Dengue Fever Dynamics in Bali, Indonesia 2010-2018: An Interplay of Population Density and Climatic Factors

Dengue Fever (DF) incidence in Bali has been the highest in Indonesia for decades. This study describes the annual distribution of DF and analyzes its association with population density, number of rainy days, and average humidity during 2010-2018 at the district level. The choropleth maps and Poisson regression were employed to provide geographical distribution and quantify the association. The P, 95% confidence interval (CI), and Akaike Information Criterion (AIC) were adopted to assess the significance and the goodness of the association. During 2010-2018 there were 55 215 new DF cases notified. The annual incidence of dengue cases in Bali increased with IRR: 1.000186 (95% CI:1.0000183:1.000189) for every increment of population density per kilometers square and increased by  IRR: 1.01043 (95% CI: 1.01019: 1.01078) for every additional one rainy day annually. The dengue cases also increased with IRR 1.0172 (95% CI: 1.0137: 1.0208) for every 1% increase in average humidity. Population density and climate factors are positively associated with dengue cases incidence in Bali from 2010 to 2018. The results underline the urgency of integrating population dynamics and climatic determinants into the DF control program and customizing the intervention program based on local characteristics.