Almost half of Indonesia’s population lives in malaria-endemic areas. In Java and Bali, where approximately 70% of the country's population live, malaria is hypoendemic and vivax malaria predominates. In the outer island groups, the incidence of malaria is much higher with the prevalence of Plasmodium falciparum and Plasmodium vivax infection almost equal.
Malaria Elimination initiatives officially have been declared by the Ministry of Health, Republic of Indonesia, on 25th April 2009, coinciding with the second World Malaria Day celebration. Malaria Elimination Performance guidance in Indonesian was stated in the decree of Ministry of Health Indonesia Republic number 293/ Menkes/ SK/ IV/ 2009, date of 28th April 2009. The targets for elimination are DKI, Bali and Batam by 2010; Java and Aceh by 2015; Sumatra, NTB, Kalimantan, Sulawesi by 2020, and Papua, West Papua, Maluku, NTT and North Maluku by 2030. The Malaria-VBDC unit contributed to the development and finalization of Malaria Elimination Guidelines.
Global fund is supporting malaria control programme in Indonesia through intensification of malaria prevention and control activities. In round 1, Ministry of Health (MoH) aimed to reduce malaria morbidity in area with 5 highest endemicity areas, which are all in the eastern Indonesians provinces. Ministry of Health aimed to build partnerships, and added integration of malaria control with antenatal care (ANC) and Expanded Programme of Immunization (EPI) activities to ensure sustainability and develop a routine malaria control programme. In round 8, MoH for the first time is extending GF-supported activities into Kalimantan and Sulawesi, areas of malaria moderate or low endemicity. WHO is also extending continued technical support to Malaria Transmission Consortium which is supporting malaria operational research through four Universities in the country.
Total malaria clinical cases in 2007 were around 1,774,845, in 2008 - 1, 624, 930 and in 2009 clinical cases reduced to 1,462,437. Total malaria confirm cases during 2007 were 311, 789, in 2008 - 266, 277 and in 2009 cases reduced to 199, 576.
Malaria clinical cases, blood slide examination and confirmed cases (2000-2009)
WHO recommendations for Diagnosis and Treatment of Malaria
- Prompt parasitologic confirmation by microscopy or alternatively by rapid diagnostic tests (RDTs) is recommended in all patients suspected of malaria before treatment is started. Treatment solely on the basis of clinical suspicion should be considered when a parasitological diagnosis is not accessible.
- Uncomplicated Plasmodium falciparummalaria should be treated with an artemisin-based combination therapy (ACT); vivaz malaria should be treated with chloroquine where it is effective, or an appropriated ACT, in areas where P. vivax resistance to chloroquine has been documented. Both chloroquine and ACTs should be combined with primaquine for 14 days in the treatment o P. vivax malaria, for the prevention of relapses, subject to considering the risk of haemolysis in patients with G6PD-deficiency.
- Five ACTs are currently recommended for use: artemetherlumefantrine, artesunte-amodiaquine, artesunate-mefloquine, artesunate-sulfadoxine pyrimethamine, and dihydroartemisinin-poperaquine. The choice of the ACT should be based on the efficacy of the combination in the country or area of intended use.
- Artemisinin derivatives should not be used as monotherapies for the treatment of uncomplicated malaria as this will promote resistance to this critically important class of antimalarials.
- A single dose of primaquine to be added as an anti-gametocyte medicine to ACT treatment of P. falciparum malaria, particularly as a component of pre-elimination or elimination programme, is recommended provided the risk of haemolysis in G6PD-deficient patients is considered.
- Severe malaria should be treated with a parenteral artemisinin derivative or quinine to be followed by a complete course of an effective ACT as soon as the patient can take oral medications. When intravenous or intramuscular treatment is not feasible, e.g. in peripheral health posts, patients should receive pre-referral treatment with an artemisinin suppository and be transferred to a health facility capable of providing definitive treatment with parenteral antimalarial medicines.
- In settings with limited health facility access, diagnosis and treatment should be provided at community level through a programme of community case management (home-based management) of malaria.