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Open Access Highly Accessed Case study

Progress towards malaria elimination in Sabang Municipality, Aceh, Indonesia

Herdiana Herdiana1*, Anis Fuad2, Puji BS Asih3, Siti Zubaedah4, Risalia Reni Arisanti1, Din Syafruddin3, Hari Kusnanto2, Maria Endang Sumiwi13, Titik Yuniarti5, Ali Imran5, Rahmadyani Rahmadyani6, Muhammad Yani6, Rita Kusriastuti4, Siti Nadia Tarmizi4, Ferdinand J Laihad1 and William A Hawley1*

Author Affiliations

1 Child Survival and Development Cluster, UNICEF Indonesia Country Office, Jalan Sudirman Kav. 31, Wisma Metropolitan II, Fl 10th, Jakarta, 12920, Indonesia

2 Faculty of Medicine, University of Gadjah Mada, Yogyakarta, Indonesia

3 Eijkman Institute for Molecular Biology, Jalan Diponegoro, 69, Jakarta, 10430, Indonesia

4 Ministry of Health, Directorate of Vector Borne and Zoonotic Diseases, Jakarta, Indonesia

5 Municipal Health Authority of Sabang, Jalan By Pass Cot Ba’U, Sabang, Province of Aceh, Indonesia

6 Provincial Health Authority of Aceh Province, Banda Aceh, Aceh Province, Indonesia

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Malaria Journal 2013, 12:42  doi:10.1186/1475-2875-12-42

Published: 30 January 2013

Abstract

Background

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. 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.

Method

From 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.

Result

Despite 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.

Discussion

The 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.

Keywords:
Malaria control; Malaria elimination; Sabang municipality; Aceh; Indonesia