English Summary
Malaria Control Programme in Indonesia
Arwati
Malaria has been identified as a major disease not only in
lndonesia but also in other tropical countries in the world.
As a disease which is widely distributed and mostly affects the
rural poor population and also the production and development
centres outside Java and Bali, hyperendemicity of malaria have a
negative impact on the socio-economic condition of the whole society.
Indonesia began a limited malaria control programme since the
Dutch occupation which was gradually expanded to a large scale
malaria control; in 1959 a malaria eradication programme was started
in Java and Bali.
The programme was integrated into the Health Services and put
under the Directorate General of Communicable Diseases Control.
The main activities carried out were treatment of cases, limited
residual house spray, anti larva measures and other supplementary
measures as needed.
The present programme resulted in the general reduction of cases
in Java and Bali, while in the other islands, reduction of prevalence
of malaria was only limited to the priority areas.
Problems encountered are the resistance of vector An. aconitus
to the insecticide DDT in Java and P. falciparum
resistant to
chloroquine in Kalimantan Timur, Irian Jaya and Lampung.
A Pharmacological View on Anti Malaria Drugs
R.H. Yudono
Anti malarial drugs are needed for causal prophylaxis, to suppress
and to cure malaria. Most of the parasites found in Indonesia were
vivax plasmodia (>50%), and falciparum plasmodia (< 50%); while
malariae plasmodia and ovale plasmodia form the minority (resp.
0,1 - 0,2% and less). The drugs used against malaria are 4-aminoquino-
lines, diaminopyrimidines, biguanides, as suppressive agents, causal
prophylaxis and as sporontosides. 8-aminoquinolines are used for
causal prophylaxis and as gametocytosides.
The mechanisms of action of those drugs are as follows :
1. Sulfonamides and sulfones block the synthesis of folic acid.
2. Diaminopyrimides and biguanides block further the reaction to
form tetrahydrofolic acid, which is necessary for the synthesis of
nucleic acid. 1 + 2 can be mixed to obtain a synergistic effect.
3. Quinine, 4-aminoquinolines and 8-aminoquinolines are drugs which
have an affinity to DNA and therefore also disturb the synthesis
of nucleic acid.
Because of inadequate use of those drugs during mass campaigns,
some falciparum plasmodia became resistant to chloroquine. In those
cases alternative drugs must be used to treat falciparum malaria.
Many therapeutic regimens can be used as substitutes, for example :
Double drug combination : Quinine sulfate + tetracycline HCI.
Triple drug combination : Quinine sulfate + pyrimethamine + sulfo-
namides or sulfones.
Although those drugs are good for eradicating malaria parasites,
most of the potent drugs, such as quinine, 4-aminoquinolines and
8-aminoquinolines, are also toxic and possibly mutagenic or carcino-
genic.
Chloroquine Resistant Plasmodium falciparum in Indonesia
Wita Pribadi, Legia S Dakung
Resistance to chloroquine in falciparum infection was first reported
in Colombia in 1961 by Moore and Lanier. Thereafter resistance
has been confirmed in several parts of South America, Panama, India
and many parts of Southeast Asia. Investigation in Africa failed to
confirm the existence of chloroquine resistant Plasmodium falciparum
(1972). However, since 1978 resistant cases has been reported from
Sudan, Zambia, Kenya and Tanzania.
In Indonesia, resistance of Plasmodium falciparum to quinine and
quinacrine was observed since 1936. In 1951 Plasmodium falciparum
and Plasmodium malariae were reported to be resista
nt toproguanil.
Resistance of Plasmodium falciparum to pyrimethamine and cross
resistance to proguanil were observed by Meuwissen in Irian Jaya
(1961). In 1973 the first 3 cases of chloroquine resistant falciparum
infection were reported from East Kalimantan. A11 3 cases were from
Samarinda, followed by 11 cases from Balikpapan and 4 cases
from Sangkulirang. Since 1975 resistant strains to chloroquine
-
have been observed in Irian Jaya.
