pestisida malaria di indonesia
REVIEW OF
NATIONAL VECTOR CONTROL POLICY IN INDONESIA
WI NARNO & BANGKI T HUTAJULU
DI RECTORATE OF VBDC DG DC & EH, MOH I NDONESI A
PROFILE OF INDONESIA
•
•
•
•
•
•
No. of Islands : 17.000
Population : 227, 3 million
Area : 1.100 x 1500 miles sqr
No. of Province : 33
No of District : 430
Life Expectancy : 67 year
Top Ten Health Problem Priority:
1. Malaria
2.Tuberculosis
3. HIV AIDS
4. DHF
5. Filariasis
6. ARI
7. Leprosies
8. Immunization
9. Diarrhea
10.Reproductive Health
General information
Population : 227.328.509 people
Population at risk: 107,785,179 (49,6%)
Endemic districts : 310 (70,3%)
No. of malaria cases has reported : 2.5 million/yr
Predicted about : 10 millions of cases/years
PETA EN DEM I SI TAS M ALARI A T H . 2 0 0 7
API
o/oo
0
0‐1
1‐5
Free
Low
Moderate
5‐49
50‐100
High
> 100
1 dot = 50 Kasus
1 dot = 250 kasus
Malaria Klinis, SD Diperiksa, Malaria Positif
Tn 2000 – 2008 (Jan‐Mei)
3,500,000
3,000,000
2,500,000
2,000,000
1,500,000
1,000,000
500,000
0
2008 (JanMei)
Klinis Malaria 3,178,212 2,737,927 2,660,674 2,482,906 2,335,585 2,113,265 2,167,028 1,774,845 543,126
SD Diperiksa 1,880,418 1,604,573 1,440,302 1,224,232 1,109,801 982,828 1,246,324 930,029
355,924
Positif Malaria
2000
2001
2002
2003
2004
2005
2006
2007
256993
267,592
273,793
223,074
268,852
315,394
347,597
311,789
93,830
•
PENYEBARAN VEKTOR MALARIA DI INDONESIA 2008
18
11
19
17
22
20
25
13
14
16
14
25
15
2
16
23
15
5
21
10
6
21
1
24
1
22
3
16
20
20
17
4 7
20
21
24
Keterangan :
1. An.aconitus
2. An.annularis
3. An.balabacensis
4. An.barbirostris
5. An.bancrofti
6. An.barbumbrosus 11. An. kochi 16. An. Maculatus
21. An. subpictus
7. An. flavirostris
12. An.punctulatus
17. An.minimus
22. An. sinensis
8. An.farauti
13. An.ludlowi
18 An.nigerimus
23. An. umbrosus
9. An.karwari
14.An.letifer
19. An. parangensis 24. An. vagus
10. An.koliensis 15. An.leucosphyrus 20. An. Sundaicus
25. An. tessellatus
8
9
12
21
SUMBER DAYA PENDUKUNG
GF R1 in Tsunami Relief Program for
MCP In Aceh and North Sumatera :
GF R6 Areas : $ 57 JUTA
GF R1 (5 Provinces),
For MCP in Eastern Indonesia
= $ 23 JUTA ( termasuk NAD &
Nias)
VEKTOR DEMAM BERDARAH DENGUE
Incidence Rate (IR) dan Case Fatality Rate (CFR) DHF
Menurut Tahun di Indonesia,1968-2008 (30 Juni)
80
71.18
IR (per 100.000 pddk)
CFR(%)
40
29.36
20
1.01
Tahun
2008
2006
2004
2002
2000
1998
1996
1994
1992
1990
1988
1986
1984
1982
1980
1978
1976
1974
1972
1970
0
1968
IR dan CFR
60
0.76
Peta Insidensi DBD Menurut Provinsi
in Indonesia, 2007
50
IR=incidence rate (per 100,000 penduduk)
Case Fatality Rate (CFR) DBD Menurut Provinsi
di Indonesia, 2007
Papua
Papua Barat
Malut
Maluku
NTT
NTB
Bali
Sultra
Sulsel
Sulbar
Sulteng
Gorontalo
Sulut
Kaltim
Kalsel
Kalteng
Kalbar
Jatim
DIY
Jateng
Jabar
DKI Jakarta
Banten
Lampung
Bengkulu
Babel
Sumsel
Jambi
Kepri
Riau
Sumbar
Sumut
NAD
0
0,5
1
1,5
2
2,5
CFR (%)
3
3,5
4
4,5
MASS DRUG ADMINISTRATION (MDA) ON 2007
• Planning of MDA 2007: 98 district in filariasis endemic targeting 30 million pop
• Realisation of MDA th 2007: 47 district filariasis endemic, covered 9.576.215 pop
VEKTOR JAPANESE ENCEPHALITIS
Species
Lokasi
Tahun
1.Cx.tritaeniorhynchus
Kapuk,Bogor,Lombok,Semarang
’72-74,85;75;85;93
2.Cx.gelidus
Bogor,Kapuk,Lombok
