International Journal of Remote Sensing Applications Volume 3 Issue 1, March 2013

www.ijrsa.org

Utilization of Geoinformation Tools for

Dengue Control Management Strategy: A
Case Study in Seberang Prai, Penang Malaysia
C.D. Nazri1,2 , Hashim A.1 , Rodziah I1, Abu Hassan2, A. Abu Yazid
1

Faculty of Health Sciences, Universiti TeknologI MARA (UiTM),

School of Biological Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia

nazricd@salam.uitm.edu.my

Abstract
Dengue has now emerged as one of the major public health
problems in Malaysia. It was first reported in 1901 in Penang
and since then the disease has become endemic concentrating
mostly in urban areas. The objective of this study was to
utilize geo-information tool to determine high risk areas for
the dengue outbreak. This study examined a total of 307
confirmed dengue fever cases, geo-coded by address in
Seberang Prai area between Jan 2005 and December 2010,
which were included in the study. The results were drawn
from a measurement of the dengue incidence in order to
determine the severity and magnitude of outbreak
transmission. Measurement of the dengue incidence found
that there were areas with significant high value. This
suggested that areas within Seberang Prai area had different
temporal characteristics for dengue occurrence. The
utilization of geo-information tool enabled to identify higherrisk areas for the occurrence of dengue fever. Even though
case notification data are subjected to bias, this information is
available to the health services and can lead to important
conclusions, recommendations and hypotheses. As a
recommendation, the geo-information tool can be utilized by
public health officials to characterize dengue rather than rely
on the traditional case incidence data.
Keywords
Dengue; Geographic Information System; Malaysia

Introduction
Dengue is a mosquito-borne infection which in recent
years has become a major international public health
concern. This deadly disease is found in tropical and
sub-tropical regions around the world, predominantly
in urban and semi-urban areas. Dengue outbreaks are
related to the vector behavior and its relationship with
the environment, like climate, breeding site density
probability and vector control, urbanization, human
population movement, etc. The presence and density of
the vector (mainly Ae. aegypti in the urban and semiurban environment) is difficult to predicate. Climatic

factors such as rainfall, temperature, humidity are all

influence dengue transmission. The high level of
humidity during the rainy season makes the survival of
the mosquito longer [1, 2].
Dengue control in Malaysia is primarily based on case
surveillance by notification of suspected dengue cases
by doctors, and vector control by space spraying of
insecticides. Vector surveillance is done by regular
larval surveys of Aedes mosquitoes and computing of
Aedes index (AI) and Breteau index (BI) according to
specific localities. However, this reactive mode of
surveillance with the health authorities waiting until
the medical community recognizes the dengue cases
before reacting to implement control measures is very
insensitive because doctors have a low threshold to
diagnose dengue during inter epidemic periods. In
most cases, outbreaks are only recognized at the peak
of transmission when it is too late to implement
effective preventive measures that impact on
transmission [16, 17, 20].
Vectrol control unit in Seberang Perai Selatan Health
Office in their daily activities using Global Positioning
System (GPS) device to collect coordinate location of
dengue cases houses and then entering the coordinate
in
Vector Computer
Programme (VEKPRO).
Geographic Information System (GIS) technologies
have been applied in epidemiological public health
studies for many years [3,4,5,6,7]. GIS and spatial
analysis
are powerful
tools
in
addressing
epidemiological problems, allowing the identification
of critical areas and variables intimately related to the
modulation of the disease dynamics [8,9,10,11,12].
Dengue is always related with environmental and
socio-cultural practice, and the interrelation between
these factors can be identified by using GIS to assess
the dengue pattern and predict a dengue outbreak
could be done at early stage [13, 14, 15, 16].

