DDT indoor residual sprayings in the Province of Central Java, Indonesia, for the past 28 years are reoieuied in terms ofAnopheles aconitus resistance to DDT and incidences of malaria. DDT resistance by An. aconitus has continued to increase and spread since its first detection in Central Java in 1962. In most areas malaria transmission is perennial, which appears to be not interrupted by DDT residual spraying of inner walls because of DDT resistance. In searching for alternatives to DDT, fenitrothion was the most effective residual compound among five insecticides tested in village scale trials, giving control for about 13 weeks at 2 g/m2. Because the target species rests largely on the lower portions of walls, when applied at 2 g/m2 to only one horizontal swath between 10 and 85 cm from the ground, this compound was effective for over two months, about one-third less than that found in full coverage applications. For a single application this selective method reduced the amount of insecticide by 65 percent and manpower by 43 percent, and three applications, to compensate for less residual effectiveness, will reduce insecticide use by about 50 percent and manpower by 15 percent, compared to two applications with full coverage. Further field investigations on application of insecticides and the ecology of the DDT-resistant vector continue to be needed in Central Java to reduce further the cost of residual sprayings in malaria control programmes. This review also suggests the possibility of other selective spraying methods and anti-vector methods applicable at the village level by the community.
A report was made of 4 cases of chloroquine resistant Plasmodium falciparum infections. The infections, detected in Jakarta, were imported from Kotabumi, Tanjung Karang, the Island of Pidada in the Lampung Province and from Pangkalpinang on the Island Bangka in the Province of South Sumatra. Treatment with courses of 1500 mg chloroquine base and with increased dosages up to 2250 mg base failed to cure the patients. The chloroquine sensitivity test in vitro was carried out in 3 patients, which showed that the Plasmodium falciparum strains were resistant to chloroquine at the R I level. The strains appeared to be similar to the Malaya Camp strain. In vivo observations revealed that the parasites were resistant at the R I level with a delayed recrudescence. The chloroquine resistant falciparum malaria cases, acquired in South Sumatra, may therefore be regarded as the first reported cases from a focus outside the already known two foci in Indonesia, namely East Kalimantan and Irian Jaya. It may be expected that chloroquine resistant Plasmodium falciparum will be encountered in other parts of Indonesia in the near future. The use of a combination of sulfadoxine and pyrimethamine should not be recommended in Indonesia because chloroquine is still considered the drug of choice against all malaria infections in Indonesia.