Malaria In North Sumatera Province
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
:
71.680 km2
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
June – September
:
Dry Season
November – March
:
Rainy Season
District
:
13 Districts
Municipality
:
7 Municipal cities
Number of Villages
:
5.238
:
11.722.397
:
1.20%
:
49.98%
Area
Geographical Location
Climate;
Population (Census)
2000
Population Growth 1990 – 2000
Male
2002 digitized by USU digital library
1
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 NonEndemic Area. Districts including in the group of 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/
Total
Municipality
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
Padang Sidempuan/ **
16
Tapanuli Selatan
6038
0
17
Madina
14773
3
18
Karo**
1090
0
2002 digitized by USU digital library
2
19
Dairi**
267
0
20
Nias*
-
-
Total
45061
Source : Department of Health North Sumatera Province
20
* : 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/
Total
Municipality
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
Padang Sidempuan/ *
5319
0
16
Tapanuli Selatan
17
Madina
10765
0
18
Karo
1227
0
19
Dairi*
0
0
20
Nias*
-
-
Total
32369
Source : Department of Health North Sumatera Province
0
* : No significant report yet
** : The report obtained only for a few months
2002 digitized by USU digital library
3
2002 digitized by USU digital library
4
5
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
No of
Plasmodia
Species of Plasmodia
Population
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
No of Cases Plasmodia
Species of 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)
%
6
Symptoms :
Fever
Pale
Jaundice
Diarrhea
Headache
58
48
8
25
33
97
80
13
42
55
Physical examination :
Fever
Pale
Jaundice
Splenomegaly
H0
H1
H2
H3
58
48
8
27
33
9
11
7
97
80
13
45
55
15
18
12
10
17
Hepatomegaly
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.
Eventhough the resistance to chloroquine and fonsidar was found in some cases; chloroquine and
fonsidar are still a drug of choice in the treatment of falciparum malaria.
7
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.
8
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
:
71.680 km2
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
June – September
:
Dry Season
November – March
:
Rainy Season
District
:
13 Districts
Municipality
:
7 Municipal cities
Number of Villages
:
5.238
:
11.722.397
:
1.20%
:
49.98%
Area
Geographical Location
Climate;
Population (Census)
2000
Population Growth 1990 – 2000
Male
2002 digitized by USU digital library
1
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 NonEndemic Area. Districts including in the group of 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/
Total
Municipality
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
Padang Sidempuan/ **
16
Tapanuli Selatan
6038
0
17
Madina
14773
3
18
Karo**
1090
0
2002 digitized by USU digital library
2
19
Dairi**
267
0
20
Nias*
-
-
Total
45061
Source : Department of Health North Sumatera Province
20
* : 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/
Total
Municipality
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
Padang Sidempuan/ *
5319
0
16
Tapanuli Selatan
17
Madina
10765
0
18
Karo
1227
0
19
Dairi*
0
0
20
Nias*
-
-
Total
32369
Source : Department of Health North Sumatera Province
0
* : No significant report yet
** : The report obtained only for a few months
2002 digitized by USU digital library
3
2002 digitized by USU digital library
4
5
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
No of
Plasmodia
Species of Plasmodia
Population
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
No of Cases Plasmodia
Species of 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)
%
6
Symptoms :
Fever
Pale
Jaundice
Diarrhea
Headache
58
48
8
25
33
97
80
13
42
55
Physical examination :
Fever
Pale
Jaundice
Splenomegaly
H0
H1
H2
H3
58
48
8
27
33
9
11
7
97
80
13
45
55
15
18
12
10
17
Hepatomegaly
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.
Eventhough the resistance to chloroquine and fonsidar was found in some cases; chloroquine and
fonsidar are still a drug of choice in the treatment of falciparum malaria.
7
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.
8