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Journal of Infection and Public Health
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Original article
Temporal and spatial patterns of dengue geographical distribution in Jeddah, Saudi Arabia
Hissah Al-Nefaie
a,c, Amirah Alsultan
b, Raghib Abusaris
c,d,⁎a Epidemiologist, Department of Communicable Diseases Control, Public Health Authority, Riyadh, Saudi Arabia
b Public Health, Public Health Authority, Riyadh, Saudi Arabia
c Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
d King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
a r t i c l e i n f o
Article history:
Received 7 February 2022
Received in revised form 29 June 2022 Accepted 6 August 2022
Keywords:
Dengue Endemic Temporal Spatial Jeddah
a b s t r a c t
Introduction: Dengue fever disease is affected by many scoioeconomic and enviromental factors throughout endemic areas globally. These factors contribute to increase the incidence of endemic dengue endemic in Jeddah, Saudi Arabia.
Objectives: This study aimed to investigate the distribution and spatial patterns of dengue fever cases in Jeddah, and to determine if there is an association between dengue fever and the following environmental factors: temperature, humidity, land cover, climate, rainfall, epicenter of reproduction, and socioeconomic factors.
Methods: A descriptive and analytical cross-sectional study was conducted in Jeddah in 2020. The study included all reported suspected and confirmed dengue cases. The sample size was 1458 cases. Data were obtained from the Dengue Active Surveillance System and the confirmed cases were geo-distributed in areas by QGIS. All significant variables were included in the logistic regression table.
Results: The majority (61.9 %) were suspected cases and 38.1 % confirmed cases. The majority of the cases were male. The highest spatial distribution was in the middle of Jeddah and the lowest in the south. The highest temporal distribution for confirmed cases was in June, and for suspected cases in December. Age, gender, occupation, and area were all significantly associated with the dengue reported cases. Most all the enviromental factors were not statistically significant.
Conclusion: The study showed three clusters of dengue fever and infection concentrated in the middle and east of Jeddah. The lack of investigation in the environmental factors regarding the dengue distribution and its impact on the population area has to be taken seriously and dengue intervention programs should be implemented to reduce the endemic dengue in Jeddah.
© 2022 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences.
CC_BY_NC_ND_4.0
Introduction
Dengue Fever Disease is known as a mosquito-borne infection that spreads across the tropical world in the past 60 years and affects half of the global population [1]. Dengue infection has been in- creasing, which has become a significant global public health con- cern [2]. Global change and urbanization are the main factors in the geographical range of dengue fever [3]. The changes in temperature
amplified the issues [4]. The spread of dengue increase in endemic centers causing a higher incidence rate and longer transmission seasons [5]. Originally, disease transmission occurred in the tropical region where it is hot and the humidity high, which expands the lifespan of the vector and reduces the expected time of virus re- plication. The Aedes mosquito is the main human vector causing dengue fever to expand throughout the tropical and subtropical urban areas [2]. Generally, female mosquitoes bite people and lay their eggs in man-made storage, such as containers, jars, and used tires. Their life expectancy is 8–15 days and they fly 50 m on average per day, with a 600 m range. As a result, it causes the spread of the disease in limited areas. The mosquitoes are more active in day, with a peak activity at sunrise and sunset [6].
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⁎ Corresponding Author at: Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
E-mail address: [email protected] (R. Abusaris).
Mosquitos have an external incubation period which decreases when the temperature increases. The size of mosquitos also increase with a higher temperature. The proportion of the infected vector and vector transmission becomes higher [7]. In addition, the larval growth and the rate of feeding increase [8]. The external incubation period is called the extrinsic incubation period which refers to the time required for the virus from actual transmission to a new host.
Furthermore, from 8 to 12 days as an average and an environment temperature between 25 °C and 28 °C are necessary for the extrinsic incubation period [2]. Some factors influence the incubation period, such as the change in the daily temperature [7,9]. When infection occurs, the ability of virus transmission in the mosquitoes is life long [2].
Clinically, dengue cases are frequently asymptomatic or presents as a flu-like illness with symptoms such as headache, rash, myalgia, retro-orbital pain, and leucopenia within 12–15 days [10]. Dengue complications results in shock and body system failure, which could be fatal and known as the Dengue Shock Syndrome (DSS) [11]. DSS or Dengue Hemorrhagic Fever (DHF) occurs after the development of a dengue case to a life-threatening severe disease [2]. Vector-borne disease control is a major approach in terms of prevention, and re- gardless of whether vaccines are effective, disease control will re- main an essential method for the prevention of dengue fever [12].
