Progress towards malaria elimination in Sabang Municipality, Aceh, Indonesia.
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Child Survival and Development Cluster, UNICEF Indonesia Country Office, Jalan Sudirman Kav, 31, Wisma Metropolitan II, Fl 10th, Jakarta, 12920, Indonesia. hherdiana@unicef.org
Herdiana
H
Herdiana
Anis
A
Fuad
Puji Bs
PB
Asih
Siti
S
Zubaedah
Risalia Reni
RR
Arisanti
Din
D
Syafruddin
Hari
H
Kusnanto
Maria Endang
ME
Sumiwi
Titik
T
Yuniarti
Ali
A
Imran
Rahmadyani
R
Rahmadyani
Muhammad
M
Yani
Rita
R
Kusriastuti
Siti Nadia
SN
Tarmizi
Ferdinand J
FJ
Laihad
William A
WA
Hawley
D000818:Animals; D000852:Anopheles / Q000254:growth & development; D002947:Cities; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D016780:Malaria, Vivax / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D008853:Microscopy; D009032:Mosquito Control / Q000379:methods; D010963:Plasmodium falciparum / Q000302:isolation & purification; D010966:Plasmodium vivax / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D015995:Prevalence; D019371:Topography, Medical