Malaria in Wanokaka and Loli sub-districts, West Sumba District, East Nusa Tenggara Province, Indonesia

Malaria has long been known as one of the major public health problems in West Sumba District, East Nusa Tenggara Province, Indonesia. To obtain baseline data for establishment of a suitable malaria control program in the area, malariometric surveys were conducted in two sub-districts, Wanokaka and Loli, during the periods of January, May, and August 2005. The survey included three selected villages in each sub-district, and blood smear analyses of 701, 921, and 894 randomly selected subjects in January, May, and August revealed 30.5%, 25.3%, and 28.2% malaria positives, respectively, consisting mainly of Plasmodium falciparum and P. vivax, and in a few cases, P. malariae. Analysis of malaria prevalence at different age groups clearly reflected the common phenomenon that younger individuals are more vulnerable by infection of either P. falciparum or P. vivax. In falciparum malaria, the frequency of cases carrying gametocytes was also relatively high involving all age groups. The findings indicate that the malaria incidence and transmission in the area are relatively high and that further exploration is warranted to establish a precise malaria control program.     

Coevolution of languages and genes on the island of Sumba, eastern Indonesia

Numerous studies indicate strong associations between languages and genes among human populations at the global scale, but all broader scale genetic and linguistic patterns must arise from processes originating at the community level. We examine linguistic and genetic variation in a contact zone on the eastern Indonesian island of Sumba, where Neolithic Austronesian farming communities settled and began interacting with aboriginal foraging societies approximately 3,500 years ago. Phylogenetic reconstruction based on a 200-word Swadesh list sampled from 29 localities supports the hypothesis that Sumbanese languages derive from a single ancestral Austronesian language. However, the proportion of cognates (words with a common origin) traceable to Proto-Austronesian (PAn) varies among language subgroups distributed across the island. Interestingly, a positive correlation was found between the percentage of Y chromosome lineages that derive from Austronesian (as opposed to aboriginal) ancestors and the retention of PAn cognates. We also find a striking correlation between the percentage of PAn cognates and geographic distance from the site where many Sumbanese believe their ancestors arrived on the island. These language-gene-geography correlations, unprecedented at such a fine scale, imply that historical patterns of social interaction between expanding farmers and resident hunter-gatherers largely explain community-level language evolution on Sumba. We propose a model to explain linguistic and demographic coevolution at fine spatial and temporal scales.     

Spatial Patterns of Plasmodium falciparum Clinical Incidence,Asymptomatic Parasite Carriage and Anopheles Density in Two Villages in Mali

Heterogeneity in malaria exposure is most readily recognized in areas with low-transmission patterns. By comparison, little research has been done on spatial patterns in malaria exposure in high-endemic settings. We determined the spatial clustering of clinical malaria incidence, asymptomatic parasite carriage, and Anopheles density in two villages in Mali exposed to low- and mesoendemic-malaria transmission. In the two study areas that were < 1 km² in size, we observed evidence for spatial clustering of Anopheles densities or malaria parasite carriage during the dry season. Anopheles density and malaria prevalence appeared associated in some of our detected hotspots. However, many households with high parasite prevalence or high Anopheles densities were located outside the identified hotspots. Our findings indicate that within small villages exposed to low- or mesoendemic-malaria transmission, spatial patterns in mosquito densities and parasite carriage are best detected in the dry season. Considering the high prevalence of parasite carriage outside detected hotspots, the suitability of the area for targeting control efforts to households or areas of more intense malaria transmission may be limited.     

