Malaria, an age old disease proves hard to control<\/p>\n
Tantri Yuliandini, The Jakarta Post, Jakarta<\/p>\n
Hundreds of years ago, malaria was thought to be caused by
\nharmful gasses from swamps (hence the name mal aria, Latin for
\nbad air), and was greatly feared due to the high death toll it
\nbrought.<\/p>\n
Today -- despite the fact that the actual cause, the
\nanopheline mosquito, has been known for more than a century --
\nmalaria remains one of the world's most problematic health
\nissues, as it has tended to re-emerge time and again despite
\naggressive efforts to control the communicable disease.<\/p>\n
World Health Organization (WHO) data show approximately 300
\nmillion people worldwide have been affected by malaria, and
\nbetween 1 and 1.5 million people die from it every year.<\/p>\n
While previously widespread, malaria is now mainly confined to
\nAfrica, Asia and Latin America where the problems of controlling
\nthe disease are aggravated by inadequate health structures and
\npoor socioeconomic conditions.<\/p>\n
In Indonesia, malaria is endemic to most areas, with the
\neastern part of the country being the most severely affected.<\/p>\n
Around 100 million of its more than 200 million people are at
\nrisk of malaria and approximately 1.5 million cases are detected
\nannually, according to WHO.<\/p>\n
A massive effort by WHO to control malaria in 1950 succeeded
\nin bringing down the estimated number of malaria cases from
\nbetween 110 and 115 million to less than one million in the
\nSoutheast Asian region.<\/p>\n
A similar effort in Indonesia during the 1960s, staged by the
\nministry of health, was so successful that Java and Bali have
\nsince been deemed relatively free of malaria.<\/p>\n
However, since 1995 the number of malaria cases reported has
\nbeen steadily increasing, especially in Central Java and
\nYogyakarta.<\/p>\n
A massive outbreak of malaria occurred between 1998 and 1999
\nin some areas of South Sumatra, Yogyakarta, Central Java, Lampung
\nand North Sumatra. Some 18,812 cases of malaria and 21 deaths
\nwere reported from the outbreak.<\/p>\n
More recently, the communicable disease was reported to have
\nkilled 54 people in Banyumas, Central Java. Some 10,000 people
\nwere reported to have been infected by the disease in the region.<\/p>\n
This came as a shock, as the ministry had been implementing
\nits program called Gerakan Basmi Kembali Malaria (Rollback
\nMalaria Program) since 1998.<\/p>\n
The Director General of Communicable Diseases and
\nEnvironmental Health at the Ministry of Health, Umar Fahmi
\nAchmadi, told The Jakarta Post Monday that globally, the re-
\nemergence of malaria was caused by an increase in the world's
\ntemperature, usually known as global warming, which had created
\nan environment ideal for the breeding of the anopheline mosquito.<\/p>\n
Malaria parasites are transmitted from one person to another
\nby the female anopheline mosquito. The males do not transmit the
\ndisease as they feed only on plant juices.<\/p>\n
Like all other mosquitoes, the anophelines breed in water,
\neach species having its preferred breeding grounds, feeding
\npatterns and resting places.<\/p>\n
\"The anophelines are known to breed faster and more
\naggressively in higher temperatures,\" Umar said.<\/p>\n
There are about 380 known species of anopheline mosquito in
\nthe world, but only 60 or so are able to transmit the parasite.<\/p>\n
\"Out of the 380 species, at least 18 are found in Indonesia
\nbut we have not yet determined how many are able to transmit
\nmalaria parasites,\" he said.<\/p>\n
Among the 18 species are Anopheline maculatus, An. sundaicus,
\nAn. aconitus, An. barbirostris, An. subpictus, An. balabacensis,
\nAn. koliensis and An. farauti.<\/p>\n
Umar said the recent malaria outbreaks could also have been
\ntriggered by the population's high mobility, especially during
\nthe Muslim and Christmas holidays last month.<\/p>\n
\"People have been moving into and out of endemic areas to
\nvisit friends and relatives -- they are highly susceptible to
\nmalaria as they have not developed immunity to the disease.\"<\/p>\n
People living in endemic regions where transmission is high
\ncan gradually develop immunity to malaria.<\/p>\n
Malaria is caused by protozoan parasites of the genus
\nPlasmodium. Four species of Plasmodium can produce the disease in
\nits various forms, but one, the P. falciparum, is the most
\nwidespread and dangerous of the four, and if left untreated can
\nlead to fatal cerebral malaria or a state of unrousable coma.<\/p>\n
The situation has become even more complex over the last few
\nyears with the increase in resistance to the drugs normally used
\nto combat the malaria parasites, especially chloroquine.<\/p>\n
Umar said the increased resistance to drugs was being caused
\nby the lack of discipline among people taking malaria medicine,
\nthe distribution of imitation drugs and the limited ability of
\nsome people to absorb the medicine.<\/p>\n
\"Patients tend to stop medication once they feel better. This
\ndoesn't eliminate the parasites wholly but only makes them woozy
\nand in the long run makes them immune to the drugs.\"<\/p>",
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