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Change of strategy is required for malaria elimination: a case study in Purworejo District, Central Java Province, Indonesia.

Murhandarwati EE, Fuad A - Malar. J. (2015)

Bottom Line: Purworejo District, a malaria-endemic area in Java with an annual parasite incidence (API) of 0.05 per 1,000 population in 2009, aims to enter this elimination stage.API in each village in Purworejo and its surrounding districts from 2007 to 2011 was stratified into high, middle or low case incidence to show the spatiotemporal mapping pattern.These changes include timely measurements of malaria transmission, revision of the decentralized government system and optimizing the use of the district capitation fund followed by an effective technical implementation of the intervention strategy.

View Article: PubMed Central - PubMed

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

ABSTRACT

Background: Malaria has been targeted for elimination from Indonesia by 2030, with varying timelines for specific geographical areas based on disease endemicity. The regional deadline for malaria elimination for Java island, given the steady decrease of malaria cases, was the end of 2015. Purworejo District, a malaria-endemic area in Java with an annual parasite incidence (API) of 0.05 per 1,000 population in 2009, aims to enter this elimination stage. This study documents factors that affect incidence and spatial distribution of malaria in Purworejo, such as geomorphology, topography, health system issues, and identifies potential constraints and challenges to achieve the elimination stage, such as inter-districts coordination, decentralization policy and allocation of financial resources for the programme.

Methods: Historical malaria data from 2007 to 2011 were collected through secondary data, in-depth interviews and focus group discussions during study year (2010-2011). Malaria cases were mapped using the village-centroid shape file to visualize its distribution with geomorphologic characteristics overlay and spatial distribution of malaria. API in each village in Purworejo and its surrounding districts from 2007 to 2011 was stratified into high, middle or low case incidence to show the spatiotemporal mapping pattern.

Results: The spatiotemporal pattern of malaria cases in Purworejo and the adjacent districts demonstrate repeated concentrated occurrences of malaria in specific areas from 2007 to 2011. District health system issues, i.e., suboptimal coordination between primary care and referral systems, suboptimal inter-district collaboration for malaria surveillance, decentralization policy and the lack of resources, especially district budget allocations for the malaria programme, were major constraints for programme sustainability.

Conclusions: A new malaria elimination approach that fits the local disease transmission, intervention and political system is required. These changes include timely measurements of malaria transmission, revision of the decentralized government system and optimizing the use of the district capitation fund followed by an effective technical implementation of the intervention strategy.

No MeSH data available.


Related in: MedlinePlus

Malaria endemicity map of Indonesia in 2010. Annual parasite incidence in each district was stratified as malaria free (white), low case incidence/LCI (API <1%, green), middle case incidence/MCI (API 1–5 per 1,000 population, yellow), high case incidence/HCI I (API 5–49 per 1,000 population, pink), high case incidence/HCI II(API 50–100 per 1,000 population, red), and high case incidence III/HCI III (API >100%, dark red) (Source DitJen P2PL RI, 2010). Inset is Java island, the area in black is the study area, Purworejo.
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Fig1: Malaria endemicity map of Indonesia in 2010. Annual parasite incidence in each district was stratified as malaria free (white), low case incidence/LCI (API <1%, green), middle case incidence/MCI (API 1–5 per 1,000 population, yellow), high case incidence/HCI I (API 5–49 per 1,000 population, pink), high case incidence/HCI II(API 50–100 per 1,000 population, red), and high case incidence III/HCI III (API >100%, dark red) (Source DitJen P2PL RI, 2010). Inset is Java island, the area in black is the study area, Purworejo.

Mentions: At national level, malaria cases have decreased over the last 5 years. The API was 2.89, 2.47, 1.85, and 1.96 per 1,000 population in 2007, 2008, 2009, and 2010, respectively. In 2010, it was estimated that 117,351,457 people in Indonesia were at risk of malaria [16]. Although API was relatively low at the national level, there was a large difference between the API within and outside Java island (Fig. 1). The API values in provinces outside Java varied between 0.24 and 18.03 per 1,000 population, whereas in Java the highest API was 0.43 per 1,000 in West Java Province. In Central Java Province, API was 0.12, 0.07, 0.08 and 0.10 per 1,000 in 2007, 2008, 2009, and 2010, respectively (Table 1) with the number of people at risk of 21,430,044. The contribution of malaria cases in Purworejo towards the total number of malaria cases at Central Java Province, Java island and national level in 2010 is depicted at Table 2.Fig. 1


Change of strategy is required for malaria elimination: a case study in Purworejo District, Central Java Province, Indonesia.