Survey of Anopheles mosquitoes (Diptera:Culicidae) in West Sumba District, Indonesia

In August 2007, mosquitoes were collected using four different collection methods at 2 upland interior and 2 coastal villages in West Sumba District, East Nusa Tenggara Province, Indonesia. Methods included human-baited and unbaited tent and malaise traps, human-landing collections (HLC), and unbaited CDC light traps. Mosquitoes were identified to species by morphological characters and all anophelines were tested for malaria circumsporozoite protein (CSP) using an enzyme-linked immunosorbent assay (ELISA). During six trap nights, 4,174 Anopheles mosquitoes belonging to 13 species were captured and identified: An. aconitus, An. annularis, An. barbirostris, An. flavirostris, Hyrcanus Group species, An. indefinitus, An. kochi, An. leucosphyrus group, An. maculatus s.l., An. subpictus s.l., An. sundaicus s.l., An. tessellatus, and An. vagus. Of potential disease vectors, An. annularis, An. subpictus, and An. vagus were the most frequently collected species in the upland interior sites, whereas An. sundaicus, An. subpictus, and An. vagus were most commonly found along the coast. The predominant species from evening human-landing collections (mosquitoes per human) were An. subpictus and An. vagus in the upland interior and An. sundaicus along the coast. All mosquitoes were non-reactive for Plasmodium CSP. One specimen of the An. leucosphyrus group was captured from indoor HLC in Tenateke Village, an upland interior location. This finding appears to represent a new collection record for Sumba Island.     

化学农药的使用对嗜人按蚊分布与疟疾发病率影响的探讨

目的探讨稻田使用化学农药对嗜人按蚊种群分布与疟疾发病率的影响。方法选择历史调查证实为嗜人按蚊分布的浙江(1987年,杭嘉湖地区的湖州、德清、安吉、长兴、余杭、萧山和嘉兴等7县的11个调查点)、四川(1987年,乐山的沐川、峨嵋、夹江和沙湾,及宜宾地区的兴文、长宁、筠连和高县等8个县10个村)和广西自治区(1983年,河池地区环江县川山公社的社村、何顿和白丹等3个村)的16个县共24个村作为调查点,用半通宵室内人饵诱捕和清晨全部人房蚊帐搜捕法,调查嗜人按蚊密度和种群比例。收集当地历年按蚊调查资料、疟疾发病率资料、单双季稻种植面积和稻田化学农药使用量情况,分析嗜人按蚊种群密度和疟疾发病率的变化与化学农药使用量的关系。结果浙江省杭嘉湖地区调查点以种植双季稻为主,至1973年农药使用量为45 kg/hm2,是20世纪50年代的50倍;嗜人按蚊密度逐年下降,至80年代末11个调查点均未发现嗜人按蚊;疟疾发病率降至1/万以下。四川省乐山和宜宾地区调查点以种植单季稻为主,60年代开始稻田使用化学农药,70～80年代初期农药使用量平均为8.6 kg/hm2,嗜人按蚊密度(86.2%)与60年代初(82.2%)比较无明显变化(χ2=0.63,P>0.05);80年代中期以后,农药使用量逐渐增加,至2000年及以后的使用量均约为18.18 kg/hm2,嗜人按蚊密度逐年下降。至2010年调查点未发现嗜人按蚊;全县无疟疾病例报告。广西环江县以双季稻为主,60、70和80年代初期稻田用农药量分别约为1.79、5.13和7.68 kg/hm2,80年代初嗜人按蚊密度为52%(1747/3 392);2000年以后平均稻田农药使用量达20.38 kg/hm2,嗜人按蚊密度明显下降。2008年后,在人房已较难捕获到嗜人按蚊,年平均发病率下降至0.14/万。结论农耕制度的改变和稻田高剂量使用化学农药,在一定程度上可破坏嗜人按蚊的孳生环境,使其分布范围缩小,数量减少或"消失",削弱了其传疟作用。     

Malaria prophylaxis using azithromycin: a double-blind, placebo-controlled trial in Irian Jaya, Indonesia.

