Assessing the Effectiveness of Community-Based Malaria Control Strategies in Papua: A Cluster Randomized Trial
Main Article Content
Abstract
Malaria remains a major public health challenge in tropical regions, particularly in Papua, Indonesia, where social, economic, and geographic disparities hinder effective disease control. Within this context, this study focuses on evaluating the effectiveness of community-based malaria control strategies using an experimental approach to understand their causal impact on prevention behaviors and disease incidence. Despite extensive public health campaigns, existing studies have rarely established direct causal relationships due to methodological limitations and lack of experimental control, leading to uncertainty about the actual effectiveness of community interventions. Here, we show through a cluster randomized controlled trial (RCT) involving 12 community clusters (N = 480 participants) that a structured community intervention significantly improved malaria prevention knowledge and compliance, resulting in a measurable reduction in malaria incidence. Our experimental design uniquely integrates behavioral, social, and epidemiological variables to isolate the causal impact of community empowerment initiatives, overcoming biases present in previous observational studies. The results indicate a substantial increase in knowledge (p < 0.001) and bed net usage (p = 0.002), accompanied by a 25% decline in malaria incidence in intervention clusters compared to controls, confirming the effectiveness of the experimental intervention model. These findings demonstrate that community engagement serves as a causal determinant of improved health outcomes, reinforcing the theoretical foundation of the Health Belief Model and Community Empowerment Theory. The study not only advances scientific understanding of malaria prevention strategies but also provides evidence-based guidance for policymakers to implement sustainable, community-driven health programs in endemic regions.
Article Details
Section
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Accrombessi, M., Cook, J., Ngufor, C., Sovi, A., Dangbénon, E., Yovogan, B., Akpovi, H., Ogouyèmi-Hounto, A., Thickstun, C., Padonou, G. G., Tokponnon, F., Messenger, L. A., Kleinschmidt, I., Rowland, M., Akogbéto, M. C., & Protopopoff, N. (2021). Assessing the efficacy of two dual-active ingredients long-lasting insecticidal nets for the control of malaria transmitted by pyrethroid-resistant vectors in Benin: Study protocol for a three-arm, single-blinded, parallel, cluster-randomized controlled trial. BMC Infectious Diseases, 21(1). Scopus. https://doi.org/10.1186/s12879-021-05879-1
Alkadir, S., Gelana, T., & Gebresilassie, A. (2020). A five year trend analysis of malaria prevalence in Guba district, Benishangul-Gumuz regional state, western Ethiopia: A retrospective study. Tropical Diseases, Travel Medicine and Vaccines, 6(1). Scopus. https://doi.org/10.1186/s40794-020-00112-4
Arlinda, S., Dewata, I., Yuniarti, E., & Firmansyah, Y. W. (2025). A Descriptive of Environmental Conditions in Stunting Case Areas in West Pasaman Regency with a Spatial Approach. Universal Journal of Public Health, 13(3), 616–626. Scopus. https://doi.org/10.13189/ujph.2025.130310
Badiane, A. S., Ndiaye, T., Thiaw, A. B., Binta, D. A., Diallo, M. A., Seck, M. C., Diongue, K., Garba, M. N., Ndiaye, M., & Ndiaye, D. (2021). High prevalence of asymptomatic Plasmodium infection in Bandafassi, South-East Senegal. Malaria Journal, 20(1). Scopus. https://doi.org/10.1186/s12936-021-03746-7
Cissoko, M., Sagara, I., Sankaré, M. H., Dieng, S., Guindo, A., Doumbia, Z., Allasseini, B., Traoré, D., Fomba, S., Bendiane, M. K., Landier, J., Dessay, N., & Gaudart, J. (2020). Geo-epidemiology of malaria at the health area level, dire health district, Mali, 2013–2017. International Journal of Environmental Research and Public Health, 17(11), 1–16. Scopus. https://doi.org/10.3390/ijerph17113982
de Sousa Pinto, L., Arroz, J. A. H., Martins, M. R. O., Hartz, Z., Negrao, N., Muchanga, V., Cossa, A., & Zulliger, R. (2021). Malaria prevention knowledge, attitudes, and practices in Zambezia Province, Mozambique. Malaria Journal, 20(1). Scopus. https://doi.org/10.1186/s12936-021-03825-9
Grossenbacher, B., Holzschuh, A., Hofmann, N. E., Omar, K. A., Stuck, L., Fakih, B. S., Ali, A., Yukich, J., Hetzel, M. W., & Felger, I. (2020). Molecular methods for tracking residual Plasmodium falciparum transmission in a close-to-elimination setting in Zanzibar. Malaria Journal, 19(1). Scopus. https://doi.org/10.1186/s12936-020-3127-x