Murhandarwati EE, Fuad A - Malar. J. (2015)

Malaria endemicity map of Indonesia in 2010. Annual parasite incidence in each district was stratified as malaria free (white), low case incidence/LCI (API <1%, green), middle case incidence/MCI (API 1–5 per 1,000 population, yellow), high case incidence/HCI I (API 5–49 per 1,000 population, pink), high case incidence/HCI II(API 50–100 per 1,000 population, red), and high case incidence III/HCI III (API >100%, dark red) (Source DitJen P2PL RI, 2010). Inset is Java island, the area in black is the study area, Purworejo.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4537575&req=5

Fig1: Malaria endemicity map of Indonesia in 2010. Annual parasite incidence in each district was stratified as malaria free (white), low case incidence/LCI (API <1%, green), middle case incidence/MCI (API 1–5 per 1,000 population, yellow), high case incidence/HCI I (API 5–49 per 1,000 population, pink), high case incidence/HCI II(API 50–100 per 1,000 population, red), and high case incidence III/HCI III (API >100%, dark red) (Source DitJen P2PL RI, 2010). Inset is Java island, the area in black is the study area, Purworejo.
Mentions: At national level, malaria cases have decreased over the last 5 years. The API was 2.89, 2.47, 1.85, and 1.96 per 1,000 population in 2007, 2008, 2009, and 2010, respectively. In 2010, it was estimated that 117,351,457 people in Indonesia were at risk of malaria [16]. Although API was relatively low at the national level, there was a large difference between the API within and outside Java island (Fig. 1). The API values in provinces outside Java varied between 0.24 and 18.03 per 1,000 population, whereas in Java the highest API was 0.43 per 1,000 in West Java Province. In Central Java Province, API was 0.12, 0.07, 0.08 and 0.10 per 1,000 in 2007, 2008, 2009, and 2010, respectively (Table 1) with the number of people at risk of 21,430,044. The contribution of malaria cases in Purworejo towards the total number of malaria cases at Central Java Province, Java island and national level in 2010 is depicted at Table 2.Fig. 1

Bottom Line: Purworejo District, a malaria-endemic area in Java with an annual parasite incidence (API) of 0.05 per 1,000 population in 2009, aims to enter this elimination stage.API in each village in Purworejo and its surrounding districts from 2007 to 2011 was stratified into high, middle or low case incidence to show the spatiotemporal mapping pattern.These changes include timely measurements of malaria transmission, revision of the decentralized government system and optimizing the use of the district capitation fund followed by an effective technical implementation of the intervention strategy.

View Article: PubMed Central - PubMed

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

ABSTRACT

Background: Malaria has been targeted for elimination from Indonesia by 2030, with varying timelines for specific geographical areas based on disease endemicity. The regional deadline for malaria elimination for Java island, given the steady decrease of malaria cases, was the end of 2015. Purworejo District, a malaria-endemic area in Java with an annual parasite incidence (API) of 0.05 per 1,000 population in 2009, aims to enter this elimination stage. This study documents factors that affect incidence and spatial distribution of malaria in Purworejo, such as geomorphology, topography, health system issues, and identifies potential constraints and challenges to achieve the elimination stage, such as inter-districts coordination, decentralization policy and allocation of financial resources for the programme.

Methods: Historical malaria data from 2007 to 2011 were collected through secondary data, in-depth interviews and focus group discussions during study year (2010-2011). Malaria cases were mapped using the village-centroid shape file to visualize its distribution with geomorphologic characteristics overlay and spatial distribution of malaria. API in each village in Purworejo and its surrounding districts from 2007 to 2011 was stratified into high, middle or low case incidence to show the spatiotemporal mapping pattern.

Results: The spatiotemporal pattern of malaria cases in Purworejo and the adjacent districts demonstrate repeated concentrated occurrences of malaria in specific areas from 2007 to 2011. District health system issues, i.e., suboptimal coordination between primary care and referral systems, suboptimal inter-district collaboration for malaria surveillance, decentralization policy and the lack of resources, especially district budget allocations for the malaria programme, were major constraints for programme sustainability.

Conclusions: A new malaria elimination approach that fits the local disease transmission, intervention and political system is required. These changes include timely measurements of malaria transmission, revision of the decentralized government system and optimizing the use of the district capitation fund followed by an effective technical implementation of the intervention strategy.

No MeSH data available.


Related in: MedlinePlus