Spatiotemporal evolution of dengue hotspots in Kuantan, Malaysia: A decade-long geospatial analysis for adaptive vector control

<h2>ABSTRACT</h2><h3>Problem considered</h3> 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. <h3>Methods</h3> 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. <h3>Results</h3> 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; 6,213 cases) and 2022 (578.2 per 100,000; 5,876 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 stabilising. Local Moran's I showed significant High–High clusters in the urban core (Moran's I=0.41, p < 0.01). <h3>Conclusion</h3> 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.