Nurse Media Journal of Nursing e-ISSN: 2406-8799, p-ISSN: 2087-7811 https://medianers.
:279-293.
August 2024 https://doi.
org/10.
14710/nmjn.
ORIGINAL RESEARCH
Malaria Prevention Strategies in Kalimantan.
Indonesia: A Secondary Analysis of 2018 Basic Health Research Data Muhammad Rasyid Ridha1,2.
Dicky Andiarsa1.
Ihya Hazairin Noor3.
Erni Wiliyani3.
Tri Ramadhani2.
Ririh Yudhastuti1 1Faculty of Public Health.
Universitas Airlangga.
Surabaya.
Indonesia 2Research Center for Public Health and Nutrition.
Research Organization for Health.
National Research and Innovation Agency.
Indonesia 3Public Health Study Program.
Medical Faculty.
Universitas Lambung Mangkurat.
Banjarmasin.
Indonesia Article Info Abstract Background: Kalimantan remains malaria-endemic, particularly in rural areas, where prevention efforts face challenges such as insecticide resistance and limited healthcare access.
Despite available measures like insecticide-treated nets, gaps in understanding individual and household prevention practices persist, especially in relation to demographics and effectiveness in reducing malaria transmission.
Purpose: This study aimed to examine the individual and household-level malaria prevention strategies utilized in rural Kalimantan and evaluate their effectiveness Keywords:
Household.
Kalimantan in reducing malaria incidence.
Methods: The study was a secondary analysis of the 2018 Indonesian basic health research (Riskesda.
A total of 67,155 respondents in Kalimantan were analyzed Corresponding Author:
including respondent characteristics, memories of malaria infection, and individual Muhammad Rasyid Ridha and household malaria prevention efforts.
The data were collected through the Faculty of Public Health.
Universitas result of the 2018 Riskesdas survey.
Bivariate regression and multivariable logistic Airlangga.
Surabaya.
Indonesia regression were used in data analysis.
Email:
Results: Self-reported malaria rates were higher among older respondents ridha-2023@fkm.
compared to younger ones.
Women reported lower malaria rates than men, especially in South Kalimantan.
In West Kalimantan, the use of bed nets was associated with higher self-reported malaria rates (OR=1.
838, 95%CI 1.
147Ae2.
Short-term use of insecticide-treated nets (ITN.
showed varying odds across provinces: Central Kalimantan (OR=3.
659, 95%CI 1.
378Ae9.
South Kalimantan (OR=10.
811, 95%CI 3.
649Ae32.
East Kalimantan (OR=2.
615, 95%CI 1.
041Ae .
, and West Kalimantan (OR=2.
428, 95%CI 1.
446Ae4.
In all provinces, preventive measures such as coils or electric mats reduced self-reported malaria The use of mosquito screens was effective in South Kalimantan (OR=0.
95%CI 0.
027Ae1.
Central Kalimantan (OR=0.
365, 95%CI 0.
120Ae2.
, and North Kalimantan (OR=0.
000, 95%CI 0.
000Ae0.
The multivariate model highlighted mosquito nets as the most effective household-scale prevention in nearly all Kalimantan provinces except North Kalimantan.
Conclusion: This study showed that individuals aged 25 and over, women, nonfarmers, and those using ITNs and other preventive measures, especially in rural areas, were less likely to report malaria, emphasizing the need for targeted interventions from local health authorities.
Article History:
Received: 10 July 2023 Revised: 25 August 2024 Accepted: 26 August 2024 Online: 31 August 2024 How to cite: Ridha.
Andiarsa.
Noor.
Wiliyani.
Ramadhani.
& Yudhastuti.
Malaria prevention strategies in Kalimantan.
Indonesia: A secondary analysis of 2018 basic health research data.
Nurse Media Journal of Nursing, 14.
, 279-293.
https://doi.
org/10.
14710/nmjn.
Copyright A 2024 by the Authors.
Published by Department of Nursing.
Faculty of Medicine.
Universitas Diponegoro.
