This chapter examines malaria and its control in Indonesia, from the earliest efforts .. at risk of P. falciparum malaria in Indonesia have been published in an Indonesian version called ‘Gebrak Malaria’ or, in English, ‘Crush Malaria’. World Malaria Report Estimated million clinical cases Incidence rate tends to decrease, since Gebrak Malaria or Roll Back. Between December and April , patients were included. After treatment parasite clearance of uncomplicated P. vivax malaria. Both treatments .. Gebrak Malaria: Pedoman Penatalaksanaan. Kasus Malaria di.

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Approximately 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 gsbrak. A complex mosaic of risk of infection across this 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. We detail important methods of control and their impact in the context of the political systems that supported them. We examine gebra for malaria control in contemporary decentralized and democratized Indonesia with multidrug-resistant malaria and greatly diminished capacities for integrated malaria control management programs.

Despite a long history of pioneering work in malaria prevention, treatment and control reaching back to the early s, no systematic review of malaria in Indonesia has yet been undertaken.

This chapter attempts to remedy this with a detailed examination of the makaria, 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 gebgak knowledge on the complex array of anopheline vectors of malaria found in Indonesia.

That topic is reserved for a separate review. The country consists of 17, islands only of which are inhabitedcovering a land area of 1. The archipelago comprises seven main islands: The annual population growth rate was 1. The ratio of male to female was 1: Life expectancy at birth for Indonesians increased from 52 years in to 69 years in Departemen Kesehatan, As shall be seen, these are also two of the most malarious provinces in Indonesia.

This crisis significantly diminished private savings and forced the closure of almost every significant business activity. The crisis also precipitated the fall of the Soeharto regime, and several years of political instability followed. Inthe health budget reached Rp. The health budget in malarua increased threefold from that of Healthcare services are made up of primary health centres, public hospitals, private and semi-private pharmaceutical industries and private sector healthcare facilities and personnel.

Primary health centres are mainly located in sub-districts and provide maternal and infant care, family planning and in-patient and out-patient services to the community, as well as communicable disease control services. Inyebrak were primary health centres, with a centre serving, on average, about 27, people Departemen Kesehatan, The number of primary health centres increases at a rate of about 2. The service coverage by province ranged from to 52, people per health centre.

Seven provinces failed to meet the standard target of a maximum of 30, people per health centre. The area coverage per centre was km 2 on average; however, in sparsely populated Papua, Central Kalimantan and East Kalimantan area, coverage was greater than km 2.

The number of hospitals was inwhich provided a total ofhospital beds Departemen Kesehatan, The overall ratio of population to each hospital bed was The annual increase in hospital beds is typically 1. In order to increase the coverage of community services, Indonesia implemented community-based health effort programs, such as health posts, with integrated village maternity huts and village drug posts.


Bythere werehealth posts, called Pos Pelayanan Terpadu or Posyandu, which provided maternity and child health services, family planning, nutritional development, immunization and diarrhoea control Departemen Kesehatan, There are four of these Posyandu in each village. In total, there were 25, maternity huts, known as Pondok Bersalin Desa or Polindes, which provide midwives with delivery units, as well as providing improved maternity and child health services and family planning services.

In addition, there are village malafia posts, known as Pos Obat Desa, which assist in the distribution of some essential drugs directly to the community. The activities of the pharmaceutical industry ensure the availability, accessibility and distribution of drugs to the community. Byaccording to the Drug and Food Control Agency, there were standard pharmaceutical companies and small, gebraj drug companies in the production sector Departemen Kesehatan, The maladia of pharmaceutical products is managed by wholesalers, 10, dispensaries, and drugstores Departemen Kesehatan, Although many statutes restrict the distribution of prescription drugs, it is generally the case that many anti-infective therapies, including antimalarials, which are officially prescription only drugs, can be purchased over the counter.

According to the Indonesian MoH in there was about half a million health personnel employed in Indonesia Departemen Kesehatan, Typically, for everypeople, there were nurses and 35 midwives.

Eight percent of these half a million health personnel were licensed physicians, yielding a service ratio of about 19 physicians perpeople.

Health personnel specializing in public health made up two percent of this half malatia million, with a service ratio of approximately four perpeople. The healthcare situation in Indonesia is relatively poor compared to the situation in neighbouring countries.

Thailand and Malaysia are developing countries with a higher GDP and a poverty rate which is two to four times lower than that of Indonesia. In terms of healthcare delivery services, the availability ratio of hospital beds in Indonesia is six times higher than the ratio in Cambodia. This ratio is three to five maalria lower than the ratio in Thailand, Malaysia and Singapore. The ratio gebgak physicians to population in Indonesia is lower two to 15 times lower than the ratio in other countries.

