EDITORIAL

New Recommendation for Malaria Treatment in Indonesia

Erni J. Nelwan
Department of Internal Medicine, Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo Hospital.
Jl. Diponegoro no. 71, Jakarta Pusat 10430, Indonesia. Correspondence mail: erni.juwita@ui.ac.id.

Malaria and men have been struggling for

many years and the struggle is not yet over.
Although, there were some successful report in
fighting the disease that has put a big burden on
poor and vulnerable populations; the problems
particularly related to drug resistance kept
rising.1-3 In a country like Indonesia, as one of
the malaria endemic countries in South-East
Asia, with more than 60% of the total population
is at some risk for malaria and 20% are at high
risk (with a report of more than 1 case per 1000
population per year), the number of cases has
slowly decreased.4,5 Moreover, not like in Africa,
most cases are due to Plasmodium falciparum but
in some part of the country it could co-exist with
Plasmodium vivax.6
For Indonesia itself, to control malaria will
have a huge impact not only in the health sector
but also in the economy and tourism sectors.7 The
health sector will be the one with much benefit
because when someone infected by Plasmodium
vivax the chance of recurrence of the disease
for those that are not even living in the endemic
area is high. This of course, will influence the
productivity and quality of life. Eventually,
people might contract the disease due to activity
during work, holiday or blood transfusion which
are not screened routinely for malaria parasites.
Therefore, the Indonesian government has focus
now on a malaria elimination program and also
has put it as one of the Millennium Goals of
Development indicator for the country together
with other infectious diseases like Tuberculosis
and HIV/AIDS.
In the clinical practice section, the new
recommendation of malaria treatment in Indonesia
designed by a Group of Malaria experts under the
coordination of the Sub directorate of Malaria
Control Program of the Ministry of Health has
been introduced recently and published in this
edition.8 The evidence regarding chloroquine

resistance in vitro and in vivo for the whole region

of the country took some time to materialize and
shared the usage of the drug for malaria was
entirely prohibited. This might due to limited
evidence and poor communication between
physician in the clinic and the researcher in the
field that created a gap of knowledge in clinical
practice.9 However, as explained on the article
by Kusriati R, the good collaboration as has
been created at this time between all institutions
concerned for malaria in Indonesia has now
decided to provide what is the best treatment
option for the infectionof malaria. In addition to
that, to assure the availability and distribution of
the medication recommended in the guidelines, a
procurement system has been designed and was
evaluated all year long.8 However, the persistence
effort to educate all Indonesian physicians
regarding drug resistance and their contribution
to the emergence of resistance, is as much as
important, as the guidelines and availability of
the medication itself.
We also will be entertained by the report
of Sutanto et.al regarding the efficacy of using
another anti malarial drug available in the country,
yet not included in the guidelines recommended
by the government. This study was conducted in
an area with high endemicity for malaria, notably
Eastern Sumba, East Nusatenggara and it has
been shown safe with high efficacy for treatment
of the uncomplicated falciparum malaria.10 The
arthemeter-lumfantrin drug that also belongs
to artemisin-based combination therapy is not
provided for free by the government but widely
available in the country.11
As a backbone of malaria treatment, the
capacity of all Indonesian doctors to suspect
malaria as one of differential diagnosis among
various acute febrile illnesses presenting in the
clinic with fever and thrombocytopenia should be
improved. Moreover the routine test for malaria

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Erni J. Nelwan

either rapid diagnostic test or microscopy when

it is available should always be conducted as the
Ministry of Health no longer approve the use of
anti malaria drugs to be used for a diagnosis on
clinical signs only.
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