In Jakarta, The Department of Parasitology and General Pathology,
University of Indonesia, identified 3 resistant cases, imported from
Irian Jaya. In 1978, 4 resistant cases were imported from a new
focus in Lampung and South Sumatra.
A total of 84 cases of chloroquine resistant Plasmodium falciparum
infection were reported from Indonesia. Most of the cases were
resistant at the R I level.
Although resistant falciparum infections are increasing, the total
number is very small in comparison to the number of malaria cases
in Indonesia. Chloroquine is still the drug of choice for the treatment
of all malarial infections. Only in areas where chloroquine resistant
cases are present, the us of other antimalarial drugs is recommended.
The Effect of Malaria on The Nutritional Status of Preschool
Children
Marbaniati
Malaria in Wanadadi subdistrict
has been an endemic disease
since 8 years ago. Many efforts have been done to control this
disease, but the slide positivity rate is still high (8,1% in 1979) and
the annual parasite incidence was 82,7 °/oo in 1979.
Observation on 5-year-old children in the Health Centres showed
that there was a relation between malaria fluctuation and child growth.
Drug prophylaxis among the five-year-old children exerted a positive
effect to the nutritional condition of the children.
A Malariometric Survey of an Endemic Area
Soesanto Tj., Supogiyono, Noerhayati S dan Siti Musfiroh
Malariometry is a measure for estimating the level of endemicity
of malaria. The village Medayu is an endemic area of stable malaria
which at the time of this survey had the characteristic of meso-
endemicity.
iii
Although the control of malaria is being carried out, the incidence
of malaria remains high. This is caused by several factors including
the resistance of
A aconitus
to DDT, inaccessible breeding places
along the Serayu River, and wet rice fields which are planted two
or three times a year.
It is necessary to increase the research for a method which is
acceptable and feasible in the community for treating malaria and
at the same time prepare a budget which will at least safeguard
the ongoing program of malaria control.
Intermittent Irrigation as a Means of Control of Malaria
Vector
Sustriayu Nalim PhD.
A study was carried out to explore the feasibility of using
intermittent irrigation as a means of control to cope with DTT
resistance in
Anophe%s aconitus
(the malaria vector in Java).
Ricefields
were flooded for 10 days and dried for 3 days. This
intermittent irrigation starts after the rice is 2 months old.
Two evaluation methods were used in the study, the larval dipping
method and the emergence traps for adult mosquito density eva -
luation. Intermittent irrigation is found to be efficient enough to
reduce mosquito population densities, provided certain criteria are met.
Brugia Timori eradication with low dose Diethylcarbamazine
"By the people and for the people" method
F. Partono, Purnomo, A. Soewarto, Sri Oemiyati
The eradication programme of
Brugia timori
was conducted since
1977 in three villages of the Kecamatan Reok, Kabupaten of
Manggarai, West Flores. Province of East Nusatenggara.
Before it was started, a preliminary survey was carried out taking sen-
sus of the population. Name, age, sex and family relations were
recorded. The population was examined clinically and the signs and
symptoms of filariasis recorded.
For filariasis examination, 20
µl
of blood were obtained by
the fingerprick method between 20.00 and 24.00 p.m. At the same
time blood was drawn by venapuncture, 1 ml before and 3 ml after
the treatment.
The blood thus obtained was filtered by Nucleopore with a pore
diameter of 5
p.
All blood samples were stained with Giemsa
according to the method of Partono and Idris (1977). The type of
microfilaria was determined and the amount counted. Diethylcarbama-
zine (DEC) was administered in a low dose : 50 mg for children of
10 years and older and 25 mg for those under 10 years of age,
once a week during 1½
years.
The drug was distributed by the schoolteachers or by the chiefs
of the villages and the amount and the side-effects caused by the
drug were carefully recorded. The whole population was examined
clinically and parasitologically every year. The results of this filariasis
eradication programme using the method "by the people for the
people
"
proved very statisfactory.
After a period of three years only three patients with
microfilaria
were found in three villages and only a few microfilaria could be
detected in 3 ml of nocturnal blood.
Both acute and chronic symptoms of filariasis were significantly
reduced. With this low dose of DEC side-effects were practically
absent.
