INDONESIA STRIVES TO BE MALARIA-FREE BY 2030 by Fardah

     Jakarta, March 4, 2014 (Antara)- The Indonesian government has been working to become a malaria-free country by 2030, as part of the "Toward Malaria-Free Indonesia" program launched by President Susilo Bambang Yudhoyono in 1998.

         Malaria is caused by five species of parasites from the genus Plasmodium that affects humans. Plasmodium parasites are transmitted to humans by the bite of infected female Anopheles mosquitoes.

      Children under five years of age and pregnant women are most vulnerable to the effects of malaria, as their immune systems are less able to fight the infection.

       Malaria is currently found widely in 99 countries, causing an estimated 219 million human infections and 660,000 deaths per year, with about 80 percent of cases, and 90 percent of deaths, occurring in Africa.

         The elimination of malaria is being pursued by 32 countries, while 67 countries have reported being in control of the spread of malaria.

         The Indonesian government has determined to eliminate malaria in phases by 2030.  In line with the health ministry's decree No. 293/MENKES/SK/IV/2009, the malaria elimination phase began in Thousand Island District, Bali, and Batam, having been completed in 2010.

         The Second phase is being carried out in Java, Aceh and Riau Islands provinces through 2015. The Third phase covers Sumatra Island  (except Aceh and Riau Islands provinces), West Nusa Tenggara (NTB), Kalimantan Island and Sulawesi Island, running through 2020.

         The last phase of the elimination program is focused on Papua, West Papua, Maluku, East Nusa Tenggara (NTT), and North Maluku until 2030.

         The health ministry's data showed Indonesia's Annual Parasite Incidence (API) is at 1.75 per 1,000 people, which means that out of every 1,000 people living in malaria-endemic regions, almost two are infected with the disease.

         Meanwhile, ideally the API should be below one per 1,000 people for a country to be called malaria-free.
    In 2012, the number of malaria cases in Indonesia was 417 thousand, and almost 75 percent of these cases occurred in Papua, West Papua and East Nusa Tenggara (NTT).

         In response, the government has established a number of Malaria Centers, particularly in eastern Indonesian regions such as Papua, West Papua and NTT, to deal with the disease.

         Malaria has posed a major public health problem in Papua, which is the largest malaria endemic region in Indonesia.

         The head of Papua's health office, Yosep Rinta Riatmaka, last year said that the prevalence of malaria in Papua was 64 cases per 1,000 people in 2012, and based on age groups, 47 percent of babies in Papua was suffering from malaria.

         He said several factors were playing a role in the spreading of the disease, namely plasmodium vivax as the cause of the disease, anopheles mosquitoes as carrier, human beings as recipients and the environment.

         "There are almost 400 species of anopheles in the world and about 60 of them are carriers," he said.

         Yosep noted that Papua also had several anopheles species which were different from those found in the western parts of Indonesia.

         Twin species were also to be found among the anopheles species that morphologically looked the same, but were genetically different,
meaning they had different capabilities in transmitting the disease.

         "Considering these conditions, more specific ways of controlling the disease in Papua are needed," he said.

         Papua is an ideal nesting place for Anopheles misquotes and
malaria parasites, because the province is still heavily covered by
forests and has a wet climate.

         Further, Indonesians are at a much higher risk of contracting the disease because the country is home to many species of mosquitoes.

         "In a publication released last year, it was revealed that out of the 3,000 species of mosquito species known in the world, 450 are found in Indonesia. The country is second only to Brazil, which has
465 types of mosquitoes," said William Hawley, an entomologist from UNICEF and the country director for the US Centers for Disease  Control and Prevention, a number of years ago.

         "The most dangerous species of Anophele mosquitoes can be found in Maluku, North Maluku and Papua," he added, referring to the genus of mosquitoes that are the primary transmitters of the
malaria-causing Plasmodium parasite.

         Despite the government's target of being malaria-free by 2030, Papua's Jayapura district administration is committed to eliminating malaria by 2026, or four years earlier that the national target.

         The "Malaria-Free Jayapura District 2026" program is being carried out in three phases.

         The first phase is the malaria control intensification program (2010-2016), the Head of Jayapura District, Mathius Awoitauw, said in Sentani, Papua, recently.

         The second phase is the malaria pre-elimination (2017-2023) Program, and the third is the consolidation phase program (2024-2026), he said.

         "The elimination of malaria is a continuation of the malaria control program, which was successful in reducing malaria-related mortality and morbidity rates. No single country is able to reduce malaria infections to zero percent," he said.

         Priority activities in the malaria elimination program include identification of, and medication for, malaria patients and carriers to prevent others from being infected by malaria.

         Other activities include the reduction of contacts between human beings and Anopheles mosquitoes, the primary carrier of malaria.

         "The World Health Organization (WHO) will issue a certificate to a country which has been free of malaria cases for over three consecutive years. At the provincial level, the evaluation will be carried out by an independent inspection team sent by the central government," he said.
    During the commemoration of World Malaria Day on April 25, 2013, the Indonesian Health Ministry distributed at least 2,032,000 mosquito nets to the public in order to reduce malaria cases in several provinces.

         "We have distributed millions of nets in 2013 and also in 2014. We distributed 1.4 millions nets in five provinces in east Indonesia, namely Papua, West Papua, East Nusa Tenggara, Maluku and North Maluku. This provinces are noted for having high levels of Malaria cases," said Health Minister Nafsiah Mboi.

         The Ministry also distributed at least 1,378,535 rapid
diagnostic tests (RDT) and one million doses of anti-malaria drugs to all provinces in Indonesia.

         Nafsiah said at least 774,623 RDT and 845,000 doses of malaria medicines were distributed to five provinces in Indonesia¿s eastern regions.

         Also, Nafsiah urged the public to keep the environment clean to avoid the spread of malaria.

         "We should keep our environment clean and avoid water puddles. People can avoid mosquito bites by using nets," the minister said.         She added that malaria has a negative impact on the quality of human resources throughout the world. ***3***
(F001/INE/B003)