Journal of Environmental Health
Vol. 18 No. 2
DOI: 10.20473/jkl.v18i2.2026.112-122
ISSN: 1829 - 7285 | E-ISSN: 2040 - 881X
Open Access
ORIGINAL RESEARCH
UNDERSTANDING KNOWLEDGE, ATTITUDE, BEHAVIOR AND DYNAMIC TRANSMISSION OF
DENGUE HAEMORRHAGIC FEVER IN SOUTH TANGERANG AND BEKASI CITY
Haryoto Kusnoputranto1, Margareta Maria Sintorini2,
Suyud Warno Utomo1, Okky Assetya Pratiwi3,
Nurusysyarifah Aliyyah4*, Epi Ria Kristina Sinaga1
Department of Environmental Health, Faculty of Public Health,
Universitas Indonesia, Depok 16424, West Java, Indonesia
2
Environmental Engineering, Faculty of Landscape Architecture
and Environmental Technology, Universitas Trisakti, West
Jakarta 11440, Special Capital Region of Jakarta, Indonesia
3
Master of Public Health Study Program, Faculty of Health
Sciences and Technology, Universitas Binawan, East Jakarta
13630, Special Capital Region of Jakarta, Indonesia
4
Public Health Study Program, Faculty of Health Sciences,
Universitas Pembangunan Nasional Veteran Jakarta, Depok
16515, West Java, Indonesia
1
Corresponding Author:
*) nurusysyarifah@upnvj.ac.id
Article Info
Submitted
In reviewed
Accepted
Available Online
: 4 November 2025
: 11 November 2025
: 30 December 2025
: 20 April 2026
Abstract
Introduction: Dengue Hemorrhagic Fever (DHF) is a viral infection prevalent
in tropical and subtropical climates worldwide, primarily in urban and semiurban areas. The World Health Organization has documented that Indonesia
ranks among the nations with the highest incidence of DHF in Southeast Asia
and is classified as one of the most dengue-endemic territories globally. Climate
factors leading to an increase in the spread of the dengue epidemic, including
the changing distribution of the responsible vectors to DHF. This study aims to
encourages urban resident’s knowledge, attitudes, and behavior towards DHF
prevention and to investigates the dynamic transmission of DHF affected by
climate factors in South Tangerang and Bekasi City. Methods: A cross-sectional
study design was used, along with a chi-square test, modeling, simulation, and
intervention. Interviews with respondents include knowledge, attitudes, and
community behavior. Climate factor measurements include rainfall, temperature,
humidity, and CO2 level in the ambient environment. Results and Discussion: The
results show that urban resident’s knowledge, attitudes, and behavior regarding the
DHF prevention were in good categories. Climate variability patterns affect the
dynamic transmission of DHF in South Tangerang and Bekasi City. Conclusion:
The government and community need to play a vital role in increasing residents'
knowledge, attitudes, and behavior regarding dengue fever through information
media, and also implement proper preventive measures.
Keywords : Attitude, Behavior, Dengue
Hemorrhagic Fever, Knowledge, Urban Resident’s
Published by Faculty of Public Health
Universitas Airlangga
INTRODUCTION
ranging between 100 and 400 million cases. The disease
burden has grown substantially over recent decades, as
evidenced by WHO data showing a rising from 505,430
in 2000 to 14.6 million in 2024 (1).
Approximately 1.3 billion people reside in the
dengue-endemic region across ten Southeast Asian
nations. Among the world’s 30 countries with the
highest endemic rates, five countries (India, Indonesia,
Myanmar, Sri Lanka, and Thailand) are included (2). The
The World Health Organization (WHO)
defines dengue cases as Dengue Fever (DF), Dengue
Hemorrhagic Fever (DHF), and Dengue Shock Syndrome
(DSS). Dengue infection has become a growing global
public health concern, transmitted to humans through
the bite of an infected mosquito. Current estimates
indicate that approximately half of the global population
faces dengue exposure risk, with annual infection rates
Cite this as :
Kusnoputranto H, Sintorini MM, Utomo SW, Pratiwi OA, Aliyyah N, Sinaga ERK. Understanding Knowledge, Attitude, Behavior, and Dynamic
Transmission of Dengue Haemorrhagic Fever in South Tangerang and Bekasi City. Jurnal Kesehatan Lingkungan. 2026;18(2):112-122. https://
doi.org/10.20473/jkl.v18i2.2026.112-122
©2026 Jurnal Kesehatan Lingkungan all right reserved.
