Investigator(s)
| WHO Technical Officer |
Herdiana Hasan Basri WHO Indonesia Herdiana Hasan Basri 
|
| Principal Investigator |
Wiku Bakti Bawono Adisasmito Department Health Policy and Administration, Faculty of Public Health, University of Indonesia Wiku Bakti Bawono Adisasmito
|
| Co-Investigator(s) |
Ajeng Tias Endarti Department Health Policy and Administration, Faculty of Public Health, University of Indonesia Ajeng Tias Endarti
|
Title(s) and abstract
| Scientific title | Estimation of malaria-related mortality through mortality audits and mathematical modelling to assess the effectiveness of intervention in high endemic provinces in Indonesia |
| Public title | Estimation of malaria-related mortality through mortality audits and mathematical modelling to assess the effectiveness of intervention in high endemic provinces in Indonesia |
| Background | Indonesia reported 443,530 malaria cases in 2022 with >76% of districts have been certified for malaria elimination but the disease remains a significant cause of death. Malaria-related deaths in Indonesia either reported or estimated by Global Malaria Programme (GMP) levelled off in the last ten years. The evidence used as a reference by GMP to calculate malaria mortality rate of Indonesia was from a retrospective study using record audits 2014 that analyzed malaria case fatality rate data from one hospital in Mimika district of Papua between 2004-2009. Estimating malaria mortality in Indonesia poses unique challenges, particularly in the context of data collection and verification methods. Medical record audits present a more practical and efficient approach for understanding malaria's impact on mortality. Furthermore, the audits allow for the analysis of clinical history, laboratory results, treatment responses, and progression of the disease in each patient. Therefore, this study aims to renew the evidence from Indonesia in estimate malaria-related mortality that can also be used in guiding public health policies and interventions and as new reference for Indonesia and GMP. |
| Objectives | Primary objective: a. To estimate malaria-related mortality through mortality audits in Indonesia. b. To determine the impact of effective interventions in high endemic districts in Indonesia. Specific objectives: a. To estimate malaria-related mortality through mortality audits in Indonesia. 1) To identify the proportion of malaria-related death cases through retrospective review of patients’ medical records from year 2010 through 2023 using defined criteria; 2) To classify malaria as primary cause, major contributor, or minor contributor of patients’ mortality; 3) To document the clinical findings of patients with malaria-related mortality; 4) To estimate case fatality rate of patients with malaria. b. To determine the impact of effective interventions in high endemic districts in Indonesia (LLIN, ACD via village malaria workers, case management, LSM) on malaria morbidity and mortality. |
| Study Methods | The malaria mortality audit will be conducted using an observational design study and secondary data analysis from medical records. All death cases will be used as the analysis unit, with data analyzed descriptively. To identify factors related to malaria mortality, a mixed methods approach with a sequential explanatory strategy will be used, beginning with a quantitative approach using a retrospective cohort design. The minimum sample size will be determined and selected randomly. Data collection will be performed by proficient enumerators at each study location. Malaria cases and deaths are influenced by individual and contextual (environmental and programmatic) variables. Multilevel analysis will be used to determine whether contextual effects are associated with outcomes at the individual level. This analysis will yield a contextual effect model, a regression model between individuals and variables at both group and individual levels. Following the quantitative study, a qualitative study involving in-depth interviews and focused group discussions will be conducted to gather information about malaria control policies and their implementation. Several interventions have been implemented to achieve the national target of malaria elimination by 2023. Evaluating these interventions will consider various contextual factors such as child survival, climatic and environmental factors, the health system, and socioeconomic factors. Impact evaluation will use a pre-and post-study with aggregate data. The established epidemiological model will serve as the foundation for mathematical modeling to estimate incidences and deaths under various scenarios, including business-as-usual, realistic, and ambitious scenarios. |
| Expected outcomes and use of results | The main result of this research is a powerful mathematical model that will be developed to accurately predict malaria cases and related deaths in various regions in Indonesia. This model aims to improve early detection and intervention strategies, ultimately reducing the burden of disease. In addition, this research will produce results related to data on the number of deaths due to malaria, factors causing deaths due to malaria, and the impact of malaria interventions that have been implemented by the government. Additionally, the findings can also be used as new evidence from Indonesia for GMP in estimating malaria mortality rate in the annual World Malaria Report. |
| Keywords | malaria, mortality rate, case fatality rate, Indonesia, mathematical modelling, predisposing factors |
Research Details
| Student research | No |
| Start Date | 01-Sep-2024 |
| End Date | 30-Apr-2025 |
| Key Implementing Institution | Center for Health Administration and Policy Studies (CHAMPS) University Indonesia |
| Multi-country research | No |
| Nationwide research | Yes |
| Research Domain(s) | Communicable Disease Research |
| Research field(s) | Malaria |
| Involves human subjects | Yes |
| Health System and Policy Research | |
| Data Collection | Primary and secondary data |
| Proposal reviewed by other Committee | Final decision available |