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

Number of malaria cases by species in 2007–2011. Pf = Plasmodium falciparum, Pv = Plasmodium vivax and Mix = mixed infection of Plasmodium falciparum and Plasmodium vivax (Source: DHO, Purworejo 2007–2011).
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig6: Number of malaria cases by species in 2007–2011. Pf = Plasmodium falciparum, Pv = Plasmodium vivax and Mix = mixed infection of Plasmodium falciparum and Plasmodium vivax (Source: DHO, Purworejo 2007–2011).

Mentions: In Purworejo, a PHC may serve about 25 villages. Only one PHC was categorized as HCI from 2007 to 2010 and three PHCs in 2011 (Fig. 5). Data collected and recapitulated included cases by month, village, number of people with clinical malaria, age, sex, pregnancy status, Plasmodium species, ACT or non-ACT treatment, and indigenous or imported malaria cases. The proportion of malaria cases caused by P. falciparum was higher than P. vivax or mixed infections, that is 358/73/7, 273/135/54, 262/39/42, 246/61/2 and 795/69/138 in 2007, 2008, 2009, 2010, and 2011, respectively (Fig. 6). Malaria cases predominantly occurred in adults (more than 90%) (Table 3).Fig. 5


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)

Number of malaria cases by species in 2007–2011. Pf = Plasmodium falciparum, Pv = Plasmodium vivax and Mix = mixed infection of Plasmodium falciparum and Plasmodium vivax (Source: DHO, Purworejo 2007–2011).
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig6: Number of malaria cases by species in 2007–2011. Pf = Plasmodium falciparum, Pv = Plasmodium vivax and Mix = mixed infection of Plasmodium falciparum and Plasmodium vivax (Source: DHO, Purworejo 2007–2011).
Mentions: In Purworejo, a PHC may serve about 25 villages. Only one PHC was categorized as HCI from 2007 to 2010 and three PHCs in 2011 (Fig. 5). Data collected and recapitulated included cases by month, village, number of people with clinical malaria, age, sex, pregnancy status, Plasmodium species, ACT or non-ACT treatment, and indigenous or imported malaria cases. The proportion of malaria cases caused by P. falciparum was higher than P. vivax or mixed infections, that is 358/73/7, 273/135/54, 262/39/42, 246/61/2 and 795/69/138 in 2007, 2008, 2009, 2010, and 2011, respectively (Fig. 6). Malaria cases predominantly occurred in adults (more than 90%) (Table 3).Fig. 5

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