The World Health Organization (WHO) stated that dengue is caused by one of four serotypes of the virus that belong to the Flaviviridae family. They are associated but different, namely DENV- 1, DENV-2, DENV-3, and DENV-4.(2) All four types could cause severe and fatal disease, and provide a limited time to develop immunity against the same serotype [13,14]. Recovered cases are totally im- mune from the serotypes. However, the immunity from other ser- otypes is temporal and limited and the risk of severe dengue fever will increase after a second infection [2].
Flaviviruses are a family with a enveloped small RNA single- stranded positivesense RNA viruses with a single open reading frame and capable of encoding three structural proteins [15]. Like all Fla- viviruses, dengue enters the host cytoplasm through class II fusion proteins where the fusion loop is located within the envelope of an (E) glycoprotein. Two human monoclonal antibodies were isolated to target this region. These antibodies can also effectively inhibit the virus's cross-neutralizing capability for all four dengue serotypes [16]. Currently, there is no particular treatment for dengue virus infections. Fluid replacement therapy and hospitalization are pro- vided for severe dengue cases. The fatality rate in dengue severe cases could be reduced to less than 1 % through early detection and appropriate medical care. However, a promising vaccine for dengue, known as Dengvaxia (CYD-TDV) is in a phase III clinical trial with 35–80 % vaccine efficacy depending on the virus serotype. The vac- cine is recommended for persons from 9 to 45 years, living in en- demic areas, and persons who previously had at least one documented infection [2].
In the last two decades, the WHO reported that the number of dengue cases has increased from 505,430–4.2 million cases in 2000 and 2019. In 2017, the severe dengue cases reduced by 53 %. In contrast, in 2019, the dengue infection and transmission inter- nationally were recorded as the highest confirmed dengue cases ever. The dengue mortality rate increased in from 960 to 4032 deaths between 2000 and 2015 [2]. In 2013, the wide range of the geographical distribution caused approximately 1.14 million USD disability-adjusted life years loss [17]. Disease mapping can be classified for studies that focused on the geographical distribution of
dengue disease. The Geographic Information System (GIS) is used for the location of the disease incidence, the spread of disease patterns as well as socio-economic factors if available [18]. Such studies focus on a specific location of the disease and the association of potential environmental and socio-economic risk factors and a hazard may be epidemiologically identified [19]. Dengue surveillance is considered an essential component of disease control to determine the potential burden of the hazards, as well as to enable the management of outbreaks more effectively [20].
The research question of this study was to investigate the tem- poral and spatial patterns of the dengue fever geographical dis- tribution and to study the association between the dengue cases and the environmental and socioeconomic factors in Jeddah, Saudi Arabia.
Methods Study area
This study was conducted in Jeddah, the second largest city in Saudi Arabia. The total area is approximately 5460 km2 and the urban area 1765 km2 (latitude 29.21 north & longitude 39.7 east).
The total population is estimated at 4.6 million, 14 % of the Saudi Arabian population, with a growth rate of 1.95 %. It has an important air, sea, and road entrance for pilgrims, 5 million annually. Jeddah's weather is mainly hot and humid with low rainfall (annually average 12.2 days, 56.8 mm). These characteristics produce a suitable zone for mosquito breeding. Jeddah experiences endemic seasonal and occasional outbreaks of dengue fever [21].
Study participants
The inclusion criteria were all the reported dengue fever cases of Jeddah residents with legible and existing addresses from 1 January to 31 December 2020 (n = 479). The exclusion criteria were the cases reported from Makkah, Jazan or Al Madinah. A sample size was not required as all the dengue cases were included (n = 1458).
Study design
The design was a descriptive and analytical cross-sectional study.
Descriptive analyses were done for the demographic characteristics and temporal patterns of the disease and an analytical analysis for the association between dengue disease and the environmental/so- cioeconomic factors. The environmental factors are air condition, cement pool, water container whether in bottle or pail, water from infiltrations or leak, proximity to a sewage line, water line in a street, water surfaces, vases, water cooler, open tanks, near to water com- pany, and stream water.
Data collection
The data were retrieved from the active surveillance system. It is reported as the Epi weekly number of reported dengue cases in Jeddah from 1st January 2020–31 st December 2020 from the Department of Communicable Disease Control, affiliated with the Saudi Center for Disease Prevention and Control in Riyadh, Saudi Arabia. The department is responsible for the dengue fever surveil- lance system and control. The active dengue surveillance system was initiated in 2020 by the Saudi Center for Disease Prevention and
Control and the passive surveillance system, adopted by the Saudi Ministry of Health from October 2014.
