Introduction

Tropical diseases refer to conditions which are prevalent in tropical and subtropical geographical regions. These diseases occur in these regions due to climatic conditions such as the occurrence of cold seasons that control the population of insects by forcing them into hibernation. History has it that tropical diseases persisted in North America and Europe in the 18th century. These diseases led to the death of millions of people (Lewis & Macpherson, 2013). These deaths created the need for health care providers and scientists to conduct extensive studies on the cause of diseases as well as the most appropriate treatment strategies. The initial motivation for tropical medicine was the need to protect colonialists in different parts of the world including Indonesia from diseases.

One of the tropical diseases that despite extensive research and development of treatment modalities have persisted as one of the leading causes of death in tropical regions is malaria (Wen et al. 2016). This paper looks at malaria in Indonesia to understand the disease ecology, epidemiology as well as the global burden of disease. Notably, even though there is a long history of innovative work in the prevention, treatment, and control of malaria, a systematic review of the disease has not yet been carried out in Indonesia. This paper highlights an overview of the general principles for the prevention and control of malaria.

Malaria in Indonesia

Disease Ecology

Plasmodium species ovale, vivax, malariae, and falciparum are the four known parasitic protozoa that cause Malaria (Autino, et al. 2012). These parasites are transmitted to the body of a healthy person through a mosquito bite. The Anopheles female mosquitoes are the vectors responsible for spreading malaria. The malaria parasite, which is found in the saliva of the mosquito, gets into a host during feeding. Once the plasmodia enter the circulatory system, they attack the red blood cells and feed on the hemoglobin eventually resulting in malaria symptoms (Wen et al. 2016). The infected person starts experiencing flu-like symptoms which include fever, malaise, headache, myalgias and chills (Autino, et al. 2012). Treatment should be sought immediately before the patient develops malaria related complications such as coma and even death. Non-immune persons who travel to endemic areas have an extremely high risk of developing malaria as compared to the inhabitants (Surjadjaja, Surya & Baird, 2016).

Epidemiology

Even though Malaria has been categorized as one of the health conditions that are endemic to most areas of Indonesia outside the metropolitan, the risk of contracting malaria is still high in the country (Lewis & Macpherson, 2013). Cases of malaria have been reported in areas that were formerly presumed to be malaria free. Statistics have it that more than 230 million cases of malaria are reported in the country annually (Lewis & Macpherson, 2013). Deaths related to malaria continue being reported in different parts of the country. It is estimated that over 10,000 people die in the country as a consequence of malaria related complications (Surjadjaja, Surya & Baird, 2016). Children and pregnant women form the largest proportion of the population exposed to malaria. Studies have revealed that children who suffered from childhood malaria acquire some form of immunity against the disease. This immunity protects them against severe malaria morbidity throughout life. The risk of death due to malaria is higher in children below two years of age, who have not yet developed this immunity as compared to their older counterparts (Surjadjaja, Surya & Baird, 2016).

Local and international health agencies in the country have adopted a collaborative approach in the fight against malaria. For instance, CDC and UNICEF-Indonesia are engaged in health care activities that focus on evidence-based integrated control of malaria. The main focus of the integrated malaria control is on maternal health, elimination of malaria, and malaria control in the regions where malaria is endemic.

Global burden of disease

International health organizations including the WHO have recognized that malaria is a major health burden especially for the people living in tropical regions. This disease leads to the death of millions of people. More than 200 million cases of malaria are reported globally. Over half a million of the diagnosed cases of malaria end up in death (Lewis & Macpherson, 2013). Fortunately, the number of deaths related to malaria complications has decreased by over 26% globally (Autino, et al. 2012). Findings from different studies show that despite the number of people exposed to Plasmodium species has decreased significantly over the years; there has been an increase in the number of those who are at risk of developing malaria (Autino, et al. 2012). The increased risk is attributed to an increase in the number of people living and traveling to endemic regions.  It is hard to determine the actual social and health burden of malaria since this disease is highly prevalent in tropical countries with limited resources (Suswardany, et al., 2015). People living in the rural areas, where access to care is limited, bear the biggest burden of the disease. Understandably, endemicity and control activities of malaria are complex and hard to implement due to the influence of host, vector, parasite and environmental factors (Wen et al. 2016). The health care systems in malaria endemic regions lack the resources necessary to implement malaria control initiatives fully.

Prevention and control of malaria

Researchers have made it clear that malaria is one of the diseases that even though are preventable are difficult to control since the vectors and parasites involved are highly adaptable (Lewis & Macpherson, 2013). It has been noted that though effective malaria control tools have been developed, mosquitoes and parasites continue evolving new means of circumventing these tools. To sustainably prevent and control malaria, health care professionals need to develop and implement novel tools besides applying evidence-based tactics in the process (Bassat, et al. 2016).

The Indonesian ministry of health is committed to the fight against malaria. The ministry has recognized vector management approaches as effective strategies by which the malaria menace can be contained. The ministry of health works in collaboration with the World Health Organization and other local and international health organizations to support mosquito control programs as well as research on malaria. The common mosquito control activities conducted in the region include environmental modification activities, sleeping under insecticide treated nets as well as minimizing travel to malaria endemic regions (Autino, et al. 2012). These activities are beneficial in reducing contact between the mosquitoes and human beings. Environmental modification is aimed at destroying mosquito larvae as well as destroying adult mosquitoes (Lewis & Macpherson, 2013).

Conclusion

Malaria is a tropical disease that despite the extensive research and development of effective treatment and prevention modalities has persisted in different parts of the world including Indonesia. Anopheles female mosquitoes are the vectors responsible for spreading malaria. The plasmodium parasite found in the mosquito’s saliva of gets into a host during feeding leading to the development of malaria symptoms Malaria-related complications may result in the death of many people living in the tropical regions. The common mosquito control activities conducted in these regions include environmental modification activities, sleeping under insecticide treated nets as well as minimizing travel to endemic malaria regions.

 

 

References

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Surjadjaja, C., Surya, A., & Baird, J. K. (2016). Epidemiology of Plasmodium vivax in

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Wen S, et al. (2016). Targeting populations at higher risk for malaria: a survey of national

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Suswardany, D. L., et al. (2015). A critical review of traditional medicine and traditional healer

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Bassat, Q., et al. (2016). Key Knowledge Gaps for Plasmodium vivax Control and Elimination.

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Lewis, M., & Macpherson, K. (2013). Health Transitions and the Double Disease Burden in Asia

and the Pacific: Histories of  Responses to Non-communicable and Communicable Diseases. New York, NY: Routledge.

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