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      Change of strategy is required for malaria elimination: a case study in Purworejo District, Central Java Province, Indonesia

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          Abstract

          Background

          Malaria 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.

          Methods

          Historical 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.

          Results

          The 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.

          Conclusions

          A 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.

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          Most cited references24

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          The changing epidemiology of malaria elimination: new strategies for new challenges.

          Malaria-eliminating countries achieved remarkable success in reducing their malaria burdens between 2000 and 2010. As a result, the epidemiology of malaria in these settings has become more complex. Malaria is increasingly imported, caused by Plasmodium vivax in settings outside sub-Saharan Africa, and clustered in small geographical areas or clustered demographically into subpopulations, which are often predominantly adult men, with shared social, behavioural, and geographical risk characteristics. The shift in the populations most at risk of malaria raises important questions for malaria-eliminating countries, since traditional control interventions are likely to be less effective. Approaches to elimination need to be aligned with these changes through the development and adoption of novel strategies and methods. Knowledge of the changing epidemiological trends of malaria in the eliminating countries will ensure improved targeting of interventions to continue to shrink the malaria map. Copyright © 2013 Elsevier Ltd. All rights reserved.
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            Elimination of tropical disease through surveillance and response

            Surveillance and response represent the final crucial steps in achieving effective control and particularly elimination of communicable diseases as recognized in the area of neglected tropical diseases (NTDs), applied in increasing numbers in endemic countries with ongoing control and elimination programmers. More and more national NTD elimination initiatives are scheduled based on the innovative and effective One world-One health perspective to detect pockets of transmission and disease reintroduction. Resource-constrained countries, which carry the heaviest NTD burdens, face various challenges how to strengthen the health system as well as developing effective and novel tools for surveillance and response tailored to local settings. Surveillance-response approaches take place in two different stages corralling the basic components of the surveillance-response system for NTD elimination. Six different research priorities have been identified:1)dynamic mapping of transmission, 2) near real-time capture of population dynamics, 3) modelling based on a minimum essential database/dataset, 4) implementation of mobile health (m-health) and sensitive diagnostics, 5) design of effective response packages tailored to different transmission settings and levels, and 6) validation of approaches and responses packages.
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              Malaria distribution, prevalence, drug resistance and control in Indonesia.

              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. Copyright © 2011 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                herdiana.elsa@gmail.com , elsa.herdiana@ugm.ac.id
                anisfuad@ugm.ac.id
                sulistyawatisuyanto@gmail.com
                dikafkugm@yahoo.co.id
                michaelbia07@gmail.com
                barandi@geo.ugm.ac.id
                drkuswantoro@yahoo.co.id
                neilflobo@gmail.com
                supargiyono@gmail.com
                byh0@cdc.gov
                Journal
                Malar J
                Malar. J
                Malaria Journal
                BioMed Central (London )
                1475-2875
                16 August 2015
                16 August 2015
                2015
                : 14
                : 318
                Affiliations
                [ ]Center for Tropical Medicine and Department of Parasitology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
                [ ]Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
                [ ]Department of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
                [ ]Politeknik Kesehatan, Kementrian Kesehatan Kupang, Kupang, Indonesia
                [ ]Cartography and Remote Sensing Department, Faculty of Geography, Universitas Gadjah Mada, Yogyakarta, Indonesia
                [ ]District Health Office of Purworejo, Purworejo, Indonesia
                [ ]Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN 46556 USA
                [ ]UNICEF, Jakarta, Indonesia
                Article
                828
                10.1186/s12936-015-0828-7
                4537575
                5ddacb7c-3ead-45b3-9aba-ce41de580879
                © Murhandarwati et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 9 June 2015
                : 30 July 2015
                Categories
                Research
                Custom metadata
                © The Author(s) 2015

                Infectious disease & Microbiology
                malaria elimination,health system,decentralization policy,strategies,purworejo

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