Malaria remains a significant global health concern, causing hundreds of thousands of deaths worldwide each year, with an estimated 409,000 deaths globally in 2019. This preventable and treatable disease continues to pose a public health challenge in Indonesia, which was once the second-largest contributor to malaria cases in Southeast Asia, with approximately 800,000 cases in 2021. The country has a long history of efforts to control malaria, dating back to the early 1900s, but the disease persists in various regions.
Geographical Distribution and Risk Areas
Malaria prevalence varies considerably across Indonesia’s vast archipelago, which spans thousands of islands and diverse habitats. High-burden areas are predominantly found in Eastern Indonesia, including provinces such as Papua, West Papua, Maluku, and East Nusa Tenggara. Papua province alone accounts for approximately 93% of Indonesia’s total malaria burden.
This high concentration is partly due to the province’s shared border with Papua New Guinea, a country also facing a substantial malaria burden. In contrast, more densely populated islands like Java and Bali are considered lower-risk areas for malaria transmission. Deforestation and mining activities can also create favorable breeding grounds for mosquitoes, leading to localized surges in cases.
Indonesia’s Control and Elimination Strategies
Indonesia has implemented a multifaceted approach to combat malaria, guided by its national goal of elimination by 2030. A core strategy involves early diagnosis and prompt treatment (EDPT), which is considered by the World Health Organization (WHO) as a foundational element for malaria control. The Ministry of Health and the United Nations Development Programme (UNDP) introduced the Malaria Slide Standard initiative, which involves 20,000 standard slides to improve the accuracy of microscopic examinations for various Plasmodium species. This initiative aims to strengthen surveillance through accurate diagnoses, addressing challenges in diagnostic reliability.
Vector control measures are also widely employed, including the distribution of insecticide-treated nets and indoor residual spraying. These interventions target the Anopheles mosquitoes responsible for transmitting the Plasmodium parasite. The country also emphasizes decentralized and coordinated action, allocating different districts to various health partners to ensure efficient efforts. This subnational elimination strategy has been recognized by the WHO Global Malaria Programme.
Obstacles to Eradication
Indonesia faces several unique challenges in its pursuit of malaria eradication, stemming from its complex geography and socio-economic factors. The archipelagic nature of the country, with its thousands of islands, makes it difficult to reach remote populations and deliver consistent healthcare services and interventions. This geographical dispersion can hinder efforts to maintain comprehensive surveillance and treatment programs across all regions.
Population mobility, particularly among groups like gold miners who travel to remote areas, also complicates control efforts. These mobile populations can inadvertently reintroduce the parasite into areas that have achieved malaria-free status, as seen with a 25-fold surge in malaria cases in Pohuwato district, Sulawesi, linked to gold mining activities. Additionally, the potential for drug resistance, such as artemisinin resistance, remains a concern, which could undermine the effectiveness of current treatments. Maintaining consistent funding and resources across diverse regions presents another significant hurdle, often leading to inadequate infrastructure and limited access to interventions in high-burden areas like Papua.
Current Status and Progress
Indonesia has made substantial progress in reducing its malaria burden, with cases decreasing from 1.1 million in 2015 to 659,000 in 2019. The country has successfully declared over 75% of its districts and 85% of its population as malaria-free. Several provincial and district-level eliminations have been achieved, demonstrating the effectiveness of implemented strategies. For instance, two of the nine low-performing districts that received focused subnational support from the WHO since November 2018 have been declared malaria-free, and one district reported no indigenous cases since January 2019.
In 2024, Indonesia reported no malaria deaths, and 48 provinces have been declared malaria-free, bringing the country closer to its nationwide elimination target by 2030. Continued efforts are focused on these remaining high-burden regions, with strengthened cross-border collaboration, particularly with Papua New Guinea, to align elimination efforts.
Preventative Measures for Travelers
Travelers to Indonesia, especially those venturing into high-risk areas like Papua, West Papua, Maluku, and East Nusa Tenggara, should take specific precautions to prevent malaria infection. Antimalarial prophylaxis, prescribed medication taken before, during, and after travel, is highly recommended for journeys to endemic regions. A healthcare professional can advise on the most suitable antimalarial drug based on the specific travel itinerary and individual health factors.
Preventing mosquito bites is also a primary defense against malaria. Travelers should use insect repellents containing DEET, picaridin, or oil of lemon eucalyptus on exposed skin. Wearing long-sleeved shirts and long pants, particularly during dawn and dusk when mosquitoes are most active, provides an additional physical barrier. Sleeping under insecticide-treated bed nets, especially in accommodations that are not fully screened or air-conditioned, further reduces the risk of bites during nighttime hours. Awareness of malaria symptoms, such as fever, chills, headache, and muscle aches, is important, and prompt medical attention should be sought if these symptoms develop after returning from a risk area.