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Abstract
Background:
Malaria is an endemic disease in Keerom Regency, Papua Province which is influenced by age, sex, education, socio-economic, use of mosquito repellent, use of insecticide-treated bed nets, wire mesh installation, house walls, puddles, presence of large animal cages and distances house with a place breeding
Objective:
To determine the risk factors for malaria in the working area of Also III Community Health Center, Keerom Regency, Papua Province.
Research Methods:
Descriptive analytic case-control design. The population was patients who resided in the Also III Community Health Center working area with 67 malaria cases and 67 controls taken in proportion to random sampling. Data were obtained using a questionnaire and analyzed using chi-square and binary logistic regression.
Results:
Factors that influence the risk of malaria incidence in Also III Health Center in Keerom Regency are gender (ρ-value = 0.037; OR = 0.453; CI95% = (0.226 – 0.906), habit of using malaria mosquito repellent (ρ-value = 0.002; OR = 3.214; CI95% = (1,585 – 6,516), use of insecticide-treated bed nets (ρ-value = 0,000 OR = 4,526; CI95% = (2,183 – 9,384), use of wire mesh (ρ-value = 0,002; OR = 3,273 ; CI95% = (1,603 – 6,683), wall of the house (ρ-value = 0,001; OR = 3,454; CI95% = (1,694 – 7,046), standing water (ρ-value = 0,004; OR = 3,170; CI95% = (1,500 – 6,698), the distance between houses and breeding places (ρ-value = 0,036; OR = 2,237; CI95% = (1,111 – 4,504). The factors that did not influence the risk of malaria incidence in Arso III Puskesmas Keerom Regency were age (ρ-value = 0,143; OR = 0,544; CI95% = (0,263 – 1,127), education (ρ-value = 0,203; OR = 1,962; CI95% = (0,807 – 4,766), social economics (ρ-value = 0,729; OR = 0,835; CI95 % = (0,424 – 1 , 648), the existence of large livestock cages (ρ-value = 0.603; OR = 1,272; CI95% = (0.644 – 2.511). The dominant factor in malaria incidence in Also III Health Center was the use of insecticide-treated bed nets (p-value = 0,000), habit of using mosquito repellent (p-value = 0,009), use of wire mesh (p-value = 0,011), standing water (p-value = 0,033) and gender (p-value = 0.025)The Indonesian Ministry of Health reports the prevalence of malaria in 2016 as many as 200,378 cases with annual parasite incidence ((API = 0.77). While the highest prevalence of malaria is in Papua Province with 128,066 cases with annual parasite incidence ((API = 39,93) compared to the four provinces’ other highest (East Nusa Tenggara, West Papua, Central Sulawesi and Maluku. The number of deaths of malaria patients in 2016 was 2,867 cases (Ministry of Health, 2016). The condition of the tropical climate in Indonesia and the development process that continually results in changes in the environment creates a situation that is very beneficial for the existence of Anopheles mosquitoes and public health problems in Indonesia, namely in 2016 as many as 74% of regions in Indonesia are in free territory / not at risk of malaria, 8.5% of the area in the medium category and 2.2% is a risky area for malaria (Ministry of Health, 2017).
The elimination announced in The United Nations Sustainable Development Goals (SDGs) agreed to achieve the target of eradicating malaria in 2015 and specifically in the eastern part of Indonesia, the target was estimated in 2030 because of the limited funds and difficulties in reaching the area. Malaria prevention efforts in Indonesia since 2007 can be monitored using the Annual Parasite Incidence (API) indicator. The National API value in 2011 was 1.75 per 1000 inhabitants and a decrease in 2012 was 1.69 per 1000 and in 2015 three provinces with the highest API were Papua (31.93%), West Papua (31.29 %), East Nusa Tenggara (7.14%) and Maluku (5.81%) and North Maluku (2.77%). While the provinces with the lowest API are DKI Jakarta, Bali and East Java (Ministry of Health, 2017).
