Epidemiology of malaria and district-level factors associated with malaria elimination in Sumatra region, Indonesia: a retrospective analysis of surveillance data

@article{lestari2026epidemiology,
  title = {{Epidemiology of malaria and district-level factors associated with malaria elimination in Sumatra region, Indonesia: a retrospective analysis of surveillance data}},
  author = {Karina D Lestari and Henry Surendra and Bimandra A Djaafara and Ihsan Fadilah and Lenny L Ekawati and Hermawan Susanto and Hellen D Prameswari and Sri B Fajariyani and Dedy Supriyanto and Herdiana Herdiana and Eamon Conway and Pimphen Charoen and Saranath Lawpoolsri and Wirichada Pan-ngum and Iqbal R F Elyazar},
  journal = {BMC Medicine},
  year = {2026},
  month = jul,
  doi = {10.1186/s12916-026-05104-3},
  url = {https://doi.org/10.1186/s12916-026-05104-3},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Epidemiology of malaria and district-level factors associated with malaria elimination in Sumatra region, Indonesia: a retrospective analysis of surveillance data
AU  - Karina D Lestari
AU  - Henry Surendra
AU  - Bimandra A Djaafara
AU  - Ihsan Fadilah
AU  - Lenny L Ekawati
AU  - Hermawan Susanto
AU  - Hellen D Prameswari
AU  - Sri B Fajariyani
AU  - Dedy Supriyanto
AU  - Herdiana Herdiana
AU  - Eamon Conway
AU  - Pimphen Charoen
AU  - Saranath Lawpoolsri
AU  - Wirichada Pan-ngum
AU  - Iqbal R F Elyazar
PY  - 2026
DA  - 2026/07/29
JO  - BMC Medicine
DO  - 10.1186/s12916-026-05104-3
UR  - https://doi.org/10.1186/s12916-026-05104-3
AB  - Background: As transmission declines, malaria becomes more spatially and demographically concentrated. This study investigated individual-level malaria characteristics and district-level factors associated with elimination in all 154 districts in Sumatra, Indonesia.  Methods: We analysed individual-level data of 13,386 reported malaria cases from 2019 to 2021. P. falciparum and P. vivax were confirmed by microscopy or rapid diagnostic test, while probable P. knowlesi was defined as microscopically identified P. knowlesi. Cases were classified as imported if they reported travel to endemic region within 2–4 weeks. Multivariable logistic regression with province as a random effect was used to examine individual-level factors associated with imported cases, and district-level socioeconomic and environmental factors associated with elimination. Spatial clustering of indigenous cases was assessed using Global Moran’s I and SaTScan.  Results: Among reported cases, 71.8% (9,617) were P. vivax, 18.4% (2,467) P. falciparum, and 2.8% (369) probable P. knowlesi. Of 11,390 investigated cases, 8,748 (76.8%) were indigenous, 1,741 (15.3%) imported, and 901 (7.9%) unclassified. Imported cases were associated with older age (adjusted odds ratio 1.79, 95%CI 1.42–2.25 for 15–24 years old, and 1.97, 1.59–2.46 for 25–64 years old, compared to < 15 years old), males (1.70, 1.43–2.03), mobile and migrant population-related occupations (1.46, 1.22–1.76), diagnosed at hospitals or clinics (2.32, 1.85–2.91), infected with P. falciparum (1.48, 1.22–1.80), and hospitalised (15.29, 12.66–18.46). At the district level, a higher human development index (1.15, 1.01–1.34), lower historical annual parasite incidence (0.46, 0.29–0.69), and fewer endemic neighbours (0.78, 0.67–0.89) were associated with a higher likelihood of elimination. Spatial analysis revealed clustering tendencies, with localised clusters for P. falciparum, P. vivax, and probable P. knowlesi.  Conclusions: Dynamics of imported malaria, heterogeneous clusters of local transmission, and lower district-level human development index challenged elimination efforts. This highlights the need for strengthened surveillance and targeted interventions.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12916-026-05104-3.
SN  - 1741-7015
ER  -