Determinant Factor Affected The Presence of Aedes Sp. in A Customary Village
Determinant Factor Affected The Presence of Aedes Sp. in A Customary Village
Determinant Factor Affected The Presence of Aedes Sp. in A Customary Village
Corresponding Author:
Nur Alvira Pascawati
Departement of Epidemiology, Public Health Study Program, Faculty of Health Science,
Respati University of Yogyakarta
Yogyakarta, Indonesia
Email: [email protected]; [email protected]
1. INTRODUCTION
Dengue hemorrhagic fever (DHF) is an infectious disease caused by a virus that is transmitted through
arthropods [1] known as the dengue virus (DENV). The virus is of the genus Flavivirus with four serotypes:
DENV 1-4. DENV is transmitted through the bite of an infected Aedes mosquito, particularly Aedes (Ae.)
aegypti Linnaeus and Ae. albopictus Skuse, which is known as a major and secondary dengue vector [2], [3].
Nearly 75% of dengue fever sufferers live in the Asia-Pacific region, and the dengue rate in Southeast Asia is
18 times higher than in the Americas, and half of the world's population lives in areas at risk for dengue [4],
[5] Indonesia is a tropical country that is home to the two main mosquito vectors of DENV species, namely
Aedes aegypti and Ae. albopictus so that it becomes endemic in almost all areas [6]. In 2021, there were
approximately 73.5 thousand dengue cases reported in Indonesia. During 2017-2021, the highest number of
dengue cases was in 2019, with more than 137 thousand confirmed cases [7].
While an effective multivalent dengue vaccine is still under research and not yet available, vector
control and entomological surveillance are the only reliable means for dengue prevention and control [8]–[11].
The development and presence of dengue vectors are influenced by various factors such as ecology,
socioeconomic, environment, climate change, globalization, travel, and also the evolution of the virus [12]–
[14]. Ae. aegypti has high adaptability to urban and domestic areas, where this vector breeds around human
habitations in various artificial and natural containers in urban and rural areas [15], [16]. Ae. albopictus exhibits
strong ecological plasticity and exhibits a remarkable capacity to adapt to urban and sub-urban climates under
various conditions, replacing Ae. Aegypti [17], [18].
Indonesia is an archipelagic country, until 2021 there were 1,331 tribes and 488 Customary Villages
[19], this makes the variables that affect the breeding and reproduction of dengue vectors very large and
complex [20] because each tribe and custom have different characteristics. Risk factors for potential vector
breeding places and physical environment can provide important information to fill the gap in our knowledge
about dengue vector dynamics, especially data related to indigenous peoples in Indonesia, which so far has not
been available. Several recent studies have shown that well-constructed modern housing can be protective in
many tropical countries [21] and simple features, including covered roofs, brick walls, tile or metal roofs, or
ceilings can reduce entry into the house of mosquito houses [22]. However, the types of community houses in
Indonesian traditional villages vary widely, such as traditional houses, mixed houses, and modern houses, so a
type house screening is needed as an effort to determine its contribution to the Aedes vector control program.
The home screening was the first intervention piloted in Italy after a link between malaria and mosquitoes was
discovered [23]. Home screening has been shown to reduce the risk of malaria in India, South Africa, and the
United States [24]. The latest information regarding the presence of dengue vectors and risk factors in
traditional villages is important for designing effective vector control programs and dengue fever prevention
strategies to create healthy tourism areas. This study aims to investigate potential vector breeding places and
environmental factors for the presence of Aedes sp. in Customary Villages.
2. METHOD
2.1. Study location
This research was conducted in the Segenter Customary Village, North Lombok, West Nusa
Tenggara, Indonesia. Reports of DHF cases in North Lombok in 2020 are 247 cases. The local culture is still
preserved by the community, one of which is the Segenter Traditional Village. This hamlet is inhabited by the
Sasak people in the form of belief in ancestral traditions that influence the behavior and patterns of community
settlements. Every rule has a meaning that contains the value of obedience and norms. The traditional house is
made of bamboo, ground/mud floor, thatch roof, and woven walls is a potential place for mosquitoes to enter
the house. The use of the container in community activities has the potential to be a breeding place for vectors.
measured using a lux meter [32]. iv) humidity was measured using a hygrometer (from e.g. 70-90%) [33].
v) the existence of cattle pens was measured using a distance meter. All measuring instruments used to measure
physical environmental conditions have been calibrated.