Similarly, the ratio of nurses and midwives to population in Indonesia is about two to five times lower than gebtak ratio in neighbouring countries.

Human population, economics and healthcare delivery system indicators for Indonesia and neighbouring countries. Annual growth rate, life expectancy at birth, health expenditure per capita and all indicators in healthcare delivery systems were regained from World Health Statistics Report and World Health Organization, ba.

Most government-affiliated infections research and surveillance systems in Indonesia are managed by three separate government agencies: All of these are under MoH authority. The Ministry of Research and Technology also sponsors infections research, primarily through the research conducted at the Eijkman Institute for Molecular Biology. Moreover, many academic institutions operating under the authority of the Ministry of Education have long histories of vibrant and productive research on infections, especially in schools of medicine and of public health.

Its main functions were 1 to develop policies, programs and implementation strategies for health systems, health policy, biomedicine, pharmaceutics, ecology, health status, nutrition and food, 2 to evaluate and screen health technologies and 3 to disseminate research results.

A total ofhouseholds andindividual household members were sampled, with sampling reaching every province. The survey collected information about household and individual demographics, mortality, access to health facilities, sanitation, food and drug consumption, history of diseases, perceived responsiveness of health facilities, health behaviour, disabilities, mental health, immunization, growth monitoring and infant health.

Riskesdas also collected 36, blood samples in order to measure biomedical variables.

In the specific instance of malaria, respondents were asked about any gebra, of confirmed malaria, symptoms of gebrrak and malaria medication usage National Institute of Health Research and Development, In this survey 10, households are selected by stratified multistage random sampling.


The survey collects information on household and individual characteristics, environment, morbidity, mortality, pregnancy and delivery Soemantri et al. The surveys are designed to collect data on fertility, family planning, and maternal and child health. A total of 35, households are sampled across all provinces.

In order to participate, respondents must be married and aged 15—49 years females or 15—54 years males Soemantri et al. The Directorate General of Disease Control consists of five directorates: The Directorate of Malaeia Diseases is responsible for malaria and vector control activities Departemen Kesehatan, c. Primary health centres generate monthly malaria reports from out-patient services and malaria case detection activities.

Primary health centres are responsible for analysing data and producing a local area monitoring report on the distribution and trends of the disease. In the specific case of malaria, a puskesmas sends a report to the district malaria control officer who in turn compiles all reports into a district health profile on malaria.

The health profile describes monthly and annual malaria cases reported at village level. The district health office then sends aggregated malaria reports three times a year to the provincial health office, as well as to the Sub-Directorate of Malaria Control at the Egbrak of Vector-borne Diseases in Jakarta Departemen Kesehatan, bfa.

Malaria data gbrak comes from laboratory gebeak in hospitals.

Malaria Distribution, Prevalence, Drug Resistance and Control in Indonesia

Finally, primary health centres and the district malaria control office are responsible for the management of vector control activities and for reporting on their progress. The indoor residual spraying IRS report, for instance, contains the number of houses sprayed, how many people live in sprayed homes, the insecticide type, the amount of insecticide used and the date of spraying.

The number of insecticide-treated mosquito nets ITN distributed, the number of people protected, the dates of bed net distribution as well as larviciding activity which includes the coverage area, the amount of larvicide used and the date of the activities are also reported.

Primary health centres and the district malaria control office also document biological control activities such as the introduction of larvivorous fish into areas where mosquito breeding sites have been found.

They keep a record of the number of fish introduced and the dates of these activities Departemen Kesehatan, b. The Malaria Atlas Project and its partners in the Sub-Directorate for Malaria Control in the Directorate of Vector-borne Diseases aim to assemble malaria parasite rate surveys across the Indonesian archipelago Guerra et al. At the time of writing, we have recorded parasite rate surveys for locations conducted between and From this assembly of data, we were able to report that four species of malaria parasite routinely infect humans in Indonesia: Plasmodium falciparumP.

The malaria parasite rate data which acquired from published sources listed these following references:. Bosh, ; Carney et al. Plasmodium falciparum appears to be the most common Plasmodium species in Indonesia.

One of the earliest published documents concerning the presence of P. The median prevalence of P. However, this prevalence was not distributed uniformly across the island groups. Prevalence was higher in eastern Indonesia median: This prevalence was not distributed uniformly across the islands. The prevalence of P. The assembled data reveal that P. The median ratio of P.

Plasmodium malariae is a relatively uncommon species in Indonesia. The presence of P.

Malaria Distribution, Prevalence, Drug Resistance and Control in Indonesia

This species has not been reliably documented anywhere else in Indonesia. The first report of P. Malaria parasite rate surveys carried out since then have recorded P.