This is an open-access article distributed under
CC BY NC–SA 4.0 license.
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Jurnal Kesehatan Lingkungan/10.20473/jkl.v18i2.2026.112-122
World Health Organization (WHO) reported 3,130 cases
of dengue fever in Cambodia during 2017, with the
number rising to 9,122 in 2018. Concurrently, Singapore
experienced an escalation in DHF incidence from 2,615
to 2,873. This situation establishes the disease as a
public health concern, affecting 100 nations where the
disease is endemic, placing 2.5 billion people at risk of
infection due to their residence in tropical and subtropical
regions (1).
The World Health Organization has documented
that Indonesia ranks among the nations with the highest
incidence of DHF in Southeast Asia and is classified as
one of the most dengue-endemic territories globally (3).
According to the 2023 Indonesian Health Survey data,
the prevalence of DHF in Indonesia is approximately
0.64% and 0.78% in West Java (4). The Dengue Fever
Case Fatality Rate (CFR) in Indonesia in 2022 was
0.86%, which is still relatively low compared to the
National Dengue Control Strategy’s target of 0.7% but
exceeds the national CFR of 0.7% (5). Records from
the Bekasi City health department indicated that dengue
cases between January and February 2020 were 109,
representing a substantial reduction from the 199 cases
in 2019. Concurrently, information from the Banten
Provincial Health Office revealed that South Tangerang
City experienced an escalation from 246 cases in 2017
to 484 cases in 2018 (6).
The 2020 population census results showed an
increase in population density in South Tangerang City
from 2021 to 2024. This poses challenges for the city,
particularly in the health sector. The high population
growth rate in South Tangerang City is partly due to
migration, as it is a significant destination for migrants
in Indonesia and serves as a hinterland for Jakarta.
Based on the geographic conditions and the dengue
fever vulnerability map for Bekasi City, West Bekasi
District is one of the areas with the highest dengue fever
vulnerability. This is due to its high population density and
its location within 0–100 meters of the river. Meanwhile,
topographically, Bekasi City is dominated by plains with
land fully utilized for residential purposes, making every
area susceptible to dengue fever (7).
Several factors are associated with an increased
risk of dengue epidemics, including changes in the
bionomic distribution of vectors (especially Aedes aegypti
and Aedes albopictus), and climate change that triggers
increased temperatures, rainfall, and high humidity (1).
Increased temperatures can reduce the time needed for
the virus to replicate and spread within the mosquito’s
body, also affecting the survival of immature Aedes
aegypti mosquitoes (8–10). Previous studies have shown
that the hatching of mosquito eggs and the emergence
of adult Aedes aegypti mosquitoes are correlated with
Vol. 18 No.2 April 2026 (112-122)
temperature and relative humidity (11). Rainfall is a
crucial factor in dengue transmission, as it can create
containers in stagnant water that serve as breeding
grounds for Aedes aegypti mosquitoes. The greater the
number of mosquito breeding sites, the easier it is for
mosquitoes to lay eggs, thus increasing the mosquito
population and the risk of dengue transmission (8).
Previous research has demonstrated a
relationship between dengue fever incidence and
climate factors, including rainfall, air temperature,
humidity, and wind speed (11–12). Another study on
climate and environmental risk factors related to dengue
fever incidence found a significant correlation between
dengue incidence and climatic factors, such as air
humidity (8,14). Air pollutants also influence the spread
of dengue fever, with previous studies showing a positive
relationship between increased carbon monoxide (CO)
concentrations and a 30% increased risk of dengue
infection (15). Increased carbon dioxide (CO2) is also a
significant global threat, contributing to climate change.