This is an open access article under the CC BY-SA License .
ttp:/creativecommons.
org/licenses/by-sa/4.
0/).
Introduction Malaria remains a major global health threat, causing an estimated 608,000 deaths in 2022, with Southeast Asia receiving only six percent of the total global investment in malaria prevention (Centers for Disease Control and Prevention, 2.
The WHO has set a goal of eliminating malaria by 2030, yet Indonesia, which ranks second in Southeast Asia for malaria cases, continues to face significant challenges in reaching this target (World Health Organization, 2.
Although the number of malaria cases in Indonesia decreased between 2021 and 2022, the trend has Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 280 remained stable (Lobo et al.
, 2.
In 2022.
Indonesia reported 443,530 malaria cases, with 89% of positive cases coming from Papua Province.
In 2024, as of April 25, there were 418,546 malaria cases in Indonesia, of which 120 died.
Kalimantan, which has been designated as the new capital of Indonesia, remains particularly vulnerable, with only 42% of its regencies having achieved malaria elimination by 2020 (Sugiarto et al.
, 2.
Despite various government efforts, such as distributing insecticide-treated bed nets (ITN.
, implementing artemisinin combination therapy (ACT), and utilizing insecticide residual spraying (IRS), malaria remains a persistent problem, particularly in rural and economically disadvantaged areas (Ministry of Health Republic of Indonesia, 2.
These regions face unique challenges, including limited access to healthcare, early diagnosis, and proper housing, which contribute to the continued transmission of malaria (Guntur et al.
, 2.
This presents a significant barrier to IndonesiaAos broader malaria elimination goals and sustainable development, especially as Kalimantan prepares to take on the role of the nationAos capital.
Malaria prevention efforts in Indonesia are shaped by both individual and contextual factors, which vary between urban and rural areas (Mpimbaza et al.
, 2017.
Ramdzan et al.
, 2.
Malaria control efforts differ between communities in rural and urban areas, which may be due to socioeconomic and development disparities (Molina Gymez et al.
, 2.
People in underdeveloped or rural areas may have limited access to better housing, as well as adequate and early diagnosis and treatment, thus contributing to increased malaria transmission (Tusting et , 2.
Research indicates that implementing malaria treatment and prevention programs in rural communities has been hampered by financial constraints.
Malaria transmission in the population varies depending on a variety of factors, including environment and socioeconomic Plasmodium, a parasite.
Anopheles mosquito, and human host are all constituents of the Gender, age, occupation, and behavior are socioeconomically significant popularity factors (Tadesse et al.
, 2.
The success of efforts to prevent malaria can also be impacted by contextual factors, personal and family prevention, and other factors (Rassi et al.
, 2.
At the family level, malaria threat elements are decided through various populations, family conditions, family monetary conditions .
, possession of insecticide-dealt with mosquito nets (ITN.
, and cap potential to get admission to health facility (Hsiung et al.
, 2.
Preventive measures at the individual level, such as the use of electric mosquito rackets, coils, and repellents, are commonly employed (Koduri & Kusneniwar, 2018.
Lwin et al.
, 2.
However, there is a lack of detailed evidence on how these prevention practices are specifically adopted by rural communities in Kalimantan.
Therefore, the purpose of the study was to examine the individual and householdlevel malaria prevention practices employed by rural areas in Kalimantan.
Indonesia, and to assess their relationship with the incidence of malaria infection among the adult population.
Methods Research design The study conducted a secondary data analysis of the 2018 Indonesian Basic Health Research (Riskesdas 2.
Riskesdas 2018 was a five-year, across-program community-based survey with a nationwide representative sample.
Since the data was readily available, complete, and based on a large sample, it could serve as a reliable basis for broader policy-making decisions.
This study attempted to evaluate critical public health indicators for policymakers at the national, provincial, and district levels.
Setting and samples The study was limited to five provinces in Kalimantan: South.
Central.
East.
West, and North Kalimantan.
The area of the island of Kalimantan is about 743,330 kmA, with a total number population of 17.