’75; 85; 85
3.Cx.vishnui
Kapuk, Pontianak
’85 ; 85
4.Cx.annulus
Pontianak
‘85
5.Cx.fuscocephalus
Kapuk, Semarang
’85; 93
6.Cx.bitaeniorhynchus
Semarang
’93
7.Cx.quinquifasciatus
Semarang
’93
8.An.annularis
Lombok
’85
9.An.vagus
Lombok, Semarang
’85; 93
10.An.kochi
Semarang
’93
11.Armigeres subalbatus
Semarang
’93
STRATEGIC ISSUE ON VECTOR BORNE
DISEASES:
1)
2)
3)
OUTBREAK (RE/NEW EMERGING DISEASES) : SEASION, POPULATION
MOVEMENT, PHISICAL ENVIRONMENT CHANGE
ENTRANCE OF NEW EMERGING DISEASES/VECTOR BORNE DISEASE (BY
INTER‐NATIONAL TRAFFIC)
ROLE OF SECTORAL & COMMUNITY SUPPORT NOT YET OPTIMUM
4)
DESENTRALIZATION Æ LACK OF PROFESSIONAL STAFF & OTHER
RESOURCES
5)
EPIDEMIOLOGICAL MAPPING (ASPECT OF CASES, VECTOR)
6)
VECTOR CONTROL AS A ONE OF MAIN ACTIVITY FOR VBDC MUST
BE RATIONAL , EFFECTIVE, SUSTAINABLE, ACHIEVABLE
MAIN ISSUES FOR VECTOR CONTROL
• HRD
‐ Medical Entomologist which comprehensive oriented .
‐
Technical & Functional Training & Education
• DEVELOPMENT OF INFORMATION SYSTEM
‐ Reactivation of Vector Surveillance in District level.
‐
Networking of Surveillance & Vector control
• PROVIDE OF MATERIAL & SUPPLIES
• PROGRAM INTEGRATED
‐ Integrated Vector Surveillance (IVS)
‐ Integrated Vector Management (IVM)
Pesticides used in Public Health
susceptibility status of target organisms
safety to humans
impact on the environment
method of application
application equipment
cost
WHO recommendations
NATI ONAL Pesticides Commission
Malaria - Alternative Pesticides
Bifenthrin
10% WP ( 0.025 gr/ m2)
Alpha-cypermethrin
5% WP ( 0.025 gr/ m2)
Bendiocarb
80 % WP ( 0.2 gr/ m2)
Deltamethrin
5% WP ( 0.02 gr/ m2)
Lambdasihalotrin
10% WP ( 0.025 gr/ m2)
Etofenprox
20% WP ( 0.1 gr/ m2)
Permethrin 10% EC
Deltametrin 2.5 %
Bacillus thuringiensis H-14 1200 I TU/ ltr
S Methopren I GR 1.8 % G 72 mg/ m2
Pyriproxifen 0.5 G 2 g/ m2
Space Spraying
DHF Alternatives
Pesticides
ADULTICIDE
Malathion 96 % ( 500 ml/ ha)
Cyflutrin 50 % EC ( 75 ml/ ha)
Cypermetrin 25 % ULV ( 400 ml/ ha)
Lamdasihalotrin 25 EC ( 75 ml/ ha)
Permetrin S Bioalterin 10/ 1.5 OS ( 100 ml/ ha)
Abate 1%
sand granules
Larvicides
Temephos 1 % G 10 gr/ 100 ltr
Metoprene 1.3 % G 72 mg/ m2
Piriproksifen 0.5 G 2 gr/ 200 ltr
Number of house sprayed vs Malaria incidence
1994 - 2001
0.9
1600000
0.8
1400000
0.7
1200000
0.6
1000000
0.5
800000
0.4
600000
0.3
400000
0.2
200000
0.1
0
1994/ 1995 1995/ 1996 1996/ 1997 1997/ 1998 1998/ 1999 1999/ 2000 2000/ 2001 2001/ 2002
Rmh Disemprot
1360258
1403368
1196334
801962
444353
189261
135460
125760
Kasus dlm API
0.17
0.07
0.08
0.12
0.3
0.52
0.81
0.62
0
INSECTICIDE USED (IRS) FOR MALARIA 2004-2006
etofenprox
carbamat
Lambda cyhalotrine, alpha cypermetrine
INSECTICIDE USED (SPRAYING) FOR DENGUE/DHF 2005-2006
pyretroid
organophosphate
Central
Province
District/
Municipality
PartnerÎ Support each others
Action gradually, Coordinate,Community involve
ORGANIZATION
CENTRAL
MOH
VBDC DIRECTORATE
PROVINCE
CDC DIVISION
VBDC SECTION / UNIT
DISTRICTS
CDC DIVISION
VBDC SECTION
MINISTRY OF HEALTH
DIRECTORATE GENERAL CDC&EH
VBDC
ROLE : CENTRAL, PROVINCE & DISTRICT/MUNICPLTY
ERA DECENTRALIZATION
ROLE
FUN CTI ON
•Policy & strategy formulated
Motor on Vector
Control at national ,
CEN TRAL international link and
donor.