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(a)
(b)
(c)
Figure 1. Comparing the potential risk factors for the presence of Aedes sp. vector based on the type of house
in the Segenter traditional village, namely: (a) customary houses, (b) mixed houses, (c) modern houses
Table 2 shows that the potential breeding places for Aedes sp. larvae found in the Segenter Customary
Village based on the BRI value are included in the high-risk category because the community provides a lot of
CC for daily water needs for all family members. Based on the HRI value, it is included in the high category
because there is still some garbage in the home environment that has the potential to be breeding places for
Aedes sp. vectors. Table 3 based on MI values shows that most of the houses (43.3%) in Customary Village
are at high risk as potential breeding places for Aedes sp.
Determinant factor affected the presence of Aedes sp. in a customary village (Nur Alvira Pascawati)
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Figure 2. Types of CC and DC in traditional villages where Aedes sp. larvae, namely: (a) Bong/Crock, (b)
Water Jug, (c) Bath
Table 2. 3x3 Matrix of BRI, HRI, and maya index (MI) value proportion in customary house
BRI
HRI/BRI categories Low Medium High
Number of houses Percentage Number of houses Percentage Number of houses Percentage
Low 2 3.4 4 6.0 21 31.3
HRI Medium 4 6.0 5 7.5 5 7.5
High 3 4.5 9 13.0 14 20.9
The larval density in the Segenter Customary Village is based on the WHO Density Figure with the
CI and BI indicators included on a scale of 8, HI included on a scale of 7 [35]. These results indicate that the
presence and density of Aedes sp. vectors in the Customary Village environment are in the high category.
Traditionally, entomological indices such as HI, BI, and CI were the main monitoring tools of many vector
control programs in dengue-endemic countries around the world [34]. This index not only measures the success
of vector control strategies but also helps to understand vector ecology. There has been no DHF control
program carried out by the community health center based on the characteristics of the community and the area
of the customary community. This condition should not be ignored, because of the high attractiveness of
Customary Villages as destinations for tourists, thus allowing for the potential for dengue transmission.
Tourists who come from various DHF endemic and non-DHF endemic areas, if supported by the presence and
density of the Aedes sp. vector in the area visited, they have the potential not only to be transmitted but also to
spread dengue virus infection both from tourists and residents [36].
Ae. aegypti is the main dengue vector in Indonesia and is well adapted to human habitation and the
surrounding environment [37], [38]. The results of the measurement of the regional risk level based on the MI
indicator show that the customary environment is at a high-risk level as a potential breeding place for the vector
Aedes sp. This is because the customary community provides lots of CC and DC-type containers that have the
potential to become mosquito-breeding places, such as bongs, water jugs, and baths made of cement and clay.
Containers made from cement and soil have a rough surface, so they have the impression of being difficult to
clean, easy to grow moss, and have low light reflections. This condition makes it easier for microorganisms to
grow on the walls of the container serving as larval food [14]. On the trough walls of the container, female
mosquitoes can hold on tightly, so that they can adjust their body position when laying eggs [39]. Containers
made of cement and soil tend to be darker in color, making them more preferred by Ae. aegypti as a breeding
place [15]. This type of container is related to the culture of customary community, traditions, and beliefs from
generation to generation in choosing the type of container to hold water as shown in Figure 2. The belief of
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these indigenous peoples is a strong binding rope, where violations of these traditions can cause feelings of
guilt in the adherents [40].
Aedes sp. is a type of vector with very good adaptability to various environmental conditions related
to the various types of containers, especially man-made open habitats/containers [15], [41], while water quality
and characteristics determine the species diversity and composition of mosquitoes [42]. Several types of
containers in this study are similar to the observations made by Wijayanti in Purwokerto which found that
indoor baths are the main breeding places for Ae. aegypti in districts with high and low incidence [43].
