INTRODUCTION:

Malaria is a global life-threatening issue caused by the Plasmodium parasite and transmitted to humans through mosquito bites¹ the pathophysiology of malaria involves a complex life cycle of Plasmodium parasites, including liver and blood stages, which are responsible for clinical manifestations.

Provided a comprehensive overview of malaria’s etiology, parasite life cycle, clinical signs, diagnostic procedures, and complications, which are critical for understanding disease progression and designing effective interventions. Recent systematic studies have shown that housing modifications, including ventilation and insecticide-treated screens, can significantly reduce the risk of malaria transmission in high-endemic areas ^2,3. The World Health Organization (2023) reported that an estimated 249 million malaria cases occurred in 85 endemic countries in 2022, with an incidence rate of 58 per 1,000 people at risk. In 2019, there were 233 million global cases with an incidence of 57 per 1,000, which increased by 55% in 2022^4,5 also stated that in 2022, malaria caused 608,000 deaths and 249 million new cases. In Indonesia, according to the Ministry of Health⁶ the country had the second-highest number of cases in Asia in 2023(1.1 million cases). Furthermore, 86% of total malaria cases in Indonesia were concentrated in Papua, Central Papua, and South Papua. In 2021, there were 811,636 new malaria cases, with 89% of Indonesia’s malaria burden occurring in Papua.⁷

Malaria remains a public health issue as it continues to be one of the diseases that contribute to increased morbidity and mortality in the community. As a result, it has become a priority target in the Ministry of Health's strategic planning. The government's program aims for the complete elimination of malaria by the year 2030. The elimination process is being implemented in stages at the district/city, provincial, regional, and national levels. Historically, the government has been on track to meet this target. However, the elimination targets have been raised each year until the COVID-19 pandemic period. The targets included 285 malaria-free certified districts/cities in 2018, 300 in 2019, and 325 in 2020, with the goal of having no high-endemic areas in Indonesia. Most of the high-endemic areas are Located in Eastern Indonesia, which requires tailored social and cultural approaches. According to data, the number of confirmed malaria cases in 2023 reached 418,546(8) increasing from 250, 628 cases in 2020 and 226,364 cases in 2021. By the end of May, there were 66,042 cases, with the distribution as follows: Papua (60,534 cases), Nusa Tenggara (2,192 cases), Sumatra (1,061 cases), Kalimantan (959 cases), Sulawesi (792 cases), Maluku Islands (279 cases), and Java (225 confirmed cases) (Ministry of Health, Republic of Indonesia, 2021).

Data from the Provincial Health Office 2020, shows that Papua remains the largest contributor to malaria cases, with 216,380 cases reported across its 29 districts. Jayapura City recorded 28,648 cases, Keerom District 21,870 cases, Jayapura District 21,472 cases, and Sarmi District 14,627 cases. Notably, Mimika District reported the highest number of confirmed malaria cases, with a total of 31,383 cases. One of the health centers (Puskesmas) contributing the most malaria cases in Mimika District is Timika Health Center Mimika, 2023. Malaria control efforts in Mimika District are ongoing, carried out by the Mimika Health Office in collaboration with malaria stakeholders in an effort to achieve malaria elimination by 2026 four years ahead of the national target set for 2030. These efforts include public outreach, prevention measures, and malaria treatment interventions.

Initial observations and data collection revealed that the high incidence of malaria in Mimika District is attributed to several factors, including difficult-to-reach geographic areas, distance to healthcare facilities, lack of knowledge, individual behavior regarding consistent use of insecticide-treated bed nets, and suboptimal malaria management and treatment practices. This aligns with the statement from the Head of the Mimika Health Office in 2023, who indicated that one of the main causes of the high number of malaria cases in Mimika District is the lack of adherence to antimalarial medication, leading to recurring cases Mimika, 2023. This is consistent with the study by⁹ which highlights the crucial role of advancing antimalarial pharmacotherapy in both clinical malaria management and large-scale public health programs aimed at eliminating malaria transmission. In line with this, recent computational research has identified promising new antimalarial agents¹⁰ demonstrated through in silico modeling that pyrazoline derivatives exhibit strong potential as future antimalarial compounds, highlighting the growing role of computational methods in accelerating drug discovery against malaria.

