Zulkifli Abdul Hadi, Agus Naba, Ahmad Mohiddin Mohd Ngesom, Nazri Che Dom
Problem considered: Dengue continues to pose a major public health burden in Malaysia, particularly in rapidly urbanising districts where shifting land-use patterns influence transmission dynamics. Despite increasing case numbers, evidence on long-term hotspot trajectories at the district scale remains limited. This study examined a decade of dengue transmission in Kuantan District, Malaysia by integrating detailed land-use characteristics with epidemiological and population data to identify persistent, emerging, and expanding hotspots. Methods: A retrospective spatiotemporal analysis was conducted using laboratory-confirmed dengue cases reported from 2014 to 2023. Case data were geocoded and aggregated at the sub-district level. Residential, commercial, industrial, and green-area land-use layers were standardised and spatially overlaid with dengue incidence rates to quantify their contribution to hotspot formation. Annual incidence rates were calculated to provide a precise measure of disease intensity across sub-districts. A multi-stage geospatial framework comprising Kernel Density Estimation, Space–Time Cube modelling, Mann–Kendall trend analysis, Emerging Hotspot Analysis, and Local Moran's I was applied to evaluate hotspot intensity, persistence, and spatial evolution. Results: A total of 38,412 dengue cases were documented, with an average annual incidence of 386.5 cases per 100,000 population. Major peaks occurred in 2019 (624.5 per 100,000; 6213 cases) and 2022 (578.2 per 100,000; 5876 cases). Persistent hotspots increased from five in 2016 to nine in 2023, primarily within high-density residential and mixed-commercial zones identified through the land-use overlay analysis. Transitional hotspots frequently emerged in peri-urban areas undergoing rapid land-use change before stabilizing. Local Moran's I showed significant High–High clusters in the urban core (Moran's I = 0.41, p < 0.01). Conclusion: Dengue transmission in Kuantan has become increasingly entrenched, driven by urban density, mixed land-use development, and peri-urban expansion. Proactive, land-use-informed hotspot surveillance is essential for strengthening targeted dengue control. © 2025 The Authors
Centre of Environmental Health & Safety, Faculty of Health Sciences, Universiti Teknologi MARA (UiTM), UITM Selangor, Puncak Alam, Selangor, 42300, Malaysia; Department of Physics, University of Brawijaya, Veteren Street, Malang, 65145, Indonesia; Public Health Division, Selangor State Health Department, Ministry of Health Malaysia, Selangor, Shah Alam, 40100, Malaysia; Institute of Biodiversity and Sustainable Development, Universiti Teknologi Mara (UiTM), Selangor, Shah Alam, 40450, Malaysia