Motor on Vector
PROVI N CE ccontrol in province
level
•Guidelines, standard, moduls
•Sosialisation
•National Campaign
•Study operational &application
•Asistance & Consult
•Develop & ajust guideline &
modul at province level.
•Evaluate
•Sosialisation
•Province campaign.
•Asistance &Consult
• Planning,, Coordination , Organize ,
Actuating, Monitoring & Evaluation
D I STRI CT
Organize &
implement on Vector
control at District
level
• Implementaion
• Supervise, Monev at District level.
• Develop infra structure
COOPERATI ON
- Networking
natnl, intern’l
functional
- Working
groups.
-Networking
regi’l /
province
- Work groups.
-Cooperation.
-Work groups.
N
A
T
I
O
N
A
L
P
R
O
V
D
I
S
T
MOH
Min Of Agricltr
Center for
License & I nvest
VBDC
Min Of Env
Min Of Agricltr
National pesticides
Commission
NFDC
Governor
Prov Agric Off
PHO
PFDC
Prov Env Off
Provincial Pesticide
Monitoring Comm
District Head
Distr Agric Off
DHO
Distr Env Office
District Pesticides
Monitoring Comm
CHALLENGES
• Decentralization impacts on procurement of
insecticides.
• Massive used of pesticide in agriculture will
impact on vector resistance to public health.
• Weak on vector resistance monitoring.
• Weak of rule and regulation on standardization.
STRATEGIES
1. Capacity building,
2. Collaboration
3. Exchange information
CAPACITY BUILDING
•
•
•
•
•
Assessment on Integrated Vector Management (IVM)
activities.
Develop Minister of Health decree on Vector Control.
Workshop and TOT on Guidelines Management Public
Health Pesticide.
Standardization public health pesticide monitoring.
Strengthen monitoring and evaluation on public health
pesticide use.
COLLABORATION
INTRA HEALTH SECTOR COLLABORATION:
• Integrate Vector control activities as a sub system of health.
• Harmonized resources used for integration.
• Commitment needed for budget allocation to achieve the integrated
objectives.
• Integrated program approach could be managing properly to
achieve mutual objectives.
INTER‐SECTOR COLLABORATION
• Establish the partnership and inter sector collaboration
• Mutual objectives, strategy, monitoring and evaluation and
budgeting.
• Identify roles of each partner.
• Government policy on partnership and collaboration
EXCHANGE INFORMATION
INTRA HEALTH SECTOR:
• Used the network available within ministry of Health to
share information between Vector Borne Diseases Control,
Food and Drug Control, NIHRD, Environmental Health
INTER SECTORS:
• Used the existing network to share information between
Ministry of Health, Ministry of Agriculture, Ministry of
Environment, Universities, Pest Control association and
other network, WHO, Private sectors.
OTHERS:
• Establishing system on information exchange:
communication network, IEC and others.
ACTION PLAN
• Training public health pesticide management
guidelines.
• Standardization public health pesticide &
resistance monitoring.
• Development other legal instruments for public
health pesticide managements..
• To establish public health pesticide & resistance
networking
To Establish Public Health Pesticide
& Resistance Networking
PROPOSE A NATIONAL CENTRALIZED
REPORTING SYSTEM FOR VECTOR CONTROL
PESTICIDES IN INDONESIA
WORK PLAN ELECTRONIC REPORTING SYSTEM
ACTIVITIES
1. REVIEW AND REVISE OF EXISTING REPORTING SYSTEM
TOOLS FOR MALARIA & DHF VECTOR CONTROL PESTICIDES
2. TO DEVELOP SOFTWARE AND HARDWARE OF DATA BASE
VECTOR CONTROL PESTICIDES USAGE
3. STRENGTHENING CAPABILITY OF MANPOWER FOR DATA
MANAGEMENT
4. WORKSHOP SOSIALIZATION & TO DEVELOP AGGREEMENT
IN REPORTING SYSTEM PROGRAM
5. IMPLEMENTATION REPORTING SYSTEM BY ELECTRONIC
TARGET ACTIVITIES
• Target Area : Start from National level consist of 33
Provinces ; and extend to all District & Municipality
Level
• Target Health Institution : Center Vector Control Data
Base, PHO, DHO, Port Health, BTKL
• Target of Intersector Institution: Agricultural, Private
sector
• Scope of Information : Number & history insectisides
usage, Resistance states, Coverage
RESISTANCE MANAGEMENT
• Insecticide usage in selected area priority (high
endemic, outbreak).
