Abstract
BackgroundIndonesia has set 2030 as its deadline for elimination of malaria transmission in the archipelago, with regional deadlines established according to present levels of malaria endemicity and strength of health infrastructure. The Municipality of Sabang which historically had one of the highest levels of malaria in Aceh province aims to achieve elimination by the end of 2013.MethodFrom 2008 to 2010, baseline surveys of malaria interventions, mapping of all confirmed malaria cases, categorization of residual foci of malaria transmission and vector surveys were conducted in Sabang, Aceh, a pilot district for malaria elimination in Indonesia. To inform future elimination efforts, mass screening from the focal areas to measure prevalence of malaria with both microscopy and PCR was conducted. G6PD deficiency prevalence was also measured.ResultDespite its small size, a diverse mixture of potential malaria vectors were documented in Sabang, including Anopheles sundaicus, Anopheles minimus, Anopheles aconitus and Anopheles dirus. Over a two-year span, the number of sub-villages with ongoing malaria transmission reduced from 61 to 43. Coverage of malaria diagnosis and treatment, IRS, and LLINs was over 80%. Screening of 16,229 residents detected 19 positive people, for a point prevalence of 0.12%. Of the 19 positive cases, three symptomatic infections and five asymptomatic infections were detected with microscopy and 11 asymptomatic infections were detected with PCR. Of the 19 cases, seven were infected with Plasmodium falciparum, 11 were infected with Plasmodium vivax, and one subject was infected with both species. Analysis of the 937 blood samples for G6PD deficiency revealed two subjects (0.2%) with deficient G6PD.DiscussionThe interventions carried out by the government of Sabang have dramatically reduced the burden of malaria over the past seven years. The first phase, carried out between 2005 and 2007, included improved malaria diagnosis, introduction of ACT for treatment, and scale-up of coverage of IRS and LLINs. The second phase, from 2008 to 2010, initiated to eliminate the persistent residual transmission of malaria, consisted of development of a malaria database to ensure rapid case reporting and investigation, stratification of malaria foci to guide interventions, and active case detection to hunt symptomatic and asymptomatic malaria carriers.
Highlights
Indonesia has set 2030 as its deadline for elimination of malaria transmission in the archipelago, with regional deadlines established according to present levels of malaria endemicity and strength of health infrastructure
Vector assessment Twenty-three adult Anopheles were collected during six nights of all night collections, including 11 An. aconitus, four Anopheles dirus, three Anopheles flavirostris, two An. sundaicus, one each of An. subpictus and An. minimus and one unidentified
In 2009, twenty microscopists active in the programme were tested by an expert team according to World Health Organization (WHO) guidelines; four of the Sabang microscopists tested as expert, three at reference, eight at advanced, and two at basic
Summary
Indonesia has set 2030 as its deadline for elimination of malaria transmission in the archipelago, with regional deadlines established according to present levels of malaria endemicity and strength of health infrastructure. Malaria is a major public health problem in most tropical countries, including Indonesia. Recent models estimate that over 105 million of Indonesia’s 239 million population are at risk for malaria infection, with transmission varying widely across this most populous entirely tropical country [1]. Though formally reported deaths are less than 1,000 annually [2], recent work estimates that about 11,000 people die annually due to infections with Plasmodium falciparum [3]. The most recent WHO estimate of the number of deaths due to malaria is approximately 3,000 per year in Indonesia [2]. In 2009, the Indonesian MOH explicitly made malaria elimination a national goal, to be accomplished in a step-by-step, island-by-island fashion over the several decades [4]
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