5 million people (Central Bureau of Statistics of Indonesia, 2.
The Riskesdas 2018 sampling framework targeted 300,000 households from 30,000 census blocks of Susenas .
ational socio-economic surve.
2018, implemented by the Central Bureau of Statistics using probability proportional to size (PPS) with linear systematic sampling.
It applied a two-stage sampling approach.
First, implicit stratification was conducted on 720,000 census blocks from the 2010 population census, selecting 180,000 blocks .
%) as the sampling frame, from which 30,000 census blocks were systematically chosen across urban and rural strata for each district/city.
In the second stage, 10 households per selected block were systematically sampled.
Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 281 stratified implicitly by the highest educational level of household heads to ensure diverse representation (Ministry of Health Republic of Indonesia, 2.
The analysis was limited to people more than 15 years old for this study .
=67,.
in five provinces of Kalimantan island as the new capital island of Indonesia, namely the Province of South Kalimantan .
=16,.
Central Kalimantan .
=14,.
East Kalimantan .
=11,.
West Kalimantan .
=19,.
, and North Kalimantan .
=4,.
In Riskesdas, ethically, interviewed respondents should be 15 years of age or older as they were generally considered to have a better level of understanding to provide valid and reliable information.
Data subsets were evaluated, including respondentsAo characteristics .
ge, gender, education, and occupatio.
The participants referred to individuals who, within the last 12 months before the survey, had been diagnosed with laboratory-confirmed malaria by a local health service provider or physician.
It also included practices such as sleeping under untreated mosquito nets, sleeping under insecticide-treated mosquito nets for three years or more, using repellents or materials to prevent mosquito bites, using electric mosquito-repellent devices .
, electric mosquito racket.
, using mosquito repellents .
urning, electric, or spra.
in the household, and installing mosquito nets on ventilation openings.
Measurement and data collection The Riskesdas was carried out in 2007, 2013, and finally, 2018.
The questionnaire had been used in the previous Riskesdas surveys .
7 and 2.
The questionnaire indicators were developed by the program holders of the Ministry of Health of the Republic of Indonesia, the National Development Planning Agency (Bappena.
, and the Central Bureau of Statistics of Indonesia (BPS).
The indicators were translated into questions that were developed into the questionnaire by health experts .
rofessional organizations, universities, and senior researchers from the Agency for Research and Developmen.
and with input from international organizations (WHO.
UNICEF, and World Ban.
The questionnaire had also been tested for validity and However, the validity and reliability of test results were not clearly stated (Ministry of Health Republic of Indonesia, 2.
The complete questionnaire can be downloaded at https://repository.
id/id/eprint/4616/1/236-kues_ind_rkd18-8.
The questionnaire consists of 309 questions on access to health facilities, environmental health, communicable diseases, non-communicable diseases, oral health, mental health, disability, and injury.
However, this study only focused on eight dichotomous questions related to preventive malaria, scoring 0 for no and 1 for yes.
Secondary data for this research were obtained from the 2018 Riskesdas survey, a publicly accessible dataset available through the Indonesian Ministry of Health .
ata service access page: https://layanandata.
id/).
formal request was submitted to the ministry to collect the data, detailing the research objectives and intended use of the data.
Upon approval, the dataset was downloaded in its raw form.
Relevant variables, including malaria infection history and individual and household prevention efforts, were extracted for analysis.
Data analysis Some statistical analyses were used in this study.
Descriptive analysis described the general characteristics .
mount, frequency, and proportio.
of explanatory variables.
A bivariate regression analysis was conducted to look at the relationship between malaria and the explanatory The multivariable logistic regression model included variables with a p-value of <0.
from the bivariate model.
Before assigning variables to the final mode, the variance inflation factor (VIF) was employed to check for multi-collinearity among explanatory variables.
After accounting for potential discoverers, a multivariable logistic regression analysis was performed to identify malaria-related covariates.
The final model assumed a 5% level of statistical The odds ratio (OR) and the 95% confidence interval (CI) were displayed.