Gusnedi, G., Fahmida, U., Witjaksono, F., Nurwidya, F., Mansyur, M., Hatma, R., Dwiriani, C. M., & Abdullah, M. (2022). Effectiveness of optimized food-based recommendation promotion to improve nutritional status and lipid profiles among Minangkabau women with dyslipidemia: A cluster-randomized trial. BMC Public Health, 22(1). Scopus. https://doi.org/10.1186/s12889-021-12462-5
Gwitira, I., Mukonoweshuro, M., Mapako, G., Shekede, M. D., Chirenda, J., & Mberikunashe, J. (2020). Spatial and spatio-temporal analysis of malaria cases in Zimbabwe. Infectious Diseases of Poverty, 9(1). Scopus. https://doi.org/10.1186/s40249-020-00764-6
Haileselassie, W., Parker, D. M., Taye, B., David, R. E., Zemene, E., Lee, M.-C., Zhong, D., Zhou, G., Setotaw, T., Tadele, G., Kazura, J. W., Koepfli, C., Deressa, W., Yewhalaw, D., & Yan, G. (2022). Burden of malaria, impact of interventions and climate variability in Western Ethiopia: An area with large irrigation based farming. BMC Public Health, 22(1). Scopus. https://doi.org/10.1186/s12889-022-12571-9
Ibrahim, A., Mańko, E., Dombrowski, J. G., Campos, M., Diez Benavente, E. D., Nolder, D., Sutherland, C. J., Nosten, F., Fernández, D., Velez-Tobón, G., Tobón-Castaño, A. T., Aguiar, A. C. C., Batista Pereira, D. B., da Silva Santos, S., Suárez-Mútis, M., Di Santi, S. M., Regina de Souza Baptista, A., Machado, R. L., Marinho, C. R. F., … Campino, S. (2023). Population-based genomic study of Plasmodium vivax malaria in seven Brazilian states and across South America. The Lancet Regional Health - Americas, 18. Scopus. https://doi.org/10.1016/j.lana.2022.100420
Ihyauddin, Z., Tengkawan, J., Anandhika Septisari, A., Eka Dewi, N., & Pambudi Karuniawaty, T. (2020). NUTRITIONAL AND DEVELOPMENTAL STATUS AMONG UNDER FIVE YEARS OLD CHILDREN IN TANJUNG KARANG, WEST NUSA TENGGARA. Media Gizi Indonesia, 15(3), 225–232. Scopus. https://doi.org/10.20473/mgi.v15i3.225-232
Kakilla, C., Manjurano, A., Zablon, K., Martin, J., Mashauri, F., Kinung’Hi, S. M., Lyimo, E., Mangalu, D., Bernard, L., Iwuchukwu, N., Mwalimu, D., Serbantez, N., Greer, G., George, K., Oxborough, R. M., & Magesa, S. M. (2020). Malaria vector species composition and entomological indices following indoor residual spraying in regions bordering Lake Victoria, Tanzania. Malaria Journal, 19(1). Scopus. https://doi.org/10.1186/s12936-020-03452-w
Lukole, E., Cook, J., Mosha, J. F., Messenger, L. A., Rowland, M., Kleinschmidt, I., Charlwood, J. D., Mosha, F. W., Manjurano, A., Wright, A., & Protopopoff, N. (2022). Protective efficacy of holed and aging PBO-pyrethroid synergist-treated nets on malaria infection prevalence in north-western Tanzania. PLOS Global Public Health, 2(10). Scopus. https://doi.org/10.1371/journal.pgph.0000453
McCann, R. S., Kabaghe, A. N., Moraga, P., Gowelo, S., Mburu, M. M., Tizifa, T., Chipeta, M. G., Nkhono, W., Di Pasquale, A., Maire, N., Manda-Taylor, L., Mzilahowa, T., van den Berg, H., Diggle, P. J., Terlouw, D. J., Takken, W., van Vugt, M., & Phiri, K. S. (2021). The effect of community-driven larval source management and house improvement on malaria transmission when added to the standard malaria control strategies in Malawi: A cluster-randomized controlled trial. Malaria Journal, 20(1). Scopus. https://doi.org/10.1186/s12936-021-03769-0
Mensah, B. A., Aydemir, O., Myers-Hansen, J. L., Opoku, M., Hathaway, N. J., Marsh, P. W., Anto, F., Bailey, J., Abuaku, B. K., & Ghansah, A. (2020). Antimalarial drug resistance profiling of Plasmodium falciparum infections in Ghana using molecular inversion probes and next-generation sequencing. Antimicrobial Agents and Chemotherapy, 64(4). Scopus. https://doi.org/10.1128/AAC.01423-19
Mensah, B. A., Myers-Hansen, J. L., Obeng Amoako, E., Opoku, M., Abuaku, B. K., & Ghansah, A. (2021). Prevalence and risk factors associated with asymptomatic malaria among school children: Repeated cross-sectional surveys of school children in two ecological zones in Ghana. BMC Public Health, 21(1). Scopus. https://doi.org/10.1186/s12889-021-11714-8
Metoh, T. N., Chen, J.-H., Fon-Gah, P., Zhou, X., Moyou-Somo, R., & Zhou, X.-N. (2020). Genetic diversity of Plasmodium falciparum and genetic profile in children affected by uncomplicated malaria in Cameroon. Malaria Journal, 19(1). Scopus. https://doi.org/10.1186/s12936-020-03161-4
Molina-de la Fuente, I., Pastor, A., Herrador, Z., Benito, A., & Berzosa, P. (2021). Impact of Plasmodium falciparum pfhrp2 and pfhrp3 gene deletions on malaria control worldwide: A systematic review and meta-analysis. Malaria Journal, 20(1). Scopus. https://doi.org/10.1186/s12936-021-03812-0
Mukhlis, L. (2025a). A Phenomenological Study of Personal Spiritual Experiences in Navigating Religious Pluralism within Interfaith Communities. Irfana: Journal of Religious Studies, 1(6), 212–220.
