A patient with dengue hemorrhagic fever is treated at the Doris Sylvanus Regional General Hospital in Palangkaraya city, Central Kalimantan. The number of dengue fever patients in Central Kalimantan, mostly children, has gradually dropped, although it is still high.
JAKARTA, KOMPAS – Treatment costs and loss of productive time caused by dengue hemorrhagic fever (DHF) has put a burden on the national economy, despite the disease being preventable.
The high prevalence of dengue hemorrhagic fever (DHF) in Indonesia puts a burden on the national economy, despite the infectious disease being preventable through eradication of mosquito larvae. Policies to control the disease have yet to be effectively implemented.
Entering the transitional season, DHF becomes increasingly prevalent, leading to higher healthcare costs for its sufferers. Mojokerto, East Java, resident Haryono said that his 11-year-old child had to be treated at the Gatoel Hospital for DHF. Previously, he had taken his child to a community health center (Puskesmas) and another hospital, but their rooms were full.
He said he had to spend Rp 1 million (US$71.36) for inpatient facilities, medicines and other needs.
Despite a decreasing number of DHF cases in the past two years, the actual figure remains high. The Health Ministry records that 26,129 Indonesians caught the disease between January and February 23, 2019, with 226 patients dying. East Java, East Nusa Tenggara and West Java are the provinces with the highest number of DHF-related fatalities.
In the article “Economic Burden of Dengue in Indonesia” published in the PLOS Neglected Tropical Diseases journal on January 10, 2019, Mardiati Nadjib and colleagues of the University of Indonesia’s school of public health said that DHF put a burden of Rp 5.3 trillion (US$381.15 million) on the national economy in 2015.
The study found that there were 898,475 DHF sufferers receiving inpatient treatment and another 596,391 receiving outpatient treatment in 2015. In the same year, the Health Ministry recorded 129,650 DHF patients and 1,071 fatalities.
The cost covered inpatient and outpatient fees and other direct and indirect supporting expenses, including transportation, patient carers and loss of productivity. “The burden rises when the number of cases does,” Mardiati said in Jakarta on Monday (25/2/2019).
In order to shrink the number of DHF cases, it is necessary to control of the spread of Aedes aegypti mosquitoes and improve the recording of DHF cases in all public and private healthcare facilities.
Data collection
Proper data collection of DHF cases will boost disease control. The costs borne by the people, the government and the Healthcare and Social Security Agency (BPJS Kesehatan) can be reduced.
However, health data collection has yet to be undertaken effectively. In Mojokerto, for instance, the local health agency says that only 12 locals have caught DHF since the beginning of the year. Meanwhile, data from several local hospitals show that it is much more than that. For example, there are 20 DHF patients at the Sakinah Islamic Hospital, 17 at Gatoel Hospital and five at the regional general hospital. All are Mojokerto residents. The Mojokerto health agency could not be reached to confirm the data.
Despite its burden on the national economy, DHF control has not been optimal. Regions like Kediri, Cirebon and Palangkaraya only launch mosquito nests’ eradication initiatives when DHF cases have already been found. The head of the Cirebon regency health agency’s infectious disease control and prevention section, Sartono, said that locals often saw fogging as the ultimate problem solver.
Central Kalimantan health agency head Suyuti Syamsul said that the agency trained mosquito larvae controllers, known as jumantik, to familiarize the public with the eradication of mosquito nests. Currently, only seven out of 14 regencies and cities in the province have larvae controllers, making the eradication program non-comprehensive.
Jakarta has Regional Regulation No. 6/2007 on DHF Control, which stipulates DHF prevention and punishments for violating homeowners, including fines if mosquito larvae are found in their homes. However, the regulation has yet to be implemented.
The Health Ministry’s vector and zoonotic infectious disease prevention and control director Siti Nadia Tarmizi said that the eradication of mosquito nests, comprising draining and covering water containers, as well as recycling used materials, was effective in DHF control. Furthermore, one house ideally has one person trained in controlling mosquito larvae. However, this has yet to be implemented effectively.
DHF control awareness is reflected in the successful eradication of mosquito nests, as seen in the larvae-free percentage. If the larvae-free percentage is higher than 95 percent, DHF can be curbed. However, in monitoring from 1994 until today, the percentage has always been below target. The eradication of mosquito nests must be a comprehensive and consistent program.
