MALARIA IN NORTH SUMATERA PROVINCE THE SITUATION AND CHARACTERISTICS
Chairuddin P. Lubis and Syahril Pasaribu
Department of Child Health
Medical School, University of Sumatera Utara Medan, Indonesia
1. Background
Malaria is a chronic, invalid-producing disease which does not directly kill more than 1 or 2 per-cent of its victims, although it is often a major cause of infant mortality. The disease results in increasing the number of deaths from other causes and it reduces life expectancy, except in epidemic times, it is insidious rather than dramatic. Nevertheless over centuries, malaria has had a profound influence on thousands of communities throughout the world. But there is ample testimony to the fact that malaria has been one of the great scourges of humanity because of its deleterious stunting of physical and mental development, its notorious restricting of social and national growth, and its blighting of agriculture, commerce and industry.(3)
In Indonesia malaria is still a major public health problem, especially out of Java and Bali.(4) In North Sumatera Province, malaria is not affecting the entire population, because cases are concentrated in some specific districts. Cases seen in other districts are imported cases, who have visited malaria areas In North Sumatera Province the Annual Malariae Incidence (AMI) in the year 2000 is 6.03%, and in the year 2001 is 3.42%.(6)
2. Profile of North Sumatera
Area : 71.680 km2
Geographical Location
Border on the North : Nanggroe Aceh Darussalam Border on the South : Riau and West Sumatera Border on the East : Strait of Malaca/Malaysia Border on the West : Indian Ocean
Climate;
June – September : Dry Season
November – March : Rainy Season
District : 13 Districts
Municipality : 7 Municipal cities
Number of Villages : 5.238
Population (Census) 2000 : 11.722.397 Population Growth 1990 – 2000 : 1.20%
Female : 50.02%
0-4 years : 11,49
Rural Population : 56.89%
Urban Population : 43.11%
Households : 2.755.606
Household Average Size : 4.25 persons
Source : BPS Statistics of Sumatera Utara Province
3. Distribution of Malaria
Regarding of malaria risk, North Sumatera Province is divided into 2 groups; Endemic Area and Non-Endemic Area. Districts including in the group of Non-Endemic Area are Mandailing Natal; Tapanuli Selatan; Tapanuli Tengah; Asahan; Labuhan Batu and Deli Serdang.
Monthly Report of Malaria Cases in North Sumatera Province
Year 2000
No. Districts/
Municipality
Total
No of Cases No of Death
1 Medan* - -
2 Binjai 0 0
3 Tebing Tinggi 0 0
4 Tanjung Balai 440 0
5 Sibolga** 630 0
6 Pematang Siantar 0 0
7 Deli Serdang 3166 0
8 Langkat* - -
9 Asahan 9619 2
10 Labuhan Batu** 1342 15
11 Simalungun 2109 0
12 Tapanuli Utara** 261 0
13 Toba Samosir 99 0
14 Tapanuli Tengah 5227 0
15 16
Padang Sidempuan/ **
Tapanuli Selatan 6038 0
17 Madina 14773 3
18 Karo** 1090 0
19 Dairi** 267 0
20 Nias* - -
Total 45061 20
Source : Department of Health North Sumatera Province
* : No significant report yet
** : The report obtained only for a few months
Monthly Report of Malaria Cases in North Sumatera Province
Year 2001
No. Districts/
Municipality
Total
No of Cases No of Death
1 Medan* - -
2 Binjai** 0 0
3 Tebing Tinggi** 0 0
4 Tanjung Balai** 297 0
5 Sibolga** 585 0
6 Pematang Siantar** 0 0
7 Deli Serdang** 1306 0
8 Langkat* 0 0
9 Asahan** 4931 0
10 Labuhan Batu 5437 0
11 Simalungun* 0 0
12 Tapanuli Utara** 240 0
13 Toba Samosir** 52 0
14 Tapanuli Tengah** 2210 0
15 16
Padang Sidempuan/ * Tapanuli Selatan