• Monitoring and evaluation during application
(operational process, entomological impact,
epidemiological outcome)
• Rotation insecticide use periodically.
• Detection of resistance status of vectors was done
by WHO standard.
• Monitoring resistance status of applied insecticides
was done in several locations.
Discriminating concentrations of Insecticides for adult mosquitoes (one hour
exposure‐WHO/CDS/CPC/MAL/98.12)
a.
Half an hour exposure
b.
Four hours exposure
c.
Two hour exposure for Anopheles sacharovi
d.
0.1% for anpheles sacharovi
e.
Two hour exposure
No
Place
Species tested
insecticide
Province/Distric/subdistric
mortality
(no of test)
Year
Control
MALARIA
1
Riau/Batam/Nongsa
An.sundaicus
Bendiocarb 0,1 %
100% (149)
2002
2
NTT/Kupang
An.subpictus
Permethrin 0,75%
100%(95)
0%
2003
An.subpictus
Lambda cyhalothrin 0,05%
100%(102)
0%
2003
An.subpictus
Bendiocarb 0,1%
100%(112)
0%
2003
DENGUE
1
Bengkulu
Ae.aegypti
Malathion 0,8%
68,59% (83 )
2
SouthSul/Makassar/kasi-kasi
Ae.aegypti
Malathion 0,8%
76,53%(115)
3
West kalimantan/Pontianak/
Ae.aegypti
Malathion 0,8%
Ae.aegypti
Mantri jeron
6
7
4.16%
2002
87%
4.76%
2002
Malathion 0,8%
79.41%
0%
2002
Ae.aegypti
Malathion 0,8%
76.59%
0%
2002
North Sulawesi/Manado
Ae.aegypti
Malathion 0,8%
82.50%
0%
2002
North Sulawesi/Manado
Ae.aegypti
Malathion 5 %
0%
2003
west Pontianak
4
South Sumatera/Palembang/
sekip
5
2002
Yogyakarta/Yogya city/
100% (104)
(Malaria, 2004)
(Malaria, 2005)
No
Province
.
Species
tested
mortality
status
year
96,1%
tolerant
2005
Lambda
cyhalothrine
0,05%
An.subpictus
100%
susceptible
2005
An.subpictus Bendiocarb 0,1%
100%
susceptible
2005
An.nigerimus Etofenprox 0,5%
100%
susceptible
2005
Deltamethrine
An.nigerimus
0,05%
100%
susceptible
2005
1 West Java
An.aconitus
2
West Nusa
Tenggara
3 West
Kalimantan
insecticide
Lambda
cyhalothrin
0,05%
No
Province
.
1
North Sulawesi
Species
tested
Ae.aegypti
insecticide
mortality
status
year
Malathion 0,8%
27%
resistant
2005
Malathion 5%
100%
susceptible
2005
2
DI Yogyakarta
Ae.aegypti
Malathion 0,8%
100%
susceptible
2005
3
West Kalimantan
Ae.aegypti
Malathion 0,8%
68,67%
tolerant
2005
4
East Java
Ae.aegypti
Malathion 5%
68%
tolerant
2005
Malathion 0,8%
100%
susceptible
2005
Malathion 0,8%
71,92%
tolerant
2005
Malathion 5%
100%
susceptible
2005
Malathion 0,8%
28%
resistant
2005
5
6
Bali
South Sumatera
Ae.aegypti
Ae.aegypti
REQUESTS THE VBDC OF INDONESIA AS
STRATEGIC POLICY DISCUSSION RELATED
WITH VECTOR CONTROL PESTICIDES
AND CLIMATE CHANGE
No
Contents
Yes
No
Comments
(1)
Provide technical support
Yes
WHO Technical Assistant to setting data
information system; operational study.
(2)
Mobilizing financial resources
Yes
Advocacy and Socialization to all
stakeholders; Identification potential partners.
(3)
Work w/ other organizations
Yes
Broadening Involvement of all potential
partners and community.
