EPIDEMIOLOGY AND

CONTROL OF MALARIA
Isna Indrawati
Department of Microbiology - Parasitology

3/15/2021 Remedial Semester 2019/2020

 Malaria is a life-threatening disease caused by
Plasmodium that are transmitted through the bites
of infected female Anopheles mosquitoes.
 It is preventable and curable.
 In 2019, there were 229 million cases of malaria
occurred worldwide ( African Region : 94%
cases)
In 2019, there were an estimated 409 000
deaths from malaria globally ;67% /274.000
are children under 5 years (WHO, Nov 2020)
3/15/2021 Remedial Semester 2019/2020
Malaria endemicity
Malaria endemicity and control activities are
influenced by factors related to :
– the host,
– the parasite
– the vector,
– the environment
– the health system capacity to fully implement
available anti-malaria

3/15/2021 Remedial Semester 2019/2020

■ Different malaria endemic areas have different
epidemiological situations and also the feasible
targets may differ.
■ According to WHO ( Autino B, 2012) , the
following terminology should be adopted when
referring to malaria endemic status :
– Malaria control
– Malaria elimination
– Malaria eradication:

3/15/2021 Remedial Semester 2019/2020

■ Malaria control is the reduction of disease incidence, prevalence,
morbidity, or mortality to a locally acceptable level as a result of
deliberate efforts. Continued intervention is required to sustain
control.
■ Malaria elimination is the interruption of local transmission (that is,
reducing the rate of malaria cases to zero) of a specified parasite in a
defined geographic area. Continued measures are required to prevent
the reestablishment of transmission.
■ Malaria eradication is a permanent reduction to zero of the worldwide
incidence of infection caused by human malaria parasites as a result
of deliberate efforts. Once eradication has been achieved,
intervention measures would no longer be needed.

https://www.ncbi.nlm.nih.gov/books/NBK525190/box/ch12.sec2.box1/?repor
t=objectonly
3/15/2021 Remedial Semester 2019/2020
Malaria Endemicity
Different methods to classify malaria endemicity in a
population exist.
1. Annual parasite incidence (API).
- number of microscopically confirmed malaria cases
detected during one year per unit population

3/15/2021 Remedial Semester 2019/2020

Malariometry

o the determination of the endemic level of malarial

infection in an area or a population:

1. Parasite rate (PR)

- proportion of individuals in a population with a
laboratory-confirmed parasite infection in peripheral
blood

https://www.merriam-webster.com/medical/malariometry
3/15/2021 Remedial Semester 2019/2020
Malariometry
2. Spleen rate (SR)
- proportion of individuals in a population with a
palpable enlargement of spleen
This malariometric attention was focused on
clinical manifestations of malaria on the
basis of splenomegaly prevalence rates in children
from 2 to 9 years old

3/15/2021 Remedial Semester 2019/2020

Spleen Rate (Malariometry)
Four different endemicity areas can be
distinguished:
- holo-endemic areas, where proportion of people
with splenomegaly >75%;
- hyper-endemic areas, where splenomegaly
prevalence is between 51 - 75%;
- meso-endemic , with prevalence 11 – 50 %;
- hypo-endemic : prevalence is < 11%.5

3/15/2021 Remedial Semester 2019/2020

Malariometry
3. Sporozoites rate
- The proportion of female Anopheline mosquitoes
that have sporozoites in their salivary glands (as seen by
dissection), or that are positive in immunologic tests to
detect sporozoite antigens

Entomological inoculation rate (EIR).

- Number of infective bites received per person in a
given unit of time, in a human population

3/15/2021 Remedial Semester 2019/2020

■ Parasite density : Average degree of parasitaemia
in a sample of group of population. Only the
positive slide are included.

■ Parasite count : degree of parasitaemia in one

person ( % parasitized RBCs and parasites per µl
blood )

3/15/2021 Remedial Semester 2019/2020

Malaria cases
Malaria cases are classified according to the
following World Health Organization categories:
■ Imported case : Malaria case or infection in which the
infection was acquired outside the area in which it is
diagnosed
■ Indigenous malaria: malaria acquired by mosquito
transmission in an area where malaria is a regular
occurrence

3/15/2021 Remedial Semester 2019/2020

■ Induced malaria
A case acquired through artificial means (e.g. a blood
transfusion or other form of parenteral inoculation ) ; not
by a natural mosquito-borne inoculation
■ Introduced Case
A case contracted locally, with strong epidemiological
evidence linking it directly to a known imported case (first-
generation local transmission)
■ Re-introduction case
A case of malaria after malaria cases have been reduced
to zero in a particular area or country (after its elimination)

3/15/2021 Remedial Semester 2019/2020

Control of Malaria
■ Control of malaria is a complex chain of measures
that often complement one another.
■ By taking personal protective :
– prevention of malaria in the given individual,
– reduction in spread,
– denying blood meal to the mosquito
reduction in mosquito eggs
reduction in mosquito population

3/15/2021 Remedial Semester 2019/2020

Man’s Role in Malaria Control:
■ Early diagnosis and treatment
o treat early to reduce parasite load
o prevent deaths
■ Treat completely to prevent spread and relapse
■ Ensure compliance with complete treatment
■ Personal Protection- prevent malaria by using bed nets,
insecticide sprays, used mosquito repellents etc., and by
chemoprophylaxis.

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 ACT

Source : https://www.malariasite.com/c

3/15/2021 Remedial Semester 2019/2020

Mosquito, the Vector
■ Vector control is the main way to prevent and reduce malaria
transmission.
 Prevent breeding site preventing the development
of the eggs into adult
o simple and cost effective,
o environment friendly.
 prevent entry into houses,
 prevent bites to humans.

■ The problems are resistance to insecticides and compliance

by humans

3/15/2021 Remedial Semester 2019/2020

Mosquito control
■ The success of vector control will depend on reducing
the density and longevity of the species responsible.
■ WHO recommends protection for all people at risk of
malaria with effective malaria vector control.
■ Two forms of vector control :
– insecticide-treated mosquito nets and
– indoor residual spraying – are effective in a
wide range of circumstances.

3/15/2021 Remedial Semester 2019/2020

Insectide Residual Spraying Insecticide-treated mosquito nets(LLINs)
 Peta Jalan Eliminasi Malaria di Indonesia

Subnational Eliminasi merupakan inovasi Indonesia sebagai negara besar 2030

untuk mencapai eliminasi malaria secara Bertahap 2029
2028 Eminiasi Malaria
Semua Prov & Regio Nasional
2025 eliminasi malaria
Semua Kab/kota
2019 eliminasi malaria
Indignous terakhir di
Indonesia
RPJMN 300 Kab/ko Eliminasi
5. Regional Papua
2029
& Papua Barat
Usulan Verifikasi Eliminasi Malaria-WHO Per Wilayah Regional
4. Regional Maluku & NTT 2028

3. Regional Kalimantan
& Malut
2027

2. Regional Sumatera,
Sulawesi, NTB
2025

1. Regional Jawa-Bali
2023