New drugs are needed for preventing drug-resistant Plasmodium falciparum malaria. The prophylactic efficacy of azithromycin against P. falciparum in malaria-immune Kenyans was 83%. We conducted a double-blind, placebo-controlled trial to determine the prophylactic efficacy of azithromycin against multidrug-resistant P. falciparum malaria and chloroquine-resistant Plasmodium vivax malaria in Indonesian adults with limited immunity. After radical cure therapy, 300 randomized subjects received azithromycin (148 subjects, 750-mg loading dose followed by 250 mg/d), placebo (77), or doxycycline (75, 100 mg/d). The end point was slide-proven parasitemia. There were 58 P. falciparum and 29 P. vivax prophylaxis failures over 20 weeks. Using incidence rates, the protective efficacy of azithromycin relative to placebo was 71.6% (95% confidence interval [CI], 50.3-83.8) against P. falciparum malaria and 98.9% (95% CI, 93.1-99.9) against P. vivax malaria. Corresponding figures for doxycycline were 96.3% (95% CI, 85.4-99.6) and 98% (95% CI, 88.0-99.9), respectively. Daily azithromycin offered excellent protection against P. vivax malaria but modest protection against P. falciparum malaria.     

The pancreas of sacrificial animals as an object of divination for the indigenous peoples on the Island of Sumba, Indonesia.

This paper describes contemporary 'intestinal' divination with the pancreas by indigenous people in Indonesia and explores the feasibility of comparing it to ancient intestinal divination. To our knowledge, divinatory use of the pancreas of sacrificial animals (chickens) has not yet been described in the literature.     

Malaria and glucose-6-phosphate dehydrogenase deficiency in North Sumatra, Indonesia

A screening test for glucose-6-phosphate dehydrogenase (G6PD) deficiency was carried out in North Sumatra, Indonesia by using a simple agar plate method. The prevalence of G6PD deficiency in male was 6.0% (9/151) in Nias prefecture, 3.9% (12/307) in Asahan prefecture and 0.9% (1/110) in Medan city (average 3.9%). The prevalence of malaria was investigated at the same time in Nias and Asahan. It was 8.6% (13/151) and 10.4% (32/307) in males. The parasite rate of Plasmodium falciparum in normal and G6PD deficient groups was 4.1% and 9.5%, respectively. There was no statistical significance between them. The usefulness of the system of detecting malaria and G6PD deficiency at the same time was discussed in relation to malaria control.     

Malaria in Indonesia: a summary of recent research into its environmental relationships

A review of the literature was carried out to evaluate malaria and its environmental relationships. Research, in 6 parts of Indonesia, addressed the relationship between malaria incidence and physical and socioeconomic environmental factors, using longitudinal and cross-sectional approaches. Physical factors, which are generally important for malaria, included rainfall, mosquito breeding and resting sites, their distance from human habitation, and elevation, though the latter was not statistically significant. Housing conditions were occasionally important. Social and economic factors of importance were income, education, use of bednets and pattern of outdoor activities, especially at night. Use of repellents, mosquito coils and sleeping arrangements were significant in some of the studies.     

Malaria past and present: the case of North Sulawesi, Indonesia

The incidence and impact of malaria in North Sulawesi have declined both in the short term during the 1990s, and over a much longer timespan (though perhaps less continuously) since the end of the colonial period. The improvement already seems to have been well underway before deliberate vector control activities became extensive in the second half of the 1970s, and environmental changes affecting the Anopheles mosquito fauna, in particular the replacement of primary and secondary forest by permanent farmland, are probably the principal reasons for the long-term trend; other possible factors include the increasing use of antimalarial drugs. The well-documented decline in malaria incidence over the years 1991-1997, nevertheless, probably reflects the unprecedented scale of residual insecticide spraying in the province during that period, while the slight resurgence of the disease in the last three years corresponds to the subsequent cessation of house spraying as a result of the current economic crisis. Despite the evident importance of environmental change as a factor ameliorating the malaria situation in the long term, experience from the colonial era suggests that the prospects for deliberate environmental management (species sanitation) as an alternative malaria control strategy are poor.     

