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Procedia Computer Science 179 (2021) 135–143

5th International Conference on Computer Science and Computational Intelligence 2020

Evaluation of Dengue Model Performances Developed Using

Artificial Neural Network and Random Forest Classifiers
Permatasari Silitongaa, Beti E. Dewib, Alhadi Bustamama,*, and Herley Shaori Al-Ashc
a
Department
Department of Mathematics, Faculty of Mathematics and Natural Sciences, Universitas Indonesia, Kampus Baru UI, Depok 16424, Indonesia
b
Department of Microbiology, Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No.5, Jakarta Pusat, Jakarta 10430, Indonesia
c
Department of Computer Science, Faculty of Computer Science, Universitas Indonesia, Kampus Baru UI, Depok 16424, Indonesia

Abstract

Dengue is one of the endemic diseases in Indonesia. Dengue is being suffered by many people, regardless of their gender and age.
Therefore, research about dengue based on dengue patients’ data was conducted. There was a lot of information written in that data
regarding the corresponding patients and the dengue they had suffered, such as gender, age, how long the patients were hospitalized,
the symptoms they experienced, and laboratory characteristics results. Diagnosis of each of the corresponding patients based on
their symptoms and laboratory characteristics results were also written in that data. The diagnoses were classified into three
different clinical degrees according to the severity level, which is DF as the mild level, DHF grade 1 as the intermediate level, and
DHF grade 2 as the severe level. In this research, data of the patients on the third day of being hospitalized was analyzed, because,
on the third day, dengue is entering a critical phase. The objectives of this research were: to evaluate the performance of the models
that were used to predict the correct class within the given dataset developed using Artificial Neural Network (ANN) classifier and
Random Forest (RF) classifier separately, and to find a classifier that yielded the best performance. The results obtained from this
research will be used in the development of a Machine Learning model that can predict the clinical degree of dengue in the critical
phase, if the laboratory characteristics results are known, using a classifier that yielded the best performance.
© 2020
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Computational Intelligence 2020
Keywords: Dengue; Artificial Neural Network; Random Forest

* Corresponding author. Tel.: +62 813-1005-8988.

E-mail address: alhadi@sci.ui.ac.id

1877-0509 © 2020 The Authors. Published by ELSEVIER B.V.

This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0)
Peer-review under responsibility of the scientific committee of the 5th International Conference on Computer Science and
Computational Intelligence 2020

1877-0509 © 2021 The Authors. Published by Elsevier B.V.

This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0)
Peer-review under responsibility of the scientific committee of the 5th International Conference on Computer Science and
Computational Intelligence 2020
10.1016/j.procs.2021.12.018
136 Permatasari Silitonga et al. / Procedia Computer Science 179 (2021) 135–143
2 Author name / Procedia Computer Science 00 (2020) 000–000

