March 24, 2014, 3:07 p.m.
By Nuraini Razak
An island once suffering from a record number of malaria cases has managed to eradicate all indigenous cases of the disease, which is a leading cause of death among children under age 5.
SABANG, Indonesia, 19 March 2014 – When Adelia’s fever simply did not go down, she was tested for the second-most-common malaria parasite – malaria vivax. That was in 2011. Thanks to immediate and effective treatment, Adelia, who is now 9 years old, managed to recover fully. But many others before her were not so lucky.
“On Sabang island, basically everyone had malaria at one point in their lives. We were so used to it,” Adelia’s mother, Rahmawati, explains. “But when it happens to one of your own children, I must say, I was terribly worried.”
“In 2008, we started working with UNICEF to eliminate malaria,” says Dr. Titik Yuniarti, Head of Communicable Disease Control in the district health office, “and today, we can claim that we no longer have any indigenous cases on the island.”
At one point, Batee Shok, the village Adelia and her mother call home in Aceh province, broke all records, with the highest number of malaria cases to be registered in a single village in Sabang.
Adelia was not yet born when the Indian Ocean tsunami hit Aceh province in 2004 and triggered a massive post-disaster response in the region, but the groundwork on implementing the malaria interventions that would one day save her life was soon to begin.
“After the tsunami, there was an increase in malaria cases in Sabang,” recalls Dr. Titik Yuniarti, Head of Communicable Disease Control in the district health office. “In 2008, we started working with UNICEF to eliminate malaria.”
Financial and technical support from UNICEF catalyzed greater government investment in controlling malaria and in enhancing health systems – and budget allocations from the local government have steadily increased. Reporting has improved among hospitals and private physicians, as has more rapid investigation of reported cases.
In addition to political commitment and community engagement, strict malaria surveillance by the local health department was essential. The local health office included each malaria case in a database, providing information on all possible aspects that may have influenced a person’s risk of exposure, including where he or she lived and whether there were habitats of Anopheles mosquito larva nearby.
Indeed, it was Adelia who suffered the last case of indigenous malaria among Sabang’s 30,000 inhabitants.These efforts have yielded enormous success. “[T]oday we can claim that we no longer have any indigenous cases on the island,” says Dr. Yuniarti.
“No one should die from a mosquito bite”
Community volunteers, trained by UNICEF, play a vital role in preventing spread of the disease. The volunteers go door-to-door to check on the health of residents and ask whether they are using their insecticide-treated bed nets correctly. A first line of defence against malaria, the nets are distributed by the local government with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria.
The volunteers also collect blood samples. Though the task has earned them the nickname “Dracula,” testing for malaria is critical to identify active cases of the disease, initiate timely treatments and prevent its further spread.
“I want malaria to be eliminated from my island,” says volunteer Srikayanti of Sabang. “It’s ridiculous; no one should die from a mosquito bite, especially no child.”
Three years ago, she made daily house calls for Adelia after she was diagnosed with malaria. Srikayanti wanted to make sure that Adelia fully adhered to her treatment – Artemisinin-based combination therapy – so that the malaria parasite could be fully removed from her system.
Saving more lives
Sabang’s significant gains have implications for saving more children like Adelia from this deadly disease.
The lessons learned in Sabang are now being applied in seven more districts in Aceh province – and have become a model for scaling up surveillance in other malaria-endemic regions throughout Indonesia.