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The eastern region of Indonesia is endemic to malaria, a tropical parasitic infection that causes significant mortality. The Sustainable Development Goals (SDGs) encompass the global commitment to prevent and eliminate malaria by the end of 2030. Nevertheless, the biggest issue lies in the antimalarial drug resistance in Indonesia. Genetic polymorphism has been a considerable factor in the mechanism of antimalarial drug resistance of which could lead to inadequate activity of antimalarial drugs to undertake Plasmodium infection by several molecular mechanisms. Hence, first-line therapy for malaria in Indonesia such as dihydroartemisinin, piperaquine, and primaquine, becomes ineffective. However, the resistance is unavoidable. This review aims to summarize the genetic polymorphism possible mechanisms contributing to antimalarial resistance in the Indonesian population and to discuss the potential new antimalarial drug candidates., Competing Interests: All the authors declare that there are no conflicts of interest., (© 2023 The Author(s).)

Background: Development in Eastern Indonesia tends to be left behind compared to other Indonesian regions, including development in the health sector. The study aimed at analyzing the health insurance ownership disparities in hospital delivery in Eastern Indonesia., Methods: The study draws on secondary data from the 2017 Indonesia Demographic and Health Survey. The study population was women aged 15-49 years who had given birth in the last five years in Eastern Indonesia. The study analyzes a weighted sample size of 2299 respondents. The study employed hospital-based birth delivery as a dependent variable. Apart from health insurance ownership, other variables analyzed as independent variables are province, residence type, age group, marital status, education level, employment status, parity, and wealth status. The final stage analysis used binary logistic regression., Results: The results showed that insured women were 1.426 times more likely than uninsured women to undergo hospital delivery (AOR 1.426; 95% CI 1.426-1.427). This analysis indicates that having health insurance is a protective factor for women in Eastern Indonesia for hospital delivery. There is still a disparity between insured and uninsured women in hospital-based birth deliveries in eastern Indonesia. Insured women are nearly one and a half times more likely than uninsured women to give birth in a hospital., Conclusion: The study concludes that there are health insurance ownership disparities for hospital delivery in eastern Indonesia. Insured women have a better chance than uninsured women for hospital delivery., (© 2021. The Author(s).)

Background: Poor access to health care providers was among the contributing factors to less prompt and ineffective malaria treatment. This limitation could cause severe diseases in remote areas. This study examined the sub-national disparities and predictors in accessing anti-malarial drug treatment among adults in Eastern Indonesia., Methods: The study analyzed a subset of the 2018 National Basic Health Survey conducted in all 34 provinces in Indonesia. We extracted socio-demographic data of 4655 adult respondents diagnosed with malaria in the past 12 months in five provinces in Eastern Indonesia. The association between socio-demographic factors and the access to anti-malarial drug treatment was assessed using logistic regression., Results: Over 20% of respondents diagnosed with malaria within last 12 months admitted that they did not receive anti-malarial drug treatment (range 12-29.9%). The proportion of untreated cases was 12.0% in East Nusa Tenggara, 29.9% in Maluku, 23.1% in North Maluku, 12.7% in West Papua, and 15.6% in Papua. The likelihood of receiving anti-malarial drug treatment was statistically lower in Maluku (adjusted OR = 0.258; 95% CI 0.161-0.143) and North Maluku (adjusted OR = 0.473; 95% CI 0.266-0.840) than those in Eastern Nusa Tenggara (reference). Urban respondents were less likely to receive malaria treatment than rural (adjusted OR = 0.545; 95% CI 0.431-0.689)., Conclusions: This study found that there were sub-national disparities in accessing anti-malarial drug treatment in Eastern Indonesia, with a high proportion of untreated malaria cases across the areas. Findings from this study could be used as baseline information to improve access to anti-malarial drug treatment and better target malaria intervention in Eastern Indonesia., (© 2021. The Author(s).)