(4)
Potential standing
recommendation
Yes
Mapping of Vector Borne Disases related with
climate change. Improvement of community
awarrenness to anticipate VBD outbreak
related with climate change
(5)
Submit proposals
Yes
WHO technical assistant to develop
proposals; Involve of all related sector and
program
NATIONAL VECTOR CONTROL POLICY IN INDONESIA
WI NARNO & BANGKI T HUTAJULU
DI RECTORATE OF VBDC DG DC & EH, MOH I NDONESI A
PROFILE OF INDONESIA
•
•
•
•
•
•
No. of Islands : 17.000
Population : 227, 3 million
Area : 1.100 x 1500 miles sqr
No. of Province : 33
No of District : 430
Life Expectancy : 67 year
Top Ten Health Problem Priority:
1. Malaria
2.Tuberculosis
3. HIV AIDS
4. DHF
5. Filariasis
6. ARI
7. Leprosies
8. Immunization
9. Diarrhea
10.Reproductive Health
General information
Population : 227.328.509 people
Population at risk: 107,785,179 (49,6%)
Endemic districts : 310 (70,3%)
No. of malaria cases has reported : 2.5 million/yr
Predicted about : 10 millions of cases/years
PETA EN DEM I SI TAS M ALARI A T H . 2 0 0 7
API
o/oo
0
0‐1
1‐5
Free
Low
Moderate
5‐49
50‐100
High
> 100
1 dot = 50 Kasus
1 dot = 250 kasus
Malaria Klinis, SD Diperiksa, Malaria Positif
Tn 2000 – 2008 (Jan‐Mei)
3,500,000
3,000,000
2,500,000
2,000,000
1,500,000
1,000,000
500,000
0
2008 (JanMei)
Klinis Malaria 3,178,212 2,737,927 2,660,674 2,482,906 2,335,585 2,113,265 2,167,028 1,774,845 543,126
SD Diperiksa 1,880,418 1,604,573 1,440,302 1,224,232 1,109,801 982,828 1,246,324 930,029
355,924
Positif Malaria
2000
2001
2002
2003
2004
2005
2006
2007
256993
267,592
273,793
223,074
268,852
315,394
347,597
311,789
93,830
•
PENYEBARAN VEKTOR MALARIA DI INDONESIA 2008
18
11
19
17
22
20
25
13
14
16
14
25
15
2
16
23
15
5
21
10
6
21
1
24
1
22
3
16
20
20
17
4 7
20
21
24
Keterangan :
1. An.aconitus
2. An.annularis
3. An.balabacensis
4. An.barbirostris
5. An.bancrofti
6. An.barbumbrosus 11. An. kochi 16. An. Maculatus
21. An. subpictus
7. An. flavirostris
12. An.punctulatus
17. An.minimus
22. An. sinensis
8. An.farauti
13. An.ludlowi
18 An.nigerimus
23. An. umbrosus
9. An.karwari
14.An.letifer
19. An. parangensis 24. An. vagus
10. An.koliensis 15. An.leucosphyrus 20. An. Sundaicus
25. An. tessellatus
8
9
12
21
SUMBER DAYA PENDUKUNG
GF R1 in Tsunami Relief Program for
MCP In Aceh and North Sumatera :
GF R6 Areas : $ 57 JUTA
GF R1 (5 Provinces),
For MCP in Eastern Indonesia
= $ 23 JUTA ( termasuk NAD &
Nias)
VEKTOR DEMAM BERDARAH DENGUE
Incidence Rate (IR) dan Case Fatality Rate (CFR) DHF
Menurut Tahun di Indonesia,1968-2008 (30 Juni)
80
71.18
IR (per 100.000 pddk)
CFR(%)
40
29.36
20
1.01
Tahun
2008
2006
2004
2002
2000
1998
1996
1994
1992
1990
1988
1986
1984
1982
1980
1978
1976
1974
1972
1970
0
1968
IR dan CFR
60
0.76
Peta Insidensi DBD Menurut Provinsi
in Indonesia, 2007
50
IR=incidence rate (per 100,000 penduduk)
Case Fatality Rate (CFR) DBD Menurut Provinsi
di Indonesia, 2007
Papua
Papua Barat
Malut
Maluku
NTT
NTB
Bali
Sultra
Sulsel
Sulbar
Sulteng
Gorontalo
Sulut
Kaltim
Kalsel
Kalteng
Kalbar
Jatim
DIY
Jateng
Jabar
DKI Jakarta
Banten
Lampung
Bengkulu
Babel
Sumsel
Jambi
Kepri
Riau
Sumbar
Sumut
NAD
0
0,5
1
1,5
2
2,5
CFR (%)
3
3,5
4
4,5
MASS DRUG ADMINISTRATION (MDA) ON 2007
• Planning of MDA 2007: 98 district in filariasis endemic targeting 30 million pop
• Realisation of MDA th 2007: 47 district filariasis endemic, covered 9.576.215 pop