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International Journal of Remote Sensing Applications Volume 3 Issue 1, March 2013

Material and Method

Study Location
Seberang Perai Selatan District consists of 16 mukim,
and 131 villages (Fig. 1). The district is located 80 km
east of Georgetown, and covers an area of 242.16
square kilometers with geographical location between
Latitude 5.2876 to 5.2980 and Longitude 5.1275 to
5.1379. The district has a population of about 152,000
people (Statistic Department of Malaysia, 2000). This
area is borders Seberang Perai Tengah on the north,
Bandar Baharu (Kedah) on the east site and Krian
district of Perak at south. The population density in
Seberang Perai Selatan district is 655 per person square
kilometers and more focused at rural and village. The
main working sector is factory worker, agriculture,
smallholder, chicken farming, and breading fish in a
cage, fisherman and self work.

confirmed DF cases reported from January to

December 2010 in Seberang Perai Selatan District.
Climatic, land use, and demographic data were
collected from the relevant state agencies.
Data on average rainfall, humidity and temperature
were collected from the Meteorological Department.
These climatic data were compared monthly with
dengue incidence data to evaluate favourable
environmental condition for DF outbreak. Socioeconomic data (number of houses, number of families,
and educational level) were obtained from a report
published by the Department of Census and Statistics
in 2010. The overall view of this study is clearly shown
in Fig 2.

FIG. 2 Conceptual framework of the surveillance and prevention

programmes using GIS application in Dengue Diseases

Data Analysis

FIG. 1 Administrative or locality map for Seberang Prai Selatan,

Penang

It is estimated 53% of population living in small town

such as Simpang Ampat, Sungai Bakap and Nibong
Tebal. Many of them work in business, small and
medium industry. With rapid growth in this district, a
number of small industries have been identified for
development within the rural area. The number of
urban resident is 93,574 population and rural area is
65,826 population.
Data Collection
Dengue incidence data were collected from the Vector
Unit, Seberang Perai Selatan Health office. This data
included information about all the suspected and

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Data from dengue cases are computed into database

call VEKPRO. During Aedes survey and investigation
of cases, GIS coordinates are collected using GPS
device on the field. All GIS coordinates collected were
in form of Kertau 1986 format. In order to use Google
Earth software map with GIS software, this data must
be converted to WGS 84 format. Eyes4software
calculator is used to convert this coordinate to targeted
format by batch. Conversions of the coordinate of the
case location are computed in MS excel before
converting it to MS Access .mdb file. After the
conversion, all of the data are imported into Google
Earth using online web pages www.earthpoint.us. This
web pages using HTML codes to export the coordinate
to .kml format that can be recognized by Google Earth.
Nowadays, the data can be viewed in Google Earth, Fig.
2 indicating all of the case locations are spread on the

International Journal of Remote Sensing Applications Volume 3 Issue 1, March 2013

map. Even though all datas are shown on the Google

Earth, there is a difficulty to recognize location in
Seberang Perai Selatan according to localities. To solve
the problem, basic later map of Seberang Perai Selatan
is created from software Map Maker and then it must
be geo-coordinated using Google Earth map. This geocoordinated map then is exported as secondary layer
on Google Earth.
The notified cases of dengue can be analyzed
accordingly by mukim and area in Seberang Perai
selatan district. Layer by layer can be overlay on
Google Earth to see linked of cases with geographic
factor such as land use. All tabular case data from the
various entities were compiled into Excel spreadsheets
using individual patient unique ID numbers linked to
GPS coordinates. Notified dengue cases data were
collected in the field utilizing a customized database in
combination with mapping software allowing
immediate case geo-coding and verification. GIS field
data collection was conducted utilizing a GPS system.
The collected data will be verified in real time in
addition to road and stream vector data. Actual GPS
positioning was simultaneously observed, verified and
collected with aerial photographs layered on data
layers.
Temperature data for weather station was downloaded
from the Meteorological Department, Butterworth.
Raw files were processed in a MS Excel editor, and then
imported into MS Acess as .dbf files. Then
converted .dbf file and processed as Map Maker layer.
Results
Epidemic Description
Dengue occurred in most area in Seberang Perai
Selatan district, causing severe health problems and
economic on the population affected. In 2005, the total
number was 189 cases, which is the highest recorded
incidence in five years. In 2006, a decrease was seen in
the number of dengue cases. The incidence of dengue
cases shows fluctuation that in 2007 dengue fever cases
strike again to 181 cases. There are steadily reductions
of dengue case starting from year 2008 until 2010 from
159 to 106 cases.
TABLE I
NOTIFICATION OF DENGUE CASES RECORDED IN FIVE YEARS
Year
DF Cases
2005
2006
2007
2008
2009
2010
189
129
181
159
151
106
Suspected DF

Confirmed DF

50

62

79

51

29

36

Using spatial analysis methods in GIS, the spatial

patterns of dengue cases in Seberang Perai Selatan

www.ijrsa.org

district from 2005-2010 were mapped and analysed. Fig.

