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Early malaria resurgence in pre-elimination areas in Kokap Subdistrict, Kulon Progo, Indonesia.

Murhandarwati EE, Fuad A, Nugraheni MD - Malar. J. (2014)

Bottom Line: However, at district level the situation is different.This study also aims to describe the community perceptions and health services delivery situation that contribute to this case.Two-hundred and twenty-six cases during an outbreak (May 2011 to April 2012) were geocoded by household addresses using a geographic information system (GIS) technique and clusters were identified by SaTScan software analysis (Arc GIS 10.1).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Parasitology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia. herdiana.elsa@gmail.com.

ABSTRACT

Background: Indonesia is among those countries committed to malaria eradication, with a continuously decreasing incidence of malaria. However, at district level the situation is different. This study presents a case of malaria resurgence Kokap Subdistrict of the Kulon Progo District in Yogyakarta Province, Java after five years of low endemicity. This study also aims to describe the community perceptions and health services delivery situation that contribute to this case.

Methods: All malaria cases (2007-2011) in Kulon Progo District were stratified to annual parasite incidence (API). Two-hundred and twenty-six cases during an outbreak (May 2011 to April 2012) were geocoded by household addresses using a geographic information system (GIS) technique and clusters were identified by SaTScan software analysis (Arc GIS 10.1). Purposive random sampling was conducted on respondents living inside the clusters to identify community perceptions and behaviour related to malaria. Interviews were conducted with malaria health officers to understand the challenges of malaria surveillance and control.

Results: After experiencing three consecutive years with API less than 1 per thousand, malaria in Kokap subdistrict increased almost ten times higher than API in the district level and five times higher than national API. Malaria cases were found in all five villages in 2012. One primary and two secondary malaria clusters in Hargotirto and Kalirejo villages were identified during the 2011-2012 outbreak. Most of the respondents were positively aware with malaria signs and activities of health workers to prevent malaria, although some social economic activities could not be hindered. Return transmigrants or migrant workers entering to their villages, reduced numbers of village malaria workers and a surge in malaria cases in the neighbouring district contributed to the resurgence.

Conclusion: Community perception, awareness and participation could constitute a solid foundation for malaria elimination in Kokap. However, decreasing number of village malaria workers and ineffective communication between primary health centres (PHCs) within boundary areas with similar malaria problems needs attention. Decentralization policy was allegedly the reason for the less integrated malaria control between districts, especially in the cross border areas. Malaria resurgence needs attention particularly when it occurs in an area that is entering the elimination phase.

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Related in: MedlinePlus

Kokap Subdistrict (green colour) is belong to Kulon Progo District, Yogyakarta Province (orange colour) and located in Java Island Indonesia (inset). The subdistrict is bordered with other malaria endemic subdistricts that is Girimulyo in the north which is also in Kulon Progo District, Yogyakarta Province and Bagelen & Kaligesing in the west which are belong to Purworejo District, Central Java Province. Kokap I PHC administrative area covers Kalirejo, Hargorejo and Hargomulyo villages whereas Kokap II PHC covers Hargotirto and Hargowilis villages.
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Figure 1: Kokap Subdistrict (green colour) is belong to Kulon Progo District, Yogyakarta Province (orange colour) and located in Java Island Indonesia (inset). The subdistrict is bordered with other malaria endemic subdistricts that is Girimulyo in the north which is also in Kulon Progo District, Yogyakarta Province and Bagelen & Kaligesing in the west which are belong to Purworejo District, Central Java Province. Kokap I PHC administrative area covers Kalirejo, Hargorejo and Hargomulyo villages whereas Kokap II PHC covers Hargotirto and Hargowilis villages.

Mentions: A survey was conducted from May 2011 to April 2012 in Kokap, a Subdistrict in Kulonprogo, in Menoreh Hills, located between 110. 045° and 110.145° E, and 7.777° to 7. 877° S, 100 m above sea level. This subdistrict is bordered by Girimulyo Subdistrict in the north, Pengasih Subdistrict in the east, Temon Subdistrict in the south, and Bagelen and Kaligesing Subdistricts in the west, and belongs to Purworejo District (Central Java Province); it is also well known as an unstable malaria area in Java (Figure 1). Kokap Subdistrict is 73,380 sq m in area and consists of five villages. People in this subdistrict are served by two primary health centres (PHCs), Kokap I and Kokap II. Kokap I PHC covers three villages (Kalirejo, Hargorejo, Hargomulyo) whereas Kokap II PHC covers two villages (Hargotirto and Hargowilis) (Figure 1).