Increased CO2 affects the survival of mosquito larvae
and increases developmental duration, thus affecting
survival and population dynamics (16).
A community’s vulnerability to dengue fever
is influenced by factors including awareness levels,
perceptions, and practices particularly regarding air
storage, plant care, and self-protection from mosquito bites
(1). Effective DHF incidence reduction is predominantly
influenced by health-promoting behaviors and individual’s
capacity to select and obtain quality healthcare services.
This behavior includes the knowledge, attitudes, and
actions of the individual (17). Healthy behavior and the
community’s ability to access high-quality health services
depend on the success of reducing the incidence of DHF
(17). In addition, overcoming DHF depends on health
workers and community participation, which supports
preventive action (3).
Previous research has shown a relationship
between knowledge and attitudes, as well as dengue
prevention behavior, in actions aimed at preventing the
incidence of dengue (17–18). The various ecological
determinants associated with DHF can serve as tracking
mechanisms, encourages researchers to explore the
potential of these environmental variables as predictive
markers for DHF cases emergence and disease
transmission patterns in South Tangerang and Bekasi
City, as well as predicting the incidence of DHF through
intervention models on system dynamics. This study
aims to investigate the dynamic transmission of dengue
hemorrhagic fever, influenced by climate factors, and to
encourage urban resident’s knowledge, attitudes, and
behavior towards Dengue Hemorrhagic Fever (DHF)
prevention in South Tangerang and Bekasi City.
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METHODS
questionnaire was tested for validity and reliability
because it was used in research at different locations in
2018 (first) and 2019 (second).
Study Design
A cross-sectional study design was employed in
this research to encourage urban resident’s knowledge,
attitudes, and behavior towards DHF and to investigate
the dynamic transmission of dengue hemorrhagic fever,
influenced by climate factors, in South Tangerang and
Bekasi City.
Analysis
Data were analyzed through a dynamic system
model in Powersim Studio 10 to determine the optimal
DHF control for the future. To get the research findings,
the study is structured into several stages: (1) validation
of environmental factors, (2) model demonstration
within the applicable context, and (3) reporting of
comprehensive findings. Within this research, DHF is
considered as one of the components of the causative
system in a scenario constructed through simulation
modeling techniques using the data of climate factors
and the DHF vector. Community data were analyzed
descriptively using SPSS 26 based on respondent
characteristics, knowledge, attitudes, and behavior. This
research was reviewed and received ethical clearance
from the Faculty of Public Health, Universitas Indonesia,
in 2019.
Data Collection
Environmental variables (rainfall, temperature,
humidity, and CO2 concentration) were collected through
direct measurements from field sampling locations and
through records from the Meteorology, Climatology, and
Geophysics Agency from 2010 to 2020. Community data
regarding cases of DHF were collected from the health
agency of Bekasi City and South Tangerang City, while
respondent characteristics, knowledge, attitudes, and
behavior (regarding DHF, causes, vector, signs and
symptoms, and disease prevention) were collected from
an online questionnaire (due to the COVID-19 pandemic)
in August to November 2020. This research is a follow-up
study, in which the questionnaire was tested for validity
and reliability because it was used in research at different
locations in 2018 (first) and 2019 (second).
RESULTS
The Model Simulation for Predicting Dengue
Hemorrhagic Fever Cases (illustrated in Figure 1a)
demonstrates the connection between DHF incidence
and community engagement associated with their health
behavior and knowledge. The presence of counseling
programs that address knowledge, perspectives, and
actions can contribute to the establishment of mosquito
breeding sites.
The occurrence of DHF demonstrates a
cyclical pattern influenced by climatic factors (Figure
1b), suggesting that the dengue virus, its vectors, and
people exhibit significant sensitivity to environmental
variables. As a result, the ecological contex related to
DHF incidence comprises several subsystems: climate
factors, the vectors, human factors, and the cases.
These four subsystems interact and affect each other.
Samples
The samples collected in this study comprise
environmental
factors
and community data.