3 shows the DF cases distribution in yearly basis for
each year since 2005-2010. The result shows that the
trend of cases distribution is depending on the
previously affected area or if the area had experienced
it before. The nature of spatial distribution was found
to be clustered in high density population centres. The
study showed that spatial distribution patterns of
dengue cases were significantly clustered, and
identified by the dengue hotspots in Seberang Perai
Selatan district.
Maps of cases were generated, which indicated the
dynamics of dengue diffusion through time. It was
observed that the temporal dynamics of outbreak
continued to the population central district. The highest
numbers of cases per month were in Sungai Bakap area.
Spreading patterns analysis was performed by yearly
basis. The tracking analysis has shown one cluster
patterns in Sungai Bakap in the study area. This is
crucial information that may support the preventive
measure by SPS Health Office in controlling the
dynamics of outbreak.
Identification of Dengue Outbreak Hotspot
The trend of the dengue cases distribution is clearly
mapped with the identified case classes. Kernel density
estimation illustrated variation in the grouping of
dengue areas across the study area, and strongly
confirmed the visible pattern on the point location map
(Fig. 4). The map showed that mukim 14, 15, 21 and 25
is in the high risk level according to five years median
of dengue fever cases, 2005-2010.
Discussion
The results showed that the proposed methods and
tools can be beneficial for public health officers to
visualize and understand the distribution and trends of
diffusion patterns of diseases and to prepare warnings
and awareness to the masses. Dengue spatio-temporal
diffusion patterns and hotspot detection may provide
useful information to support public health officers to
control and predict dengue spread over critical hotspot
areas only rather than for a whole district. This may
save time and cost and make public health department
efforts more efficient. Public health officers may
employ the model to plan a strategy to control dengue
by the information received on distribution and
hotspots for various months. In future it would be
important to have regular daily analysis for several
years to converge faster at outbreak locations and be
prepared for preventive measures. Some additional

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International Journal of Remote Sensing Applications Volume 3 Issue 1, March 2013

findings of the study such as influence of rainfall,

which is time dependent, also throw light on its
significance. Race and education level vulnerability are
also an interesting outcomes of the study. The
methodology is based on ideas on general principles of
geostatistics and has the potential for application for
others communicable diseases.

Legend
Very High

High

Medium

Low

FIG. 4 Mapping of dengue high risk localities in Seberang Perai

Selatan district by GIS according to median of cases in five years

This study indicated that some localities in Seberang

Perai Selatan district have a high risk for outbreaks of
Aedes mosquito-borne diseases such as dengue and
chikungunya. Data collected in this study are likely to
aid in the selection of test and control sites and at the
same time could provide important entomological
information for the design of an effective integrated
vector control program to combat Aedes mosquitoes in
this area. From generated map of GIS that showed
location of future planning, it easy to predict such
localities as mukim 13 can increase potential for
dengue epidemic near future. This can help vector
control program to strengthen their activities an
engaged more workers in the upcoming years.
Presently prevention of dengue infections is primarily
dependent on keeping the population of Aedes below a
threshold level that does not allow transmission to take
place. It is suggested the local authorities develop
appropriate strategies to monitor and control the vector
population throughout the year. Sufficient funding
need to be channelled to vector control measures.
Licensing of business activities, approval of buildings
and its use must cater for anti Aedes measures activities.
However, the final responsibility of urban mosquito
control still lies with the citizens of the community,
who by their behaviour in the domestic and work

