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Malaria Inspirational Story from East Nusa Tenggara, Indonesia - Book 2
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After more than 50 years of effective management, resurgent malaria threatens residents in the Menoreh Hills and the foothills of the Dieng Plateau of Central Java, Indonesia. The Dieng Plateau dominates the highland center of Central Java. The steep Menoreh Hills, surrounded by rice paddy habitats, cover approximately 500 km2 with no peaks greater than 1,000 m. We studied epidemic malaria in Purworejo district, one of the three districts containing the Menoreh Hills. Between 1986 and 1995, the annual parasite incidence (API) in Purworejo ranged from 2 to 11 cases per 1,000 residents per year and was typically approximately 5 per 1,000. In 2000 the API was 44.5. This sharp increase was confined to subdistricts in and around the Menoreh Hills and Dieng Plateau foothills. The primary vectors of malaria, those favoring steep, forested hillsides on Java, were Anopheles maculatus and Anopheles balabacensis. Deterioration of vector control activity, followed by a severe economic downturn in 1997, may explain the epidemic. Malaria in the Menoreh Hills and lower Dieng Plateau threatens surrounding areas of rice paddy inhabited by Anopheles aconitus as well as a nearby coastal habitat where the even more efficient vector Anopheles sundaicus occurs in abundance. Most of the 130 million people living on Java never experienced the hyper- and holoendemic malaria that occurred throughout most of the island before the effective DDT spraying and chloroquine treatment campaigns of the 1950s. Reintroduced endemic malaria threatens the island of Java.
Vector control is the most effective method for the prevention of malaria transmission and whenever possible this should be the general strategy of control programmes in combination with surveillance and chemotherapy. Whereas classical insecticidal spraying may still play an important role in malaria control, emphasis must be placed on integrated control with other than insecticidal measures because of the anticipated development of insecticide resistance. -from Authors
Evidence of emerging resistance to chloroquine by Plasmodium vivax is described from Irian Jaya (Indonesian New Guinea). Sixteen of 24 residents in the village of Arso PIR II taking supervised weekly chloroquine prophylaxis (5 mg base/kg) had asexual parasitemia with P. vivax at least once during eight weeks of surveillance. An American working in the same village developed symptomatic P. vivax parasitemia despite chloroquine prophylaxis. Five days after therapy with 600 mg chloroquine base, the asexual parasitemia in the American increased 40-fold, but cleared after treatment with 1,500 mg chloroquine base. Serum samples were not available from many of the cases, but six local residents and the American had serum levels of chloroquine in excess of the ordinarily suppressive 15 ng/ml at the time of their asexual parasitemias (16-70 ng/ml). The weekly 300 mg base tablet of chloroquine, which has been the standard for prophylaxis against malaria for more than 40 years, was not effective against P. vivax in Arso PIR, Irian Jaya.
This report describes one of the few remaining foci of endemic malaria on the island of Java, the Kokap subdistrict, near the Southcentral coast. Kokap was hypoendemic in June 1994 with prevalence of parasitemia at 0.98% (n = 10,606 of 40,246 residents). Plasmodium vivax comprised 63% of infections and P. falciparum all others. The incidence of indigenous infection during 1993 was 48 cases/1,000 person-years (p-yr), and it was relatively uniform among age groups (38 to 53/1,000 p-yr). Nine deaths due to malaria had been recorded in the past three years (8.3 deaths per 100,000 p-yr); the case fatality rate was 0.17%. Subdistricts adjoining Kokap to the north, east, and south reported incidence rates of < 2 cases/1,000 p-yr. To the west, Purworejo District had a high case incidence (11 cases/1,000 p-yr) but other districts to the west did not (< 1.2 cases/1,000 p-yr). The highest case incidence village area within Kokap (169 cases/1,000 p-yr) bordered the district of Purworejo to the west. Endemic malaria in Kokap and Purworejo coincided with where steep hills and narrow valleys dominated the terrain.
In February 1995 we surveyed to chloroquine among patients with Plasmodium vivax malaria at Nias Island, in the Indian Ocean near north-western Sumatra, Indonesa. The subjects, 21 indigenous males and females (6-50 years old) infected with > 40 asexual blood stage parasites of P. vivax per microliter of blood, had mild symptoms or none at all. Seven of these patients had > 100 ng/mL whole blood chloroquine levels before the first supervised dose of chloroquine (3 doses of 10 mg/kg, 10 mg/kg, 5 mg/kg of base given at 24 h intervals). Whole blood chloroquine levels on the last day of dosing confirmed normal absorption (range 413-3248, mean 1141, SD 616 ng/mL). Blood films were examined on days 0, 2, 4, 7, 11, 14, 18, 21 and 28 after initiating therapy. Three patients had recurrent asexual P. vivax parasitaemias between days 14 and 18, despite effective levels of chloroquine in whole blood (> or = 100 ng/mL) at the time of recurrence. Resistance to standard chloroquine therapy by P. vivax appeared in 14% of infections among residents of Nias.
In 1733 an unknown deadly disease broke out in Batavia (now Jakarta), then the main seat of the Dutch East India Company (VOC) in Asia. Mortality among its personnel rose alarmingly and caused serious shortages of sailors, soldiers and craftsmen. Ever-growing numbers of people had to be sent from the Netherlands to Batavia to make up for the high losses. In the end, military posts could no longer be filled, homeward-bound vessels no longer be manned and precious cargo had to remain in Batavia. The unhealthiness of the town, 'so deadly for the growth and prosperity of the colony [and] ruinous for the interests and finances of the Company' (Nederburgh 1794), claimed more than 85,000 victims among VOC personnel. The 'unhealthiness of Batavia' remained unexplained through the ages. In this paper reasons for its origin and aftermath are proposed.
The authors report on preliminary observations carried out in three experimental houses in Netherlands New Guinea, the object of which was to determine whether residual spraying with insecticides might be expected to give good results in the control of malaria transmitted by mosquitos of the Anopheles punctulatus group and by A. karwari. One house was sprayed with DDT, another with dieldrin, and the third was left unsprayed. From the kills recorded of mosquitos entering these houses at night it is apparent that good results can be anticipated with both insecticides, although dieldrin is the more effective.Observations made at the same time on the behaviour of these mosquitos indicate that they have greater contact with the inside walls of houses than was previously thought.
20 Years of Progress in Malaria Research
- J K Baird
- M J Bangs
- H A Marwoto
- A M Harijani
- P Rustama
Baird, J. K., Bangs, M. J., Marwoto, H. A., Harijani, A. M., A.R., P., & Rustama
, D. (1990). 20 Years of Progress in Malaria Research. Buletin Penelitian
Kesehatan, 18 (3 & 4) TR-1118, 13-17.