The Riskesdas 2018 data sampling structure was complex, necessitating extensive data analysis.
All statistical analyses were conducted using SPSS 21 (Chicago.
IL.
USA).
Malaria prevalence map was created in QGIS ver.
22 (Meyer & Riechert, 2.
The administrative boundary polygon shapefile was obtained from the Central Bureau of Statistics of Indonesia (Statistical Service Information Syste.
ttp://w.
Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 282 Ethical considerations The Riskesdas 2018 protocol was evaluated and authorized by the National Ethics Commission for Health Research.
Institute for Health Research and Development (NIHRD).
Ministry of Health of the Republic of Indonesia (Number: LB.
01/2/KE.
024/2.
on January 24, 2018.
Ethical considerations in this study were addressed by ensuring confidentiality and compliance with any data use restriction, as the original data was collected for a national health Results Characteristics of respondents Table 1 shows the socio-demographic characteristics of the subjects.
The majority of respondents in the survey were adults over 25 years old .
33%) in all provinces, with gender representation in the sample appearing to be balanced.
A substantial number of respondents in East Kalimantan .
%).
North Kalimantan .
7%), and Central Kalimantan .
2%) had completed secondary school.
In West Kalimantan, however, the majority of respondents had no education .
2%) or had not completed primary education .
3%).
Agriculture and nonagriculture jobs were approximately evenly distributed across all provinces.
Table 1.
General characteristics of the respondents .
=67,.
Characteristics West Kalimantan .
=19,.
Age .
15 Ae 24 25 and above Gender Male Female Education No education Primary Secondary Tertiary Occupation Not working Farmer Non-farmer Individual preventive measures Used mosquito bed nets Used ITNs O 3 Used ITNs > 3 Used repellent Used electric Household-level preventive measures Used coil/electric Installed window Self-reported Malaria Central Kalimantan .
=14,.
South Kalimantan .
=16,.
East Kalimantan .
=11,.
North Kalimantan .
=4,.
All Kalimantan .
=67,.
For individual preventive measures, as many as 38.
65% of the total respondents said they slept using a bed net.
However, 5.
64% of all respondents said they had been using insecticidetreated nets (ITN.
for less than three years.
West Kalimantan had the highest number of respondents who had used ITNs for under three years out of the five provinces .
2%).
In all provinces, less than 20% of respondents had been using ITNs for over five years.
Around half of all responders reported using insect repellent, though only 45.
7% in Central Kalimantan did so.
Additionally, just 9.
36% of participants mentioned using electric mosquito rackets.
In addition to household-level preventive measures, approximately 73.
2% of respondents in North Kalimantan, 1% in South Kalimantan used coils or electric mosquito mats in their houses.
Mosquito Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 283 window screens were mostly reported by respondents in East Kalimantan .
3%) and South Kalimantan .
6%).
The prevalence of self-reported malaria by districts Figure 1a depicts the prevalence of self-reported malaria by provinces.
Self-reported malaria data by province was the highest in West Kalimantan .
%) and the lowest in North Kalimantan .
%).
The geographical distribution of self-reported malaria prevalence in five provinces can be seen from Figure 1b.
Malinau .
3%) had the greatest prevalence of self-reported malaria, followed by Nunukan .
3%) and Tarakan .
3%) in Northern Kalimantan.
Paser .
%) and Kutai .
%) in Eastern Kalimantan.
Bengkayang .
4%) in Western Kalimantan.
Tanah Bumbu .
%) in Southern Kalimantan.
and Gunung Mas .
2%) in Central Kalimantan.
North Kalimantan East Kalimantan West Kalimantan South Kalimantan Central Kalimantan West Kalimantan Central Kalimantan South Kalimantan East Kalimantan North Kalimantan Figure 1.
The prevalence of self-reported malaria by district and geographical distribution The relationship between self-reported malaria and respondentAos characteristics Table 2 highlights factors related to self-reported malaria across KalimantanAos five provinces, examining demographic characteristics .
ge, gender, education, and occupatio.
and preventive Self-reported malaria rates were higher among older individuals.
