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JAKARTA - There has been an alarming increase in malaria outbreaks in Indonesia in the past few years, with some areas showing a 200 percent rise in the number of reported cases. Officials attribute the rise to, among other things, environmental changes, relatively high population mobility and refugees.
The Ministry of Health and Social Welfare reported on Tuesday that between 1997 and 1999 there was a more than 200 percent increase in malaria cases in Java and Bali. Outside of Java and Bali there was an increase of 56.25 percent.
The number of malaria cases in Java and Bali -- except for Jakarta -- increased from 12 cases per 100,000 people in 1997 to 38 cases per 100,000 in 1999, with the most occurrences in Yogyakarta with 35 cases per 10,000 persons. Outside of Java and Bali, from the 1,600 malaria cases per 100,000 in 1997, the figure increased to 2,500 cases in 1999, with the highest in East Nusa Tenggara with 16,290 cases per 100,000.
That amounts to a total of about 15 million people who have suffered malaria in this country with a mortality rate of 30,000 people. The ministry's Director General of Communicable Disease Control and Environmental Health Umar Fahmi Achmadi highlighted environmental changes as the cause.
"For example in Cilacap, Central Java, where farming land has been converted into fish ponds, or neglected shrimp ponds which have become potential breeding grounds," he told reporters on Tuesday on the sidelines of a partnership meeting to eradicate malaria with the World Health Organization (WHO). Yogyakarta, he said, especially Kulon Progo, is prone to malaria due to its natural soil condition which contains a lot of rocks.
According to Umar, the clearing of mangrove forests, global climatic changes and the economic crisis also contributed to the increase of malaria cases. He added that the number of malaria cases was expected to rise this year due to the increasing number of refugee camps.
"Malaria is rampant in the camps," he said. Umar once mentioned that based on a brief survey, some 80 percent to 90 percent of refugees suffer from malaria. There is an estimated 800,000 refugees in the country who have been displaced due to conflicts or natural disasters.
Most of the refugees are in Aceh, North Sumatra, West Kalimantan, East Nusa Tenggara, South Sulawesi, Southeast Sulawesi and Maluku. Umar also said that malaria patients had a tendency not to finish the full course of medication. "They are usually reluctant to take medicine. The patients stop taking medicine when they feel a little better, while in fact they have to take it until they are really cured," he said.
Such reluctance, he added, increases the medical cost tenfold. According to Umar, although malaria is an acute disease, it claims fewer lives compared to dengue hemorrhagic fever. "But while it doesn't cause immediate death, it decreases people's productivity. It actually results in a higher economic cost. That is why malaria is called the silent killer," he said.
Therefore, Umar said, regional administrations should not hesitate in investing money for medicine in treat malaria. The government, he added, launched the Malaria Eradication Movement (Gebrak Malaria) in April last year, particularly targeting susceptible areas including Central Java, West Java, South Sumatra, South Kalimantan, Southeast Sulawesi and East Nusa Tenggara.
"Eradicating malaria is one of our priorities this year," Umar said. The strategy includes surveillance, proper diagnosis and treatment, prevention, research and development, and increasing health services. "Hopefully in 2010, we can at least reduce malaria prevalence by 50 percent," Umar said.
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