Abstract
BackgroundSabang Municipality, in Aceh Province, Indonesia, plans to initiate a malaria elimination programme in 2013. A baseline survey of the distribution of malaria in the municipality was conducted to lay the foundations for an evidence-based programme and to assess the island’s readiness to begin the elimination process.MethodsThe entire population of the municipality was screened for malaria infection and G6PD deficiency. Specimens collected included blood slides, blots and tubes for selected households.Results and DiscussionSamples were collected from 16,229 residents. Microscopic examination of the blood smears revealed 12 malaria infections; 10 with Plasmodium falciparum and 2 with Plasmodium vivax. To confirm the parasite prevalence, polymerase chain reaction (PCR) diagnosis was performed on the entire positive cases by microscopy and randomized 10% of the microscopically negative blood samples. PCR revealed an additional 11 subjects with malaria; one P. falciparum infection from the village of Paya Keunekai, and nine P. vivax infections and one mixed P. falciparum/P. vivax infection from the village of Batee Shok. The overall slide positivity rate was 0.074% (CI 95%: 0.070 – 0.078) and PCR corrected prevalence 0,590% (CI 95%: 0.582 – 0.597). Analysis of 937 blood samples for G6PD deficiency revealed two subjects (0.2%) of deficient G6PD. Analysis of several genes of the parasite, such as Pfdhfr, Pfdhps, Pfmdr1, Pfcrt, Pfmsp1, Pfmsp2, Pvdhfr, Pvdhps, Pvmdr1 and host gene, such as G6PD gene revealed that both P. falciparum and P. vivax carried the mutation associated with chloroquine resistance.ConclusionMalariometric and host genetic analysis indicated that there is a low prevalence of both malaria and G6PD deficiency in the population of Sabang Municipality. Nevertheless, malaria cases were clustered in three rural villages and efforts for malaria elimination in Sabang should be particularly focused on those three villages.
Highlights
Sabang Municipality, in Aceh Province, Indonesia, plans to initiate a malaria elimination programme in 2013
The annual malaria incidences (AMI) of Sabang Municipality fell from 269 cases per 1,000 populations in 2001 to 33 cases per 1,000 populations in 2009, while the annual parasite incidence (API) fell from 101 cases in 2001 to 3 cases per 1,000 populations in 2009 [3]
The surveys covered 83.47% of the total inhabitants of the targeted survey areas and by microscopy 10 subjects were found with Plasmodium falciparum infection: seven from the village of Batee Shok, two from Paya Keunekai and one from Ie Meuleu
Summary
Sabang Municipality, in Aceh Province, Indonesia, plans to initiate a malaria elimination programme in 2013. A baseline survey of the distribution of malaria in the municipality was conducted to lay the foundations for an evidence-based programme and to assess the island’s readiness to begin the elimination process. Malaria remains a major public health problem in Indonesia, with 30 million cases and 120,000 deaths annually. Measures of annual parasite incidence (API) have varied substantially between provinces, but the highest API is consistently detected in the eastern parts of Indonesia. Aceh Province, Sumatera, is the western most point of the Malaria in Sabang has been documented by several previous surveys both before and after the 2004 tsunami that destroyed much of the coastal region in Aceh [1]. Measurement of the prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency using a colorimetric assay identified 0.8% subjects with less G6PD activity, and molecular analyses found Vianchang type G6PD deficiency mutation (Syafruddin, unpublished report)
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