Women generally reported fewer malaria cases than men, especially in South Kalimantan, where the gender difference was statistically significant.
Occupational trends showed that farmers had higher selfreported malaria rates than non-farmers, although these differences were not significant.
In terms of preventive measures, the use of bed nets in West Kalimantan was associated with higher odds of self-reported malaria (OR=1.
838, 95%CI 1.
Self-reported malaria was related to short-term use of insecticide-treated nets (ITN.
in Central (OR=3.
659, 95% CI 1.
South (OR=10.
811, 95% CI 3.
, and East Kalimantan (OR=2.
615, 95% CI 1.
Household measures like mosquito coils and window screens were linked to low selfreported malaria, with variation in effectiveness across regions.
These findings underscored the importance of tailored malaria prevention strategies that consider regional and demographic differences in Kalimantan.
The most effective measures in preventing malaria Findings from the multivariate model (Table 3, see Appendi.
show that the most effective malaria prevention practice in almost all Kalimantan provinces was mosquito nets, either without or with ITNs.
In West Kalimantan, the two malaria prevention practices were related .
OR=1.
95%CI 1.
852 and aOR=2.
375, 95%CI 1.
with malaria prevention.
In Central Kalimantan, only the use of ITN less than 3 years contributed .
OR=3.
355, 95%CI 1.
as well as in South Kalimantan .
OR=11.
034, 95%CI 4.
and in East Kalimantan .
OR=2.
859, 95%CI 1.
Unique findings were found in North Kalimantan, where multivariate analysis had not shown any effective malaria prevention .
>0.
Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 284 In addition, the study also highlighted the use of electric mosquito rackets and mosquito The use of mosquito repellents reduced the likelihood of self-reported malaria in East Kalimantan .
OR = 0.
509, 95% CI 0.
261Ae0.
Meanwhile, the use of electric mosquito rackets was associated with a reduced likelihood of malaria reports in South Kalimantan .
OR = 2.
95% CI 0.
752Ae6.
and North Kalimantan .
OR = 0.
804, 95% CI 0.
271Ae2.
, though the results varied across provinces and were not always statistically significant.
Table 2.
The associating factors of self-reported malaria .
=67,.
West Kalimantan Characteristics .
%CI) Age .
Gender .
Education .
Occupation .
Individual Preventive Measures Bed nets .
ITNs O 3 years .
ITNs > 3 years .
Repellent .
Electric .
Household-Level Preventive Measures Coils/electric .
Anti-mosquito window screen .
Central Kalimantan .
%CI) .
,1303.
Self-Reported Malaria South Kalimantan .
%CI) .
East Kalimantan .
%CI) .
North Kalimantan .
%CI) .
Note.
*Significantly different Discussion Our research focused on a sample of data from a recent community-based national representative survey in Indonesia (Riskesdas 2.
, aiming to examine malaria prevention strategies and evaluate their effectiveness in reducing malaria incidence utilized in rural Kalimantan.
In this study, we found that reports of malaria were more common among older adults and men in rural areas throughout five provinces in Kalimantan.
Our findings are in line with those of a study conducted in Sub-Saharan Africa.
South Africa (Kisia et al.
, 2.
, and eastern Indonesia (Dhewantara et al.
, 2019.
Ipa et al.
, 2.
Malaria is a major public health concern among adults, particularly among economically active males, according to reports.
For example, research in Kenya found that Plasmodium falciparum infection was linked to males who were poor and malnourished (Kepha et al.
, 2.
Compared to men, women were less likely to be diagnosed with malaria and earlier research in Indonesia (Hasyim et al.
, 2.
Malaria tends to be more common in men and older adults due to several biological, behavioral, and social factors (Quaresima et al.
, 2.
Biologically, men may be more exposed to Anopheles mosquitoes due to outdoor activities, especially at night when mosquitoes are most active (Mponzi et al.