One of the action plans for accelerating malaria elimination implemented in Mimika Regency and also part of a national initiative is the distribution of mosquito nets up to the year 2023. The nets distributed are Long-Lasting Insecticidal Nets (LLINs), which are effective in protecting the community from malaria transmission. These nets are treated with insecticides that are either incorporated into or coated onto the fibers of the netting. In addition to serving as a physical barrier against mosquitoes, the insecticidal activity within the nets can also kill mosquitoes through a knockdown effect (Ministry of Health of the Republic of Indonesia, 2020). However, traditional approaches such as insecticide-treated nets and indoor residual spraying need to be complemented with innovative interventions, such as the modification of ventilation screens, especially in areas where housing conditions are substandard^11,12

However, the use of mosquito nets has not been optimal because many community members do not use the distributed nets. In response to these limitations, modern pharmaceutical research is exploring advanced delivery systems and nanotechnology-based approaches for malaria control.¹³ highlighted that nanotechnology offers promising strategies to improve drug efficacy, enhance mosquito-targeted interventions, and overcome challenges faced by conventional malaria control tools. A preliminary study conducted through direct interviews with several individuals who tested positive for malaria, as well as with family members accompanying patients to a public health center (Puskesmas) in Mimika Regency between April 2021 and 2023, found that most respondents reported not using the mosquito nets provided by the health center. The main reason cited was that sleeping under the nets felt hot and stifling. Discomfort in using mosquito nets has also been reported in Tanzania and Uganda, where people preferred insecticide-treated window screens that do not disturb their sleep^14,15 Similar findings were reported¹⁶, who conducted a comparative meta-synthesis in African and Asian communities. They identified consistent barriers to malaria control interventions, including discomfort with mosquito nets, cultural resistance, and poor accessibility, emphasizing the need for locally adapted and socially acceptable strategies. This aligns with findings who stated that barriers to net use include discomfort during hot weather, sleeping patterns, and sensitivity to the insecticides used in the nets. Similarly,¹⁷ reported that mosquito nets were avoided due to feelings of suffocation, strong odors, and heat. Also found that nets were not used regularly only Occasionally and some people did not use them at all for similar reasons. Likewise, concluded that net usage remained suboptimal, as people frequently complained about feeling too hot and uncomfortable.

Another factor influencing the use of mosquito nets is improper maintenance. Observations revealed that some individuals used the nets for alternative purposes, such as covering plants on their home terraces, fishing, or simply storing them away unused. Among those who did use the nets, many never washed them, citing the inconvenience and time required to remove and reinstall the nets. Improper use of mosquito nets significantly affects malaria control efforts, as behavior plays a protective role in malaria prevention by acting as a barrier that cannot be penetrated by malaria vectors, thus preventing mosquito bites Ministry of Health, Republic of Indonesia, 2021. reported that insecticidal window curtains maintained their efficacy, with a 94% mosquito mortality rate even after 20 washes. Noted that some community members were unwilling to wash their mosquito nets. The use of insecticide-treated nets can be an effective method for preventing malaria transmission if supported by proper maintenance of the nets.

Suboptimal use and poor maintenance of mosquito nets can hinder the acceleration of malaria elimination efforts. Therefore, to support malaria control and eradication, appropriate innovations are needed to assist the government in expediting malaria elimination. One such innovation is to repurpose unused mosquito nets by modifying them into insecticidal ventilation curtains or window screens. This modification can not only increase usage but also make it easier to remove and clean. Furthermore, converting insecticide-treated nets into ventilation screens can improve their functionality and maintain their protective effect. A protocol study conducted in Côte d'Ivoire demonstrated the effectiveness of lethal house lures and EaveTubes in reducing malaria prevalence through modifications to house ventilation^18,7. One potential modification is transforming mosquito nets into ventilation mesh to optimize the use of insecticide-treated nets.¹⁹ stated that both the use of mosquito nets and wire mesh screens influence malaria incidence. Similarly, research by²⁰ found no association between mosquito net use and malaria Incidence, but did find a significant association between the use of window screens and reduced malaria cases.

