Nugroho Susanto, M. Dody Izhar, Frans Manangsang

Children Under 5 Years as Predicting Dengue Transmission in Kebumen District, Indonesia: Case Study Mapping Approaches

Introduction

Children under 5 years as predicting dengue transmission in kebumen district, indonesia: case study mapping approaches. Investigates dengue transmission in Kebumen, Indonesia. Identifies children under 5, population density, and incidence rates as key predictors, mapping high-risk zones via case study.

Abstract

Background: Dengue disease is still a problem in the world. Factors affecting population main importance for dengue transmission. The dengue cases severity 34.40% in Indonesia, and the study area is an endemic dengue. The study aimed to determine factors causing dengue transmission in the Kebumen district, Central Java Province.Subjects and Method: A cross-sectional study was conducted in 460 villages in Kebumen district, Central Java. The study was conducted in 2024 by taking dengue data from medical records in the period January 2023 to December 2023. The number of dengue cases during the study period was 395 cases that were diagnosed. The dependent variable is transmission zone. The status village transmission is a number of dengue cases> 2 cases in the village during the study based on medical records. The independent variables are children under 5 years, the incidence rate of dengue, the incidence rate area, the incidence rate density, and population age > 70 years (elderly). Data of dengue cases were obtained from medical record. The data were analyzed with an independent t-test, linear regression test, and survival test (Cox proportional hazards).Results: The incidence rate averaged 30.17 higher than the government standard, with 10 cases/ 100,000 population for each village, and was higher in March. The population, density, children under 5 years, elderly upper 70 years, incidence density, incidence case, incidence areas, and large no significant differences between village transmission and no transmission p≤0.050, and variable contributing to dengue transmission R2= 0.39 or 39.20%. The hazard time for infection (HR = 0.62; CI95%= 0.46 to 0.83).Conclusion: The zone is high risk for dengue transmission, 24.6% of the 460. The factors significantly related to dengue transmission in the village as population size, population density, children under 5 years, elderly upper 70 years, incidence density, incidence case, and incidence area contributing to dengue transmission, R2= 0.39. The main factor contributing to dengue transmission is incidence density, β= 69.95.

Review

This study addresses the important and persistent public health challenge of dengue transmission in Kebumen District, Indonesia, employing a broad cross-sectional design across 460 villages. The aim to identify factors driving dengue transmission is highly relevant for guiding targeted interventions, particularly given the reported high incidence rate exceeding government standards. The use of a large dataset derived from medical records spanning a full year (January-December 2023) represents a significant effort to gather comprehensive epidemiological data. However, the abstract's presentation of the study's focus, particularly the emphasis on "children under 5 years" in the title, is not clearly borne out by the results, which is an initial point of concern. Methodologically, the abstract introduces several ambiguities that require clarification. While a cross-sectional design is suitable for identifying associations, the choice of statistical analyses, including independent t-test, linear regression, and survival analysis (Cox proportional hazards), appears eclectic for a dependent variable defined as a binary "transmission zone" (>2 cases). The application of a Cox model, typically used for time-to-event data, in a cross-sectional study measuring "hazard time for infection" needs substantial justification and clear explanation of how "time" was incorporated. Most critically, the results section presents a direct contradiction: it states that "no significant differences" were found for any of the tested independent variables (population, density, children under 5, elderly, incidence density, incidence case, incidence areas) between transmission and no-transmission villages (p≤0.050). Immediately following this, it mentions an R2 of 0.39 for variables "contributing to dengue transmission" and an unexplained hazard ratio. This fundamental inconsistency undermines the credibility of the reported findings. The aforementioned contradictions between the results and conclusion sections represent a major flaw in this abstract. While the conclusion asserts that "factors significantly related to dengue transmission in the village as population size, population density, children under 5 years, elderly upper 70 years, incidence density, incidence case, and incidence area contributing to dengue transmission," this directly contradicts the preceding results stating "no significant differences." This makes it impossible to ascertain which factors, if any, were truly significant. Furthermore, the identification of "incidence density" as the "main factor contributing to dengue transmission" with a beta value of 69.95 is rendered unreliable by the preceding conflicting statements. Before any policy implications can be drawn, the statistical analysis must be re-evaluated for consistency and clarity, ensuring that the results presented accurately reflect the performed analyses and support the conclusions drawn. As it stands, the abstract fails to provide a coherent or reliable summary of the study's findings.

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