Socially and economically, men often work in high-risk environments such as agriculture, forestry, or construction areas, which are often close to mosquito habitats (Swai et al.
, 2.
Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 285 addition, immunity to malaria tends to decline with age, especially in individuals living in lowtransmission areas, where repeated exposure to the parasite is not enough to maintain immunity (Tadesse et al.
, 2.
Behavioral factors also play a role, such as the lack of use of preventive measures, including bed nets or repellants, among older men and adults (Gryseels et al.
, 2.
The combination of these factors makes these groups more susceptible to malaria infection.
The study found a notable relationship between self-reported malaria and occupation.
general, farmers in West Kalimantan.
Central Kalimantan.
South Kalimantan, and East Kalimantan reported higher malaria rates than those who were unemployed, though these differences were not statistically significant.
However, a unique finding emerged in South Kalimantan, where individuals working in non-agricultural sectors reported higher rates of This result contrasted with the general pattern where agricultural workers tend to report more malaria cases, possibly due to greater exposure to outdoor environments where malaria vectors are more prevalent.
The study findings were almost similar to those of a prior study conducted in Ethiopia (Tadesse et al.
, 2.
The fact that both studies used different statistical approaches could explain some discrepancies.
The discrepancies between our findings and the prior study in Ethiopia may be attributed to differences in environmental contexts, access to prevention tools, and definitions of occupational categories.
Furthermore, variations in statistical methods and socioeconomic behaviors across regions may also contribute to these differences.
For instance, while agricultural workers in Ethiopia might have greater access to preventive measures, those in Kalimantan could face unique challenges, such as limited access to insecticidetreated nets or differences in educational background, which influence malaria prevention The study also discovered a link between education and self-reported malaria.
Our research indicated that people who had completed secondary school had a higher likelihood of reporting malaria, although the differences were also not statistically significant.
Two previous studies support this finding that individuals who completed secondary school were more likely to report malaria, i.
education plays a role in increasing awareness and the likelihood of reporting malaria cases (Hasyim et al.
, 2019.
Yimer et al.
, 2.
In contrast, individuals with lower levels of education were more likely to report malaria in Uganda, likely due to higher exposure to malaria-prone environments (Mpimbaza et al.
, 2.
These differences highlight the complex interactions between education, awareness, and access to health services in malaria-endemic An individualAos socioeconomic status, work, and education are significant risk factors for This could be explained by the fact that people with higher levels of education are more likely to be knowledgeable about and aware of malaria.
Therefore, there was a higher likelihood that individuals would overreport malaria or know about malaria prevention strategies.
The study identified several malaria-prevention measures used by participants in various provinces, including bed nets, insecticide-treated nets (ITN.
, repellents and mosquito electric rackets, coils or electric mats, and mosquito screens.
Our findings showed that sleeping under a bed net reduced the risk of malaria in West Kalimantan but not in the other areas.
This is similar to a study conducted on the border of Myanmar and Thailand which mentioned that mosquito net ownership had an impact on reducing malaria (Pooseesod et al.
, 2.
The counterintuitive result might suggest improper use or maintenance of bed nets, or it could indicate other confounding factors, such as higher exposure to malaria in areas where bed nets are more commonly used.
Particularly in endemic locations, mosquito nets are extremely important for preventing malaria since they physically shield humans from Anopheles mosquito bites, therefore shielding them from the malaria parasite (Fornace et al.
, 2.
Not only can insecticide-treated nets (ITN.
stop bites, but they also kill mosquitoes that come into touch with them, therefore lowering malaria transmission.
Long-term protection at a reasonable cost comes from using Long-Lasting Insecticidal Nets (LLIN.
(Ridha et al.
, 2.
Furthermore, the distribution of bed nets is sometimes accompanied by educational initiatives to increase public awareness of the need for malaria prevention and motivate regular bed nets use, which have been demonstrated to greatly lower malaria incidence (Mosha et al.
, 2.
The variation in the effectiveness of ITNs across different provinces, as observed in Kalimantan, suggests several underlying factors that may influence their protective capacity.
