Spatiotemporal heterogeneity in malaria transmission across Indonesia: analysis of routine surveillance data 2010–2019

Djaafara, Bimandra, Sherrard-Smith, Ellie, Churcher, Thomas, Budi Fajariyani, Sri, Dewi Prameswari, Hellen, Herdiana, Herdiana, Tiara Puspadewi, Riskha, Lestari, Karina, Elyazar, Iqbal and Walker, Patrick (2025) 'Spatiotemporal heterogeneity in malaria transmission across Indonesia: analysis of routine surveillance data 2010–2019'. BMC Medicine, Vol 23, Issue 136.

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Abstract

Background
Indonesia faces challenges in achieving its goal of eliminating malaria by 2030, with cases stagnating between 2015 and 2019. This study analysed regional epidemiological trends and demographic changes in malaria cases from 2010 to 2019, considering differences in surveillance across the country.

Methods
We analysed national and sub-national malaria routine surveillance data using generalised additive and generalised linear models to assess temporal trends in case reporting, test positivity, demographics, and parasite species distribution while accounting for surveillance variations.

Results
After adjusting for increased testing from 2015 onwards, we estimated declining malaria incidence in six of seven Indonesian regions. These regions showed a demographic shift toward older, predominantly male cases, suggesting a transition from household to occupational transmission. In contrast, Papua maintained high transmission with cases concentrated in children. Despite comprising only 2% of Indonesia’s population, Papua’s contribution to national malaria cases rose from 40 to 90% (2010–2019).

Conclusion
While most Indonesian regions progress toward elimination by addressing mobile and migrant populations and P. vivax transmission, Papua shows different patterns with persistently high transmission among children. Achieving nationwide elimination requires enhanced control measures, improved healthcare access, and strengthened multisectoral collaboration to address these region-specific challenges.

Item Type:	Article
Subjects:	QX Parasitology > Insects. Other Parasites > QX 510 Mosquitoes WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
Faculty: Department:	Biological Sciences > Vector Biology Department
Digital Object Identifer (DOI):	https://doi.org/10.1186/s12916-025-03902-9
Depositing User:	Mary Creegan
Date Deposited:	24 Mar 2025 10:10
Last Modified:	24 Mar 2025 10:10
URI:	https://archive.lstmed.ac.uk/id/eprint/26259

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