Case definition
A suspected case was defined as a case without a warning sign that lives in or is coming from a home where dengue is endemic with a presence of acute febrile illness for 2–7 days with two of the following symptoms: nausea and vomiting, rash, pain, and aches in different parts of the body. A positive tourniquet test, known as the Rumble test, Leddy's Capillary Fragility is a clinical method for di- agnosing capillary fragility and susceptibility to platelet counts.
Lastly, the appearance of leukopenia or the appearance of any warning signs of severe dengue. A confirmed case was a case com- patible with the clinical description and confirmed by any of the following laboratory tests: a positive detection of dengue virus or its components by isolation of the dengue virus in a laboratory spe- cimen, or a serological response after the infection by IgG and IgM antibodies with an increase of at least four times in the antibodies to one or more dengue viruses of two blood samples, or an indication of dengue virus antigen through NS1 detection test, or detection of viral genomic sequences by polymerase chain reaction (PCR) test.[22].
Statistical analysis
For the statistical analysis, the data were cleaned in an Excel sheet. The Statistical Package for Social Sciences (SPSS) version 25.0 was used [23]. The data were tested for normality using the Kol- mogorov-Smirnov test, skewness and kurtosis, and plotting a graph.
The descriptive statistics, as frequency and percentage, were calcu- lated for the numeric variables such as age, gender, months of in- fection. For the geographical distribution, QGIS Geographic Information System software version 3.16.11 was used for the spatial distribution of the confirmed cases by using their geo-location [24].
Regarding the bivariate analysis, a Pearson Chi-square was used to identify differences between suspected and confirmed dengue fever infection for dichotomous categorical variables, and to identify an association between dengue fever disease and the socioeconomic factors. The Fisher’s Exact test was used to identify an association between dengue fever disease and the environmental factors. For the multivariate analysis, logistic regression was used for adjustment.
The confidence interval was based on 95% and the level of sig- nificance was indicated as p-value ≤ 0.05.
Results
A total of 1458 cases were reported in the dengue surveillance system in Jeddah, and 360 cases outside Jeddah were excluded. By using the QGIS as a tool, the dengue clusters were identified. The spatial analysis of the confirmed cases show the dengue distribution concentrated in the middle of Jeddah (Fig. 1). Fig. 2 illustrates the closer spatial detail of the case distribution and displays three main clusters of confirmed dengue cases, in the east and middle of Jeddah with the highest prevalence of dengue fever 34.9 % and 27,9 %, re- spectively. The northern area of Jeddah had an insignificant cluster of confirmed cases. Of the 1098 cases, 38.1 % were confirmed infected with dengue virus. Age was categorized in five groups, children less than 15 years (11.2%), 15–24 years (9.7 %), 25–44 years (51 %), 45–65
years (23.8 %), and elderly cases above 65 years (4.3 %). The age group with the highest proportion was 25–44 years. The majority were male (77 %), and (63 %) were non-health workers and (30%) are not employed. In addition, all cases with dengue infection were lo- cated in the north, east, middle, and south of Jeddah at 22.7 %, 27.9 %, 34.9 %, and 14.5 %, respectively (Table 1). Table 2 shows the asso- ciation between the dengue cases, suspected or confirmed, and confounders. A statistically significant association was found with age, gender, occupation, and area (p < .001). Most of the confirmed cases (62.5 %) were younger than 25–44 years, followed by 45–65 years (16.4 %), 15–24 years (14 %), and less than 15 years (5.6%).
Fig. 3 displays the dengue distribution in Jeddah. The highest prevalence in the middle of Jeddah (34.9 %), and (14.6 %) in the south which was the lowest prevalence of the four areas, followed by (27.9
%) and (22.7 %) for east and north, respectively. In the middle area, 21.1 % were suspected and 13.8 % confirmed cases. In contrast, in the east there were 17.7 % confirmed cases compared to 10.18% sus- pected cases. The lowest prevalence of confirmed cases was in the north and south, 8.7% and 4.9%, respectively (Fig. 4). Regarding the monthly distribution, the highest percentage of suspected cases were reported in December (17.5 %). The highest prevalence of confirmed cases occurred in June and July, 29.67 % and 26.79 %, re- spectively (Fig. 5). Overall, the trend line curve for all dengue cases shows a peak in mid-June, which declined until October with the lowest rate (Figs. 6 and 7). Fig. 8 shows the activity graph by com- paring the confirmed cases in 2018 and 2019–2020. The chart in- dicates endemic dengue in Jeddah decreased between 2018 and 2020. However, an increase of confirmed cases was experienced in 2020, within the timeframe of the endemic dengue peak.
