Malaria Distribution, Prevalence, Drug Resistance and Control in Indonesia

Abstract

Approximately 230 million people live in Indonesia. The country is also home to over 20 anopheline vectors of malaria which transmit all four of the species of Plasmodium that routinely infect humans. A complex mosaic of risk of infection across this 5000-km-long archipelago of thousands of islands and distinctive habitats seriously challenges efforts to control malaria. Social, economic and political dimensions contribute to these complexities. This chapter examines malaria and its control in Indonesia, from the earliest efforts by malariologists of the colonial Netherlands East Indies, through the Global Malaria Eradication Campaign of the 1950s, the tumult following the coup d'état of 1965, the global resurgence of malaria through the 1980s and 1990s and finally through to the decentralization of government authority following the fall of the authoritarian Soeharto regime in 1998. We detail important methods of control and their impact in the context of the political systems that supported them. We examine prospects for malaria control in contemporary decentralized and democratized Indonesia with multidrug-resistant malaria and greatly diminished capacities for integrated malaria control management programs. INTRODUCTIONEach year Indonesia's 230 million people collectively suffer at least several million cases of malaria caused by all four known species of human Plasmodium. Despite a long history of pioneering work in malaria prevention, treatment and control reaching back to the early 1900s, no systematic review of malaria in Indonesia has yet been undertaken. This chapter attempts to remedy this with a detailed examination of the genesis, nature and outcome of control strategies, along with a comprehensive review of peer-reviewed and published work on malaria. We also examine contemporary malaria in the context of government systems arrayed against it. This article does not include the body of knowledge on the complex array of anopheline vectors of malaria found in Indonesia. That topic is reserved for a separate review.© 2011 Elsevier Ltd. All rights reserved. Author contributions: I. R. F. E. compiled malaria parasite rate data and antimalarial drug susceptibility test data. I. R. F. E. wrote the first draft of the chapter. J. K. B. and S. I. H. commented on the final draft of chapter. Fig. 2.1). The country consists of 17,504 islands (only 6000 of which are inhabited), covering a land area of 1.9 million km 2 (Departemen Dalam Negeri, 2004. The archipelago comprises seven main islands: Sumatra, Java, Kalimantan, Sulawesi, Maluku, the Lesser Sundas and Papua. Since decentralization of government power in 2000, Indonesia has been considered to consist of 33 provinces, 465 districts/municipalities, 6093 sub-districts and 73,067 villages . Census authorities in 2007 estimated a population of 227 million people, with an average density of 118 people/km 2 . The annual population growth rate was 1.3% (Badan Pusat Statistik, 2007a). The population density on Java and Bali (977 people/km 2 ) was much hig...

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Andrographolide and Its Derivative - A Story of Antimalarial Drug Design and Synthesis

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“…The first-line treatment for uncomplicated PF malaria in the country is the artesunate-amodiaquine combination [2]. However, a failure rate of more than 10%, associated with drug resistance, was reported for this treatment in Indonesia for the period 2000-2007 [2].…”