Furthermore, converting insecticide-treated nets into ventilation screens can improve their functionality and maintain their protective effect. A comprehensive review by (21) emphasized that effective malaria control requires integrated strategies, including pharmaceutical interventions, vector control measures, and environmental modifications. Innovations at the household level such as modified ventilation systems are increasingly being recognized as essential components of sustainable malaria management. Based on the results of the preliminary study, the author is interested in conducting research on “The Effectiveness of Modified Insecticide-Treated Ventilation Screens Compared to Insecticide-Treated Bed Nets on Malaria Incidence in the Working Area of Timika Public Health Center, Mimika Regency.”

MATERIALS AND METHODS:

Study Design and Setting:

A pre-experimental post-test only design without a control group was employed to evaluate the impact of modified insecticide-treated ventilation screens. The study was conducted in the service area of Timika Public Health Center, Mimika Regency, Papua, Indonesia, during 2023. The mosquito nets used in this study were Long-Lasting Insecticidal Nets (LLINs), distributed by the Ministry of Health in 2023. These nets are made from polyester, polyethylene, or polypropylene, with insecticide embedded within the fibers and gradually released over a period of 4 to 5 years. The nets were cut and adjusted to fit the ventilation openings of each house. Data collection tools included structured questionnaires, observation sheets, and microscopes for malaria blood examination.

Participants and Sampling:

Population: All households with malaria cases within the Public Health Center's coverage area in 2023.

Sample: Thirty (n = 30) households were selected using total sampling based on these inclusion criteria:

1. Absence of insecticide-treated ventilation screens prior to the intervention

2. Presence of household ventilation openings

3. Documented history of malaria infection within the preceding 12 months

4. At least one first‑trimester pregnant woman or an infant/toddler per household

Intervention:

Modified insecticide-treated ventilation screens were installed in the ventilation openings of each selected household. Forty days post-installation, malaria incidence was evaluated.

Data Collection:

Data sources included:

Primary data:

Field observations conducted during site visits to all participating Households post-intervention.

Secondary data: Malaria Incidence records obtained from the Timika Public Health Center surveillance system.

The primary instrument was a structured questionnaire, previously validated using biserial correlation, and assessed for reliability via test–retest analysis on 30 non-sample households.

Instrument Validity and Reliability:

Validity: Examined using point biserial correlation coefficients; only items with r ≥ 0.30 were retained.

Reliability: Evaluated by Cronbach’s alpha; a value of α ≥ 0.70 was considered acceptable.

Data Analysis

Data we’re entered and analyzed in SPSS version 25.

Univariate analysis described sample characteristics and malaria incidence rates.

Bivariate analysis (e.g., chi-square test or Fisher’s exact test) assessed the association between the intervention and changes in malaria incidence.

A p-value < 0.05 was considered statistically significant.

Ethical Considerations:

This study complied with ethical standards and received approval from the KESBANGPOL (badan Kesatuan Bangsa dan Politik) and Health Office of Mimika Regency and All participating households provided written informed consent.

RESULT:

Univariate Analysis:

Table 1: Characteristics of Age, Number of Household Members, and Date of Installation of Modified Ventilation Screens

Characteristic		N=Sample	(%)
AGE	12-25 tahun 26-45 tahun 46-65 tahun	13 16 1	43,3% 53,3% 3,3%
AGE	Total	30	100%
Household Size	3 4 5 6	12 9 7 2	40% 30% 23.3% 6.7%
Household Size	Total	30	100%
Installation Date	3 januari 2023 4 Januari 2023 5 januari 2023	7 8 15	23.3% 26.7% 50%
Installation Date	Total	30	100%

Table 1 shows that the majority of respondents were aged between 26–45 years (53.3%). Most households had 3 occupants (40%), and the most frequent installation date for the modified ventilation screens was January 5, 2023.