However, this study contradicts the research of Edillo et al. in the Philippines who found that plastic drums,
metal drums, and plastic containers were the main breeding places for Ae. aegypti [44]. To eliminate the main
breeding places for Aedes sp. it is recommended that containers be emptied, tightly closed, and cleaned
regularly, while used goods that can accommodate can be disposed or recycled [45].
Table 4. The relationship between the environment with the presence of dengue vectors in Customary Village
Variable Control measures for vector Aedes sp. Point estimates Ratio p-
High risk (CI>20%) Low/Not risk Risk (%) prevalence value
(CI≤20%) (CI 95%)
n % n % Ex- Un- Overall
posed Exposed
House type
Modern* (Unexposed) 13 19.4 20 29.9
Mixed (Exposed) 15 22.4 6 9.0 45.5 39.4 40.9 1.813 0.0256
(1.097-
2.996)
Traditional (Exposed) 11 16.4 2 3.0 84.6 39.4 52.1 2.148 0.0069
(1.326-
3.480)
House temperature
Risk (Exposed)
No risk (Unexposed) 24 35.8 8 11.9 75.0 42.9 58.2 1.750 0.0090
(1.136-
15 22.4 20 29.9 2.695)
Light intensity
Dim (Exposed) 23 34.3 12 17.9 65.7 50.0 58.2 1.314 0.2061
Bright (Unexposed) (0.863-
16 23.9 16 23.9 2.002)
Humidity
Risk (Exposed) 27 40.3 10 14.9 73.0 40.0 88.2 1.824 0.0079
No-risk (Unexposed) (1.129-
12 17.9 18 26.9 2.949)
Corral
Distance (Exposed) 22 32.8 12 17,9 64.7 51.5 58.2 1.256 0.2883
Distance (Unexposed) (0.830-
17 25.4 16 23.9 1.900)
Total 39 28
Notes: %: Percentage, CI 95%: Confidence interval 95%
3.6. Determinant factors related to control measures for vector Aedes sp. breeding places
Table 5 shows the determinant factor that affects the presence of dengue vectors (Ae. aegypti and Ae.
albopictus) in Customary Village.
Determinant factor affected the presence of Aedes sp. in a customary village (Nur Alvira Pascawati)
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Table 5. Determinant factors for the presence of dengue vectors in Customary Village
β Sig. Exp (β) 95% C.I.for Exp (β)
Lower Upper
Traditional House 1.108 0.005 2.138 1.232 2.876
Humidity 1.113 0.009 1.764 1.122 2.738
Temperature 1.089 0.011 1.650 1.136 3.322
Mixed Type House 0.871 0.067 1.413 0.832 2.165
Constant -3.488 0.014 .086
Note: Exp (β)= Exponent Beta; Sig= Significance; CI for Exp (β)= Confidence Interval for Exponent Beta. The result of the function
quality assessment based on the calibration parameters of the Hosmer and Lemeshow Test showed 0.782 score, which means that
the acquired function has a decent calibration because p-value > 0.05. The discriminant value based on Area Under Curve (AUC)
was 0.782 (78.2%= close to 100%).
The determinant factor that affects the presence of dengue vectors (Ae. aegypti and Ae. albopictus) in
Customary Village is the traditional type house. The 70-90% humidity, 25-30 oC house temperatures, and
mixed-type house strengthen this factor. These are the probability and function results to predict the high
presence of Aedes sp. vector in Customary Village (1). This equation shows that non-routine physical measures,
knowledge of the head of the family about DHF are traditional type houses, 70-90% humidity, 25-30 oC house
temperatures, and mixed-type community houses contribute 78.23% to the high presence of vectors Aedes sp.
in the Customary Village.