Immunity in Filariasis
D.A. Higgins
The filariae are complex parasites with three major life stages :
the adult worm, the microfilariae and the third stage, infective larvae.
These stages interact with the host to initiate a variety of immune
responses including antibody production,
cellular immunity and
combinations of cellular and antibody mechanisms. It is probable
that the clinical picture presented by the host is dependent upon
the type of immune response produced. There is also a possibility
that some individuals are protectively immune, suggesting that in
filariasis the development of a vaccine might be feasible. A scheme
suggesting the interdependence of clinical picture and expression of
immunity will be presented. Recent evidence pointing to the invol-
vement of antibody, eosinophils and lymphocytes in a combined
mechanism of response under the control of T cells will be discussed.
Filariasis Bancrofti in Semarang : the Results of Entomologic
and Parasitologic Survey
F.A. Sudjadi, Soesanto Tj., Moetrarsi F, Noerhayati S, Isdiarto H,
Agus Soewito
The results of a dissection of 8,926 mosquitoes, gathered from
various areas in Semarang, proved the existance of filarial infections
in Ngemplak Simongan, West Semarang; Sendang Guwo, East Semarang;
and in Petompon, South Semarang, The vector was shown to the
Culex fatigans
which had an infection rate of 0,09% in Sendang
Guwo and 0,10% in Petompon.
The results of examination of blood specimens from 1,472 persons
from the same three areas demonstrated the presence of Bancroftian
filariasis with micro filaremia rates of 4.5%, 5.4% and 6.5%, and
microfilarial densities of 7.2, 14.9, and 13.3 per 30 mm
3
, respectively,
in Ngemplak Simongan, Sendang Guwo, and Petompon.
It is possible that the infection rate of
Culex fatigans
gives an
indication of the level of endemicity and intensity of Bancroftian
filarial infection in Semarang.
Effectiveness of Long and Short Term Mass Treatment of
Filariasis with Diethylcarbamazine and associated side effects
Jan Rusch, JR Palmieri, DT Dennis, B. Ibrahim, Hariyani A. Marwoto
Mass treatment of
Brugia malayi
filariasis with diethylcarbamazine
was conducted in Pengiuran and Sungai Baru, two villages of Banjar
Regency, South Kalimantan, Indonesia. Pengiuran was given a short
term treatment of 10 mg/kg BW/day for 5 consecutive days. Sungai
Baru received a long term treatment of 2 mg/kg BW/day for 25
consecutive days. Reexamination six months and 12 months post
treatment revealed prevalence reductions of 93% and 79%, respectively,
in Pengiuran and 73% and 78%, respectively, in Sungai Baru.
The MFD
50
also decreases from 4 to 1.5 six months and 12 months
post treatment in Pengiuran and from 4.5 to 2 six months post
treatment and to 2.7 twelve months post treatment in Sungai Baru.
In Pengiuran, 22% experienced general reactions and 3% local reactions
while in Sungai Baru, 9% had general reactions and 18% local reactions.
The short term treatment with high doses of DEC evoked a greater .
number of general reactions than the long term treatment with
low doses. On the contrary, the long term treatment schedule evoked.
more local reactions than the short term regime.
iv
Schistosomiasis in Indonesia, 1980
WP Carney, Moh Sudomo
Classical oriental schistosomiasis transmission in Indonesia is very li-
mited in distribution. Extensive parasitological examinations and snail
surveys indicate that Schistosoma
japonicum
and its molluscan host,
Oncomelania hupensis,
are limited in distribution to two contiguous
drainage system of Central Sulawesi, the Gumbasa River and the
Lariang River systems. In these drainage systems transmission areas
have only been found at high elevations, 1,000 meters or more.
It is estimated that 7,000 Indonesians are exposed to schistosomiasis
in the Lindu and Napu Valieys and that 35 to 60% of these individuals
are infected.
Cases of schistosomiasis from other areas of Indonesia are discussed.
Most are considered non-autochthonous but some most likely due to
a mammalian schistosome with Schistosoma japonicum-like eggs.