Early malaria resurgence in pre-elimination areas in Kokap Subdistrict, Kulon Progo, Indonesia.

Murhandarwati EE, Fuad A, Nugraheni MD - Malar. J. (2014)

Kokap Subdistrict (green colour) is belong to Kulon Progo District, Yogyakarta Province (orange colour) and located in Java Island Indonesia (inset). The subdistrict is bordered with other malaria endemic subdistricts that is Girimulyo in the north which is also in Kulon Progo District, Yogyakarta Province and Bagelen & Kaligesing in the west which are belong to Purworejo District, Central Java Province. Kokap I PHC administrative area covers Kalirejo, Hargorejo and Hargomulyo villages whereas Kokap II PHC covers Hargotirto and Hargowilis villages.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230011&req=5

Figure 1: Kokap Subdistrict (green colour) is belong to Kulon Progo District, Yogyakarta Province (orange colour) and located in Java Island Indonesia (inset). The subdistrict is bordered with other malaria endemic subdistricts that is Girimulyo in the north which is also in Kulon Progo District, Yogyakarta Province and Bagelen & Kaligesing in the west which are belong to Purworejo District, Central Java Province. Kokap I PHC administrative area covers Kalirejo, Hargorejo and Hargomulyo villages whereas Kokap II PHC covers Hargotirto and Hargowilis villages.
Mentions: A survey was conducted from May 2011 to April 2012 in Kokap, a Subdistrict in Kulonprogo, in Menoreh Hills, located between 110. 045° and 110.145° E, and 7.777° to 7. 877° S, 100 m above sea level. This subdistrict is bordered by Girimulyo Subdistrict in the north, Pengasih Subdistrict in the east, Temon Subdistrict in the south, and Bagelen and Kaligesing Subdistricts in the west, and belongs to Purworejo District (Central Java Province); it is also well known as an unstable malaria area in Java (Figure 1). Kokap Subdistrict is 73,380 sq m in area and consists of five villages. People in this subdistrict are served by two primary health centres (PHCs), Kokap I and Kokap II. Kokap I PHC covers three villages (Kalirejo, Hargorejo, Hargomulyo) whereas Kokap II PHC covers two villages (Hargotirto and Hargowilis) (Figure 1).

Bottom Line: However, at district level the situation is different.This study also aims to describe the community perceptions and health services delivery situation that contribute to this case.Two-hundred and twenty-six cases during an outbreak (May 2011 to April 2012) were geocoded by household addresses using a geographic information system (GIS) technique and clusters were identified by SaTScan software analysis (Arc GIS 10.1).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Parasitology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia. herdiana.elsa@gmail.com.

ABSTRACT

Background: Indonesia is among those countries committed to malaria eradication, with a continuously decreasing incidence of malaria. However, at district level the situation is different. This study presents a case of malaria resurgence Kokap Subdistrict of the Kulon Progo District in Yogyakarta Province, Java after five years of low endemicity. This study also aims to describe the community perceptions and health services delivery situation that contribute to this case.

Methods: All malaria cases (2007-2011) in Kulon Progo District were stratified to annual parasite incidence (API). Two-hundred and twenty-six cases during an outbreak (May 2011 to April 2012) were geocoded by household addresses using a geographic information system (GIS) technique and clusters were identified by SaTScan software analysis (Arc GIS 10.1). Purposive random sampling was conducted on respondents living inside the clusters to identify community perceptions and behaviour related to malaria. Interviews were conducted with malaria health officers to understand the challenges of malaria surveillance and control.

Results: After experiencing three consecutive years with API less than 1 per thousand, malaria in Kokap subdistrict increased almost ten times higher than API in the district level and five times higher than national API. Malaria cases were found in all five villages in 2012. One primary and two secondary malaria clusters in Hargotirto and Kalirejo villages were identified during the 2011-2012 outbreak. Most of the respondents were positively aware with malaria signs and activities of health workers to prevent malaria, although some social economic activities could not be hindered. Return transmigrants or migrant workers entering to their villages, reduced numbers of village malaria workers and a surge in malaria cases in the neighbouring district contributed to the resurgence.

Conclusion: Community perception, awareness and participation could constitute a solid foundation for malaria elimination in Kokap. However, decreasing number of village malaria workers and ineffective communication between primary health centres (PHCs) within boundary areas with similar malaria problems needs attention. Decentralization policy was allegedly the reason for the less integrated malaria control between districts, especially in the cross border areas. Malaria resurgence needs attention particularly when it occurs in an area that is entering the elimination phase.

Show MeSH
Related in: MedlinePlus