Equation (y) = -3.488+ 1.108 (Traditional House) + 1.113 (Humidity) + 1.337 (Temperature) +
1.218 (Mixed Type House) = 1.288
1 1
Probability (P) = (1+𝑒 −𝑦 ) = (1+ −1,288) = 0.548x 100 = 78.23% (1)
2,7
Notes:
P= the probability of an event occurring; e = natural number = 2.7; y = Constant
The results of this study show that there is a relationship between traditional house types and mixed
house types with the presence of Aedes sp. in the Customary Village. The buildings in the Customary Village
use natural materials that are easily found in the surrounding area, such as the walls of the building using woven
bamboo which can provide good air circulation through the gaps of the woven bamboo. The roof of the building
used reed material which can protect from the hot sun and warmth at night and the higher floor of the house
can provide warmth for the occupants of the house [34], [46]. Walls and roofs with woven bamboo that are not
tight are a favorite place for mosquitoes to rest and become accessible for mosquitoes to enter the house [24],
[47]. Customary houses also do not have partitions, so the kitchen, bedroom, and dining room become one.
This condition increases the risk of household occupants coming into contact with mosquito vectors. This study
is confirmed by the results of previous studies which state that full-house screening is effective in reducing
indoor vector density so if the screening is only on the roof, the integrated tropical disease control program
will be neglected [48]. Customary house types built over 20 years are associated with the presence of
mosquitoes [49], [50]. Changes in house construction patterns can help prevent human-mosquito contact and
potentially reduce the transmission of vector-borne diseases through a local approach. In the alert phase, a
community-based approach is needed to improve and maintain the condition of the house and the peridomestic
environment, carry out surveillance activities, and apply simple self-protection methods such as using mosquito
nets while sleeping, using household insecticides, repellents, and others [47].
The results of this study show that there is a relationship between temperature and humidity with
vector abundance of Aedes sp. This condition can be influenced by the physical construction of the traditional
and mixed-type houses described previously. There are several studies in Indonesia and other countries that
show that temperature is one of the key factors for mosquito spread and DENV transmission [46], [51].
Temperature modulates the DENV epidemic impacting reproduction numbers and generation intervals [53].
The speed of the dengue epidemic is affected by increasing temperature, not only because there are more
infections per generation but also because generations are getting faster [52] with increasing temperature, the
extrinsic incubation period decrease, the frequency of biting increases, and the average life span of mosquitoes
increase [53], [54]. The thermodynamic model predicts that when the mean temperature is <18 °C, the DENV
transmission increases as the diurnal temperature range (DTR) increases, whereas when the mean temperature
is >18 °C, the DENV transmission decreases [55]. Previous studies have shown that relative humidity is also
a contributing factor to vector abundance and DENV [55]. Temperature dictates a reasonable range of
transmission and humidity within that range reinforces that potential [55].
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4. CONCLUSION
The study revealed that the vector density level of Aedes sp. was in the high category and had a high
risk of becoming a potential breeding place for vectors. The determinant factor that affects the presence of
dengue vectors in the Customary Village is the traditional type of house. This factor is strengthened by the
70-90% humidity, 25-30 oC house temperatures, and mixed-type house. These findings contribute to the
development of an early warning system regarding the potential spread of Aedes. vector-borne diseases,
increase awareness of the public and tourists, promote prevention and control measures in the community and
individuals about DHF, and its vectors to realize healthy tourism in Indonesia.
ACKNOWLEDGEMENTS
The authors would like to express their appreciation to the Faculty of Medicine-Gadjah Mada
University, Respati University of Yogyakarta, and all members of the Customary Village who participated in
this survey.
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BIOGRAPHIES OF AUTHORS
Nur Alvira Pascawati Nur Alvira is a lecturer at the Faculty of Health Science,
Respati University of Yogyakarta. She is Assistant Professor at Faculty of Health Science,
Respati University of Yogyakarta. She earned her Master from Field Epidemiology Training
Program of Gadjah Mada University. Her research focuses on the risk of infectious diseases.
She also investigated the causes of risk factors for DHF in Indonesia in terms of changes in
climate, environment, behavior, and vector characteristics. She can be contacted at email:
[email protected]; [email protected].
Determinant factor affected the presence of Aedes sp. in a customary village (Nur Alvira Pascawati)