Environmental variables were collected through direct
measurements from field sampling locations and
through records from the Meteorology, Climatology, and
Geophysics Agency from 2010 to 2020. Community data
regarding cases of DHF were collected from the health
agency of Bekasi City and South Tangerang City, while
respondent characteristics, knowledge, attitudes, and
behavior were collected from an online questionnaire
(due to the COVID-19 pandemic) in August to November
2020. This research is a follow-up study, in which the
Greenhouse
Effect
CO2
+
+
Global
Temperature
-
+
Knowledge,
Attitude,
Practice
+
Reactivity of
the Dengue
Virus
Sea Surface
Temperature
+
Eggs
+
Human
Risk
+
Infected
Human
-
-
+
+
DHF Cases
Immune
Human
-
-
+
Man Landing
Rate
+
Community
Activeness
+
DHF
Morbidity
Pupa
+
Transmission
Rate
+
Carrier
Infected
Aedes
+
+
Individual
Actively
-
+
+
+
+
Adult Aedes
-
+
Ambient
Temperature
+
Breeding
Places
Infected
Aedes
+
+
Man Landing
Rate
+
-
+
Larva
Community
Activeness
+
-
+
Pupa
+
+
+
+
+
Adult Aedes
Global
Temperature
Rainfall
CO2
+
+
+
+
+
+
+
Eggs
Larva
+ Born
Ambient
Temperature
+
Greenhouse
Effect
Greenhouse
Gases
+
Breeding
Places
-
+
El Nino
-
+
+
Sea Surface
Temperature
Rainfall
+
Vol. 18 No.2 April 2026 (112-122)
-
+
+
+
Human
Risk
Transmission
Rate
+
+
Carrier
-
a)
Individual
Actively
DHF Cases
+
+
-
b)
Figure 1. a) Dynamics System Model of DHF Cases with Community Role Improvement (PSP) Intervention
b) Dynamics System Model of DHF Cases with Environmental Intervention
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Respondents in South Tangerang City and
Bekasi City were predominantly female, of productive age
(15–64 years), employed, with a university education,
and no history of dengue fever in the past year. The
percentages in South Tangerang City were 55.3%,
98.7%, 56.6%, 67.1%, and 84.2%, respectively, while
in Bekasi City, they were 60.9%, 94.6%, 65.8%, 58.9%,
and 88.1%, respectively. Most of the residents of South
Tangerang City in this study live in Serpong District and
Setu District, while the residents of Bekasi City live in
West Bekasi District, Rawalumbu District and Pondok
Gede District (Table 1).
The distribution of respondents’ knowledge
regarding dengue fever in South Tangerang City and
Bekasi City showed that almost all respondents in
both cities were aware of DHF. However, only a small
proportion answered that viruses were the cause: 15.8%
in South Tangerang City and 10.4% in Bekasi City.
The majority of respondents in both cities also stated
that DHF is both dangerous and preventable, with the
percentages in South Tangerang City being 94.7% for
dangerous and 97.4% for preventable. Similarly, in
Bekasi City, the percentages were approximately 97.5%
and 99.5% (Table 2).
Table 1. Distribution of Residents Characteristics and
DHF Incidence History in South Tangerang and Bekasi
City in 2020
Variable
Gender
Age (years)
Job status
Education
South
Tangerang
City (N = 76)
Vol. 18 No.2 April 2026 (112-122)
The
municipalities
majority
of
participants
demonstrated
toward DHF prevention
across
positive
initiatives. Personal
both
attitudes
health
consciousness was evident, with 3M implementation
Bekasi City
(N = 202)
practices reaching approximately 100% in South
Tangerang and 98.5% in Bekasi. Similarly, residents
n
%
n
%
Male
34
44.7
79
39.1
Female
42
55.3
123
60.9
< 15
1
1.3
9
4.5
15-64
75
98.7
191
94.6
Tangerang participants and 98.5% of Bekasi residents
> 64
0
0.0
2
1.0
reported being actively involved in implementing DHF
Work
43
56.6
133
65.8
prevention measures. Moreover, respondents from
Does not work
33
43.4
69
34.2
both locations predominantly supported the routine
Not completed
in primary
school
0
0.0
1
0.5
implementation of larval control activities to assist
expressed their commitment to consistently conducting
prevention activities. Additionally, 94.7% of South
governmental initiatives focused on eliminating mosquito
breeding sites through the 3M plus approach (Table 2).