These mammalian schistosomes which are probably more closely
related to S. mekongi than to S. japonicum are most likely transmitted
through amall, aquatic triculinid mollusks.
Current knowledge of other schistosomes enzootic to Indonesia,
Schistosoma
incognitum,
Schistosoma spindale and Trichobilharzia
brevis, are reviewed. Particular emphasis is placed on S.
incognitum
as an emerging zoonosis and because of its potential to hybridize with
S.
japonicum
and generate an offspring that retains infectivity to man
yet utilizes ubiquitous freshwater limnaeid mollusks.
Mass Treatment of Soil Transmitted Helminthic Infections
with Pyrantel pamoate to Primary School Children
Ncerhayati S, Soegeng Yuwono M, Cholid Baidlowi, Prayitno,
Soetrisno Eram, Soelarno
Various techniques of mass treatment for soil-transmitted hel-
minthic infection using pyrantel pamoate with different dose regi-
ments and frequencies have been reported.
However, the appropriate schedule of treatment for controling
these parasites in endemic areas should still be determined.
In view of these, an evaluation was made to compare the
effectiveness of mass treatment with pyrantel pamoate 10 mg/kg
body weight to primary schoolchildren, given at 2 month intervals
in one area and at a 6 month interval in the second area.
In Sleman regency, Yogyakarta, the pretreatment prevalence rate
of Ascaris lumbricoides was 84.2%, and of hookworm 30.5%.
The average EPG (eggs per gram feces) was 8273 for Ascaris and
54 for hookworm. After three mass treatments given every two
months during a period of seven months (August 1976--March 1977),
there was a regression of the prevalence rate of A. /umbricoides to
only 9.0%. There was an absolute drop of 75,2% after the third
treatment, which was a 89,3% reduction. The infection rate of
hoakworm decreased from 30,3% to 5.0% after the treatment, which
was a 83.5% reduction. The averages EPG after the third treatment
were 1677 and 27 for A. lumbricoides and hookworm respectively.
In Sewon, Bantul regency, Yogyakarta, after two mass treatments
with a 6 month interval in a period of seven months (August 1977 --
March 1978), there was a regression of the prevalence rate of
A. lumbricoides from 76.4% to 28.6%. It was a 62.6% reduction.
The averages EPG of Ascaris were 4806 and 2794, before and after
the second treatment respectively. The prevalence rate of hookworm
prior to the first treatment was 41,4%, reduced to 24,6% after
the second treatment, which was a 40,6% reduction. The average EPG
of hookworm was 29 before treatment, decreased to 25 after the
second treatment.
After four times mass treatments in Sewon, Bantul regency given
every 6 months (March 1979), it was found that the result was not
as effective as in Sleman regency.
It seemed that Trichuris trichiura was more resistant to pyrantel
pamoate.
Intestinal Nematode Infections in Preschool Children and
Their Treatment : A study in The Village of Berta, Susukan,
Banjarnegara
Moetrarsi F, Noerhayati S, Sri Soemarni, Soenarno, Elias Winoto
A study of soil transmitted helminthic infection and its treatment
with piperazine citrate among 84 preschool children was carried
out Berta Susukan, Banjarnegara.
It was found that the prevalence rates of A.
Lumbricoides,
T. Trichiura and hookworm prior to treatment were 89.3%, 77,4%
and 20.2% respectively.
The infection rate of hookworms was higher in males (33.3%)
than in females (12.2%). This difference was statistically significanti
The result of treatment showed that piperazine citrate was more
effective against A. Lubricoides than against T. Trichiura and -
hookworm. The cure rate for A. Lumbricoides was 46.1%.
Three months after treatment
the re-infection rate of A. Lumbri-
coides was 24.4%; T. Trichiura 20% and of hookworm 50%.
Combination of Mebendazole -- Tetramizole and Pyrantel
pamoate -- Mebendazole Single Dose for the Treatntent of
Intestinal Nematode Infections
Soebagyo Loehoeri, Soenarno, Sumarni
142 patients with intestinal nematode infection were divided into
two groups. The first group was treated with a combination of
300 mg mebendazole and 75 tetramizole in single dose, the second
group was treated with a combination of 500 mg pyrantel pamoate
and 150 mg mebendazole in single dose.