Table 3 shows the association between the environmental factors and the dengue cases. All the variables were not statistically sig- nificant with the dengue cases except for water containers (p = < .001) which indicates a significant association with the sus- pected and confirmed dengue cases.
For the logistic regression model, a univariate and multivariate regression analysis were done to assess the association of the de- mographic variables and the dengue cases (Table 4). Regarding the univariate model, all the variables were entered and age, gender, occupation, areas, and months were statistically significant (p = < .05), but nationality and language were insignificant. For the multivariate analysis, age < 15 years and 15–24 years categories were significantly associated with dengue infection (p < .001) and (p < .001), respectively. The east was associated with dengue in- fection (p = .006). After performing the logistic regression to calcu- late the adjusted odds ratio, only age, area, and months of infection were significantly associated with dengue infection after adjustment for all the variables (p < .05). The east was significantly associated with dengue infection (p < .001). The odds ratio of 2.15 indicates a risk effect of the east for dengue infection. Both the north and middle areas were not significantly associated with dengue infection (p = .442 and.305), respectively.
Discussion
4.1. Dengue fever temporal and spatial
Dengue fever is a critical disease in Saudi Arabia, in terms of disease severity and economic burden. Jeddah reported cases from 1994 to 2020 [25]. In the present study, the main findings indicated
Fig. 1. Distribution of Dengue Confirmed Cases in Jeddah, Saudi Arabia.
Fig. 2. Clusters of Dengue Confirmed Cases in Jeddah, Saudi Arabia.
two peaks of dengue in Jeddah, the first peak occurs in the summer and the second in December. More than half of the reported cases were suspected cases. Based on a study explaining the average of temperature in 2018, this seasonal variation could be explained [26].
The increase in the reported cases was a stepwise increase with the weather and temperature from the middle of the year until October.
However, in November, the number of cases increased but the temperature decreased. Our findings are similar to a study con- ducted in 2018 in Jeddah [27].
Regarding Kholedi et al., the study showed an increase of the reported cases in the summer months and also in December [27]. In contrast, a study done in 2013 with 4187 cases, identified April to May as the peak of the cases [28]. Similarly, a Jazan study in 2014
reported the same findings with 264 cases, [29] and Aziz et al. re- ported dengue from 2006 to 2013 with a similar peak of the reported cases.[30] The months of June and July are the time of the pilgrims visiting Jeddah in transit to Makkah every year for Hajj. Due to the COVID-19 pandemic and restrictions, only about 10,000 pilgrims went to Hajj, of which 30 % was Saudi and the rest foreign residents in Saudi Arabia, in the age group 20–50 years selected for Hajj 2020 [31]. The Hajj presents an opportunity to expand the exchange of infectious viruses, such as dengue viruses to the pilgrims [32]. The second peak had a major increase in cases compared to the first, which was observed in the 4th quarter of the year, and may be as- sociated with the occurrence of seasonal rain.(26).
Regarding the spatial distribution of dengue cases, the southern area of Jeddah registered the lowest number of cases compared with the middle area with the highest prevalence of dengue in the three clusters in 2020. In contrast, the Alzahrani et al. study indicated that during 2006–2008 the endemic dengue was concentrated in the southern and northern regions with five clusters [6]. Non-Saudi workers settle in the south and central areas of Jeddah, more than other areas as it is considered a preferred area to live and work due to the presence of the main commercial port in Jeddah, in addition to low residential rent.
Demographic-geographic distribution
The current study revealed that more than three-quarters of the dengue cases were adults, similar to the Badreddine et al. study with 85 % adults [33]. The majority of our study was male, more than two thirds of the dengue reported cases, similar to Alzahrani et al. re- porting 71 % male. However, in our study half of the dengue cases were between 15 and 44 years, in contrast to the Alzahrani et al.
study with most cases between 15 and 30 years old [6]. A reason could be that the adult men may be exposed to dengue at the workplace, home or outdoor activities. Regarding workers, our re- sults showed that more than half of the cases are non-health workers which could raise the risk of exposure of workers in Table 1
Demographic Characteristics of the Dengue Cases in Jeddah, Saudi Arabia.
