complex and involve many demographic and societal as well as climatic factors. Transmission requires that the reservoir host, a competent vector and the pathogen be present in an area at the same time and in adequate numbers to maintain transmission. Among others, the important of vector-borne diseases related to climate change in Indonesia is dengue hemorrhagic fever (DHF). South Sumatera, Java, Bali, Central Kalimantan, and North Sulawesi are endemic areas for DHF. Dengue hemorrhagic fever has spread to all cities throughout Indonesia since the 1968. In 1968 IR of DHF reported cases were 0,05/100.000 population with a case fatality rate (CFR) of 41,3%, thereafter, outbreaks frequently occur in several areas. In 1998 an outbreak with 72.133 cases, and a mortality rate of 2%, was the most severe outbreak ever happened since the first DHF case was reported in Indonesia. In 2004 a national outbreak occurred, in 40 districts and cities in 12 provinces with a number of cases of 28.077, with mortality of 381 cases (CFR 1.36%). DHF increases continuously for the period of 1999-2007 reaching an IR of 71,78 per 100.000 population, even if there had been a case of decrease in 1998. All year round throughout 2007, 11 provinces suffered from DHF outbreaks, namely, West Java, South Sumatera, Lampung, DKI Jakarta, Central Java, East Kalimantan, Central Sulawesi, East Java, Banten, and DI Yogyakarta. Its number of cases were 156.767, an IR of 71,18/100.000 population, and fatality of 1570 cases (CFR 1,00 %). Total number of Dengue Hemorrhagic Fever (DHF) cases reported in 2008 is 136,333 cases with 1,170 deaths (CFR=0.86%, and Incidence Rate=60.06 per 100,000 population). The highest incidence rate is in DKI Jakarta, is 317.09 per 100,000 population and the highest CFR recorded is Jambi (CFR = 3.67%). In 2009, 154,855 cases of DHF were reported with 1,384 deaths (CFR: 0.89%). In 2010, 159,322 cases of DHF were also reported with 1,317 deaths (CFR: 0.87%).(Ministry of Health the Republic of Indonesia, 2008a) The increasing number of cases over years and its spread in Indonesia is shown on Figure 1.
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INCIDENCE RATE PER 1000 POPULATION BY NUMBER OF CITIES/REGENCIES WITH DENGUE HEMORRHAGIC FEVER CASES Cities/Regencies
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Figure 1. Incidence of DHF per 1000 population by number of cities/regencies infected
In 2010, a study reported by ICCSR (Indonesian Climate Change Sector Roadmap) generated Maps of DHF’s risk caused by climate change across the country (Figure 2).(ICCSR, 2010)
Map of dengue haemorrhagic fever risk in Indonesia
Less risk Low risk Middle risk
High risk Very high risk
Source: ICCSR 2010 Figure 2. Map of Dengue Haemorrhagic Fever Risk in Indonesia 73-4
DENGUE FEVER VULNERABILITY ASSESSMENT Conducted by the Research Center for Climate Change University of Indonesia (RCCC UI) in collaboration with the Directorate of Environmental Health of the Ministry of Health and ICCTF (Indonesia Climate Change Trust Fund), a study on dengue fever vulnerability had been carried out with the aims to reveal the relationship of Dengue Hemorrhagic Fever (DHF) to climate change or variability and to develop models and vulnerability map for the distribution of communities and regions prone to climate induced DHF in 2038, in 20 districts/cities in 5 Provinces: West Sumatera, Jakarta, East Java, Bali and Central Kalimantan. The 20 cities/districts were selected based on its availability of monitoring station of the Climatology Meteorology and Geophysics (BMKG). Research design used in this study are: 1) ecological time-series study to prove the statistical relationship between climatic factors with the incidence of DHF; 2) Vulnerability Analysis of the IPCC 2001 was used to develop a model of community vulnerability in accordance to the character of DHF disease based on variables in the component such as exposure, sensitivity, and adaptive capacity; and 3) Geographic Information Systems (GIS) with its following extensions was used to map the distribution of DHF by year, patient’s address, flight range of Aedes aegypti’s mosquitoes from its original breeding place, land use, hydrology, contours, roads, and socio-economic data. The data revealed that number of DHF patients per 100,000 population (Incidence Rate = IR) in almost all study areas show a similar pattern since 2001, which was likely to increase significantly with the peak in year 2010. Then IR decreased sharply in 2011, but was followed by a tendency to increase in subsequent years. Correlation and regression analysis showed that higher rainfall was associated with an increased incidence of DHF (p
