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Abstract
BackgroundMalaria 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.MethodsHistorical 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.ResultsThe 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.ConclusionsA 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.
Highlights
Malaria has been targeted for elimination from Indonesia by 2030, with varying timelines for specific geographical areas based on disease endemicity
Since Indonesia’s independence in 1945, malaria control has been intensively conducted through the Malaria Control Programme (1945–1958) [3, 4] and the Malaria Eradication Programme (1959–1968) which focused on DDT spraying and treatment of fever cases with chloroquine
This was followed by the Malaria Control Phase (1969–1999) and Indonesia Roll Back Malaria Campaign (2000 to present) which focuses on malaria case detection and surveillance and integrated activities as recommended by WHO [5]
Summary
Malaria has been targeted for elimination from Indonesia by 2030, with varying timelines for specific geographical areas based on disease endemicity. 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. The Bill and Melinda Gates Foundation (BMGF) [with endorsement by the WHO and Roll-Back Malaria (RBM) Partnership] announced global eradication of malaria as a Foundation priority in 2007. Since Indonesia’s independence in 1945, malaria control has been intensively conducted through the Malaria Control Programme (1945–1958) [3, 4] and the Malaria Eradication Programme (1959–1968) which focused on DDT spraying and treatment of fever cases with chloroquine This was followed by the Malaria Control Phase (1969–1999) and Indonesia Roll Back Malaria Campaign (2000 to present) which focuses on malaria case detection and surveillance and integrated activities as recommended by WHO [5]
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