Variable N % Mean ± SD
Dengue infection Suspected 680 61.9
Confirmed 418 38.1
Age 36.15 ± 16.46
< 15 years 121 11.2 15–24 years 104 9.7 25–44 years 549 51 45–65 years 256 23.8
> 65 years 46 4.3
Gender Male 846 77
Female 252 23
Occupation Not worker 317 28.9
Health worker 28 2.6 Non-health worker 691 62.9
Nationality Saudi 395 36
Non-Saudi 703 64
Language Arabic 862 78.5
Non-Arabic 236 21.5
District North 187 22.7
East 230 27.9
Middle 288 34.9
South 120 14.5
Table 2
Descriptive Statistics of the Dengue Fever Cases and the Demographic Variables in Jeddah, Saudi Arabia.
Variable Category Suspected Confirmed Chi-square P-value
N % N %
Age < 15 years 98 14.7 23 5.6 75.05 < .001
15–24 years 47 7 57 14
25–44 years 294 44 255 62.5
45–65 years 189 28.3 67 16.4
> 65 years 40 6 6 1.5
Total 668 408
Gender Male 498 73.2 348 83.3 14.70 < .001
Female 182 26.8 70 16.7
Total 680 418
Nationality Saudi 235 34.6 160 38.3 1.55 .213
Non-Saudi 445 65.4 258 61.7
Total 680 418
Occupation Not worker 265 39 114 27.3 23.04 < .001
Health worker 23 3.4 5 1.2
Non-health worker 392 57.6 299 71.5
Total 680 418
Area North 115 13.9 72 8.7 43.97 < .001
East 84 10.2 146 17.7
Middle 174 21.1 114 13.8
South 79 9.6 41 5
Total 452 373
multiple unsuitable environments. Both Alzahrani et al. and Alwafi et al. offer the same explanation that a male has a higher risk of becoming infected due to working outside and less likely to be covered compared to females due to the Saudi culture [6,28].
Several studies reported the impact of environmental factors on dengue fever vectors. The Al-Raddadi et al. study stated that both the presence of mosquitoes in homes and the absence of awareness campaigns were significantly associated with dengue [28]. However, the current study did not find a significant asso- ciation between the distribution of dengue and the environmental factors due to the time this study was conducted. In 2020, COVID-
19 have been detected, resulting in government limitations which prevented collecting inspection data regarding the environmental factors related to dengue cases inside or outside their home. The COVID-19 related restrictions caused a decline in the education, inspection, and control of the risk factors of mosquito breeding sites inside and outside houses.
Strength and limitations
A strength of our study is a unique dengue study using the active surveillance system in Jeddah. This resulted in identifying the Fig. 4. Bar Chart of Jeddah Districts Categories for Distribution of Dengue Fever Disease.
Fig. 3. Descriptive Bar Chart of Dengue Fever Cases per Jeddah Districts.
dengue fever clusters in 2020 to support the geospatial information of dengue infection control in Jeddah, Saudi Arabia. The study used the QGIS as a tool to clarify that the high-risk clusters were relevant to the high-risk areas of Jeddah during 2020, and the most reported cases from vector-borne diseases in Jeddah. Despite these strengths and due to limited time, the data from the dengue surveillance system have missing data which may affect the environmental as- sociation with dengue cases. The environmental factors were limited to a few factors and the data were reported from March. COVID-19
affected the activity of the dengue control program inside the houses which may have caused confounding bias. In addition, this study does not reflect the true proportion of endemic dengue in each district.
Recommendations
Based on the current study, we recommend that future dengue studies should focus on the meteorological factors with the dengue Fig. 5. Bar Chart of Dengue Fever Reported Cases by Month in 2020 in Jeddah, Saudi Arabia.
Fig. 6. Trend line for the Monthly Distribution of all Reported Cases in Jeddah, 2020.
serotypes, as well as explore the differences between the suspected and confirmed for specific seasons. It is highly recommended to compare the current study with future studies for evidence related to the endemic dengue and to redirect the program and resources to control the spread in Jeddah.
Regarding public implications, the government is addressing this problem through the Ministry of Health. An intervention to increase awareness is required to screen people with DFV and to treat the complications of DFV. Regarding clinical implications, field epide- miology should participate in public health awareness campaigns by implementing opportunistic screening programs for DFV in Jeddah and other endemic areas in Saudi Arabia. Physicians should partici- pate to increase the awareness of their patients about the im- portance of checking for DFV, as well as how to prevent infection in their areas. Due to the Saudi government investing substantially in the dengue control and prevention plan, it is important to under- stand all the factors that are affecting the endemic dengue.
