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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

The decreasing of national API at periode 2007–2012 was not in line with the API of Kulon Progo District and Kokap Subdistrict. Drastic increase of Kokap API and the occurence of subsequent clusters was triggered by the increased of average number of hamlets covered by a village malaria worker as a consequence of the reduction of Village Malaria Workers number and increasing malaria cases at the border areas between two adjacent Districts.
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Figure 5: The decreasing of national API at periode 2007–2012 was not in line with the API of Kulon Progo District and Kokap Subdistrict. Drastic increase of Kokap API and the occurence of subsequent clusters was triggered by the increased of average number of hamlets covered by a village malaria worker as a consequence of the reduction of Village Malaria Workers number and increasing malaria cases at the border areas between two adjacent Districts.

Mentions: According to Purworejo DHO report, ten villages in Kaligesing and Bagelen Subdistrict had malaria outbreaks in October 2011, of which were Donorejo and Jatirejo villages in Kaligesing Subdistrict and Hargorojo and Durensari villages in Bagelen Subdistrict that were located at the boundary area of Kokap (Figure 5) [18]. Malaria started to increase in Purworejo in 2011 with API 1.34‰, three times higher compared to 2010 (API 0.48‰). The monthly malaria incidence (MOPI) of those villages fluctuated from 5-15‰ (Somorejo), 2-10‰ (Tlogokotes), 1-3‰ (Dadirejo) from early 2011 to October 2011 and 0-6‰ (Donorejo), 0-50‰ (Jatirejo), 0-45‰ (Durensari) from early 2011 to December 2011. Those uncontrolled malaria cases at boundary areas might have been the source of malaria transmission that finally led to malaria outbreaks in Kalirejo around August to October 2011 and in Hargotirto around December 2011 to January 2012.


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

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

The decreasing of national API at periode 2007–2012 was not in line with the API of Kulon Progo District and Kokap Subdistrict. Drastic increase of Kokap API and the occurence of subsequent clusters was triggered by the increased of average number of hamlets covered by a village malaria worker as a consequence of the reduction of Village Malaria Workers number and increasing malaria cases at the border areas between two adjacent Districts.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: The decreasing of national API at periode 2007–2012 was not in line with the API of Kulon Progo District and Kokap Subdistrict. Drastic increase of Kokap API and the occurence of subsequent clusters was triggered by the increased of average number of hamlets covered by a village malaria worker as a consequence of the reduction of Village Malaria Workers number and increasing malaria cases at the border areas between two adjacent Districts.
Mentions: According to Purworejo DHO report, ten villages in Kaligesing and Bagelen Subdistrict had malaria outbreaks in October 2011, of which were Donorejo and Jatirejo villages in Kaligesing Subdistrict and Hargorojo and Durensari villages in Bagelen Subdistrict that were located at the boundary area of Kokap (Figure 5) [18]. Malaria started to increase in Purworejo in 2011 with API 1.34‰, three times higher compared to 2010 (API 0.48‰). The monthly malaria incidence (MOPI) of those villages fluctuated from 5-15‰ (Somorejo), 2-10‰ (Tlogokotes), 1-3‰ (Dadirejo) from early 2011 to October 2011 and 0-6‰ (Donorejo), 0-50‰ (Jatirejo), 0-45‰ (Durensari) from early 2011 to December 2011. Those uncontrolled malaria cases at boundary areas might have been the source of malaria transmission that finally led to malaria outbreaks in Kalirejo around August to October 2011 and in Hargotirto around December 2011 to January 2012.

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