Social and behavioral aspects of filariasis transmission in Kumpeh, Jambi, Indonesia.

Studies on the social and behavioral aspects of filariasis transmission were conducted in the transmigration area of Kumpeh, in the province of Jambi, Sumatra, Indonesia. Three methods were used in the study namely, interview, participation observation and focus group discussion. A total of 266 respondents (136 males and 130 females) were interviewed. The results of the study showed the most of the transmigrants were not familiar with the word "filariasis". They were more used to the name of "penyakit kaki gajah" or "elephant's leg" disease or "untut". The word "untut" is similar to what people of Selangor, Malaysia call this disease. The community attitude towards control efforts against filariasis was positive, as evidenced by their readiness in being bled and their readiness to help change the environment which serves as mosquito breeding places. Usually the transmigrants live in the "ladang" or dry farming area for 3-4 months to protect their crops from damages by pests. This habit was rather negative, because in their "ladangs" they exposed themselves to high risk of mosquito bites and thus to filariasis infection.

The role of primary health care in filariasis control in Indonesia.

In filariasis control in Indonesia, various regimes of DEC administration have been tried out with good results. However, the higher dosage regimes gave severe reactions. Since a trial with low dosage administration by community leaders gave very good results with minimal side effects, the execution of the control program was handed over to the Primary Health Care unit whose personnel trained community leaders to recognize the symptoms of the disease, distribute the drugs and treat side effects when they occurred. Communicable disease control through health care approach is now being promoted. The activities in the Integrated Services post are carried out by volunteers through village organizations supervised by the health care unit was established, using 1 cadre to look after the health of 10 households.

Current status of filariasis in Indonesia.

Filariasis in Indonesia is widely distributed. Three species consisting of 5 ecologically different types have been identified infecting man. Compared to older data, infection rates are much lower, partly due to environmental change and partly as a result of control programs. Various dosage treatments have given good results. The higher dosage treatment gave severe reactions especially in brugian filariasis. Pockets of high endemicity can still be found in remote rural areas. Therefore a weekly low dosage treatment of 40 weeks through the Primary Health Care approach has been adopted. Filariasis research in Indonesia at present is concentrating on the use of biotechnological tools, especially for diagnostic and vector identification purposes, and to understand better the pathophysiology. Treatment trials with new drugs such as Ivermectin and DEC are being conducted both in man and experimental animals.

The importance of communication with the foci of infection in the transmission of filariasis in Indonesia.

Studies on the occurrence of early symptoms of filariasis have been conducted in two transmigration Units in the valley of the Wae Apu river, Buru island, Maluku Province, Indonesia. In both Units, higher disease rates were found in areas, where there was a closer contact with positive natives, higher density of the vector mosquito, and higher infective rates in the mosquitoes.

Further studies on the development of Wuchereria bancrofti in laboratory animals.

In an attempt to obtain a small animal laboratory model for Wuchereria bancrofti Mongolian gerbils and hamsters were infected with third-stage larvae of strains of the parasite from Indonesia and China. Gerbils were necropsied at 7 to 591 days and larvae recovered up to 219 days. The third molt occurred on or before 10 days and worms found after 14 days were in the fourth stage. More worms were recovered early in the infection (7 to 30 days) than in older infections. The worms were usually recovered from the testes, pelt and carcass and heart and lungs. An adult male worm was recovered on one occasion from the lung of a gerbil at 92 days. The parasite was also found to develop in hamsters with results similar to those in gerbils. Gerbils and hamsters were given antithymocyte sera before and after infection and more worms were recovered and the worms larger in size in some treated animals. Continued studies with geographic strains of W. bancrofti in various animals should be encouraged in order to find a small laboratory animal model for the parasite.

The association of clinical filariasis and Wuchereria bancrofti infections in Jakarta.

In a study carried out in Jakarta, Indonesia between 1969--1977, patients with clinical manifestations of filariasis were examined for microfilaremia. Finger blood (3 X 20 microliter) were examined by conventional methods, venous blood by membrane filtration, urine and hydrocele fluid by concentration methods. A total of 1,422 patients were examined and 182 (12.8%) were positive by blood smear; however, examination by membrane filtration and concentration of urine and hydrocele fluid did not appreciably increase the association between clinical manifestations and Wuchereria bancrofti infection. Approximately 16% of the patients without patent infection were indirectly associated with filariasis, since they co-habitated with persons with microfilaremia. Results of these studies showed that more than 60% of the patients were without patent infection. Factors that may be responsible for these findings are briefly discussed.

Malayan filariasis in Central Sulawesi (Celebes), Indonesia.

Seven villages in Central Sulawesi were surveyed in September 1971 and finger blood samples from 3,658 persons examined for microfilariae. Periodic, nocturnal Brugia malayi was endemic in all seven villages with microfilarial rates (Mf-rate) of 10-42% (av. 25%). The median microfilarial density (MfD50) averaged 5.4 and varied from 0.8 to 9.4 microfilariae per 20 microliter of blood. Males had higher Mf-rate and MfD50 value than females and in males Mf-rates and MfD50 values increased with age. In the female population, however, neither Mf-rates or MfD50 values varied significantly with age. Clinical manifestations of filariasis were found in 12% of 2,412 persons examined and only 2% had elephantiasis. Clinical signs of disease with the exception of elephantiasis, showed good correlations with Mf-rates but not with MfD50 values. Transmigrants experienced clinical manifestations of filariasis earlier and more often than the indigenous population.

