ABSTRACT
Fasciolopsiasis is a parasitic infection caused by the flatworm Fasciolopsis buski. Since 1982, fasciolopsiasis has been reported in Indonesia's Hulu Sungai Utara (HSU) Regency, South Kalimantan Province. Fasciolopsiasis occurs when contaminated raw or undercooked aquatic plants are consumed. Cercariae of the parasite encyst in a variety of aquatic plants and grow into metacercariae that infect and reproduce in the human intestine. Until now, treatment for F. buski infection in the HSU Regency has been comparatively short, with patients receiving only a single dose of praziquantel, 30 mg/kg body weight, without further observation. A long-term effort through health promotion activities and intensive health education, particularly for elementary school children enrolled in the School Health Program, is ongoing to help prevent fasciolopsiasis from spreading and to improve environmental sanitation. Through 2018, intervention efforts successfully reduced the incidence of F. buski infection. Sustaining surveillance and investigation of fasciolopsiasis, including identification of new cases and community education, is critical for the elimination of the parasite from Indonesia. This review describes the spread of F. buski and its possible impact on public health to understand the critical nature of continuing F. buski surveillance and control efforts.
ABSTRACT
BACKGROUND: Malaria remains a significant public health concern in Indonesia. Knowledge about spatial patterns of the residual malaria hotspots is critical to help design elimination strategies in Kotabaru district, South Kalimantan, Indonesia. METHODS: Laboratory-confirmed malaria cases from 2012 to 2016 were analysed to examine the trend in malaria cases. Decomposition analysis was performed to assess seasonality. Annual spatial clustering of the incidence and hotspots were identified by Moran's I and the local indicator for spatial association, respectively. RESULTS: The annual parasite incidence of malaria was significantly reduced by 87% from 2012 to 2016. Plasmodium vivax infections were significantly much more prevalent over time, followed by Plasmodium falciparum infections (p<0.001). The monthly seasonality of P. vivax and P. falciparum was distinct. High incidence was spatially clustered identified in the north, west and parts of south Kotabaru. Two persistent and four re-emerging high-risk clusters were identified during the period. Despite the significant reduction in the incidence of malaria, the residual high-risk villages remained clustered in the northern part of Kotabaru. CONCLUSIONS: A spatially explicit decision support system is needed to support surveillance and control programs in the identified high-risk areas to succeed in the elimination goal of 2030.