VEKTOR JAPANESE ENCEPHALITIS
Species
Lokasi
Tahun
1.Cx.tritaeniorhynchus
Kapuk,Bogor,Lombok,Semarang
’72-74,85;75;85;93
2.Cx.gelidus
Bogor,Kapuk,Lombok
’75; 85; 85
3.Cx.vishnui
Kapuk, Pontianak
’85 ; 85
4.Cx.annulus
Pontianak
‘85
5.Cx.fuscocephalus
Kapuk, Semarang
’85; 93
6.Cx.bitaeniorhynchus
Semarang
’93
7.Cx.quinquifasciatus
Semarang
’93
8.An.annularis
Lombok
’85
9.An.vagus
Lombok, Semarang
’85; 93
10.An.kochi
Semarang
’93
11.Armigeres subalbatus
Semarang
’93
STRATEGIC ISSUE ON VECTOR BORNE
DISEASES:
1)
2)
3)
OUTBREAK (RE/NEW EMERGING DISEASES) : SEASION, POPULATION
MOVEMENT, PHISICAL ENVIRONMENT CHANGE
ENTRANCE OF NEW EMERGING DISEASES/VECTOR BORNE DISEASE (BY
INTER‐NATIONAL TRAFFIC)
ROLE OF SECTORAL & COMMUNITY SUPPORT NOT YET OPTIMUM
4)
DESENTRALIZATION Æ LACK OF PROFESSIONAL STAFF & OTHER
RESOURCES
5)
EPIDEMIOLOGICAL MAPPING (ASPECT OF CASES, VECTOR)
6)
VECTOR CONTROL AS A ONE OF MAIN ACTIVITY FOR VBDC MUST
BE RATIONAL , EFFECTIVE, SUSTAINABLE, ACHIEVABLE
MAIN ISSUES FOR VECTOR CONTROL
• HRD
‐ Medical Entomologist which comprehensive oriented .
‐
Technical & Functional Training & Education
• DEVELOPMENT OF INFORMATION SYSTEM
‐ Reactivation of Vector Surveillance in District level.
‐
Networking of Surveillance & Vector control
• PROVIDE OF MATERIAL & SUPPLIES
• PROGRAM INTEGRATED
‐ Integrated Vector Surveillance (IVS)
‐ Integrated Vector Management (IVM)
Pesticides used in Public Health
susceptibility status of target organisms
safety to humans
impact on the environment
method of application
application equipment
cost
WHO recommendations
NATI ONAL Pesticides Commission
Malaria - Alternative Pesticides
Bifenthrin
10% WP ( 0.025 gr/ m2)
Alpha-cypermethrin
5% WP ( 0.025 gr/ m2)
Bendiocarb
80 % WP ( 0.2 gr/ m2)
Deltamethrin
5% WP ( 0.02 gr/ m2)
Lambdasihalotrin
10% WP ( 0.025 gr/ m2)
Etofenprox
20% WP ( 0.1 gr/ m2)
Permethrin 10% EC
Deltametrin 2.5 %
Bacillus thuringiensis H-14 1200 I TU/ ltr
S Methopren I GR 1.8 % G 72 mg/ m2
Pyriproxifen 0.5 G 2 g/ m2
Space Spraying
DHF Alternatives
Pesticides
ADULTICIDE
Malathion 96 % ( 500 ml/ ha)
Cyflutrin 50 % EC ( 75 ml/ ha)
Cypermetrin 25 % ULV ( 400 ml/ ha)
Lamdasihalotrin 25 EC ( 75 ml/ ha)
Permetrin S Bioalterin 10/ 1.5 OS ( 100 ml/ ha)
Abate 1%
sand granules
Larvicides
Temephos 1 % G 10 gr/ 100 ltr
Metoprene 1.3 % G 72 mg/ m2
Piriproksifen 0.5 G 2 gr/ 200 ltr
Number of house sprayed vs Malaria incidence
1994 - 2001
0.9
1600000
0.8
1400000
0.7
1200000
0.6
1000000
0.5
800000
0.4
600000
0.3
400000
0.2
200000
0.1
0
1994/ 1995 1995/ 1996 1996/ 1997 1997/ 1998 1998/ 1999 1999/ 2000 2000/ 2001 2001/ 2002
Rmh Disemprot
1360258
1403368
1196334
801962
444353
189261
135460
125760
Kasus dlm API
0.17
0.07
0.08
0.12
0.3
0.52
0.81
0.62
0
INSECTICIDE USED (IRS) FOR MALARIA 2004-2006
etofenprox
carbamat
Lambda cyhalotrine, alpha cypermetrine
INSECTICIDE USED (SPRAYING) FOR DENGUE/DHF 2005-2006
pyretroid
organophosphate
Central
Province
District/
Municipality
PartnerÎ Support each others
Action gradually, Coordinate,Community involve
ORGANIZATION
CENTRAL
MOH
VBDC DIRECTORATE
PROVINCE
CDC DIVISION
VBDC SECTION / UNIT
DISTRICTS
CDC DIVISION
VBDC SECTION
MINISTRY OF HEALTH
DIRECTORATE GENERAL CDC&EH
VBDC
ROLE : CENTRAL, PROVINCE & DISTRICT/MUNICPLTY
ERA DECENTRALIZATION
ROLE
FUN CTI ON
•Policy & strategy formulated
Motor on Vector
Control at national ,
CEN TRAL international link and
donor.