1. Preliminary

1.1. Problem background

Dengue is a disease caused by dengue virus. Dengue virus is a part of the family Flaviviridae and genus Flavivirus
1
. Dengue virus is transmitted to humans through female mosquitoes that are infected by the virus itself. Dengue virus
is transmitted by Aedes aegypti female mosquitoes as the primer vector and Aedes albopictus female mosquitoes as
the secondary vector. Dengue virus has an incubation period for 4-10 days 2. After the incubation period ends, an
infected mosquito can transmit dengue virus in its lifetime. Dengue virus consists of four serotypes, which are DENV-
1, DENV-2, DENV-3, and DENV-4. A person who is infected by dengue virus can be infected by one serotype of
dengue virus or more 3.
Dengue has three different clinical degrees according to its severity level, which is DF (Dengue Fever), DHF
(Dengue Hemorrhagic Fever), dan DSS (Dengue Shock Syndrome) 4. Dengue cases are commonly found in tropical
and subtropical countries, such as Southeast Asia, South America, and many more. Generally, dengue cases happen
in urban and suburban areas 5, and frequently appear in rainy season.
Dengue is one of the endemic diseases in Indonesia. In 1968, dengue was first found in Indonesia, in the city of
Jakarta and Surabaya 6. According to WHO, Indonesia is a country with the highest amount of dengue patients in
Southeast Asia (WHO, 2012). In 2013, the number of reported dengue patients in Indonesia was 112,511 persons,
with the number of deaths was 871 persons (Incidence Rate (IR) = 45.85% per 100,000 citizens and Case Fatality
Rate (CFR) = 0.77%) 7. In 2014, the number of reported dengue patients in Indonesia was 100,347 persons (IR =
39.8% and CFR = 0.9%). In 2015, the number of reported dengue patients in Indonesia was 129,650 persons, with the
number of deaths was 1,071 persons (IR = 50.75% and CFR = 0.83%) 7.
In this research, dengue was analyzed based on dengue patients’ data. There was a lot of information written in that
data regarding the corresponding patients and the dengue they had suffered, such as gender, age, how long the patients
were hospitalized, the symptoms they experienced, and laboratory characteristics results. Diagnosis of each of the
corresponding patients based on the symptoms and laboratory characteristics results were also written in that data.
The diagnoses were classified into three different clinical degrees according to its severity level, which is DF as the
mild level, DHF grade 1 as the intermediate level, and DHF grade 2 as the severe level. Laboratory characteristics
were defined as the independent variables, while the diagnosis was defined as the dependent variable.
As explained previously, dengue has three different clinical degrees according to its severity level, which is DF,
DHF, dan DSS. But in this research, clinical degrees that were analyzed are only DF and DHF, where DHF was
divided into two different degrees, which was DHF grade 1 and DHF grade 2.
There was a lot of independent variables that were collected for ten times in the corresponding data. Ten times
collection mean the corresponding independent variables were being observed for ten days. Nevertheless, variables
used in this research were only variables on the third day of observation, which were variables from the patients’ data
on the third day of being hospitalized. Because on the third day, dengue patients are entering the critical phase (critical
phase of dengue occurs on day fourth to sixth). Those variables were only used when the patients are entering the
critical phase because results obtained from this research will be used in the development of machine learning model
that can predict the clinical degree of dengue in the critical phase, if the laboratory characteristics results are known.
Laboratory characteristics that were used in this research consist of Hemoglobin, Hematocrit, Leukocyte,
Thrombocyte (platelet count), Neutrophil, Lymphocyte, and Monocyte. Some of the other laboratory characteristics
were only measured on the first, fourth or fifth, and seventh day of observation. Because they weren’t measured on
the third day of observation, they weren’t used in this research.
A note to remember, the results that we showed were the evaluation the performance of the models that were used
to predict the correct class within the given dataset developed using Artificial Neural Network (ANN) classifier and
Random Forest (RF) classifier separately, and our conclusion regarding a classifier that yielded the best performance.
Problem formulations of this research were how was the performance of the models that were used to predict the
correct class within the given dataset developed using ANN classifier and RF classifier separately? And which
classifier yielded the best performance?
The objectives of this research were to evaluate the performance of the models that were used to predict the correct
class within the given dataset developed using ANN classifier and RF classifier separately, and to find a classifier that
yielded the best performance.
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Author name / Procedia Computer Science 00 (2020) 000–000 3

The results obtained from this research will be used in the development of a machine learning model that can
predict the clinical degree of dengue in the critical phase, if the laboratory characteristics results are known, using a
classifier that yielded the best performance.