The genus Waminoa currently contains two described species, which each contains two types of endosymbiotic algae. Waminoa individuals are basically brown in body color, derived from these algal symbionts, and their body shape has been described as "discoid to obcordate". They have been found as associates of various anthozoans (Cnidaria) in the Indo-Pacific Ocean and the Red Sea. In order to reveal the diversity of the genus Waminoa and their hosts, we conducted phylogenetic and morphological analyses on acoelomate flatworms specimens collected from Japan, Palau and Indonesia. At least 18 Waminoa morphotypes were found on at least 20 anthozoan host species, and two specimens were found on species of two sea stars. Overall, there were two main body shapes of specimens; obcordate, as seen in W. litus and W. brickneri, and the other molar-like with an elongated body. These two body shapes each represented a separate clade in 18S rDNA and mitochondrial cytochrome c oxidase subunit 1 (COI) phylogenetic trees, with W. brickneri included in the obcordate subclade. Automatic Barcode Gap Discovery (ABGD) analyses on COI sequences of our specimens revealed the presence of at least five operational taxonomic units (OTUs). These five OTUs consisted of one large group of all obcordate animals, three OTUs consisting of one specimen each within the molar-like clade, and one large group of the remaining molar-like specimens. Both clades contain numerous morphotypes and were associated with a variety of hosts. Finally, based on genetic distances, the molar-like specimens are considered as an unnamed genus group separate from Waminoa, which needs to be clarified in future studies., (Copyright © 2019. Published by Elsevier GmbH.)

Classical swine fever has been negatively impacting pig production in Nusa Tenggara Timur province in eastern Indonesia since its introduction in the 1990s, with live market trade contributing to disease spread. To understand market trader knowledge and practices regarding pig management, biosecurity, pig movements and pig health (specifically CSF), a repeated survey was conducted with pig sellers and pig buyers at 9 market sites across West Timor and the islands of Flores and Sumba. A total of 292 sellers and 281 buyers were interviewed in 2009 during two periods (rounds), a high-demand month (September) and a low-demand month (November). Information was collected via questionnaire. The majority of traders were male (sellers: 89%; buyers: 87%) with the highest level of completed education being primary school (sellers: 48%; buyers: 41%). The primary occupation of most respondents was farming: 90% of sellers and 87% of buyers were smallholder pig farmers and tended to sell their own home-raised pigs at market (52%). Pigs were sold for monetary gain either for primary (52%) or extra income (44%). Markets tended to be selected based on a good reputation (62%), a location close to residence (62%) and having the desired pig type (59%). Pig sales through markets were reported to be highest from August to October with 31% of sellers trading pigs at two or more markets. Prices at market were significantly higher on Sumba compared to West Timor and cross-bred pigs were significantly more expensive than indigenous pigs. Understanding of CSF and biosecurity was limited: 85% of sellers and 83% of buyers had no prior knowledge of CSF. Fifty-four percent of sellers reported no use of any biosecurity practices at market. Most respondents (88%) were able to recognise at least one clinical sign of a sick pig. Informal pig movements were also identified: 18% of pig buyers purchased pigs directly from other farmers. This study has provided baseline information on market trader activities at live pig markets in NTT that can contribute to the formation of sustainable strategies for improving pig health. Since NTT is the poorest province in Indonesia and pigs play a vital socioeconomic role in this province, market management and farmer education is needed to improve the pig market chain and contribute to socioeconomic development., (Copyright © 2015 Elsevier B.V. All rights reserved.)

This article critically examines engagements of village leaders in an NGO-facilitated participatory conservation program in eastern Indonesia. It explores how the program's implementation strengthened leadership legitimacy of a dominant customary social group. Customary leaders ensured distribution according to particular norms, and in organizing village governance upheld specific interests and claims over natural resources. Villagers outside of the customary group remained marginalized in village governance, despite being important stakeholders. Findings reveal complex relationships between leaders and villagers that were strongly framed by orders of power and cultural history, which influenced how and to what extent peripheral groups participated. The case study concludes that village leaders can form effective avenues to deliver on conservation outcomes. However, in their preoccupation with maintaining leadership legitimacy, they may inadequately address dynamic intra-community tensions that could jeopardize long-term outcomes. Co-management partners can play significant roles in adapting management and prompting more inclusive governance processes.

The causes of maternal death are well known, and are largely preventable if skilled health care is received promptly. Complex interactions between geographic and socio-cultural factors affect access to, and remoteness from, health care but research on this topic rarely integrates spatial and social sciences. In this study, modeling of travel time was integrated with social science research to refine our understanding of remoteness from health care. Travel time to health facilities offering emergency obstetric care (EmOC) and population distribution were modelled for a district in eastern Indonesia. As an index of remoteness, the proportion of the population more than two hours estimated travel time from EmOC was calculated. For the best case scenario (transport by ambulance in the dry season), modelling estimated more than 10,000 fertile aged women were more than two hours from EmOC. Maternal mortality ratios were positively correlated with the remoteness index, however there was considerable variation around this relationship. In a companion study, ethnographic research in a subdistrict with relatively good access to health care and high maternal mortality identified factors influencing access to EmOC, including some that had not been incorporated into the travel time model. Ethnographic research provided information about actual travel involved in requesting and reaching EmOC. Modeled travel time could be improved by incorporating time to deliver request for care. Further integration of social and spatial methods and the development of more dynamic travel time models are needed to develop programs and policies to address these multiple factors to improve maternal health outcomes., Competing Interests: Conflict of Interest: The research was funded by Charles Darwin University and the authors have received no reimbursements, fees, funding or salaries from an organization that may gain from the publication of this paper. The authors have no competing financial or non-financial interests in the publication of this paper.