Motor on Vector
PROVI N CE ccontrol in province
level
•Guidelines, standard, moduls
•Sosialisation
•National Campaign
•Study operational &application
•Asistance & Consult
•Develop & ajust guideline &
modul at province level.
•Evaluate
•Sosialisation
•Province campaign.
•Asistance &Consult
• Planning,, Coordination , Organize ,
Actuating, Monitoring & Evaluation
D I STRI CT
Organize &
implement on Vector
control at District
level
• Implementaion
• Supervise, Monev at District level.
• Develop infra structure
COOPERATI ON
- Networking
natnl, intern’l
functional
- Working
groups.
-Networking
regi’l /
province
- Work groups.
-Cooperation.
-Work groups.
N
A
T
I
O
N
A
L
P
R
O
V
D
I
S
T
MOH
Min Of Agricltr
Center for
License & I nvest
VBDC
Min Of Env
Min Of Agricltr
National pesticides
Commission
NFDC
Governor
Prov Agric Off
PHO
PFDC
Prov Env Off
Provincial Pesticide
Monitoring Comm
District Head
Distr Agric Off
DHO
Distr Env Office
District Pesticides
Monitoring Comm
CHALLENGES
• Decentralization impacts on procurement of
insecticides.
• Massive used of pesticide in agriculture will
impact on vector resistance to public health.
• Weak on vector resistance monitoring.
• Weak of rule and regulation on standardization.
STRATEGIES
1. Capacity building,
2. Collaboration
3. Exchange information
CAPACITY BUILDING
•
•
•
•
•
Assessment on Integrated Vector Management (IVM)
activities.
Develop Minister of Health decree on Vector Control.
Workshop and TOT on Guidelines Management Public
Health Pesticide.
Standardization public health pesticide monitoring.
Strengthen monitoring and evaluation on public health
pesticide use.
COLLABORATION
INTRA HEALTH SECTOR COLLABORATION:
• Integrate Vector control activities as a sub system of health.
• Harmonized resources used for integration.
• Commitment needed for budget allocation to achieve the integrated
objectives.
• Integrated program approach could be managing properly to
achieve mutual objectives.
INTER‐SECTOR COLLABORATION
• Establish the partnership and inter sector collaboration
• Mutual objectives, strategy, monitoring and evaluation and
budgeting.
• Identify roles of each partner.
• Government policy on partnership and collaboration
EXCHANGE INFORMATION
INTRA HEALTH SECTOR:
• Used the network available within ministry of Health to
share information between Vector Borne Diseases Control,
Food and Drug Control, NIHRD, Environmental Health
INTER SECTORS:
• Used the existing network to share information between
Ministry of Health, Ministry of Agriculture, Ministry of
Environment, Universities, Pest Control association and
other network, WHO, Private sectors.
OTHERS:
• Establishing system on information exchange:
communication network, IEC and others.
ACTION PLAN
• Training public health pesticide management
guidelines.
• Standardization public health pesticide &
resistance monitoring.
• Development other legal instruments for public
health pesticide managements..
• To establish public health pesticide & resistance
networking
To Establish Public Health Pesticide
& Resistance Networking
PROPOSE A NATIONAL CENTRALIZED
REPORTING SYSTEM FOR VECTOR CONTROL
PESTICIDES IN INDONESIA
WORK PLAN ELECTRONIC REPORTING SYSTEM
ACTIVITIES
1. REVIEW AND REVISE OF EXISTING REPORTING SYSTEM
TOOLS FOR MALARIA & DHF VECTOR CONTROL PESTICIDES
2. TO DEVELOP SOFTWARE AND HARDWARE OF DATA BASE
VECTOR CONTROL PESTICIDES USAGE
3. STRENGTHENING CAPABILITY OF MANPOWER FOR DATA
MANAGEMENT
4. WORKSHOP SOSIALIZATION & TO DEVELOP AGGREEMENT
IN REPORTING SYSTEM PROGRAM
5. IMPLEMENTATION REPORTING SYSTEM BY ELECTRONIC
TARGET ACTIVITIES
• Target Area : Start from National level consist of 33
Provinces ; and extend to all District & Municipality
Level
• Target Health Institution : Center Vector Control Data
Base, PHO, DHO, Port Health, BTKL
• Target of Intersector Institution: Agricultural, Private
sector
• Scope of Information : Number & history insectisides
usage, Resistance states, Coverage
RESISTANCE MANAGEMENT
• Insecticide usage in selected area priority (high
endemic, outbreak).
