Indonesia is committed to eliminating lymphatic filariasis in the form of a public health problem

“Community health volunteers are members of the community themselves and know how to effectively engage people to improve compliance“Said Dr. Stefanus Bria Seran, Regent of Malacca District, one of Indonesia’s endemic LF districts. “In addition to ensuring that each individual is given the medication they are given, these community workers help to disseminate information prior to a major treatment campaign and also assist in reporting activities related to each treatment campaign.”

Indonesia’s efforts to eliminate lymphatic filariasis began in the 1970s, but faced many challenges, including coordinating programs in many populated islands, implementing information, education and awareness programs, lack of capacity and
not enough medication.

Furthermore, the situation in Indonesia is more unusual than in many other countries endemic to lymphatic filariasis because the country is endemic to all three species of filamentous filarial worms – Brugia malayi, Brugia timors, i Wuchereria bancrofti –
which cause disease. Most infections in Indonesia, however, cause it B. malayi.

In the past, some of the factors preventing access to medicines (DEC and albendazole) were disease-related social stigmatization, the vast geography of the territory, and the challenges of reaching a remote population.

With an estimated population of 242 million, Indonesia is the world’s largest island nation and consists of approximately 17,000 islands, 5,000 to 6,000. The fourth most populous country behind China, India and the United States
States.

Indonesia is endemic to many other neglected tropical diseases, with an estimated 110 million Indonesians suffering from at least one neglected tropical disease (NTD), including lymphatic filariasis and helminthic soil-borne infections.
Leptospirosis (not classified as NTD) is also widespread.

Indonesia is thIt is the only Southeast Asian country in the WHO region with endemic schistosomiasis. Like many other countries in the Region, it also faces repeated threats of a dengue epidemic.

Global progress

The world has made significant progress toward eliminating lymphatic filariasis as a public health problem.

Sixteen countries⁵ and the WHO recognized one territory that eliminated lymphatic filariasis as a public health problem.

Seven additional countries have successfully implemented the recommended strategies, halted large-scale treatment and have monitored the elimination achieved.

Disease

Lymphatic filariasis is caused by infection with parasitic worms that live in the lymphatic system. Parasite larvae (microfilariae) circulate in the blood and mosquitoes are transmitted from person to person.

Infection includes asymptomatic, acute and chronic conditions. Most infections are asymptomatic, showing no outward signs while contributing to the transmission of the parasite. Although asymptomatic, these infections still cause damage to the lymph
system and kidneys and alter the body’s immune system.

When lymphatic filariasis develops into chronic conditions, it leads to lymphedema (tissue swelling) or elephantiasis (skin / tissue thickening) of the limbs and hydrocele (eardrum). The involvement of the breast and genital organs is common.

Manifestation of illness after infection is time consuming and can result in altered lymphatic system, causing abnormal enlargement of body parts and leading to serious disability and social stigmatization of the diseased.

¹Lymphatic filariasis is transmitted by different types of mosquitoes – e.g. Culex mosquito that is widespread in urban and semi-urban areas; Anopheles, is mainly found in rural areas; and, Aedes, mostly
in the endemic islands in the Pacific.

²In 2017, the WHO recommended alternative treatment for the three drugs to accelerate the global removal of lymphatic filariasis. The treatment, known as IDA, involves a combination of ivermectin, diethylcarbamazine citrate and albendazole.
It is recommended annually in environments where its use is expected to have the greatest impact.

³Community health workers, also called human resources, are volunteers who form part of the communities they serve and work with
community education communities. Their contribution to promoting health is significant in the country.

⁴Cambodia, Cook Islands, Egypt, Kiribati, Maldives, Marshall Islands, Niue, Palau, Sri Lanka, Thailand, Togo, Tonga, Vanuatu, Vietnam, Wallis and Futuna and Yemen