Bivariate Analisys:

Table 2: The Association of Knowledge, Attitude, and Environmental Factors with Malaria Incidence

Karekateristik	Sample N=30	Pv
Knowledge & Malaria Incidence	30	0.004
Attitude & Malaria Incidence	30	0,014
Environment & Malaria Incidence	30	0,003

Table 2 indicates a significant association between Knowledge, Attitude, and Environmental factors and malaria incidence.

In table-3, the significance value was 0.000 (p < 0.05), indicating a statistically significant difference in malaria incidence before and after 7 months of intervention with the installation of modified insecticide-treated ventilation screens. The 95% confidence interval (CI) ranged from -0.901 to -0.565, which suggests with 95% confidence that the true mean difference in malaria incidence between the pre- and post-intervention periods lies within this interval.

Table 3: Angka Kejadian Malaria Sebelum dan Setelah Intervensi

Paired Samples Test
	Paired Differences					t	df	Sig. (2-tailed)
	Mean	Std. Deviation	Std. Error Mean	95% Confidence Interval of the Difference
				Lower	Upper
Malaria Incidence Before the Study- Malaria Incidence During the Study	-0.733	0.450	0.082	-0.901	-0.565	-8.930	29	0.000

This study was conducted in houses with residents who contracted Plasmodium vivax malaria in 2023 within the working area of Timika Public Health Center, Papua. Initially, the researchers obtained permission from the Regional Unity for Politics and Security (Kesbangpol) of Mimika Regency, followed by the Mimika District Health Office, and then the Timika Public Health Center. After coordinating with the Head of Timika Public Health Center, the research team liaised with the person in charge of malaria at the health center and subsequently with the malaria cadres. The researchers scheduled meetings with the malaria cadres to assist in the implementation of the study. Researchers and cadres aligned their understanding regarding the type of activities and the questions to be posed to the respondents. Malaria cadres were involved in the study because they have experience and are more familiar with the area and the houses selected as research samples. In Mimika Regency, malaria cadres act as extensions of the Public Health Center. These cadres are trained in how to provide proper malaria education to the community and how to perform malaria screening using Rapid Diagnostic Tests (RDT) at residents’ homes. Furthermore, the cadres collect malaria medication from the Public Health Center to distribute to community members diagnosed with malaria.

In this study, malaria cadres were responsible for providing malaria education to community members who had been diagnosed with malaria at the Public Health Center. The cadres then inspected the houses of residents meeting the study criteria, conducted measurements and counts of the patients’ home ventilation, and coordinated with the researchers. The researchers acted as observers and also evaluated the cadres’ activities. Before the cadres installed the modified insecticide-treated ventilation screens in the residents’ homes, the researchers first demonstrated how to properly measure and install the screens. The involvement of malaria cadres in the study greatly assisted the researchers. Moreover, the presence of cadres was appreciated by the community, as it eliminated the need for patients to visit the Public Health Center; instead, the cadres came directly to their homes. This aligns with findings from²² which stated that cadre-assisted home visits are an effective strategy in malaria elimination because they can improve community behavior in malaria prevention among patients and their families.

Table 1 shows that the majority of respondents in this study were aged 26-45 years (50%). Sampling was conducted according to inclusion criteria, where the sample consisted of houses with residents diagnosed with Plasmodium vivax malaria who had completed a 14-day course of antimalarial treatment. Based on observations by the researchers, most malaria patients in this age group are of productive age and still work outside the home. This finding aligns with a previous study by, which reported that among 412 respondents, the highest malaria incidence occurred in individuals aged 25 years and older. Furthermore, in this study, all respondent households with malaria had more than three occupants. Relating ²³ this to family theory, where a nuclear family typically consists of father, mother, and children, most of the houses in this study were occupied by nuclear families. However, observations also revealed that some respondent households included non-nuclear family members, leading to household sizes that did not correspond with the physical condition of the house, potentially influencing malaria incidence. This is consistent with previous research by²⁴, who studied 6,503 children, of whom 1,506 tested positive for malaria. They reported that the number of household members significantly affected malaria incidence, with an odds ratio (OR) of 1.10 (95% CI: 1.08–1.81). Similarly, a study by ²⁵ conducted in 62 villages with a total of 7,117 households, found that household size was associated with malaria incidence.