Knowledge of live animal movement through markets and from farm-to-farm is needed to inform strategies for control of trans-boundary animal diseases (TADs) in south-east Asia, particularly due to consumer preference for fresh meat. In eastern Indonesia a TAD of principal interest for control is classical swine fever (CSF) due to its impacts on smallholder farmers. Pig movement is considered a contributor to failure of current CSF control efforts but pig movement patterns are not well understood. This study investigated movement of live pigs in West Timor, Flores and Sumba islands during 2009-2010, with the aim of informing CSF control policies for Nusa Tenggara Timor province. A market survey of 292 pig sellers and 281 pig buyers across nine live pig markets and a farmer survey across 18 villages with 289 smallholder farmers were conducted and information collected on pig movements. The data obtained was used for social network analysis (SNA) on formal (via a market) and informal (village-to-village) movements using information on trading practices, source and destination locations, and the number of pigs being moved. Both inter- and intra-island movements were identified, however inter-island movement was only observed between Flores and Sumba islands. West Timor and Sumba had highly connected networks where large numbers of villages were directly and indirectly linked through pig movement. Further for West Timor, both formal and informal pig movements linked the capital Kupang, on the eastern end of the island to the western districts bordering East Timor connecting all five districts and demonstrating that informal movement transports pigs over distances similar to formal movement on this island. Sumba had a higher potential for pigs to move to a greater number of sequential locations across the entire island. Flores was found to have a more fragmented network, with pig movements concentrated in its eastern or western regions, influenced by terrain. Markets were confirmed as high-risk locations for the introduction and spread of disease, having over 20 contacts (based on in- and out-degree values) depending on operational day. Villages considered high-risk for CSF spread via informal movements were characterised by higher volume of pig exits and/or linkage to higher numbers of other villages. These findings demonstrate that informal movement (often related to cultural practices) can be extensive and the high level of connectivity dictates that control strategies for CSF and other highly transmissible diseases must be formulated at the provincial level and in collaboration with East Timor., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Pig farming is a common practice among smallholder farmers in Nusa Tenggara Timur province (NTT), eastern Indonesia. To understand their production systems a survey of smallholder pig farmers was conducted. Eighteen villages were randomly selected across West Timor, Flores and Sumba islands, and 289 pig farmers were interviewed. Information on pig management, biosecurity practices, pig movements and knowledge of pig health and disease, specifically classical swine fever was collected. The mean number of pigs per herd was 5.0 (not including piglets), and total marketable herd size (pigs≥two months of age) did not differ significantly between islands (P=0.215). Chickens (71%) and dogs (62%) were the most commonly kept animal species in addition to pigs. Pigs were mainly kept as a secondary income source (69%) and 83% of farmers owned at least one sow. Seventy-four percent (74%) of pigs were housed in a kandang (small bamboo pen) and 25% were tethered. Pig feeds were primarily locally sourced agricultural products (93%). The majority of farmers had no knowledge of classical swine fever (91%) and biosecurity practices were minimal. Forty-five percent (45%) reported to consuming a pig when it died and 74% failed to report cases of sick or dead pigs to appropriate authorities. Sixty-five percent (65%) of farmers reported that a veterinarian or animal health worker had never visited their village. Backyard slaughter was common practice (55%), with meat mainly used for home consumption (89%). Most (73%) farmers purchased pigs in order to raise the animal on their farm with 36% purchasing at least one pig within the last year. Predominantly fattener pigs (34%) were given as gifts for celebratory events, most commonly for funerals (32%), traditional ceremonies (27%) and marriages (10%). For improved productivity of this traditional low-input system, research incorporating farming training and improved knowledge on pig disease and biosecurity needs to be integrated with greater access to extension services., (Copyright © 2014 Elsevier B.V. All rights reserved.)