Only 45 patients of the first group could be evaluated 5 days
after treatment; the results showed that the cure rate of Ascaris
lumbricoides, Trichuris trichiura and Necator americanus were 77%,
51%, and 81% respectively. And the egg reduction rate of A. lumbri-
coides, T. trichiura and N. americanus were respectively 99%, 96%
and 98%.
From the 45 patients of the second group which were evaluated
5 days after treatment, the results showed that the cure rate of
A. lumbricoides, T. trichiura and N. americanus were 100%, 81%
and 85% respectively. And the egg reduction rate of A. lumbricoides,
T. trichiura, N. americanus were 100%, 92% and 95% respectively.
In this study both combinations of 300 mg mebendazole and
75 mg tetramizole or 500 mg pyrantel pamoate and 150 mg meben-
dazole were fairly good and effective in the reduction rate of
A. /umbricoides, T. trichiura
and N. americanus, although the
combination of 300 mg mebendazole and 75 mg tetramizole showed
minimal side effects on 3 out of 45 patients.
v
The Effect of Diethylcarbamazine (DEC) and Mebendazole
treatment on Intestinal Helminths in South Kalimantan
(Borneo), Indonesia
Harijani A. Marwoto, PB Mc Greevy, DT Dennis, Sutanti Ritiwayanto,
Sofyan M.
This study was conducted from May 1977 through Apri11978
in a rubber estate, Banjar Regency, South Kalimantan, inhabited
by people of low socio-economic status, who derive their livehood
as rubber tappers. In the study area filariasis is highly endemic
(35% 40%) and intestinal parasitoses which include ascariasis,
trichuriasis and hookworm are common. Four villages were selected
for this study.
In village I, mebendazole was administered twice at a 3 month
interval, at 100 mg 2 x daily for 3 days. In village II, DEC was
administered at 5
mg/kg body weight/day for 10 consecutive days.
In village III, both mebendazole and DEC were administered at
the above dosage rates, while village IV served as an untreated
control area.
In village I, one month after the first treatment with mebendazole
the prevalence rates
of Ascaris
lumbricoides, Trichuris trichiura and
hookworm were reduced 80%, 83% and 96% respectively. After the
second treatment with mebendazole there was only a slight further
reduction in the prevalence of
T.
trichiura and hookworm, while
the prevalence of A. lumbricoides remained unchanged.
In the village treated with just DEC the prevalence of
T.
trichiura
and hookworm decreased significantly one month after treatment,
whereas DEC alone did not appear to have an immediate effect on
A.
lumbricoides but after six months the prevalence of
A.
lumbricoides
also decreased significantly. In the village treated with both DEC
and mebendazole there was a decrease in prevalence of all three species
of soil transmitted helminths that similar to the results find in
the village treated with DEC alone.
The dry latrine in the prevention of infection by intestinal
helminths
Tonny Sadjimin, Soesanto Tjokrosonto
The low environmental health level is a contributing factor to
the high morbidity and mortality rate in developing countries.
Methods of fecal disposal are very much influenced by social customs.
Among the factors, educational level, poverty and indifference are
closely related and are determining factors in the succes of community
health services.
Prevention of infection by intestinal helminths can be accomplished
by interupting the epidemiological chain of the parasites. The dry
latrine is one of the methods. It does not require water and is
relatively easy to maintain by the village population. It can be used
indefinitely and together with the compost it produces are distinct
advantages.
Acceptance of this type of latrine, how to cope with the difficulties
and the results of parasitological examination of its contents are
discussed. More studies should be carried out to evaluate the acceptance
of the dry latrine, its possible contamination of waterwells, its
influence on the prevalence of intestinal helminths and on the
incidence of diarrhoea.
Nutrition and Parasitic Infection
Soemilah Sastroamidjojo
The "host" and "agent" interaction concept can be applied to
the interaction between nutritional status and parasitic infection.