2. Related works

Abdiel E. Laureano-Rosario et al. 8 utilized Artificial Neural Networks (ANN) which was trained with genetic
algorithm to predict dengue fever outbreak in Puerto Rico and some areas in the coast of Mexico. They concluded that
the model they developed using ANN had a good predictive ability.
Jorge D. Mello-Román et al. 9 compared two machine learning methods, which were Artificial Neural Networks
multilayer perceptron (ANN-MLP) and Support Vector Machine (SVM) as the tools to assist medical diagnosis. ANN-
MLP produced a better result with averagely 96% accuracy, 96% sensitivity, and 97% specificity. In conclusion,
ANN-MLP and could be used as a classifier to diagnose dengue infection with high accuracy, sensitivity, and
specificity.
N. Rajathi et al. 10 compared Naïve Bayes, J48, Random Forest, Reduces Error Pruning (REP) tree, Sequential
Minimal Optimization (SMO), Locally Weighted Learning (LWL), AdaboostM1, and ZeroR algorithms to find the
best algorithm to be used in early detection of dengue. Based on the results obtained, Random Forest algorithm yielded
the best classification performance.
Meanwhile, Subhram Dasgupta et al. 11 evaluated the performances of three machine learning techniques, which
were Linear Support Vector Machine (LSVM), Decision Tree Classifier (DTC), and Random Forest Classifier (RFC)
to find features that have important roles in dengue transmission. Based on the results obtained, RFC was the best
algorithm, yielded 95.45% accuracy without FSMs, and 95.78% accuracy with FSMs.
ANN and RF have been widely used to predict dengue cases. Furthermore, the models developed using ANN and
RF usually have high accuracy 8, 9, 10, 11. That is why we decided to use both methods separately in our research, to
build models to predict the correct class within the given dataset. We used WEKA to develop the models. WEKA,
which stands for Waikato Environment for Knowledge Analysis, is an open source machine learning software that
has been widely used nowadays. WEKA was created by Machine Learning Group from University of Waikato.
Research studies 12 and 13 were quite similar to ours. Nonetheless, there were some noticeable differences. The first
difference between 12 and our research was, the independent variables used in 12 were eight clinical attributes, which
consist of fever, headache, body ache, abdominal pain, vomiting, hemoglobin, leukocyte, and platelet count. Five out
of eight clinical attributes weren’t used in our research. Only three clinical attributes were the same as three of the
laboratory characteristics used in our research, which were hemoglobin, leukocyte, and platelet count.
Secondly, the dependent variables used in 12 consisted of two categories, which were positive and negative.
Furthermore, the researchers aimed to classify or predict whether a patient belongs to the positive or negative category.
While in our research, the dependent variables consist of three clinical degrees of dengue, which are DF, DHF grade
1, and DHF grade 2. We aimed to predict the correct class, specifically the clinical degree of dengue, within the given
dataset. We aimed to predict whether a patient suffers degree DF, DHF grade 1, or DHF grade 2.
Thirdly, dengue dataset samples in 12 were divided in 10-fold. While in our research, the dataset was divided in 10-
fold for the model developed using ANN, and 5-fold and 10-fold for the models developed using RF.
Research 13 also had some differences with ours. Firstly, the researchers developed models that can forecast future
dengue cases, namely, predict weekly dengue cases at 12-weeks ahead. While in our research, we developed models
that can predict the clinical degree of dengue suffered by the patients.
Secondly, data used in 13 was data of the Colombian patients. Meanwhile, we used data of the Indonesian patients.
Colombians and Indonesians have different genetical structures. They can have different immunity system and
characteristics in suffering dengue. Therefore, it is highly possible to have different results using the same methods.
Thirdly, the independent variables used in 13 were historical dengue cases, environmental, meteorological, socio-
demographic, and week predictors. While the independent variables used our research were seven laboratory
characteristics, which consist of Hemoglobin, Hematocrit, Leukocyte, Thrombocyte (platelet count), Neutrophil,
Lymphocyte, and Monocyte.
Fourthly, using ANN and RF, the researchers developed two models each, which were national and local. In total,
there were four models developed. Meanwhile, we developed one model using ANN with 10-fold cross-validation
scheme, and two models using RF with 5-fold and 10-fold cross-validation schemes, which later will be explained.
4138 Permatasari
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To this far, methods that have been widely used in similar research studies were ANN 8, 9, 12, 13, RF 10, 11, 13,
Decision Tree Classifier (DTC) 10, 11, 12, SVM 9, 11, 12, Naïve Bayes 10, 12, etc. There were already many researchers
who used ANN and RF in their studies to predict matters related to dengue. Nevertheless, there hasn’t been a researcher
who used ANN or RF to develop a model to predict the correct class within the given dataset, specifically, to predict
the clinical degree of dengue with Hemoglobin, Hematocrit, Leukocyte, Thrombocyte (platelet count), Neutrophil,
Lymphocyte, and Monocyte as the independent variables. This is state of the art from our research. The results
obtained in our research can contribute to healthcare research, especially in helping physicians determine the clinical
degree of dengue of the patients based on their laboratory characteristics values.