Five Districts in Papua Province ranked highest among 29 Districts, including Mimika Regency with 36,378 malaria cases, Keerom District with 23,966 malaria cases, Jayapura Regency with 22,516 malaria cases, Jayapura City with 14,888 malaria cases, and Kabu Nabire patent with 10,482 cases. With the Malaria case that occurred in Papua Province in 2016, it was reported that there were 147,239 cases, Malaria experienced an increase in 2017 amounting to 261,617 National and for Papua 192,648 cases of malaria. The number of cases in Keerom Regency in 2016 was 25,912 API cases 482.9%, in 2017 amounted to 20,571 API Cases 373.9%, while Skamto Health Center in 2014 amounted to 6332 API cases 415.5%, in 2015 amounted to 6496 API cases 453.2%, in 2016 amounted to 7783 API cases 499.6%, in 2017 amounted to 6753 cases of API 482, 3%. (Case report of Keerom District Health Office and Skamto Health Center).
Several factors that might influence the high number of malaria cases in Keerom Regency include the environment such as the presence of water around the house such as containers of water storage for daily use, small ponds around the house such as water spinach ponds, ponds for livestock drinking, this can be a breeding place because the flight range of malaria mosquitoes (flight range) can reach 0.5-3 Km, if there are strong winds of malaria mosquitoes can be carried up to 20-30 Km, besides the presence of bushes shrubs/plantations, swamps and cattle sheds as a Resting place.
The commitment of the Governor of Papua (8-9 May 2017) The aim of malaria prevention in Indonesia is to achieve elimination in stages no later than 2030 where Papua is earlier, by 2025 it must reach the stage of eliminating malaria with a Malaria Morbidity Rate of less than 1 per 1,000 residents and will undergo a maintenance phase for three consecutive years to obtain the certification of Papua Malaria Free in 2028 carried by the ELMARIPA AT 2028 slogan or the Elimination of Papuan Malaria in 2028. In the national malaria program policy, malaria elimination is implemented by strengthening the health system in the regions that is integrated based on the principles of Basic Health Services. Health promotion is a very important part of community empowerment. The National Health System refers to the decentralization policy which focuses on the district/city level. Cross-sector cooperation plays an important role in malaria elimination. It is expected that sectors related to the health sector make policies that promote or improve health (Health in All Policies). The government and local governments are fully responsible for achieving malaria elimination given the nature of malaria elimination is public goods. Basic and operational research and development of appropriate technology to support malaria elimination need to be improved. The malaria elimination program must be a movement that is consistent and has clear objectives involving all components of the community under the coordination of the head of the provincial / district/city area Age is a lifetime (Handayani, 2012). The more people age, the more their soul will mature in doing everything and the older they will become wiser and the more information they will find and the more things they will do (Hurlock, 2009). The older a person is, the better his mental development process, but at a certain age, the increase in the mental development process is not as fast as when he was a teenager, thus it can be concluded that age factors will affect the level of knowledge a person will experience at age certain and will decrease the ability to accept or remember things as you get older. The results obtained in the case group of malaria in respondents aged> 20 years as many as 59.7% and respondents aged The absence of influence of age was conveyed by Gunawan (2000) in Harijanto (2012), that in general all people could potentially be infected with malaria, the difference in malaria prevalence according to age was related to the level of immunity due to variations in exposure to mosquito bites. Immunity obtained by babies from their mothers provides protection against malaria. Babies usually get more protection from mothers for mosquito bites, so they are rarely found in infants. But if there are cases in infants, it is indicated the high rate of malaria transmission in the area. While at the age of children it is very susceptible to infection with malaria, this is because the antibody in children has not been formed properly while the immunity of the mother continues to decline. The incidence of malaria in children often occurs because in general children do not know the causes of malaria so they do not prevent mosquito bites. In this condition, the role of parents in protecting children from malaria infection by providing clothes that can protect children from mosquito bites, and protecting children while sleeping with mosquito nets, is very necessary to prevent malaria transmission in children.
At the age of adolescents and adults is an age susceptible to malaria infection because it has high activity both during the day and at night, including doing work. Teenagers usually hang out on the roadside, around coffee shops or in other open places that allow exposure to mosquito bites. However, adolescents are able to protect themselves from mosquito bites by wearing clothing that is good or repellent as mosquito repellent. While in the natural age of the body anti-body has been formed both from previous infections or the state of individual nutrition. But adults with high activity in connection with the work done tend to not pay attention and ignore mosquito bites while working. High-risk occupations contracting malaria such as farmers, livestock raising, and laborers are the cause of the high incidence of malaria.
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