Elementary
School or
equivalent
0
Junior high
school or
equivalent
1
1.3
72
35.6
Senior High
school or
equivalent
24
31.6
4
2.0
College
51
67.1
119
58.9
History of
DHF (last
year)
Yes
12
15.8
24
11.9
Not
64
84.2
178
88.1
Domicile
Serpong
subdistrict
43
15.5
33
11.9
Setu
subdistrict
from both South Tangerang (100%) and Bekasi (98%)
0.0
6
Meanwhile, behavioral variables were assessed
3.0
based on the most common daily dengue fever prevention
efforts and their duration. The primary preventive
behavior exhibited by respondents against DHF in South
Tangerang and Bekasi Cities involved mosquito spray
application (72.4% and 68.8%, respectively). Additional
prevention measures implemented among residents
of South Tangerang (98.7%) and Bekasi City (98.5%)
included weekly cleaning of water reservoirs or drainage
(in South Tangerang City, 69.7%, and in Bekasi City,
76.7%) (Table 2). Regarding the knowledge, attitudes,
and behavior of residents in South Tangerang concerning
dengue fever, the classification by sub-district shows rates
West Bekasi
subdistrict
66
23.7
Rawalumbu
subdistrict
69
24.8
Pondok Gede
subdistrict
67
24.1
of 52.6%, 60.5%, and 56.6%, respectively. Concurrently,
the rates of Bekasi City residents were 55.4%, 60.9%,
and 59.4%, respectively. Given the residents’ good
knowledge, positive attitudes, and proactive behavior,
the risk of dengue transmission is reduced (Table 2).
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Vol. 18 No.2 April 2026 (112-122)
Table 2. Distribution of Resident Knowledge, Attitude and Behaviour in South Tangerang and Bekasi City about DHF, Mode
of Transmission, Signs, Symptoms, and DHF Prevention in 2020
South Tangerang City (N = 76)
Variable
Knowledge
Know about DHF
Causes of DHF
The DHF vectors
DHF is dangerous
DHF signs and
symptoms
DHF can be
prevented
DHF prevention
efforts
Attitude
Bekasi City (N = 202)
n
%
n
%
Yes
75
98.7
201
99.5
Not
1
1.3
1
0.5
Insect bites (mosquitoes,
flies, and others)
64
84.2
175
86.6
Virus
Food / drink not well
cooked and clean
Do not know
12
15.8
21
10.4
0
0.0
5
2.5
0
0.0
1
0.5
Virus
4
5.3
1
0.5
Flies
0
0.0
1
0.5
Mosquito
71
93.4
199
98.5
Do not know
1
1.3
1
0.5
Yes
72
94.7
197
97.5
Not
3
3.9
4
2.0
Do not know
1
1.3
1
0.5
Good (≥ 3 signs,
symptoms)
26
34.2
68
33.7
Enough (1–2 signs,
symptoms)
35
46.1
106
52.4
Less
15
19.7
28
13.9
Yes
74
97.4
201
99.5
Not
1
1.3
0
0.0
Do not know
1
1.3
1
0.5
Good (≥ 3 prevention
efforts)
58
76.3
146
72.3
Enough (1–2 prevention
efforts)
18
23.7
53
26.2
Less
0
0.0
3
1.5
Knowledge
categories
Good
40
52.6
112
55.4
Less
36
47.4
90
44.6
DHF prevention
efforts
Just doing 3M
0
0.0
2
1.0
Only pay attention to
personal health
0
0.0
1
0.5
Pay attention to personal
health and do 3M
76
100.0
199
98.5
Preventive
measures: carried
out periodically /
routinely
Agree
76
100.0
198
98.0
Disagree
0
0.0
4
2.0
Participate in DHF
prevention efforts
Yes
72
94.7
199
98.5
Not
4
5.3
3
1.5
Agree
75
98.7
201
99.5
Disagree
1
1.3
1
0.5
Support the
government 3M
program
Agree
75
98.7
202
100.0
Attitude categories
Good
46
60.5
123
60.9
Less
30
39.5
79
39.1
Disagree
1
1.3
0
0.0
Routine: cleaning /
draining the bath
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South Tangerang City (N = 76)
Variable
Behaviour
Vol. 18 No.2 April 2026 (112-122)
Bekasi City (N = 202)
n
%
n
%
Burn mosquito repellent
5
6,6
18
8,9
Using mosquito spray
55
72,4
139
68,8
Apply repellent
8
10,5
26
12,9
Wearing a mosquito net
7
9,2
14
6,9
Never did anything
1
1,3
5
2,5
Cleaning / draining