This result was supported by one study in southern Ethiopia, reporting that malaria prevalence was as high despite frequent bed-net use.
the heterogeneity of bed-net use and malaria incidence was demonstrated (Debo & Kassa, 2.
One possible reason for reduced efficacy in certain regions, such as South Kalimantan, could be the improper use or maintenance of ITNs.
Frequent use Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 286 without proper care, such as regular washing or re-treating with insecticide, may reduce the netAos effectiveness, especially after several years of use.
Debo and Kassa .
also support this concern, indicating that incorrect usage or reluctance to use treated nets contributes to continued malaria transmission.
Another critical factor may due to insecticide resistance among mosquito populations, which can reduce the protective effect of ITNs.
This phenomenon has been observed in various malaria-endemic regions, where mosquitoes have evolved resistance to the pyrethroid insecticides commonly used in bed nets (Lindsay et al.
, 2.
In Malawi, for example.
ITNs showed no significant protective effect against malaria, likely due to such resistance (Mathanga et al.
, 2015.
Mbewe et al.
, 2.
The differences in mosquito vector behavior and ecology could also explain the regional disparities in ITN's effectiveness (Obala et al.
, 2.
In some areas, mosquitoes may enter homes and bite at times or places where nets are not used, diminishing the protection they offer (Mponzi et al.
, 2.
In contrast, the success of ITN programs in Nigeria, where educational initiatives were combined with net distribution, underscores the importance of community education and engagement in malaria prevention efforts (Olowookere et al.
, 2.
Education improves compliance with ITN use and ensures the proper handling of nets, maximizing their protective This suggests that addressing the human factors-such as proper use, consistent application, and understanding of the benefits of ITNs-is crucial for their success.
Future interventions should focus on enhancing ITN durability and resistance management, ensuring regular re-treatment or replacement of nets, and conducting behavior change communication campaigns to increase proper usage.
Research should also explore regional differences in vector behavior and insecticide resistance patterns to tailor more effective malaria prevention strategies.
Ongoing monitoring and evaluation of ITN efficacy, combined with community-driven educational programs, will be key to sustaining malaria control efforts and adapting to evolving This study reported that the usage of repellents and mosquito electric rackets was linked to a lower risk of reporting malaria across the provinces.
This suggested that these measures were effective at preventing mosquito bites, which reduced malaria transmission.
This result was supported by clinical research in Chennai and Raurkela.
India, which discovered a weaker relationship between repellents and malaria (Van Eijk et al.
, 2.
In Afghanistan, however, there were no significant declines in adult malaria cases with mosquito repellents or electric rackets (Rowlands et al.
, 2.
Similar research found that, despite entomological statistics showing that in more than five hours, the Picaridin repellent reduced mosquito bites by 97%, there was no evidence of a decrease in malaria prevalence in Cambodia (Gryseels et al.
, 2.
These findings were strengthened by Maia et al.
, who pointed out in their study that the evidence supporting the claim that repellent sources, locally or geographically, can stop the spread of malaria is insufficient.
Several discrepancies with this studyAos findings could be explained by a significant desire for repellent application on a regular basis.
This was observed particularly among individuals, usually men, who engaged in economic and subsistence activities in the forest, especially in areas with high levels of insect annoyance.
Insect annoyance is one of the primary motivators for repellent application in other situations (Yimer et al.
, 2.
Our research showed that using coils or applying electric anti-mosquito mats and installing mosquito window screens could minimize the risk of malaria.
The finding is consistent with some previous studies.
Mosquito window screens significantly decreased mosquito exposure in homes (Morakinyo et al.
, 2.
Similarly, coils and electric mats effectively lowered malaria risk in rural areas with limited access to other preventive measures (Guerra et al.
, 2.
, while Wanzirah et al.
highlighted the importance of home improvements, including mosquito screens, in reducing malaria transmission.
However, the participants in South and North Kalimantan looked to be less protected.
One potential explanation for these domestic preventative techniques was that they only protected people who were present in the house.
