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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

Mapping of malaria cases in Kokap Sub District (5 villages) and its clusters during May 2011- April 2012 outbreaks. Using Space-Time Permutation model, that considered time and locations in the analysis, three significant clusters (P-value < 0.05), shown inside the circles, were identified, i.e. Kalirejo, Hargotirto and Hargomulyo clusters.
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Figure 4: Mapping of malaria cases in Kokap Sub District (5 villages) and its clusters during May 2011- April 2012 outbreaks. Using Space-Time Permutation model, that considered time and locations in the analysis, three significant clusters (P-value < 0.05), shown inside the circles, were identified, i.e. Kalirejo, Hargotirto and Hargomulyo clusters.

Mentions: Kalirejo and Hargotirto villages almost experiencing the similar situation with the reduction of village malaria workers. In Kalirejo for example, while in 2007 three malaria village workers covered 9 hamlets (around 1,000 households), in 2010 only one malaria village worker covered entire all 9 hamlets. Meanwhile in Hargotirto, when in 2007 seven malaria village workers covered 14 hamlets (around 2,000 households), in 2010 only three malaria village worker covered entire all 14 hamlets. This means that the workload became three times harder for village malaria worker in Kalirejo and twice harder for those in Hargotirto and as a consequence, slow down the pace of malaria finding. The increase of average number of hamlets that expected to be covered by a village malaria worker from 2007 to 2011 is shown in Figure 4.


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

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

Mapping of malaria cases in Kokap Sub District (5 villages) and its clusters during May 2011- April 2012 outbreaks. Using Space-Time Permutation model, that considered time and locations in the analysis, three significant clusters (P-value < 0.05), shown inside the circles, were identified, i.e. Kalirejo, Hargotirto and Hargomulyo clusters.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Mapping of malaria cases in Kokap Sub District (5 villages) and its clusters during May 2011- April 2012 outbreaks. Using Space-Time Permutation model, that considered time and locations in the analysis, three significant clusters (P-value < 0.05), shown inside the circles, were identified, i.e. Kalirejo, Hargotirto and Hargomulyo clusters.
Mentions: Kalirejo and Hargotirto villages almost experiencing the similar situation with the reduction of village malaria workers. In Kalirejo for example, while in 2007 three malaria village workers covered 9 hamlets (around 1,000 households), in 2010 only one malaria village worker covered entire all 9 hamlets. Meanwhile in Hargotirto, when in 2007 seven malaria village workers covered 14 hamlets (around 2,000 households), in 2010 only three malaria village worker covered entire all 14 hamlets. This means that the workload became three times harder for village malaria worker in Kalirejo and twice harder for those in Hargotirto and as a consequence, slow down the pace of malaria finding. The increase of average number of hamlets that expected to be covered by a village malaria worker from 2007 to 2011 is shown in Figure 4.

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