water reservoirs
Yes
75
98,7
199
98,5
No
1
1,3
3
1,5
Duration of
cleaning / draining
Once a week
53
69,7
155
76,7
2 weeks
13
17,1
26
12,9
3 weeks
3
3,9
6
3,0
Once a month
7
9,2
15
7,4
Good
43
56.6
120
59.4
Less
33
43.4
82
40.6
DHF prevention
efforts: most often
Behaviour
categories
Regarding home ownership, demographically,
respondents in South Tangerang City reside in areas with
relatively high population density, namely Setu District
at 5,586 per km2 and Serpong District at 5,897 per km2
(28). Respondents in Bekasi City reside in Pondok Gede
District, Rawalumbu District, and West Bekasi District,
with high-density levels of 14,569, 13,441, and 19,215
per km2, respectively (29). Previous research in West
Java Province found a relationship between population
density and dengue fever incidence. High population
density can reduce the distance between houses, making
the spread of dengue fever easier (30).
Generally, the understanding of DHF prevention
among residents in both cities was classified as satisfactory.
Enhancing this awareness should not be confined to
community based initiatives alone but must incorporate
more individualized and clinical approaches. Adequate
knowledge regarding dengue transmission pathways
effectively reduces exposure risks (31). Consequently,
ensuring that household members, especially regarding
DHF, possess sufficient understanding helps minimize
such risks. Moreover, elevated public awareness of
dengue prevention strategies influences an individual’s
mindset and decision making processes, as those with
comprehensive knowledge and practical experience
concerning DHF demonstrate greater confidence in
implementing preventive measures (23,32). Additional
research findings underscore that experience-based
knowledge proves more enduring than behavior lacking a
knowledge foundation. Consequently, individuals aware
DISCUSSION
Climate subsystems related to climate change
are linked to the increase in global Earth temperature.
Consequently, this worldwide phenomenon can impact
the primary insect responsible for DHF, specifically the
Aedes aegypti mosquito. Climate sensitivities for the
dengue vector and host include the rise in temperature,
precipitation levels, rainfall, and sunlight duration (20). A
study in Indonesia, namely in East Jakarta City, showed
a significant relationship between atmospheric humidity
and dengue fever incidence, indicating that elevated
humidity levels correspond with increases in dengue
fever cases (21).
The change in temperature and other climate
variables controls the redistribution of vectors. Other
studies have shown a connection between the climate
subsystem and the breeding habitats of mosquitoes.
Rainfall creates these breeding sites for mosquitoes
(22–24). When it rains heavily, the breeding place is
filled easily with water, and a positive arrow indicates
this relationship. The environmental temperature is a
crucial factor that affects dengue transmission regarding
its vector survival and metabolism within adult Aedes
known as the Extrinsic Incubation Period (EIP) (24–
25). Increased temperatures and fluctuations in rainfall
patterns are associated with mosquito reproduction and
virus transmission (27). Previous studies also show
a positive, non-linear association between ambient
temperature and dengue (15).
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of the necessary preventive measures to interrupt the
transmission cycle tend to demonstrate more effective
preventive behaviors (33).