A Community-Wide Study of Malaria Reduction: Evaluating Efficacy and User-Acceptance of a Low-Cost Repellent in Northern Ghana

NO MAS (NM) mosquito repellent was evaluated in two farming villages (4 km apart) in the Kassena Nankana district of northern Ghana. We determined its efficacy against local malaria vectors, degree of user acceptance, and its effect on malaria prevalence in households using insecticide-treated bed nets. The average protective efficacy of NM against Anopheles mosquitoes over 9 hours was 89.6%. Controls averaged 86 bites/person/night versus 9 bites/person/night with the use of NM. Use of repellent was associated with a decrease of absolute malaria prevalence by 19.2% in the repellent village and by 6.5% in the control village (45.5 to 26.3, and 29.5 to 23.0, respectively). The user-acceptance rate of NM repellent was 96.1%. Ten percent (10%) of repellent users reported irritation as the main adverse effect during the period. Eighty-five percent (85%) of the users found the odor of NM appealing and 87% reported no inconvenience in applying the repellent daily.     

Spatial Patterns of Malaria Reported Deaths in Yunnan Province,China

Malaria has been a heavy social and health burden in the remote and poor areas in southern China. Analyses of malaria epidemic patterns can uncover important features of malaria transmission. This study identified spatial clusters, seasonal patterns, and geographic variations of malaria deaths at a county level in Yunnan, China, during 1991–2010. A discrete Poisson model was used to identify purely spatial clusters of malaria deaths. Logistic regression analysis was performed to detect changes in geographic patterns. The results show that malaria mortality had declined in Yunnan over the study period and the most likely spatial clusters (relative risk [RR] = 23.03–32.06, P < 0.001) of malaria deaths were identified in western Yunnan along the China–Myanmar border. The highest risk of malaria deaths occurred in autumn (RR = 58.91, P < 0.001) and summer (RR = 31.91, P < 0.001). The results suggested that the geographic distribution of malaria deaths was significantly changed with longitude, which indicated there was decreased mortality of malaria in eastern areas over the last two decades, although there was no significant change in latitude during the same period. Public health interventions should target populations in western Yunnan along border areas, especially focusing on floating populations crossing international borders.     

非稳定性疟区用时间序列模型预测疟疾发病率的可行性研究

目的 探讨应用季节性时间序列ARIMA模型预测非稳定性疟区疟疾发病率的可行性。 方法 应用SPSS13.0软件对淮河流域河南省桐柏县及安徽省怀远县1998-2005年逐月发病率进行ARIMA建模拟合；按照残差不相关和简洁的原则确定模型结构，依据赤池信息准则（AIC）与贝叶斯信息准则（BIC）确定模型的优度。用所得模型预测2006年两县的月发病率，比较预测值与实际值，检验预测效果；再以1998-2006年的发病率数据构建ARIMA模型，预测2007年疟疾发病率。 结果　 模型ARIMA（1，0，0）（0，1，1）12的自回归参数（AR1=0.512）与季节平均移动参数（SMA1=0.609）均通过了统计学检验（P<0.01），AIC=67.01，BIC=71.87，模型残差为白噪声（P>0.05）；该模型很好地拟合了既往时段上的发病率序列，2006年各月疟疾发病率预测值符合实际发病率的变动趋势。预测2007年的疟疾发病率为106.50/10万，发病高峰在7～10月份（占总发病的74.81%）。 结论 ARIMA模型可以很好地模拟疟疾发病率在时间序列上的变动趋势，可用于预测未来的疟疾发病率进行，是一种短期预测精度较高的预测模型。     

中缅边境缅方瓦族村寨疟疾病例的主动侦察

目的 探讨通过主动病例侦察,加强资源匮乏高疟区的疟疾监测和防治服务.方法 逐个访问高疟村寨,寻找1周内发过烧的"四热"患者,使用疟疾快速诊断检测疟原虫抗原.结果 发现和血检发热患者453例,2年疟史率77.92%;确诊疟疾270例,其中恶性疟243例,问日疟20例和三日疟7例;阳性率59.6%,恶性疟比例90.00%;当地仍为高度地方性疟疾流行区.结论 在缺乏基本医疗卫生服务的高疟区,主动病例侦察应该是有效的疟疾监测和防治方法之一.     