Mukhlis, L. (2025b). Spiritual Grounds for Economic Growth: A Qualitative Exploration of Rural Indonesian Women’s Transformative Journeys Through Mosque-Led Empowerment Programs. Servina: Jurnal Pengabdian Kepada Masyarakat, 1(8), 289–298.
Mukhlis, L., & Abdullah, M. N. (2025). Hukum Keluarga Islam di Indonesia (1st edn). Mukhlisina Revolution Center.
Mukhlis, L., Arifin, T., Ridwan, A. H., & Zulbaidah. (2024). Integrating Artificial Intelligenceand Maqāṣid al-Syarī‘ah: Revolutionizing Indonesia’s Sharia Online Trading System. Computer Fraud and Security, 2024(11), 301–309. https://doi.org/10.52710/cfs.238
Mukhlis, L., Arifin, T., Ridwan, A. H., & Zulbaidah. (2025). Reorientation of Sharia Stock Regulations: Integrating Taṣarrufāt al-Rasūl and Maqāṣid al-Sharī‘ah for Justice and Sustainability. Journal of Information Systems Engineering and Management, 10(10s), 58–66. https://doi.org/10.52783/jisem.v10i10s.1341
Mukhlis, L., Arifin, T., Ridwan, A. H., Zulbaidah, Rosadi, A., & Solehudin, E. (2025). Reformulation of Islamic Stock Law: The Application of Taṣarrufāt al-Rasūl and Maqāṣid al-Syarī‘ahto Develop a Dynamic and Sustainable Islamic Capital Market in Indonesia. Journal of Posthumanism, 5(3), 1–13. https://doi.org/10.63332/joph.v5i3.913
Mukhlis, L., Janwari, Y., & Syafe`i, R. (2023). INDONESIA STOCK EXCHANGE: THEORETICAL AND PHILOSOPHICAL ANALYSIS OF MUDHARABAH AND MUSYARAKAH CONTRACTS. Yurisprudentia: Jurnal Hukum Ekonomi, 9(2), 243–264. https://doi.org/10.24952/yurisprudentia.v9i2.8466
Mukhlis, L., Maryam, S., & Sormin, S. A. (2023). Model Pembelajaran Living History Berbasis PjBL Untuk Meningkatkan Keterampilan Histografi Mahasiswa. Jurnal Educatio FKIP UNMA, 9(4), 1800–1809. https://doi.org/10.31949/educatio.v9i4.5595
Mukhlis, L., & Saidah, Y. (2025). Dynamics of Nature-Based learning in Developing Children’s Motoricic Skills: Teacher and Parent Perspectives. HUMANISMA: Journal of Gender Studies, 9(1), 64–79. http://dx.doi.org/10.30983/humanisme.v4i2.9366
Mukhlis, L., Suradi, Janwari, Y., & Syafe`i, R. (2023). Sosialisasi Saham Syariah sebagai Instrumen Pengembangan Ekonomi Masyarakat di Badan Kontak Majelis Taklim (BKMT) Kabupaten Mandailing Natal. Jurnal Pengabdian Multidisiplin, 3(2), 2–9. https://doi.org/10.51214/japamul.v3i2.604
Nguyen-Hoang, L., Dinh, L. T., Tai, A. S. T., Nguyen, D.-A., Pooh, R. K., Shiozaki, A., Zheng, M., Hu, Y., Li, B., Kusuma, A., Yapan, P., Gosavi, A., Kaneko, M., Luewan, S., Chang, T.-Y., Chaiyasit, N., Nanthakomon, T., Liu, H., Shaw, S. W., … Shimokawa, O. (2024). Implementation of First-Trimester Screening and Prevention of Preeclampsia: A Stepped Wedge Cluster-Randomized Trial in Asia. Circulation, 150(16), 1223–1235. Scopus. https://doi.org/10.1161/CIRCULATIONAHA.124.069907
Niman, S., Firmansyah, Y. W., Ajie, W. T. S., Parulian, T. S., & Sinaga, F. (2025). A Health Behaviour Knowledge Reinforcement Model to Improve Healthy Living Knowledge in Semi-Urban Communities, Primary Health Dayeuhkolot, Bandung Regency, Indonesia: A Quasi Experimental Study Susanti. Universal Journal of Public Health, 13(4), 1040–1047. Scopus. https://doi.org/10.13189/ujph.2025.130426