Approximately half of the participants across
both cities exhibited positive attitudes and behaviors
toward DHF prevention efforts. Dengue fever prevention
requires heightened awareness and active participation
from residents in both cities, recognizing that this disease
is preventable. Prevention strategies encompass
implementing the 3M plus campaign, utilizing mosquito
nets, and avoiding the practice of hanging worn clothing.
Most respondents from South Tangerang and Bekasi
demonstrated favorable attitudes toward dengue
transmission prevention initiatives. This result highlights
the crucial role of public awareness and behavioral
practices in preventing the transmission of dengue. An
individual’s knowledge level directly influences their
attitude and behavior in preventing DHF transmission
(34–36).
Beyond knowledge, attitude is another variable
supporting DHF prevention and control efforts. Individuals
who support the eradication of mosquito breeding sites
tend to prioritize environmental sanitation activities,
such as drainage management (draining, covering, and
burying water reservoirs). Attitude constitutes a closed
response that is not immediately visible; it can only
be inferred through observable behavior. In addition,
attitude is not an act but serves as a predisposing factor
toward action. When circumstances allow, this attitude
will manifest as action (17).
This result aligns with findings from South
Kalimantan, which demonstrated a correlation between
community actions and the population density of Aedes
aegypti mosquitoes. Individuals possessing adequate
knowledge typically exhibit positive and appropriate
behaviors. Additional research in Jamaica indicates that
good knowledge is associated with positive perspectives
and behavioral practices regarding dengue prevention
activities (37–38).
The findings of this study reaffirm that the
interaction between environmental, climatic, and
behavioral factors strongly influences the dynamics of
DHF transmission. The simulation model demonstrated
that community knowledge, attitudes, and behaviors are
central determinants that can either suppress or amplify
the risk of DHF, especially in urban environments such
as South Tangerang and Bekasi, where population
density and urbanization are high. The predictive model
suggests that changes in temperature, humidity, and
rainfall have a significant impact on the vector population
and its breeding potential. This result aligns with global
evidence that Aedes aegypti populations tend to expand
Vol. 18 No.2 April 2026 (112-122)
under warmer and more humid conditions, thereby
increasing the likelihood of dengue transmission (39).
In the context of climate change, urban
microclimates play a critical role in shaping mosquito
ecology. The urban heat island effect, poor water
management, and irregular waste disposal create
favorable breeding habitats for Aedes mosquitoes.
Studies in other Southeast Asian cities have shown that
even small increases in average temperature (1–2°C) can
reduce extrinsic incubation period (EIP) of the dengue
virus, accelerate mosquito maturation, and increase
virus replication rates (15,40). Therefore, temperature
sensitive modeling, such as the model used in this study,
is crucial for anticipating outbreaks and guiding vector
control programs.
Moreover, behavioral and socioeconomic
dimensions add another layer of complexity to dengue
transmission. The finding that many residents possess
sound knowledge, but not all demonstrate consistent
preventive behavior, echoes a pattern commonly
observed in public health research. Knowledge does not
automatically translate into sustainable practice unless
supported by enabling environmental and institutional
factors. For instance, even when individuals recognize
the importance of draining water containers, factors such
as a lack of time, competing priorities, or inadequate
community based monitoring can hinder consistent
implementation. This gap between knowledge and action
underscores the importance of strengthening behavioral
change communication and ensuring community
participation through locally tailored health promotion
strategies (37–38).
The data showing that nearly all residents
recognize DHF as a preventable disease and understand
the 3M Plus strategy indicates a strong baseline of
awareness. However, the persistence of dengue cases
suggests that routine practices need reinforcement
through continuous health education and environmental
management programs. Recent studies have shown
that interventions combining education, environmental
modification, and regular vector surveillance are
significantly more effective than isolated information
campaigns (42). Integrating digital tools, such as
mobile-based vector reporting or GIS-based mapping,
can further enhance community participation and early
warning capacity, especially in densely populated areas
like Bekasi and South Tangerang.
The demographic composition observed in this
study also contributes valuable insights. The dominance
of productive age groups and individuals with tertiary
education suggests a high capacity for information
processing and participation in preventive programs.
