**6. Conclusion**

**Figure 6.** Estimated annual number of dengue cases and hospitalizations in Indonesia following adjustment of

system and associated health system parameters, a study to estimate the proportion of dengue was conducted by Delphi panel in 2017. The iterative estimation was generated by calculating the expansion factors (EF), the ratio of total and reported cases during the presentation of medical and epidemiological data and subsequent discussions. The data revealed that from all of symptomatic Indonesian dengue episodes, 57.8% enter healthcare facilities to seek treatment but only 39.3% of them are diagnosed as dengue. Furthermore, only 20.3% of them are subsequently reported in the surveillance system. Public sector found dominating occurrence of hospitalizations and followed by private sector for ambulatory episodes (∼55%). Therefore, estimations gave an overall EF of 5.00; hospitalized EF of 1.66; and ambulatory EF of 34.01 which, when combined with passive surveillance data, equates to an annual average (2006–2015) of 612,005 dengue cases, and 183,297 hospitalizations (**Figure 6**.). The findings are lower than those similar estimations published elsewhere, perhaps due to case definitions,

The goal of WHO Global Strategy is to reduce the burden of dengue. Its specific objectives are: (1) to reduce dengue mortality by at least 50% by 2020, (2) to reduce dengue morbidity by at least 25% by 2020, and (3) to estimate true burden of the disease by 2015 (the year 2010 is used as the baseline). The implementing strategy is expected to pave the way for reducing dengue morbidity and mortality nationwide through strengthening local and national capabilities, as well as regional coordination. National Dengue Control Program in Indonesia

surveillance reports with EFs, and their 95% confidence intervals (CIs), 2006–2015.

88 Current Topics in Tropical Emerging Diseases and Travel Medicine

local clinical perceptions, and treatment-seeking behavior [34].

**5. Dengue fever prevention and control**

Given the wide area in the tropical temperature, high population density in urban area, and various geographic and biodiversity, putting Indonesia as a natural potential for the habitat of dengue viruses. The number of dengue fever cases reported dramatically increases since it was firstly found in 1968 and spread out almost in 80% cities and districts in Indonesia in 2016. Many of those cities and districts were very vulnerable and putting million people at risk to the disease in 2012. Some challenges are still heading in the front of the prevention and control implementation actions. However, keeping spirit for struggling to combat dengue fever in Indonesia along with full commitment and involvement of community are urgently needed as well as to revitalize dengue disease eradication programs at every stage with close monitoring implementation.

In addition, technical guidance and increased skills of health officers are indispensable. Socialization of a hands-on program activities in particular and increased capacity and active participation of community on the action could be a joint action in preventing the increase in dengue disease associated to climate change.