Filariasis in West Kalimantan (Borneo), Indonesia.

A survey was carried out among persons residing in 8 villages in the Province of West Kalimantan, Indonesia to determine the prevalence of filariasis. Finger tip blood smears were obtained at night from over 3,000 people and microfilariae of Brugia malayi were found in 108 (3.5%) and Wuchereria bancrofti in 10 (0.3%). Most B. malayi (96 carriers) was found in Kakap, a village near the coast, 20 km from the provincial capital of Pontianak. Nine of 10 cases of W. bancrofti were located in Pahauman, a village 130 km northeast of the provincial capital. Periodicity studies indicate the strain of B. malayi to be subperiodic. In Kakap 18% of 226 persons examined had a clinical history of filariasis and elephantiasis was seen in 13%. This is the first report of rural bancroftian filariasis in the area. A few Mansonia species of mosquitoes were examined but none were infected with filarial larvae.

Brugia malayi in seven villages in South Kalimantan, Indonesia.

Seven villages in South Kalimantan were visited in 1971 and night peripheral blood smears from 2,764 people examined for microfilariae. Brugia malayi was found endemic in all villages with microfilarial rates of 12--46% (average 25%) and the median microfilarial density (MfD50) of 6 to 15 microfilariae per 20 microliter of blood. The microfilariae showed a typical subperiodic pattern. The disease was more common in males than females and the prevalence increased with age. Clinical manifestations of filariasis were found in 20% of 1,099 persons examined. Mansonia species are considered important vectors and cats important reservoir hosts. In addition to B. malayi, Dirofilaria repens and an unknown microfilaria were found in cats in the area and strains of the B. malayi and D. repens have been established in the laboratory.

Prevalence and distribution of schistosomiasis in Indonesia: a review.

The prevalence and distribution of schistosomiasis in Indonesia is given, with the emphasis on the current data. An extensive investigation was started in 1971. Control measures became desirable because of development schemes in and around the endemic areas, thus increasing the possibility of the spread of the infection. This investigation consisted of: a study of prevalence, distribution, and intensity of the infection in man and animals; clinical studies, treatment and follow-up; and epidemiological studies. A comparison was made between the results of different workers. In addition to the only known endemic area at Lake Lindu, another endemic area was discovered recently at Napu Valley, situated 50 km southeast of Lake Lindu at an altitude of 1200 meters. Surveys in other areas gave negative results. Nine species of wild and domestic animals were found positive. The intermediate host was discovered in 1971 and described as Oncomelania hupensis lindoensis. This snail is widely distributed in the endemic areas.

Parasitology survey in the Palu Valley, central Sulawesi (Celebes), Indonesia.

A survey was undertaken in the Palu Valley, Central Sulasesi to determine whether schisto somiasis japonica was endemic in the area and to determine the prevalences rates of intestinal and blood parasites. Seven villages along the Palu River drainage system with an estimated popualtion of 18,700 were surveyed and 2,433 stools, 3,651 blood smears and 1,167 sera were collected and examined.

Studies on filariasis in the Pacific. 4. The application of the membrane filter concentration technique to a survey of Wuchereria bancrofti filariasis in Kepu district, Jakarta, Indonesia.

A blood survey for filariasis was carried out in the Kepu District of Jakarta. Examination of stained 20 c.mm finger-prick blood thick films and membrane filter concentration (MFC) of 1 ml venous blood. The youngest age group examined, 5-9 years old revealed a mf rate of 17% of which 71% were of a low density character detected by MFC only. The mf rate appears to remain relatively constant from the 10-14 year old group onward, approximately 35%, but at all age groups at least half the infections were of low density. The highest mf rate and density was observed present in the 15-20 year old group.

Parasitology survey and seroepidemiology of amoebiasis in South Kalimantan (Borneo), Indonesia.

A parasitology surevy was conducted among inhabitants of 7 villages in 3 regencies in South Kalimantan Province, Indonesia. A total of 2,169 stool specimens, 2,756 blood smears and 1,027 serum specimens were obtained, representing samples from approximately 10%, 12% and 5% of the population, respectively. One to 8 different intestinal parasitic infections were detected in 97% of the people. Those parasites most frequently found were Trichuris trichiura (83%), Ascaris lumbricoides (79%), and hookworm (65%), followed by Entamoeba coli (37%), Endolimaxnana (12%), Entamoeba histolytica (12%), Iodamoeba bütschlii (11%), Giardia lamblia (5%), Entamoeba hartmanni (2%), Chilomastix mesnili (2%). Other parasites found were Enterobius vermicularis, Strongyloides stercoralis, Capillaria sp., Echinostoma sp., Hymenolepis diminuta, and Trichomonas hominis. Giardia lamblia was found more often in younger people and Entamoeba coli, Iodamoeba bütschlii and hookworm in the older age group. Ascaris lumbricoides occurred more frequently in females, and hookworm in males. Plasmodium vivax and Plasmodium falciparum were found in the blood smears of 4.4% of the people, mostly in the younger age groups. Seroepidemiological studies on amoebiasis were done by use of the indirect hemagglutination test with antigens prepared from the HK9 strain of Entamoeba histolytica maintained in axenic cultures. The frequency distribution of the reciprocal antibody titers showed a bimodal distribution with 34% of the population demonstrating positive reactions at titers of 1:128 or greater.