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

Inverse relationship between available resources and malaria endemicity in Purworejo District (2007–2011). Decreased district budget for malaria and number of VMWs (village malaria workers) were followed by the increasing malaria cases/month and API (annual parasite incidence) in 2010.
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Fig7: Inverse relationship between available resources and malaria endemicity in Purworejo District (2007–2011). Decreased district budget for malaria and number of VMWs (village malaria workers) were followed by the increasing malaria cases/month and API (annual parasite incidence) in 2010.

Mentions: The Wonosobo malaria control programme operates in a complex decentralized environment. While technically autonomous, the success of the programme depends upon cooperation with other sectors and advocacy to and negotiation with both executive and legislative parts of district government. Such advocacy is continuous: i.e., members of the health commission in the local parliament might change every 2 years, requiring renewed advocacy with every membership rotation to ensure that malaria elimination is supported. Along with Wonosobo, Magelang and Kulon Progo districts were also successful in getting funding for their malaria control programmes. Even though malaria cases decreased over the last 5 years, the DHOs of Magelang and Kulon Progo’s malaria funding was sustained at levels to allow hiring of malaria workers and village cadres/volunteers for surveillance activities. In contrast to Purworejo, VMWs were continuously on duty in Wonosobo, Magelang and Kulon Progo. The decline in malaria cases in Purworejo led to reduced funding, fewer resources for VMWs, and a small absolute increase in the API from 0.49 to 1.31 (Fig. 7). This is a conundrum faced by any elimination strategy: the only cost-effective exit strategy is success, otherwise the programme will be in a cycle of decline in cases, followed by a decline in commitment and funding, then resurgence.Fig. 7


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)

Inverse relationship between available resources and malaria endemicity in Purworejo District (2007–2011). Decreased district budget for malaria and number of VMWs (village malaria workers) were followed by the increasing malaria cases/month and API (annual parasite incidence) in 2010.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig7: Inverse relationship between available resources and malaria endemicity in Purworejo District (2007–2011). Decreased district budget for malaria and number of VMWs (village malaria workers) were followed by the increasing malaria cases/month and API (annual parasite incidence) in 2010.
Mentions: The Wonosobo malaria control programme operates in a complex decentralized environment. While technically autonomous, the success of the programme depends upon cooperation with other sectors and advocacy to and negotiation with both executive and legislative parts of district government. Such advocacy is continuous: i.e., members of the health commission in the local parliament might change every 2 years, requiring renewed advocacy with every membership rotation to ensure that malaria elimination is supported. Along with Wonosobo, Magelang and Kulon Progo districts were also successful in getting funding for their malaria control programmes. Even though malaria cases decreased over the last 5 years, the DHOs of Magelang and Kulon Progo’s malaria funding was sustained at levels to allow hiring of malaria workers and village cadres/volunteers for surveillance activities. In contrast to Purworejo, VMWs were continuously on duty in Wonosobo, Magelang and Kulon Progo. The decline in malaria cases in Purworejo led to reduced funding, fewer resources for VMWs, and a small absolute increase in the API from 0.49 to 1.31 (Fig. 7). This is a conundrum faced by any elimination strategy: the only cost-effective exit strategy is success, otherwise the programme will be in a cycle of decline in cases, followed by a decline in commitment and funding, then resurgence.Fig. 7

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