Generally, it is important to maintain the dengue active surveillance system to detect early dengue activity and to take effective actions for the control of the vector’s existence.
Fig. 7. Trend line for the Monthly Distribution of Both Dengue fever Cases in Jeddah, 2020.
Fig. 8. Activity Graph of Monthly Distribution of Dengue Fever, 2018–2020.
Table 3
Descriptive Statistics of the Environmental Factors Associated with Dengue Cases.
Factor Suspected
N (%)
Confirmed N (%)
Chi-square P-valuea
Air condition 6 (0.5) 1 (0.1) 1.69 .184
Cement pool 3 (0.3) 0 1.85 .237
Water containerb 444 3 (0.3) 20.91 < .001
Infiltrationsc 2 (0.2) 0 1.23 .383
Sewaged 1 (0.1) 0 .615 .619
Streete 1 (0.1) 0 .615 .619
Water Surfaces 0 3 (0.3) 4.89 .055
Vases 0 1 (0.1) 1.63 .381
Water cooler 3 (0.3) 0 1.85 .237
Open tanks 0 1 (0.1) 1.63 .318
Water companyf 1 (0.1) 0 .615 .619
Stream water 0 1 (0.1) 1.63 .318
a Fisher’s exact test.
b water container whether in bottle or pail
c water from infiltration or leak
d proximity to a sewage line
e water line in a street
f near to water company
Conclusions
The study revealed that the association of dengue confirmed and suspected cases with temporal and spatial distribution, but the en- vironmental factors were not completely detected in 2020 given that the impact of covid-19 on human mobility. However, these factors are still present. The highest distribution of the endemic dengue was in the middle and east of Jeddah, and the highest number of con- firmed cases were in June and geographically in the east of Jeddah.
The dengue fever virus ranks as an endemic infection as one of the most infectious diseases in Jeddah, the prevalence of dengue fever virus is high and it is a public health problem in Saudi Arabia. Lastly, the consequence of lacking environmental factor investigation about dengue distribution and infection of the population requires serious actions by following the dengue intervention programs to reduce the endemic dengue in Jeddah. As a recommendation, future studies with a minimum of three years data should focus essentially on the direction of dengue control and surveillance actions to evaluate mosquito vector distribution and spread, and risk factors. An un- derstanding of the seasonal effect of new interventions helps deci- sion-makers to sufficiently prepare for and respond to future changes in dengue risk.
Scientific and ethics approval
The research project obtained approval from the Research Center in Saudi Center for Disease Prevention and Control, Riyadh. Data was collected, cleaned, managed, and analyzed after receiving approval from the ethical committee. Cases were identified with serial
Sources of Funding
This research project has not received any grant from any orga- nization whether in the public, commercial, or health sectors.
Conflict of Interest
The authors declare that there is no conflict of interest.
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Table 4
Logistic Regression Analysis for Characteristic Variables of Dengue Infection.
Variable Univariate analysis Multivariate Analysis
OR (CI) P-value AOR (CI) P-value
Age < .001
< 15 years 1.57 (.59–4.13) 5.46(2.55–11.72) < .001
15–24 years 8.08 (3.16–20.72) 3.40(1.80–6.42) < .001
25–44 years 5.78 (2.14–13.86) 1.19(.67–2.34) .607
45–65 years 2.36 (.96–5.83) .726(.23-.2.34) .226
> 65 years ® 1
Gender Male 1
Female 1.82 (1.34–2.47) < .001
Occupation < .001
Not worker ® 1
Health worker .486 (.18–1.32) .49(.15–1.56) .227
Non-health worker 1.71 (1.29–2.26) 1.03(.67–1.59) .893
Area < .001
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East 3.35 (2.11–5.32) 2.15 (1.25–3.71) .006
Middle 1.26 (.81–1.97) 1.19(.710–1.99) .513
South ® 1
Month < .001
Mar 10.50 (3.56–30.91) .806(.42–1.56) .521
Apr 6.79 (2.12–21.74) .561(.25–1.24) .154
May 14.56 (4.78–44.36) 1.17(.60–2.44) .660
Jun 58.56(20.67–165.91) 4.25 (2.33–7.76) < .001
Jul 70.89(24.74–203.19) 4.56 (2.43–8.55) < .001
Aug 16.65 (5.78–47.97) 1.461(.78–2.74) .237
Sep 10.14 (3.45–29.84)
Oct 11.44 (3.58–36.52)
Nov 11.67 (3.80–35.85)
Dec ® 1
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