Progress towards malaria elimination in Sabang Municipality, Aceh, Indonesia

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.

A comprehensive assessment of the malaria microscopy system of Aceh, Indonesia, in preparation for malaria elimination

“…This study represents one of the few efforts to comprehensively document the readiness of a large administrative unit – in this case, the province of Aceh, Indonesia, with a population of 4.5 million people – to carry out the high quality diagnosis needed for malaria elimination. Thanks to large scale malaria control efforts including LLIN distribution, IRS, and roll-out of ACT in Aceh post-tsunami, the incidence of malaria has declined to the point where mapping and follow-up of individual cases known as “active” case surveillance for malaria elimination has become feasible [ 34 ]. However this is premised on a sufficiently robust and effective diagnostic network.…”

The Use of Artesunate Combination Therapy (Acts) and Long- Lasting Insecticidal Net (LLIN) in Low Endemic Area to Achieve Malaria Elimination in Indonesia

“…The Sabang situation after tsunami hit the area in 2005, the ACT already used in that area brought and introduced by international agencies but not recorded well, yet chloroquine still used for malaria treatment in many health facilities [21]. Followed National Policy for treatment in using ACT in 2008 as well a good data recording and reporting as well as mapping and active surveillance activities by VMV, it was observed a steady decreasing of malaria cases, either P. falciparum and or P. vivax.…”

“…The National Malaria Control Program goal was shifted toward malaria elimination in 2008 followed by shifted of treatment strategy from monotherapy to combination therapy used ACT [21]. This strategy was adopted and followed by all the malaria endemic areas throughout Indonesia.…”

The first evaluation of glucose-6-phospate dehydrogenase defciency (G6PD) gene mutation in malaria endemic region at South Central Timor (SCT) district, Eastern Indonesia 2014–2015

“…(1) producing a map of endemicity and foci of malaria, (2) assessing the feasibility of collaboration between communities and government, (3) developing a strategic plan for malaria control, (4) support from the district health office and legislative council, (5) developing an integrated working plan, (6) implementing the working plan, and (7) monitoring and evaluating the strategy and the progress made (Omumbo et al, 2005;Herdiana et al, 2013). 20 (80) 18 (40) 10 (40) Hutagalung et al…”