5319 0
17 Madina 10765 0
18 Karo 1227 0
19 Dairi* 0 0
20 Nias* - -
Total 32369 0
Source : Department of Health North Sumatera Province
* : No significant report yet
4. The Species of Malaria
Since 1997 until 2001, the Department of Health has done a survey of malaria in some villages in six districts of North Sumatera Province. The number of population was 6.394 included in this survey. Blood smear examination showed that malaria positive was found in 1.382 cases, the species of plasmodia being falciparum and vivax.(6)
The Species of Malaria in North Sumatera Province
Species of Plasmodia No of
Population
Plasmodia
Positive Falciparum Vivax Mixed
6,394 1,382 903 458 21
Source : Department of Health North Sumatera Province
During April 2001, Pasaribu S. conducted a study of malaria in 5 villages in District of Mandailing Natal. 152 patients of malaria; 60 cases were malaria falciparum; 83 vivax malaria and 9 of mixed infection.(5)
The Species of Malaria
Species of Plasmodia No of Cases Plasmodia
Positive Falciparum Vivax Mixed
152 60 83 9
From these data we consider that only two out of four species of plasmodia is of natural parasites of man in North Sumatera Province that is falciparum and vivax. There is no report about ovale and malariae species in this area.
5. Clinical manifestation of malaria patients
From history, the most clinical symptoms were fever (97%), pale (80%), headache (55%), diarrhea (42%), and jaundice (13%) respectively. On physical examination we found that 27 patients had splenomegaly.(5)
Symptoms/Physical examination Total
N(60) %
Symptoms :
Fever 58 97
Pale 48 80
Jaundice 8 13
Diarrhea 25 42
Headache 33 55
Physical examination :
Fever 58 97
Pale 48 80
Jaundice 8 13
Splenomegaly 27 45
H0 33 55
H1 9 15
H2 11 18
H3 7 12
Hepatomegaly 10 17
Source : Syahril Pasaribu
6. Antimalarial Drugs
Emil Azlin et al in their study found that.
- 35 patients (falciparum malaria) had been treated with Chloroquine. Plasmodia falciparum Resistance to Chloroquine were found in 10 cases (Grade RII), and 1 case with (Grade RIII).
- 48 patients (falciparum malaria) had been treated with Fansidar. Plasmodia falciparum resistance to
Fansidar were found in 14 cases (Grade RII).
In Indonesia these two drugs are still the drug of choice in the treatment cases of falciparum malaria.
7. Conclussion
Malaria is still a main problem in some districts of North Sumatera Province.
We considered that, two species out of four species of plasmodia (falciparum and vivax) to be natural parasite of man in North Sumatera Province.
References
1. BPS Statistics of Sumatera Utara : Sumatera Utara Dalam Angka.
2. Emil Azlin, Batubara IHH et al : The efficacy of Chloroquine Compared to Fonsidar in Treating Falciparum Malaria in Mandailing Natal; Presented at National Congress of Pediatric (KONIKA) XIII,
Bali, Indonesia, 1st of July 2002.
3. Faust, Evnest Carroll and Paul Farr Russel, 1965 : Malaria Parasite; in Clinical Parasitology, Philadelphia : Lea & Febiger
4. Marleta R, Hariyani et al : Penelitian Malaria Di Kecamatan Teluk Dalam, Nias, Sumatera Utara, Cermin Dunia Kedokteran, 1996; 106 : 5 – 9.
5. Pasaribu S and Lubis C.P. : The Correlation Between Parasetemia And Spleen Size In Children. With Falciparum Malaria; Presented Pediatrics Ankara, Turkey, 26-30 September 2002.
6. Suhardiono, Department of Health, North Sumatera Province (Unpublished) : Analisa Situasi Penyakit Malaria 2000 & 2001 Dan Program P2 Malaria Tahun 2002 Di Propinsi Sumatera Utara.