Impact of a tetanus toxoid immunization mass campaign on neonatal tetanus mortality in Aceh Province, Indonesia.

Neonatal tetanus mortality declined dramatically in Pidie district (Aceh Province) Indonesia between 1984 and 1987. Baseline and follow-up survey results demonstrated an 85% reduction in neonatal tetanus mortality during this period, from 32.1/1000 live births to 4.9/1000 live births. During 1985 a tetanus toxoid mass campaign was conducted in Pidie district which resulted in 84% of women 10-45 years of age receiving two tetanus toxoid injections. Analysis of the results of the two surveys provides very strong evidence of the impact of the tetanus toxoid mass campaign on neonatal tetanus mortality.     

Poor Housing Construction Associated with Increased Malaria Incidence in a Cohort of Young Ugandan Children

Despite the use of accepted interventions to combat malaria, such as insecticide-treated bed nets and artemisinin-based combination therapy, malaria remains a leading cause of morbidity and mortality in Uganda. We investigated associations between household factors and malaria incidence in a cohort of children living in a highly endemic region of Uganda. Living in a modern house, defined as the use of non-earth floors, non-thatched roofs, and non-mud walls, was associated with approximately half malaria incidence compared with living in a traditional home (incidence rate ratio [IRR] = 0.54, P = 0.001). Other factors found to be associated with a lower incidence of malaria included living in town versus rural setting; sleeping in a room with openings to the outside (windows, eaves, and airbricks); and having an older and more educated primary caregiver. This study adds to the growing body of evidence that improved house construction may be associated with a lower risk of malaria.     

Predictors of Plasmodium falciparum Malaria Incidence in Chano Mille, South Ethiopia: A Longitudinal Study

Abstract. We assessed potential effects of local meteorological and environmental conditions, indoor residual spraying with insecticides, insecticide-treated nets (ITNs) use at individual and community levels, and individual factors on Plasmodium falciparum malaria incidence in a village in south Ethiopia. A cohort of 8,121 people was followed for 101 weeks with active and passive surveillance. Among 317 microscopically confirmed P. falciparum malaria episodes, 29.3% occurred among temporary residents. The incidence density was 3.6/10,000 person-weeks of observation. We observed higher malaria incidence among males, children 5-14 years of age, ITNs non-users, the poor, and people who lived closer to vector breeding places. Rainfall increased and indoor residual spraying with Deltamethrin reduced falciparum incidence. Although ITNs prevented falciparum malaria for the users, we did not find that free mass ITNs distribution reduced falciparum malaria on a village level.     

复方萘酚喹及其组分单药治疗恶性疟的临床研究

目的对比观察复方萘酚喹(Co-NQ)与组分单药萘酚喹(NQ)和青蒿素(QHS)对恶性疟的疗效和安全性。方法用Co-NQ(总量含NQ400mg及QHS1000mg)、NQ(总量1000mg)和QHS(总量2500mg)分别治疗恶性疟患者100例、100例和30例。所有患者住院7d,随访28d,观察疗效和安全性。结果Co-NQ、NQ和QHS3组的平均退热时间分别为(17.5±12.3)h,(32.7±17.7)h和(18.1±9.7)h;平均原虫转阴时间分别为(30.0±8.8)h,(45.5±10.0)h和(29.1±6.0)h;28d治愈率分别为97.0％,100.0％和66.7％。Co-NQ组临床未见不良反应。结论Co-NQ具有QHS的速效和NQ的持效作用,是一个高效、速效、持效的新复方。