Primaquine (PQ) is a key drug in the malaria pre-elimination stage. However, PQ can trigger acute hemolysis for people with G6PD deficiency (G6PDd). In 2013, 15-25 million Indonesian people were infected with malaria, with 30,000-38,000 deaths each year mostly in eastern Indonesia with API= 15.6 %. Recently, the Ministry of Health of the Republic of Indonesia announced a plan to reach the pre-elimination stage based on WHO guidelines. This study assesses whether eastern Indonesia should proceed with the activities of malaria pre-elimination. A total 555 healthy people in five subdistricts in eastern Indonesia were selected by systematic random samping. All data were collected using a standard questionnaire, physical examination, and laboratory tests. PCR and DNA sequencing protocols followed respective manufacture's instructions. Statistical analysis by bivariate with α= 0.05 and 95% CI were performed using the SPSS software package. Based on the nested PCR, the result showed a malaria prevalence of 32.6% with being the dominant species (52.5%). Malaria cases were found in all study sites and not using a bed net was the moost significant risk factors with Exp B= 1.54 with 95% CI= 0.99-2.38. G6PDd prevalence was 16.6%, the highest G6PDd ever found in Indonesia with variant molecular dominant 10.883 T>C and one sample with a heterozygous female. Malaria pre-elimination in eastern Indonesia should be delayed. High risk patients should be tested for enzyme G6PD activities before antimalarial administration.
Evaluation of malaria risk factors prevention and control program in Kulon Progo RegencyPurposeThe purpose of this research was to evaluate the program of prevention and control of malaria risk factors in Kulon Progo District in 2016 based on system approach.MethodThis research was evaluation program used mixed methods (sequential explanatory design). Data collected from 7 public health center of active focus malaria and district health office. Respondents were program managers and head of public health center, district program managers, head of control and eradication of communicable diseases, and head of district health offices. The instruments used structured questionnaires and in-depth interview guides. Quantitative data analysis was descriptive and qualitative data used Miles and Huberman model.Results Most of the availability of human resources, funds, facilities, materials, and methods already meet implementation needs except entomologists, allocation of funds activities other than IRS, time of the implementation of larval fish deployment. Most of the processes that started from the planning, implementation, monitoring, and evaluation have gone well except for planning other than IRS, preparation vector control without entomology database, implementation of environmental management, larviciding, and larval fish deployment. Coverage of LLINs, coverage of IRS, control of LLINs efficacy, and test of vector resistance have met the target, except coverage of larviciding and larval fish deployment was not available.ConclusionPrevention and control program of malaria risk factors has implemented but wasn’t based on entomological data. District health offices should recruit entomologist to support vector control activities.
Lymphatic filariasis (LF) has long been endemic in Indonesia. Agam District is an endemic area for LF in West Sumatera. We conducted a case-control study and performed spatial analysis to assess distribution and risk factors for filariasis in affected community. Data were collected by direct interview, household observation and geo-coordinate capture of their houses by global positioning system. Risk factors for filariasis were estimated by bivariate and multivariate analysis. Spatial analyses by GeoDa (spatial significant), SaTScan (clustering poisson model) and Excel Discalc (distance) were used as tools for mapping. Total 91 cases, including 51 elephantiasis, were identified. Most cases (56%) were from Tiku Sub-district, with median age 45 years (range 10-80 years). Living near a palm plantation (<100 meter) (p-value=0.002, OR (95%CI) = 11.5 (2.56-45.89)), and not using ventilation net (p-value = 0.023, OR (95%CI) = 9.0 (1.21-26.42)), or bed net (p-value = 0.002, OR (95%CI) = 2.1 (2.45-2.79)) were strongly associated with LF. Spatial analysis found significant clustering in one area with 15 cases (16.5%) at elevation between 400-700 meters above the sea level.
About 4.8 million Indonesians were infected with malaria in 2013 while the infections were mostly in Eastern Indonesia. Indonesia Ministry of Health announced that malaria pre-elimination stage should be reached by 2015-2020 and free of malaria transmission by 2030 in Eastern Indonesia. Although detailed maps of epidemiological distribution, prevalence and risk factors for malaria were needed, there was limited access to routine surveillance data such as annual parasitic incidence and surveillance report. Hence, this study aimed to assess the epidemiological situation of this area. Total 555 people who aged 14 years and above, and lived in one of five districts in Eastern Indonesia were enrolled in this study. About 32.6% (181/555) were tested positive for malaria by nested polymerase chain reaction, with Plasmodium vivax as the dominant species. Not using bed nets was the most significant risk factors. Spatial analysis indicated three distinguished clusters (180, 229 and 88 cases). Hence, malaria pre-elimination program in Eastern Indonesia should be postponed as the situation did not meet the criteria yet. Routine treatment to stop silent transmission, scaling up control measures and improving laboratory surveillance were needed before pre-elimination.
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