14

environment unwittingly be responsible for the

breeding of the vector mosquitoes and blame the
government for the recurring epidemics. Larval source
reduction by the community is the only cost-effective
and sustainable measure that will reduce vector density
to very low levels. However, the major disadvantage is
that it is slow and may take many years before human
behaviour is modified enough to impact on disease
transmission [23,24].
A proactive laboratory based surveillance needs to be
developed that will provide an early warning,
predictive capability for epidemic dengue. Trend
analysis of data based on rapid diagnosis and
identification of serotype can provide the necessary
information for initiating vector control measures well
in advance to prevent outbreaks. Thus, if the
surveillance system can predict dengue epidemics,
steps can be taken to prevent them or at least decrease
the overall incidence of the disease. There are no
absolute solutions to the dengue problem in Seberang
Perai Selatan district and Malaysia generally. However,
with strategies based more on community based source
reduction and less on space spraying of insecticides,
coupled with a system of proactive surveillance and
commitment by the local governments on integrated
and sustainable vector control measures, dengue
infections in this district can be reduced in the long
term.
Ways and means to enlist community participation for
the control of dengue infection should be explored. The
most effective way to control the population of Aedes
mosquito is larval source reduction, which is
eliminating or cleaning water-holding containers that
serve as the larval habitats for the mosquito in the
domestic environment. Social behavioural research
needs to be strengthened to improve communication at
the community level for better prevention and control
such as COMBI program. Ultimately the prevention of
dengue depends on the availability of an effective
vaccine. Although a live attenuated quadrivalent
vaccine is undergoing trials and recombinant vaccine is
in the early stages of development, their actual
deployment in the community will take many more
years [17].
The rationale is that sustainable Aedes mosquito control
can be accomplished only by the people who live in the
houses where the problems occur and by the people
who help create the mosquito larval habitats by their
lifestyles [18,19]. Community participation in and
ownership of prevention programs require extensive
health education and community outreach.

International Journal of Remote Sensing Applications Volume 3 Issue 1, March 2013

2005

2007

2009

www.ijrsa.org

2006

2008

2010

FIG. 3 Spatial mapping of distribution pattern of DF cases in Seberang Prai, Malaysia (January 2005 to December 2010)
Note: 1 dot represent 1 DF case

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International Journal of Remote Sensing Applications Volume 3 Issue 1, March 2013

transmission risk assessment in Subang Jaya, Malaysia.

In summary, demographic and societal changes,
Taylor & Francis
decreasing resources for vector-borne infectious disease
prevention and control, and changes in public health [4]
Dom, N. C., Latif, Z. A., Ahmad, A. H., Ismail, R., &
policy have all contributed to increased epidemic
Pradhan, B (2012). Manifestation of GIS Tools for Spatial
dengue activity, the development of hyper endemic city,
Pattern Distribution Analysis of Dengue Fever Epidemic
and the emergence of epidemic DHF.
in the City of Subang Jaya, Malaysia. EnvironmentAsia, 5.

Conclusions
The utilization GIS software has great potential to
strengthen overall public health capacity and facilitate
decision support system approaches for prevention and
control of vector-borne diseases. Dengue spatiotemporal diffusion patterns and hotspot detection may
provide useful information for support public health
officers to control and predict dengue spread over
critical hotspot areas only rather than for a whole
district. This may save time and cost and make public
health department efforts more efficient. Public health
officers may employ the model to plan a strategy to
control dengue by the information received on
distribution and hotspots for various months. In future
it would be important to have regular daily analysis for
several years to converge faster at outbreak locations
and be prepared for preventive measures. The
methodology is based on ideas on general principles of
geostatistics and has the potential for application to
other communicable diseases.
ACKNOWLEDGMENT
The authors sincerely thank to Ministry of Health
for
providing ground data on DF cases for this research
work. The contribution of research funding from
Universiti Teknologi MARA (UiTM) and Ministry of
Higher Education (MOHE) Malaysia are also duly
acknowledged.
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Nazri Che Dom was born in Kelantan,
Malaysia. He received the Master of
Environmental Sciences from University
Putra Malaysia (UPM) in 2007. He is a
PhD candidate in School of Biological
Sciences, Universiti Sains Malaysia (USM),
Malaysia. His current research interests
are remote sensing, GIS on health and epidemiological study.
Rodziah Ismail was born in Perlis,
Malaysia. She received the Master of
Environmental Sciences from University
of Strachclyde, Scotland in 1999. She is a
Associate Professor in Department of
Environmental
Health,
Universiti
Teknologi MARA (UiTM), Malaysia. Her
current research interests are remote
sensing and GIS on health.
Hashim Ahmad was born in Kelantan,
Malaysia. He received the Master of
Environmental Sciences from University
Putra Malaysia (UPM) in 2003. He is a
Seniur Lecturer in Department of
Environmental
Health,
Universiti
Teknologi MARA (UiTM), Malaysia. His
current research interests are remote
sensing and GIS on health.

dengue in Thailand. J Vect Borne Dis , 73-76.

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