3. Methods

3.1. Artificial Neural Network (ANN)

Artificial Neural Network (ANN) is a simple imitation of neuron structure of a human brain 14. Similar to human
brain, ANN is capable to analyze incomplete or unclear information, and furthermore, evaluate them. ANN imitates
human brain in processing input signals and transforming it into output signals 15. ANN is also capable to learn from
data without any assumptions of certain functions.
ANN consists of processing units which are called neuron (artificial). Artificial neurons try to imitate the structure
and behavior of biological neurons. A neuron can consist of more than one input (dendrite), but commonly consists
of only one output (synapsis through axon).
A neuron has a function which determines the activation of the neuron itself. That function is called an activation
function. An activation function processes input signals that have been combined together, then transforms them into
an output signal. Mathematically, the procedure of signal processing can be expressed as follows:
y ( x) = F (å n

i =1
wi × xi )
where 𝑦𝑦 is the output signal, Φ() is the activation function, 𝑥𝑥 is the input variable, and 𝑤𝑤 is the weight that is given to
each of the input variable(s).
ANN can be widely used in different scopes of problems, include finding new features, and classifying or predicting
using huge sets of data. Some of the fields where ANN is frequently used are speech recognition, character recognition,
signature verification application, human face recognition, medical diagnosis prediction, etc 16.
3.2. Random Forest (RF)
Random Forest (RF) is a classification method that operates by constructing regression trees that consist of a set of
decision trees 17. The trees are selected randomly from the available training data, then combined using Breiman’s
bagging method. Prediction for the result is made by aggregating the decisions made by the decision trees. Bagging
itself is a technique to build ensemble of classifiers, where each classifier is built using a randomly drawn sample of
data, so the classifiers are likely to diverse from each other.
Random Forest (RF) has some beneficial characteristics. Firstly, RF is capable of handling high dimensional data.
Furthermore, RF can process continuous, categorical, and binary data. It can also handle missing values. Secondly,
RF can handle large variable inputs and balance errors in unbalanced datasets problems. Thirdly, in handling training
data, RF is less sensitive to outliers. Lastly, RF yields accurate prediction results in various fields of applications.
After the model is developed, the model will be trained. Through model training, the importance of each data feature
can be measured.
Classification performance of RF is significantly better than a single decision tree 18. RF has a high prediction
accuracy for various types of datasets. Accurate predictions and better generalizations are achieved because RF utilizes
random sampling and ensemble scheme.

4. Results and discussion

4.1. Experiment workflow
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Author name / Procedia Computer Science 00 (2020) 000–000 5

Below was the experiment workflow of this research:

Fig. 1. Experiment workflow.

The data used in this research was obtained from Department of Microbiology, Universitas Indonesia
(https://drive.google.com/drive/folders/1C1ZciLa2Cwsb1IrDpBpULP-2IZrcskBQ?usp=sharing). They consisted of
two different data that were combined together. The first data consisted of 53 dengue patients’ data, and the second
data consisted of 24 dengue patients’ data. In total, there were 77 dengue patients’ data. Both data were labelled data.
The data were categorized as labelled data because the targeted values, which were the clinical degrees of dengue,
were known. We used the first data as the training data to develop the models.
The data was standardized before it was used to develop the models. We only standardized the data of the
independent variables, which were the seven laboratory characteristics. We didn’t standardize the data of the
dependent variable, which was the clinical degree of dengue, because we wanted the real values of the dependent
variable. Data of the independent variables was standardized because the values varied greatly and had different units.
It was also standardized in order to develop better models compared to models developed using unstandardized data.
We used Z-score method to standardize the data.
In training phase, models to predict the correct class within the given dataset – was called “the models” for short –
were developed using supervised learning method, because the corresponding data was a labelled data. Furthermore,
the models were developed using classifier algorithms, for the models would be used to classify new data into three
categories of clinical degree of dengue, which is 0 for degree DF, 1 for degree DHF grade 1, and 2 for degree DHF
grade 2. The classifier algorithms used in this research are Artificial Neural Network (ANN) classifier and Random
Forest (RF). We developed three models in total. One model was developed using Artificial Neural Network (ANN)
classifier with 10-fold cross validation scheme. The other two models were developed using Random Forest (RF)
classifier; one with 5-fold cross validation scheme, and the other with 10-fold cross validation scheme.
After the models were developed, in testing phase they were evaluated using labelled testing data from each fold.
The testing data used in this research was the second data which consists of 24 dengue patients’ data. Although we
used different data as the training and testing data, both data had some things in common. That was why we used them
as training and testing data in this research. Firstly, the seven laboratory characteristics that were necessary for this
research were collected in both data. Both data collected Hemoglobin, Hematocrit, Leukocyte, Thrombocyte (platelet
140 Permatasari Silitonga et al. / Procedia Computer Science 179 (2021) 135–143
6 Author name / Procedia Computer Science 00 (2020) 000–000