Oxlade, O., Benedetti, A., Adjobimey, M., Alsdurf, H., Anagonou, S., Cook, V. J., Fisher, D., Fox, G. J., Fregonese, F., Hadisoemarto, P., Hill, P. C., Johnston, J., Ahmad Khan, F. A., Long, R., Nguyen, N. V., Nguyen, T. A., Obeng, J., Ruslami, R., Schwartzman, K., … Richard (Dick), D. (2021). Effectiveness and cost-effectiveness of a health systems intervention for latent tuberculosis infection management (ACT4): A cluster-randomised trial. The Lancet Public Health, 6(5), e272–e282. Scopus. https://doi.org/10.1016/S2468-2667(20)30261-9
Paintain, L., Hill, J., Ahmed, R., Umbu Reku Landuwulang, C., Ansariadi, A., Rini Poespoprodjo, J., Syafruddin, D., Khairallah, C., Burdam, F. H., Bonsapia, I., ter Kuile, F. O., & Webster, J. (2020). Cost-effectiveness of intermittent preventive treatment with dihydroartemisinin-piperaquine versus single screening and treatment for the control of malaria in pregnancy in Papua, Indonesia: A provider perspective analysis from a cluster-randomised trial. The Lancet Global Health, 8(12), e1524–e1533. Scopus. https://doi.org/10.1016/S2214-109X(20)30386-7
Palmizal, A., Ihsan, F., Kurniawan, A., & Pratiwi, A. S. (2025). Development of an evidencebased physical fitness planning program for sustainable health outcomes in urban and rural populations – a systematic review. Fizjoterapia Polska, 2025(1), 159–169. Scopus. https://doi.org/10.56984/8ZG007DE9BO
Paratmanitya, Y., Helmyati, S., Nurdiati, D. S., Lewis, E. C., Gittelsohn, J., & Hadi, H. (2021). The effect of a maternal mentoring program on the timing of first antenatal care visit among pregnant women in Bantul, Indonesia: Results of a cluster randomized trial. Health Promotion Perspectives, 11(3), 307–315. Scopus. https://doi.org/10.34172/hpp.2021.39
Praet, N., Asante, K. P., Bozonnat, M.-C., Akite, E. J., Ansah, P. O., Baril, L., Boahen, O., Mendoza, Y. G., Haine, V., Kariuki, S., Lamy, M., Maleta, K., Mungwira, R., Ndeketa, L., Oduro, A., Ogutu, B., Olewe, F., Oneko, M., Orsini, M., … Pirçon, J.-Y. (2022). Assessing the safety, impact and effectiveness of RTS,S/AS01E malaria vaccine following its introduction in three sub-Saharan African countries: Methodological approaches and study set-up. Malaria Journal, 21(1). Scopus. https://doi.org/10.1186/s12936-022-04144-3
Rudasingwa, G., & Cho, S.-I. (2020). Determinants of the persistence of malaria in Rwanda. Malaria Journal, 19(1). Scopus. https://doi.org/10.1186/s12936-020-3117-z
Runge, M., Molteni, F., Mandike, R., Snow, R. W., Lengeler, C., Mohamed, A., & Pothin, E. (2020). Applied mathematical modelling to inform national malaria policies, strategies and operations in Tanzania. Malaria Journal, 19(1). Scopus. https://doi.org/10.1186/s12936-020-03173-0
Touré, M., Kéita, M., Kane, F., Sanogo, D., Kanté, S., Konaté, D., Diarra, A., Sogoba, N., Coulibaly, M. B., Traoré, S. F., Alifrangis, M., Diakite, M., Shaffer, J. G., Krogstad, D. J., & Doumbia, S. (2022). Trends in malaria epidemiological factors following the implementation of current control strategies in Dangassa, Mali. Malaria Journal, 21(1). Scopus. https://doi.org/10.1186/s12936-022-04058-0
Wardika, I. J., Azizah, A., Wildana, F., Taplo, Y. M., & Wartakusumah, R. (2025). Community-Based Intervention for Type 2 Diabetes Management in Developing Countries: A Systematic Review. Jurnal Keperawatan Indonesia, 28(2), 68–83. Scopus. https://doi.org/10.7454/jki.v28i2.1494