Risk of Agricultural Pesticide Exposure to Malaria Incidence and Anopheles Susceptibility at an Endemic Area in Central Java, Indonesia – A Case–control Study

BACKGROUND: Malaria is an infectious disease caused by Plasmodium sp. This disease often occurs in tropical countries and has sometimes been reported in agricultural countries. This vector-borne disease is associated with environmental factors and the presence of vectors. Some studies found that Anopheles is resistant to insecticide, and this topic was encouraged by the WHO for malaria control. AIM: This research aimed to explain the causal effects of agricultural pesticide exposure on malaria incidence and Anopheles susceptibility in an endemic area of Indonesia. METHODS: A case–control study was conducted between September and October 2016 in Purworejo, Central Java. The case group involved 131 individuals who had malaria in 2016 based on their medical records, whereas the control group comprised 131 individuals who were neighbors of the cases and never had a history of malaria. Cases were selected randomly from hospital medical records. Both case and control groups were interviewed using the same questionnaire, and data were analyzed using logistic regression. Insecticide susceptibility test was used to test the 80 mosquito samples collected from the neighborhood of recent malaria cases. RESULTS: The quantity of agricultural pesticide remains a potential health risk to malaria (odds ratio = 2.15; 95% confidence interval 1.000–4.638), which was adjusted by confounders (sex, resting place, and insecticide net). The susceptibility test indicated that Anopheles was resistant to both permethrin (86.25%) and bendiocarb (68.75%). CONCLUSIONS: The quantity of agricultural pesticide contributes as a risk factor to malaria incidences, and Anopheles was indicated to be resistant to bendiocarb in Purworejo, Central Java