Table 2 presents the results measured by the researchers, including knowledge, attitude, and environment. Although these variables were not the primary focus of the study, the researchers attempted to analyze the results obtained from questionnaires. Similarly, (26) found that inadequate knowledge, poor attitudes, and ineffective malaria prevention practices among community members in Tamil Nadu were strongly associated with higher malaria incidence. Their study highlighted the importance of strengthening community-based education and behavioral interventions to reduce transmission. The results obtained from questionnaires administered to respondents, as well as from observations and interviews conducted during the study. Data analysis from the questionnaires revealed a significant relationship between knowledge and the incidence of malaria. Respondents’ knowledge was assessed through a malaria-related questionnaire that measured their awareness and understanding of malaria, its treatment, and prevention. The results showed that a considerable number of respondents had insufficient knowledge about malaria (p = 0.004). Educational interventions targeting youth populations have proven effective in improving malaria-related knowledge and attitudes²⁷ demonstrated that distributing booklet packages significantly enhanced adolescents’ understanding of malaria control and prevention, reinforcing the importance of continuous health education as part of community-based malaria elimination strategies. Indicated that the lack of knowledge among respondents was likely due to infrequent exposure to health education provided by healthcare workers. This finding is consistent with previous research by²⁸ in Arso District, Kerom Regency, involving 70 respondents, which demonstrated a significant influence of knowledge on malaria incidence (p = 0.001). Similarly,²⁹ conducted a study in East Africa with 431 households and reported that the age of respondents significantly affected their knowledge about malaria (p < 0.001). A study by³⁰ conducted in Mangalore assessed adult knowledge regarding malaria prevention using a descriptive survey approach. While some participants had adequate understanding of malaria transmission and prevention, the study revealed a notable gap in knowledge particularly related to vector control measures and early treatment-seeking behaviors. These findings are consistent with the present study, which also showed that inadequate knowledge significantly contributed to malaria incidence among respondents (p = 0.004). This highlights the urgent need for community-targeted health education as part of malaria prevention strategies.

An analysis of community attitudes and behaviors was also conducted to determine whether there is a relationship with the incidence of malaria. The results showed that attitude was significantly associated with malaria occurrence (p = 0.014). Attitude was measured using a validated questionnaire. The majority of respondents in this study exhibited poor attitudes. This unfavorable behavior was influenced by respondents’ habits, where most frequently engaged in activities outside the home after 5 PM and did not use the insecticide-treated bed nets provided. Additionally, two respondents reported allergic reactions to the Provided bed nets. Therefore, it can be concluded that attitude influences malaria incidence. This finding is consistent ²⁸ who reported that attitude significantly affects malaria occurrence (p = 0.008). Similarly, (17) and (31) in studies conducted at Timika Jaya Public Health Center, Mimika Regency, found that attitude had a significant effect on malaria incidence (p = 0.001). Habits related to bed net use also play an important role in malaria incidence. Interviews revealed that each family was provided with one bed net, but it was not used because of discomfort due to heat. According to the researchers, beyond personal dislike, the number of bed nets provided to patients was insufficient relative to the number of household members. Interviews found that some families consisted of six or more members who were not part of the nuclear family, resulting in an inadequate number of bed nets for all users. This finding aligns with ³² who reported that bed net utilization is influenced by the household member-to-net ratio, with households having fewer than two members per net showing increased risk (Adjusted Odds Ratio [AOR] = 1.6; 95% CI: 1.3–2.1).