count), Neutrophil, Lymphocyte, and Monocyte test results of the dengue patients. Secondly, the laboratory
characteristics in both data were observed for ten days. So, there were ten values collected of each laboratory
characteristics. As mentioned previously, we only needed the values of laboratory characteristics on the third day of
observation. Because both data collected the values of laboratory characteristics on the third day of observation, they
were reasonable to be used in this research.
In this research, the obtained results were as follows:
a. Evaluation of the classifiers
In section 4.3, we showed performances of the models developed using ANN classifier and RF classifier
separately. There were three model performances:
i) A model performance developed using ANN classifier with 10-fold cross-validation,
ii) A model performance developed using RF classifier with 5-fold cross-validation, and
iii) A model performance developed using RF classifier with 10-fold cross-validation.
The performance measurement that we used was Correctly Classified Instances (CCI). CCI was used to
represent the accuracy of the models. So, there will be three CCI values displayed. They will be evaluated.
The classifier that yielded the highest CCI value means it yielded the best performance.
b. A classifier that yielded the best performance
After the classifiers were evaluated, we concluded one classifier that yielded the best performance. On the
next part of the research, we will develop a more precise model that can predict the clinical degree of dengue
in the critical phase, if the laboratory characteristics results are known, using a classifier that yielded the best
performance. However, because the predictive model has not been built on this part of the research yet, it
wasn’t furtherly discussed in this paper.

4.2. ANN architecture

Fig. 2. ANN architecture used in this research.

In this research, we developed one ANN model with 10-fold cross-validation scheme. The ANN classifier that we
used was the original WEKA ANN classifier. Our ANN architecture consisted of one input layer, two hidden layers,
and one output layer. There were seven neurons in input layer, which were x1 until x7. Those seven neurons represented
seven laboratory characteristics used in this research as follows:
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Author name / Procedia Computer Science 00 (2020) 000–000 7

x1: Hemoglobin
x2: Hematocrit
x3: Leukocyte
x4: Thrombocyte (platelet count)
x5: Neutrophil
x6: Lymphocyte
x7: Monocyte
In the first hidden layer, there were four neurons. While in the second hidden layer, there was one neuron. In these
hidden layers, there were activation functions that processed the seven laboratory characteristics values that had been
combined together, then transformed them into a clinical degree of dengue. The number of hidden layers and neurons
in each hidden layer were obtained through iteration process, until the accuracy cannot be furtherly improved 13.
In output layer, there was one neuron. Through that neuron, an output value would be obtained. The output value
itself represented a clinical degree of dengue in the form of number 0 for degree DF, 1 for degree DHF grade 1, or 2
for degree DHF grade 2.

4.3. RF settings
In this research, we developed two RF models, one with 5-fold cross-validation scheme, and the other with 10-fold
cross-validation scheme. The RF classifier that we used was the original WEKA RF classifier that operates in four
steps:
1. For every tree ti, bootstrap samples Bi are drawn by randomly selecting instances with replacement from X
until the sizes of Bi and X are equal. Note that X stands for the number of training data.
2. For each Bi, a random subset of features is selected and used for training the tree ti in the forest.
3. An information gain metric is used to grow unpruned decision trees 19.
4. The final classification or prediction result is an aggregation of the decisions made by trees in the forest.
Majority vote is employed in the process of aggregation.
4.4. Results
The results obtained were as follows:
1. Performance of the model developed using Artificial Neural Network (ANN) classifier with 10-fold cross
validation scheme
Table 1. Performance of the model developed using ANN classifier with 10-fold cross validation scheme.
No. Measurement metrics Number of instances Classification performance result
1. Correctly classified instances 59 56.7308%
2. Incorrectly classified instances 45 43.2692%
Total number of instances 104
Using ANN classifier with 10-fold cross validation scheme, we obtained a model to predict the correct class within
the given dataset with 56.7308% accuracy, which was rounded to 57%.

