Limits...
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

Spatio-temporal mapping of malaria in Purworejo and its surroundings districts (2007–2011). Malaria incidence in each village was stratified as high case incidence/HCI (red), middle case incidence/MCI (yellow) and low case incidence/LCI (green).
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Spatio-temporal mapping of malaria in Purworejo and its surroundings districts (2007–2011). Malaria incidence in each village was stratified as high case incidence/HCI (red), middle case incidence/MCI (yellow) and low case incidence/LCI (green).

Mentions: API in each village in Purworejo and its surroundings districts was temporally (2007–2011) stratified by incidence (Fig. 4). In 2007, it was shown that middle case incidence (MCI) villages were more dominant than LCI or high case incidence (HCI) villages and the distribution of HCI villages was located in the north and northeast areas. In 2008, the number of villages with malaria increased but were more concentrated in northeast and eastern areas at the border with Magelang and Kulon Progo. Although there was a decrease in the number of HCI villages in 2009 and 2010, it was followed by a sharp increase both in the total number of villages with malaria and HCI villages in 2011, moving from east to south at the border of Kulon Progo. A similar situation occurred in Kulon Progo, particularly in 2009 when the number of malaria-endemic villages decreased but then increased sharply in 2010 with one HCI village in 2011 [24].Fig. 4


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)

Spatio-temporal mapping of malaria in Purworejo and its surroundings districts (2007–2011). Malaria incidence in each village was stratified as high case incidence/HCI (red), middle case incidence/MCI (yellow) and low case incidence/LCI (green).
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Spatio-temporal mapping of malaria in Purworejo and its surroundings districts (2007–2011). Malaria incidence in each village was stratified as high case incidence/HCI (red), middle case incidence/MCI (yellow) and low case incidence/LCI (green).
Mentions: API in each village in Purworejo and its surroundings districts was temporally (2007–2011) stratified by incidence (Fig. 4). In 2007, it was shown that middle case incidence (MCI) villages were more dominant than LCI or high case incidence (HCI) villages and the distribution of HCI villages was located in the north and northeast areas. In 2008, the number of villages with malaria increased but were more concentrated in northeast and eastern areas at the border with Magelang and Kulon Progo. Although there was a decrease in the number of HCI villages in 2009 and 2010, it was followed by a sharp increase both in the total number of villages with malaria and HCI villages in 2011, moving from east to south at the border of Kulon Progo. A similar situation occurred in Kulon Progo, particularly in 2009 when the number of malaria-endemic villages decreased but then increased sharply in 2010 with one HCI village in 2011 [24].Fig. 4

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