Basically the interaction concerns (1) the need for the same nutrients
by both the host and agent, and (2) the immune response mechanism
which involves nutrients.
Relatively
extensive studies on animals have shown that the
effect of interaction may be synergism or antagonism or an indifferent
effect. However, limited studies in man have shown that synergism
seems to be the general rule, infection (including parasitic infection)
negatively affects nutritional status and moderate to severe nutritional
deficiencies increase the seriousness of infection.
Immunological Aspects of Parasitic Diseases
Aryatmo Tjokronegoro
Organisms such as protozoa and metazoa consist of, or produce,
various kinds of foreign antigens capable of eliciting an immune
response. Basically there are two systems of body immunity responsible
for the protection of the body from parasitic diseases, i.e. (i) humoral
immunity system, represented by the antibody molecules, and (ii)
cellular immunity system, carried by sensitized lymphocyte cells.
Not all of the body immune responses against the very complex
antigens have the characteristics of
"
protective immunity
"
. On the
contrary, some of the clinical symptoms of parasitic diseases are
the result of the immune response itself.
So, although the body immune response has been induced, and
effector mechanisms of the immunity systems have arisen, sometimes
the parasites are capable of living safely in the immune body.
This is exactly what differentiates multicellular organisms from
unicellular ones.
The mechanism of the immune response, the mechanism along
which the parasites avoid the attack of the immune response, its
implications in the diagnosis through immunological methods, and
the prevention of the disease by vaccination are discussed in this paper.
Amoebic Liver Abscess in the University of Gajah Mada
Hospital, Yogyakarta
Haryono Adenan, Soegijanto Soemomarto, J Wijono
A retrospective study was conducted on 14 patients with amoebic
liver abscess admitted to the Department of Medicine, Gadjah Mada
University Hospital, Yogyakarta, from June 1975 to December 1979.
These 14 patients consisted of 6 males and 8 females, age between
20 - 60 years, and peak incidence between 40 - 49 years.
The main complains were fever (78,57%), right hypochondrial
pain (71,42%), an history of watery and bloody stool (37,7%).
Physical examinations revealed hepatomegaly (40%), fever (78,57%)
hepatic pain and tenderness (64,28%), jaundice (28,57%), anaemia
with hemoglobin less than 10 gr% (64,28%), leukocytosis (64,28%).
Stool examinations did not show any evidence of either cystic
forms or trophozoite forms of entamoeba.
Two patients underwent an open aspiration with evidence of
anchovy sauce and no evidence of trophozoites of entamoeba. All
of these patients were treated with metronidazole 500 mg, thrice
daily, for 10 days, with good response.
vi
Intestinal Amoebiasis in Hospital Employees
Siti Moesfiroh Is., Cholid A.B., Sutarti A, Noerhayati S, Mufrodi
Hospital employees closely associated with patients with amoebiasis
may have an increased prevalence of intestinal amoeba. This study
demonstrated a prevalence of 17%.
Gastro-intestinal symptoms were demonstrated in 41% of the
infected employees; 40% complained of abdominal cramps, 36% of
nausea, and 28% of obstipation.
Diagnosis was based on two different laboratory examinations :
a direct and an indirect method.
Endamoeba histolytica was
demonstrated in the cyst form.
Two thirds of the infected employees were treated with metroni-
dazole 50 mg/kg/day for 5 successive days; the remaining one third
were used as controls.
Based on
a
single post treatment stool specimen, the cure rate
was 100%.
Side effects of the metronidazole treatment (nausea in 59%,
headache in 41% and abdominal colic in 34%) disappeared following
the conclusion of treatment.
Giardiasis in Children
Yati Soenarto, Moenginah P.A., Teluk Sebodo, Cholid A.B.,
Siti Musfiroh, Noerhayati Soeripto
A study on giardiasis in children with dianhoea, children suffering
from PCM, and
"
normal
"
asymptomatic children was conducted in
the Department of Pediatrics, Gajah Mada University Hospital and
in a village, Godean.
This article presents the results of
the study and also discussed
the problems of diagnosis and therapy in giardiasis.
vii