Meanwhile, malaria transmission can occur both inside and outside the house.
Given that mosquito vector bites are mostly an outdoor danger for malaria (Iliyasu et al.
, 2.
, the efficacy of domestic prevention strategies is questioned (Guerra et al.
, 2.
According to our analysis, the majority of residences in all provinces used coils rather than traditional window screens.
This discovery is consistent with the results of a Nigerian study, reporting that malaria infection was shown to be higher in people living in unimproved dwellings (Morakinyo et al.
, 2.
Another study in Uganda found that the rate of human-biting mosquitos was lower in modern dwellings than in traditional ones.
Malaria Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 287 infection rates in modern households are decreasing across all subcounties (Wanzirah et al.
Although dwellings are not the only places where malaria spreads, they remain the principal transmission habitat in many endemic areas (Van Eijk et al.
, 2.
House upgrades include the complete covering or sealing of apertures, including doors, windows, eaves, and ceiling structures.
The goal is to reduce mosquito-human interaction indoors.
Although mosquitos bite and transmit disease outside, evidence suggests that they will visit home before biting someone contagious at some point in their lives (Killeen et al.
, 2.
A Gambian study revealed that when 500 families in a neighborhood were given either total screening, screened ceilings, or no screening at all, more mosquitos were captured in the houses without screening than in the other structures (Kirby et al.
, 2.
Implications and limitations The studyAos findings highlighted significant regional differences in the effectiveness of ITNs, suggesting that improper use and insecticide resistance might undermine malaria prevention in Kalimantan.
To improve outcomes, strategies should focus on education campaigns about proper ITNs use, regular net replacement, and monitoring mosquito resistance.
Combining these with ITN use could enhance malaria prevention in provinces where other methods like electric mats and screens were effective.
For nursing, this study emphasized the role of nurses in health education, improving ITN compliance, and advocating for comprehensive malaria prevention Nurses could provide direct community engagement, ensuring proper ITN use, early diagnosis, and prompt treatment, which were keys to reducing malaria transmission.
The studyAos limitations included potential reporting and social desirability biases, where respondents might inaccurately report or overstate their malaria prevention practices.
Additionally, the cross-sectional design limits causal inference, as it only provided a snapshot in time without establishing how changes in prevention practices affected malaria incidence.
These factors suggested a cautious interpretation of the findings and highlighted the need for longitudinal studies to better understand causal relationships.
Conclusion The study showed that self-reported malaria rates were higher among older individuals and The educational factor was less significant in self-reporting of malaria, but based on occupation, farmers were more likely to report malaria.
Another result was that in rural areas, individuals using ITNs, insect repellents, and electric mosquito rackets were less likely to report malaria and had a lower probability of contracting malaria.
The most effective malaria preventive measures identified in this study included the consistent use of insecticide-treated nets (ITN.
, which offer dual protection by physically blocking mosquito bites and killing mosquitoes on The use of ITNs becomes more effective when combined with other prevention strategies to protect against malaria.
Indoor residual spraying (IRS) complements the protection of bed nets by killing mosquitoes resting on the walls of the house, while the use of repellants on the skin or clothing provides additional protection during activities outside the home.
In addition, wearing protective clothing, especially at night, and using electronic mosquito-repellent devices inside the home can support the effectiveness of mosquito nets.
These measures, when accompanied by community education on the importance of bed net use and other preventive measures, provide more comprehensive protection against the risk of malaria transmission, especially in endemic Therefore, this study recommends that the local health authorities establish targeted intervention strategies combined with community education to prevent Malaria in Kalimantan.
Longitudinal studies are also needed in the future to explore better causal relationships of Malaria.
Acknowledgment We thank the Ministry of Health of the Republic of Indonesia for assisting with this research.
Author contribution MRR.
RY: Conceptualization, methodology, formal analysis, writing.
IHN.
EWZR: Formal analysis, writing, and editing.
DA.
TR: Reviewing, investigation, validation, and editing.
Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 288 Conflict of interest The authors declare no conflict of interest.
References