<![CDATA[Background: Dengue hemorrhagic fever (DHF) is a disease caused by the dengue virus through the bite of the Aedes aegypti mosquito. DHF is an endemic disease in more than 100 countries. There were 728 cases of DHF and 8 cases of death in Grobogan, Central Java, in 2017. The purpose of this study was to examine the contextual effect of the village on the incidence of DHF.Subjects and Method: This was a case-control study conducted in Grobogan, Central Java, from November to December 2018. A sample of 200 study subjects was selected by fixed disease sampling. The dependent variable was DHF. The independent variables were the presence of water shelter, ponds, farmland, mosquito larvae, hanging clothes, house density, eradication of mosquito nest, education, and employment. The data were collected by questionnaire and observation. The data were analyzed by a multilevel logistic regression.Results: Existence of water shelter (b= 4.53; 95% CI= 1.29 to 7.76; p= 0.006), ponds (b= 2.71; 95% CI= 0.26 to 5.17; p= 0.030), farm land (b = 3.40; 95% CI = 0.52 to 6.28; p= 0.021), mosquito larvae (b= 3.45; 95% CI= 0.61 to 6.29; p= 0.017), hanging clothes (b= 2.39; 95% CI= 0.23 to 4.56; p= 0.030), and house density (b= 5.55; 95% CI= 1.59 to 9.51; p= 0.006), increased the risk of DHF.  Education ≥senior high school (b= -4.79; 95% CI= -8.44 to -1.13; p= 0.010), employed (b= - 5.36; 95% CI= -9.22 to -1.49; p= 0.006), and exposed to DHF mosquito nest eradication program (b= -4.31; 95% CI= -7.64 to -0.97; p= 0.011) decreased the risk of DHF. Village environment had strong contextual effect on DHF with ICC= 51.33%.Conclusion: Existence of water shelter, ponds, farmland, mosquito larvae, hanging clothes, and house density, increase the risk of DHF.  Education ≥senior high school, employed and exposed to DHF mosquito nest eradication program decrease the risk of DHF. Village environment has a strong contextual effect on DHF.Keywords: dengue hemorrhagic fever, environmental factors, eradication of mosquito nests, village strata, multilevel analysisCorrespondence: Ambar Sari. Masters Program in Public Health. Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: ambarsari69.as@gmail.com. Mobile: +625647847180; 08562623045Journal of Epidemiology and Public Health (2019), 4(3): 156-170https://doi.org/10.26911/jepublichealth.2019.04.03.02]]>