2. Performance of the model developed using Random Forest (RF) classifier

a. 5-fold cross validation scheme
Table 2. Performance of the model developed using RF classifier with 5-fold cross validation scheme.
No. Measurement metrics Number of instances Classification performance result
1. Correctly classified instances 53 50.9615%
2. Incorrectly classified instances 51 49.0385%
Total number of instances 104
Using RF classifier with 5-fold cross validation scheme, we obtained a model to predict the correct class within the
given dataset with 50.9615% accuracy, which was rounded to 51%.

b. 10-fold cross validation scheme

Table 3. Performance of the model developed using RF classifier with 10-fold cross validation scheme.
No. Measurement metrics Number of instances Classification performance result
1. Correctly classified instances 60 57.6923%
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8 Author name / Procedia Computer Science 00 (2020) 000–000

2. Incorrectly classified instances 44 42.3077%

Total number of instances 104
Using RF classifier with 10-fold cross validation scheme, we obtained a model to predict the correct class within the
given dataset with 57.6923% accuracy, which was rounded to 58%.
It was shown that RF classifier with 10-fold cross validation scheme yielded a model with higher accuracy
compared to the one that 5-fold cross validation scheme yielded. Generally, 10-fold cross validation scheme is better
even though it has less amount of data, because it has less bias compared to the 5-fold. However, it is not valid in
every case. In some cases, 5-fold cross validation scheme yields a better result compared to the 10-fold. Usually, 5-
fold is used if 10-fold fails to achieve a result with high accuracy. Because when we use 5-fold, the amount of data in
each fold is more than the amount of data when we use 10-fold. So, the model can learn better using more data.
In many previous research studies, models developed using ANN and RF were proven to have high accuracy.
Nonetheless, in this research, the models had a quite small accuracy. It was possibly due to a small amount of data.
Data that consisted of laboratory characteristics used in this research is hard to find. The party with whom we obtained
the data themselves are still collecting new data this year. Later, when the new data are fully collected, we may be
able to redevelop the models, and hopefully, the models will have higher accuracy.
In this research, we didn’t have any baseline performances. It was hardly possible to compare our results with other
results because there haven’t been any other similar research studies previously. Therefore, results obtained from our
research can contribute to healthcare research, especially in helping physicians determine the clinical degree of dengue
of the patients based on their laboratory characteristics values.

5. Conclusion and recommendations

We proposed RF classifier with 10-fold cross validation scheme as the classifier algorithm to develop a more
precise model that can predict the clinical degree of dengue in the critical phase, if the laboratory characteristics results
are known, because it yielded a model with the highest accuracy (58%) compared to the other two classifiers.
There were some limitations in this research. It would be much appreciated if other researchers that will conduct
further research about dengue consider these recommendations below:
1. Laboratory characteristics analyzed in this research were limited. In further research, it would be better to
analyze other laboratory characteristics that hadn’t been analyzed in this research, such as Immunoglobulin
G, Immunoglobulin M, etcetera.
2. Data used in this research was only data on the third day of observation. In further research, it would be better
to analyze data on the other days of observation, particularly on day fourth to sixth. Because on those days,
dengue patients are in the critical phase.
3. Data used in this research only consisted of 77 data of dengue patients. In further research, it would be better
to use a more significant number of data so the data will represent the population of dengue patients in the
analyzed region better, and the developed model can have higher accuracy.
4. In further research, researchers may develop another ANN architecture to be applied to the same data – which
the link has been given – to obtain a new model with higher accuracy.

Acknowledgements

This work was fully funded by Thesis Magister Grant 2020 with the contract no. NKB-
478/UN2.RST/HKP.05.00/2020 from Kementrian Riset dan Teknologi/Badan Riset dan Inovasi Nasional, Indonesia.

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