World Malaria Day which falls on April 25 every year, still makes malaria as one of the major health problem in many tropical and subtropical regions. Malaria disease are common in tropical regions, the pattern of spread is caused by various factors such as environmental changes, vectors, socio-culture and drug resistance, but it is also due to the limited coverage of health services in some areas.
Malaria Health Issues
The World Malaria Report (2011) reported that half of the world’s population at risk of malaria. Transmission of malaria in Indonesia is still occurs, based on the basic health research report shows until 2011, there were 374 malaria endemic districts.
In 2011, the number of cases of malaria in Indonesia recorded as many as 256 592 people out of 1,322,451 suspected malaria cases were examined by blood. By Annual Parasite Insidence numbers (API) 1.75 per thousand population, meaning that in every 1,000 population in endemic areas there are 2 people exposed to malaria. Very real impact on the decline in the quality of human resources that lead to a variety of social, economic and even affect the national security. Therefore malaria is one of the diseases targeted by the government to gradually eliminated and Indonesia targeted malaria-free in 2030.
To eliminate malaria, Indonesia has conducted various efforts. History records through the Komando Pembasmian Malaria (KOPEM) in the 1950s, which has successfully managed to reduce the number of malaria cases significantly especially in Java. Furthermore, since the limited funding, the program was halted in 1969 and gradually transformed into eradication efforts are integrated into the healthcare system, such as health centers, health centers (Pustu), and others.
However, efforts to control malaria failed because only rely on health sector, but malaria is a disease related to human behavior and the environment. Hence the need to involve other sectors contribute in malaria epidemiology. On this basis then WHO launched an intensification of malaria control movement with global partnership, which is known to Roll Back Malaria Initiative (RBMI) in October 1998.
RBMI Operational form in Indonesia known as the Fight Back Malaria Movement (RBM) which was inaugurated by the Minister of Health on 8 April 2000 in Kupang, East Nusa Tenggara. So RBM is an effort to eradicate malaria in partnership with the entire community. Furthermore, Indonesia is committed to the elimination of malaria by 2030, according to the Minister of Health Decree No.293/Menkes/SK/IV/2009 dated 28 April 2009 on the Elimination of malaria in Indonesia.
In a report issued by the World Health Organization (WHO) in 2012, thanks to the cooperation among donor agencies in 2010, Indonesia has been noted that the cost of malaria prevention over U.S. $ 45 million either from the government or foreign donors fund. However, a decline in 2011, only about U.S. $22 million.
Malaria can affects both men and women and in all age groups, from babies to adults and are generally attacked the people living in the countryside and a lot of water puddles.
Malaria is a disease caused by a parasite called Plasmodium and is transmitted through the bite of an infected mosquito parasites. In the human body, the parasite Plasmodium will proliferate in the liver and then infect red blood cells. The disease is most common in tropical and subtropical areas where Plasmodium parasites can thrive as well as vector mosquito Anopheles. Area south of the Sahara in Africa and Papua New Guinea in Oceania are the places with the highest malaria incidence.
The shoot / incubation malaria can occur a few days to a few months later, then came the signs and symptoms complained of by the patient. Early symptoms experienced by patients of malaria are fever chills periodically and usually accompanied by severe headaches, body feels weak, nausea, vomiting and loss of appetite, yellowing of the eyes, dark tea-colored urine and pale from lack of blood. If it does not get adequate treatment, convulsions may occur and loss of consciousness.
However, the classic symptoms appear in a patient malaria is a sudden feeling of coldness followed by rigor and then fever and sweating emergence after 4 to 6 hours later, it takes place every two days. Among this period, the patient may feel healthy as before.
Malaria is classified into 4 types, namely, first, tertian malaria, caused by Plasmodium vivax malaria in which patients experience fever appears every third day and is the cause of approximately 43% of cases of malaria in humans. Second, quartana Malaria, caused by Plasmodium malariae, feel the fever of malaria patients every fourth day and cause approximately 7% of malaria in the world.
And third, malaria tropica, caused by Plasmodium falciparum malaria and is the most dangerous and often fatal. This type of malaria is the most serious, because it can cause serious complications such as cerebral malaria (cerebral malaria), severe anemia, shock, acute renal failure, bleeding, shortness of breath, etc.. Patients with this type of malaria fever accompanied by symptoms of irregular parts of the brain, coma and even entered a phase of sudden death. As well, four, pernicious malaria, caused by Plasmodium ovale. This type of malaria is rarely encountered, generally many in Africa and the Western Pacific.
Malaria illnes diagnosis is made by symptoms of fever and chills that occur periodically without any obvious cause. Alleged malaria stronger if within one year earlier, the patient had visited malaria endemic areas. To confirm the diagnosis of blood examination to find the cause parasites. May need to be done several times checking for levels of parasites in the blood varies from time to time.
Effective prevention of malaria is the first, to avoid mosquito bites by using mosquito nets, using insect repellent and wearing mosquito repellent ointment at bedtime, as well as pairs of wire netting on ventilation, animal pens away from home and less outside the house at night. Secondly, the spread-eating mosquito larvae density to suppress the spread larvae-eating fish, such as fish head tin, red tilapia, and tilapia gupi. Also coupled with efforts to clean up the environment through puddles hoarding, cleaning moss and mutual help clean up the neighborhood
The third form of prevention is the drug delivery, two days before leaving for malaria area, take medication doksisilin 1 x 1 capsule / day to 2 weeks after leaving the malaria endemic locations.
Treatment depends on the type of malaria parasites and parasite resistance to chloroquine. For an attack of acute falciparum malaria parasites resistant to chloroquine, quinine or kuinidin can be given intravenously. On the other rare malaria resistance to chloroquine, because it’s usually given chloroquine and primaquine.
Malaria drugs recently have been using new drugs such as Artemisinin-based Combination Therapy (ACT), upon the recommendation of the doctor and the right dose, ACT is expected to reduce the number of deaths from malaria. This is where the need for cooperation between the community, government and non-governmental organizations in particular at the community health service centers participated combating the spread of malaria.
Hopefully, with joint movements, RBM, Indonesia hopes malaria free in 20130 can be realized perfectly.
oleh : dr. H. Yahmin Setiawan, MARS (Director of RST Dompet Dhuafa)