The relationship between the environment and the incidence of malaria was assessed using a questionnaire. The analysis results indicated a strong association between environmental factors and malaria occurrence among respondents (p = 0.003). Observations and interviews conducted by the Researchers revealed that the incidence of malaria was influenced by residential locations situated in swampy areas. Most houses were found to be close to bushes, densely packed, near pools or stagnant water, and close to livestock pens. These environmental conditions are significant factors influencing malaria incidence, as they provide suitable breeding grounds for malaria mosquitoes. This finding aligns with³³ who in a meta-analysis reported that the presence of livestock pens was associated with increased malaria risk (Odds Ratio [OR] = 1.253; 95% Confidence Interval [CI]: 0.462–2.045), and that the use of bed nets reduced the risk of malaria infection (OR = 0.579; 95% CI: -0.212–1.370).

Table 3 presents the results of the variables studied. The results indicate that the use of insecticide-modified ventilation screens is effective in reducing the incidence of malaria in the working area of the Timika Health Center, as evidenced by a significant p-value (p = 0.000). Observations, interviews, and questionnaires revealed that most patients did not experience malaria, influenced by the intervention provided. According to respondents, they were assisted in remembering to take their medication through reminders from malaria cadres. Prior to the installation of the insecticide-modified ventilation screens, the cadres also provided education on proper maintenance, which contributed to reducing malaria incidence. This finding contrasts with³² who reported that education did not have a significant effect on malaria prevention.

The intervention was conducted by first inspecting the houses, measuring the ventilation, and then installing the modified insecticidal ventilation screens in the homes of malaria patients. These ventilation screens differ from conventional screens as they use Adhesive similar to that used for shoes. This adhesive design was intended to facilitate easier maintenance for the respondents. Based on interviews and evaluations conducted by the researcher, most respondents expressed great satisfaction and found the insecticide-modified ventilation screens helpful, especially for those who dislike using bed nets. Housing-based interventions, such as window screens and ventilation modifications, are considered more socially acceptable, particularly in communities that reject bed nets due to heat and allergies ³⁴ In addition to structural interventions, plant-based larvicidal agents have shown promising results in vector control.³⁵ demonstrated that Laggera alata extracts possess significant larvicidal activity against mosquito larvae, suggesting that natural phytochemicals can complement environmental modifications in integrated malaria control strategies. Additionally, the modified ventilation screens are easy to install. Such household innovations are crucial for sustainable vector control, especially in areas with resistance to traditional interventions ^4,15 When the screens become dirty, they can simply be removed and reinstalled. Analysis of data before and after the intervention shows that the use of ventilation screens significantly affects malaria incidence. This finding is supported by experimental studies in The Gambia and Tanzania, demonstrating that insecticide-treated house ventilation effectively reduces indoor temperature and malaria vector mosquito density ^{12, 11} Similarly, ²⁰ reported a significant association between the use of wire mesh screens and malaria incidence with an odds ratio (OR) of 5.7, while (19) reported an OR of 2.5.

CONCLUSION:

This study found that the use of insecticide-modified ventilation screens is effective in reducing the incidence of malaria among respondents.

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this investigation.

ACKNOWLEDGMENTS:

Mr. Johanes Retob, Head of the Malaria Centre of Mimika Regency, and Mrs. Imelda Ohoiledjaan, Malaria Coordinator, who provided the bed nets grant for modification. We also thanks Dr. Moses Untung, Head of Timika Health Center, Mrs. Indarayani, Malaria Coordinator, and Cadre Ema for facilitating and supporting the Malaria Cadres. Our appreciation also goes to the Malaria Cadres in the Timika Health Center working area for their assistance in sewing and installing the modified ventilation screens.

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Received on 10.07.2025 Revised on 13.08.2025

Accepted on 12.09.2025 Published on 03.11.2025

Available online from November 15, 2025

A and V Pub Int. J. of Nursing and Med. Res. 2025; 4(4):189-196.

DOI: 10.52711/ijnmr.2025.35

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