Vector-borne infectious disease: Malaria and Dengue fever

32 Table 9 Lists of Dengue Fever events in Indonesia Year No. of Incidence Incidence Rate IR DeathsCase Fatality Rate CFR Remarks 1968 - 0.05100,000 -14.3 First occurence 1998 73,133 - 14112 Extreme event 2004 28,077 - 1.36 334 districtscities 2007 156,767 71,18100,000 15701.00 357 districtscities 2008 98,869 43,62100,000 346 districtscities During the last decade, malaria in Indonesia has been reoccurring, and around 35 of Indonesia’s population is living in an endemic area. Cases of malaria in Java and Bali, which is stated in the annual parasite incidence API during the period of 1995-2000 has increased drastically from 0.07 1995 to 81 2000. During 2002 and 2003 API has be decreased to consecutively 0.47 and 0.32. Malaria cases outside Java and Bali which are stated in annual malaria incidence AMI during 1995-2003 period fluctuates sharply from time to time starting from 20 1995 to 22.7 2003. Projections of future risks of dengue fever and malaria because of climate change are illustrated in the following maps. Figure 11 Map of Dengue Fever Risks in 2030 33 Figure 12 Map of Malaria Risks in 2030

8.1.2 Diarrheal Disease

Direct contagious diseases such as diarrhea are still a problem for public health. Extreme events which decrease the quality of drinking water and poor sanitation occur yearly. The 2004 and 2005 data show that diarrhea events are always high during January-March, however during 2006 diarrhea events are constantly high throughout the year with the peak of events during January, April, and October. In general, contagious diseases are not directly environmental based, and often occur within vulnerable society toddlers and pregnant women especially in villages which in majority have low income and difficult access from health services. Projection of future risks due to climate change on diarrhea is illustrated in the map below. 34 Figure 13 Map of Diarrheal Risk in 2030 8.2 Issues in the Health Sector The risk analysis in the Roadmap for adaptation in the health sector has identified several potential risks associated with climate change in the future. Those risks are: ƒ Diseases or deaths caused by disasters related to extreme climate events and diseases that might be outbreak in the refugee sites ƒ The increase of respiratory diseases as a result of increasing air pollution, in particular ozone and NO 2 , which are associated with the rise of surface temperature ƒ The increase of agents of water-borne diseases or contagious diseases, which normally take place during droughts or floods ƒ Malnutrition during famine due to failed harvests ƒ Changing pattern of diseases brought by vectors such as mosquito due to land use conversion and climate change. Moreover, temperature rise of 2-3 degree Celsius is projected to increase the number vector-borne diseases by 3-5 and also to increase the distribution of the vectors ƒ Precipitation level also contribute to the type and intensity of vectors’ habitat