118
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Nonetheless, urban mobility, long working hours, and
lifestyle factors can all contributed to reduced adherence
to preventive behaviors at home. It highlights the need
for workplace based health promotion programs and
collaboration with local industries and community
organizations to expand the reach of dengue prevention
messages beyond the household level (43).
Another critical aspect emerging from this study
is the role of gender in dengue prevention. With women
constituting the majority of respondents, their role as key
health influencers in the household becomes central to
the success of community-based prevention programs.
Prior research emphasizes that empowering women
through targeted health education and leadership in
neighborhood health groups can significantly reduce the
incidence of dengue (44).
As demonstrated in this study, integrating
climatic, ecological, and behavioral data into predictive
modeling represents a step toward adaptive dengue
prevention strategies. Predictive models incorporating
real time meteorological data can serve as an early
warning system for local health departments, providing
valuable insights into potential health risks. Combined
with KAP (Knowledge, Attitude, and Practice) data, these
models can prioritize high-risk areas and populations,
optimizing resource allocation for vector control and
health education campaigns. Future research should
consider incorporating spatial analysis using remote
sensing and time-series climate data to improve model
precision and guide policy decisions at the municipal
level.
Ultimately, this study highlights the significance
of a comprehensive approach to dengue prevention.
Sustainable success requires individual awareness,
collective community engagement, institutional support,
and adaptive climate policies. Urban resilience to dengue
must be built through cross-sectoral collaboration
between public health, urban planning, education,
and environmental management sectors. One of the
community empowerment methods that is used to control
DHF in cities with high urbanization is the Clean and
Larva-Free Village (Berbatik) program, which actively
involves all elements of society, researchers, the private
sector, and the media through a pent helix approach
in the spirit of community empowerment. Community
empowerment through Kampung Berbatik is carried out
through the 3M Plus program, regular larva inspections,
appropriate technology such as the use of Ovi traps
in every home, and dissemination of information on
dengue fever cases in the community (45). Community
empowerment, behavioral reinforcement, and climate-
Vol. 18 No.2 April 2026 (112-122)
informed surveillance will mitigate dengue risks in rapidly
urbanizing Indonesian cities. Thus, strengthening early
detection systems, promoting continuous community
based education, and integrating climate adaptation
measures into local public health policies are essential
steps toward reducing the long-term burden of dengue
fever.
CONCLUSION
This study demonstrates that the knowledge,
attitudes, and behaviors of urban residents in South
Tangerang
and
Bekasi City regarding Dengue
Hemorrhagic Fever (DHF) prevention are generally
in good categories, which contribute to reducing
dengue transmission risks. Climate variability including
temperature, humidity, rainfall, and CO₂ levels,
significantly affects the dynamic transmission of DHF
by influencing vector breeding and virus replication.
The system dynamics modeling reveals that enhanced
community participation, combined with environmental
interventions, can substantially reduce mosquito breeding
sites and DHF incidence rates. However, gaps remain
in translating knowledge into consistent preventive
practices, particularly during transitional periods leading
to the rainy season. Both government and community
stakeholders must play vital roles in strengthening health
promotion through diverse media channels, implementing
the 3M Plus program comprehensively, and integrating
climate-informed surveillance systems into local public
health policies.
ACKNOWLEDGMENTS
The authors appreciate the support from the
Indonesian Ministry of Research, Technology and
Higher Education, for funding this research through
PTUPT Program grant. Thanks, are also conveyed
to the Meteorology, Climatology, and Geophysics
Agency in Bekasi City and South Tangerang City. The
authors would also like to convey their gratitude to
the participants who were willing to participate in this
research implementation.
AUTHORS’ CONTRIBUTION
All authors contributed to research and writing
to this article. HK: Conceptualization, Investigation,
Supervision. MMS: Conceptualization, writing—original
draft preparation, writing—review and editing. SWU:
Writing—original draft preparation, Methodology. OAP:
Editing, Software. NA: Formal analysis, Validation.
ERKS: Methodology, Formal analysis.
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