Abstract. We surveyed adults in a randomly selected sample of 1,000 households in 50 villages in nine malarial sub-districts in Purworejo, central Java, Indonesia from May to July 2001. The survey assessed malaria knowledge, attitudes, and practices in communities experiencing epidemic malaria to begin exploring broad strategies for controlling the disease in the region. A pre-tested survey instrument consisting of 93 questions addressed demographic characteristics, socioeconomic factors, knowledge and perceptions of malaria, burden and severity of disease, treatment-seeking behavior, malaria prevention practices, and perceptions of government malaria control efforts. The survey was taken by in-person interview of all subjects. Most (97%) subjects were aware of malaria and more than two-thirds correctly identified mosquitoes as the vector. Forty-one percent of households in both forest/hilly and agricultural/urban areas reported malaria illness in the past year. Thirty-six percent (357 households) owned at least one bed net, 92% of these had been purchased by the owners. However, only 36% of households with bed nets affirmed their use as a means of preventing malaria. Nearly all respondents reported a willingness to accept spraying of residual insecticides for malaria prevention, yet less than 5% were willing to pay a nominal fee (US $3) for this service. Fifty-two percent of respondents reported self-treatment of malaria illness without visiting a health facility. This assessment of knowledge, attitudes, and practices showed a broad awareness of malaria and its consequences among residents of malarial areas in the Menoreh Hills of Central Java.

A recent malaria epidemic in the Menoreh Hills of Central Java has increased concern about the re-emergence of endemic malaria on Java, which threatens the island's 120 million residents. A 28-day, in-vivo test of the efficacy of treatment of malaria with antimalarial drugs was conducted among 167 villagers in the Menoreh Hills. The treatments investigated, chloroquine (CQ) and sulfadoxine-pyrimethamine (SP), constitute, respectively, the first- and second-line treatments for uncomplicated malaria in Indonesia. The prevalence of malaria among 1389 residents screened prior to enrollment was 33%. Treatment outcomes were assessed by microscopical diagnoses, PCR-based confirmation of the diagnoses, measurement of the whole-blood concentrations of CQ and desethylchloroquine (DCQ), and identification of the Plasmodium falciparum genotypes. The 28-day cumulative incidences of therapeutic failure for CQ and SP were, respectively, 47% (N = 36) and 22% (N = 50) in the treatment of P. falciparum, and 18% (N = 77) and 67% (N = 6) in the treatment of P. vivax. Chloroquine was thus an ineffective therapy for P. falciparum malaria, and the presence of CQ-resistant P. vivax and SP-resistant P. falciparum will further compromise efforts to control resurgent malaria on Java.

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