Indonesia is the second country (after India) in Southeast Asia who holds the highest number of malaria cases, based on the World Health Organization (WHO) report in the World Malaria Report 2020. Despite a declining number between 2010-2014, the trend in Indonesia tends to stagnate between 2014-2019.
The trend of positive malaria cases and the number of malaria sufferers (Annual Parasite Incidence/API) shows a concentration of high malaria endemic districts or cities in Eastern Indonesia. The Indonesian Ministry of Health stated that about 86% of malaria cases occurred in Papua Province with a total of 216,380 cases in 2019. Followed by East Nusa Tenggara Province with 12,909 cases and West Papua Province with 7,079 cases. However, there are still high endemic areas in central Indonesia, specifically in North Penajaman Paser Regency, East Kalimantan Province.
Meanwhile, there are about 300 districts and cities (58%) that fall within the elimination status, and around 208.1 million people (77.7%) live in malaria-free areas. Several provinces in Indonesia have successfully eliminated malaria from the territory completely, namely DKI Jakarta Province, East Java Province, and Bali Province.
For the low endemicity category (API less than 1 per 1,000), there are still 160 districts and cities (31%) that fall in this category, with a total of 52.4 million people (19.6%) living in a low endemic zone. Then, around 31 districts and cities (6%) with 4.4 million people (1.7%) fall into the category of moderate endemic areas (API 1-5 per 1,000). Meanwhile, there are still 23 districts and cities (4%) that fall into high endemic areas (API more than 5 per 1,000) with 2.9 million people (1.1%) living in these areas.
The following is a detailed report on malaria endemicity in Indonesia in 2019.
1.Central Java; 33 malaria-free areas, 2 low endemic
2.Aceh; 21 malaria-free areas, 2 low endemic
3.West Sumatra; 17 malaria-free areas, 1 low endemic
4.Bangka Belitung Islands; there are 6 malaria free areas, 1 low endemic 5. West Java; there are 23 elimination areas, 4 low endemic
6.Riau; 10 malaria-free areas, 2 low endemic
7.South Sulawesi; 20 malaria free areas, 4 low endemic
8.West Sulawesi; there are 5 malaria free areas, 1 low endemic
9.Yogyakarta; there are 4 malaria free areas, 1 low endemic
10.Banten; 6 malaria free areas, 2 low endemic
11.Lampung; there are 11 malaria-free areas, 3 low endemic areas, 1 moderate endemic area
12.Central Kalimantan; 10 malaria free areas, 4 low endemic
13.Jambi; 7 malaria free areas, 4 low endemic
14.North Sumatra; 21 malaria-free areas, 11 low endemic, 1 moderate endemi
15.South Kalimantan; 7 areas free of malaria, 6 low endemic
16.Southeast Sulawesi; 9 malaria free, 7 low endemic, 1 moderate endemic 17. South Sumatra; 8 malaria-free areas, 9 low endemic
18.Riau islands; 3 malaria-free areas, 3 low endemic, 1 moderate endemic 19. North Sulawesi; 6 malaria free areas, 9 low endemic
20.Central Sulawesi; 5 malaria free areas, 8 low endemic
21.Gorontalo; 2 malaria free areas, 4 low endemic
22.Bengkulu; there are 3 malaria free areas, 7 are low endemic
23.West Nusa Tenggara; 3 malaria free areas, 7 low endemic
24.West Kalimantan; 3 elimination areas, 11 low endemic
25.East Kalimantan; there are 3 elimination areas, 5 low endemic, 1 moderate endemic, 1 high endemic
26.North Kalimantan; 1 elimination area, 4 low endemic
27.North Maluku; 8 low endemic, 2 moderate endemic
28.Maluku; 8 low endemic, 3 moderate endemic
29.East Nusa Tenggara; 15 low endemic, 4 moderate endemic, 3 high endemic 30. West Papua; there are 3 low endemic areas, 6 moderate endemic areas, 4 high endemic areas
31.Papua; there are 4 low endemic, 10 moderate endemic, and 15 high endemi
Why is Malaria Concentrated in Eastern Indonesia?
Weather is one of the main causes of malaria outbreaks in eastern regions, such as in Mimika, Papua. The weather in Mimika is difficult to predict, even by the Meteorology, Climatology and Geophysics Agency (BMKG) in the region. Even though the rainy season lasts several months,
sometimes scorching heat can emerge in Mimika. This fast-changing weather contributes to people's bodies being more susceptible to malaria.
Symptoms of malaria that are similar to mild illness also make it difficult for people in high endemic areas to identify themselves as infected with malaria, so medical treatment sometimes gets too late. In addition, this difficulty also delayed people to take action on handling the source of transmission; such as water reservoirs that have become nests for parasite-carrying mosquitoes and are still used for consumption.
People who have been infected and recovered are also easily infected again with malaria for not taking precautions. The living areas are also prone to being surrounded by mosquito nests because the areas are covered in puddles when the rainfall is high, coupled with unsanitary environment.