• Monitoring and evaluation during application
(operational process, entomological impact,
epidemiological outcome)
• Rotation insecticide use periodically.
• Detection of resistance status of vectors was done
by WHO standard.
• Monitoring resistance status of applied insecticides
was done in several locations.
Discriminating concentrations of Insecticides for adult mosquitoes (one hour
exposure‐WHO/CDS/CPC/MAL/98.12)
a.
Half an hour exposure
b.
Four hours exposure
c.
Two hour exposure for Anopheles sacharovi
d.
0.1% for anpheles sacharovi
e.
Two hour exposure
No
Place
Species tested
insecticide
Province/Distric/subdistric
mortality
(no of test)
Year
Control
MALARIA
1
Riau/Batam/Nongsa
An.sundaicus
Bendiocarb 0,1 %
100% (149)
2002
2
NTT/Kupang
An.subpictus
Permethrin 0,75%
100%(95)
0%
2003
An.subpictus
Lambda cyhalothrin 0,05%
100%(102)
0%
2003
An.subpictus
Bendiocarb 0,1%
100%(112)
0%
2003
DENGUE
1
Bengkulu
Ae.aegypti
Malathion 0,8%
68,59% (83 )
2
SouthSul/Makassar/kasi-kasi
Ae.aegypti
Malathion 0,8%
76,53%(115)
3
West kalimantan/Pontianak/
Ae.aegypti
Malathion 0,8%
Ae.aegypti
Mantri jeron
6
7
4.16%
2002
87%
4.76%
2002
Malathion 0,8%
79.41%
0%
2002
Ae.aegypti
Malathion 0,8%
76.59%
0%
2002
North Sulawesi/Manado
Ae.aegypti
Malathion 0,8%
82.50%
0%
2002
North Sulawesi/Manado
Ae.aegypti
Malathion 5 %
0%
2003
west Pontianak
4
South Sumatera/Palembang/
sekip
5
2002
Yogyakarta/Yogya city/
100% (104)
(Malaria, 2004)
(Malaria, 2005)
No
Province
.
Species
tested
mortality
status
year
96,1%
tolerant
2005
Lambda
cyhalothrine
0,05%
An.subpictus
100%
susceptible
2005
An.subpictus Bendiocarb 0,1%
100%
susceptible
2005
An.nigerimus Etofenprox 0,5%
100%
susceptible
2005
Deltamethrine
An.nigerimus
0,05%
100%
susceptible
2005
1 West Java
An.aconitus
2
West Nusa
Tenggara
3 West
Kalimantan
insecticide
Lambda
cyhalothrin
0,05%
No
Province
.
1
North Sulawesi
Species
tested
Ae.aegypti
insecticide
mortality
status
year
Malathion 0,8%
27%
resistant
2005
Malathion 5%
100%
susceptible
2005
2
DI Yogyakarta
Ae.aegypti
Malathion 0,8%
100%
susceptible
2005
3
West Kalimantan
Ae.aegypti
Malathion 0,8%
68,67%
tolerant
2005
4
East Java
Ae.aegypti
Malathion 5%
68%
tolerant
2005
Malathion 0,8%
100%
susceptible
2005
Malathion 0,8%
71,92%
tolerant
2005
Malathion 5%
100%
susceptible
2005
Malathion 0,8%
28%
resistant
2005
5
6
Bali
South Sumatera
Ae.aegypti
Ae.aegypti
REQUESTS THE VBDC OF INDONESIA AS
STRATEGIC POLICY DISCUSSION RELATED
WITH VECTOR CONTROL PESTICIDES
AND CLIMATE CHANGE
No
Contents
Yes
No
Comments
(1)
Provide technical support
Yes
WHO Technical Assistant to setting data
information system; operational study.
(2)
Mobilizing financial resources
Yes
Advocacy and Socialization to all
stakeholders; Identification potential partners.
(3)
Work w/ other organizations
Yes
Broadening Involvement of all potential
partners and community.
(4)
Potential standing
recommendation
Yes
Mapping of Vector Borne Disases related with
climate change. Improvement of community
awarrenness to anticipate VBD outbreak
related with climate change
(5)
Submit proposals
Yes
WHO technical assistant to develop
proposals; Involve of all related sector and
program