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Nurse Ibu Noua (left) takes a blood sample from a child at a school in the village of Aneuk Laot in the Indonesian district of Sabang. The blood-testing programme, supported by UNICEF, aims to eliminate malaria in the district by targeting the whole population – not just people showing symptoms.
By Edward Carwardine
SABANG, Indonesia, 13 July 2010 – Mohamed Safrina, 22, has never suffered from malaria, but he knows it’s a dangerous illness. However, the labourer from Sabang, an island district off the north-west coast of Indonesia, is terrified of needles and a little apprehensive of the gloved nurse kneeling beside him.
Mohamed shuts his eyes and turns his head away from the nurse and the needle. The children in the room watch with fascination as the drops of crimson blood gather on a glass slide.
A few minutes later, it’s over. His sample is recorded and safely stored for transport back to the laboratory, a few kilometres from this village of Aneuk Laot, which has been the focus of this special malaria elimination campaign.
The campaign is targeting everyone in some 14 villages – a population of 24,000 people. Routine malaria testing only covers those demonstrating symptoms of the disease, but the current exercise sets out to ensure that no potential carrier is missed.
“We want to identify the human reservoirs of malaria and stop them passing on the disease,” explains local health worker Ibu Nazaria. “If someone is carrying the parasite, and is bitten by a mosquito again, that mosquito can pass on malaria to someone else in the same family, or same community.”
Testing and treatment
Because not everyone with malaria immediately displays the symptoms, or may not come forward for medical help, the risk of transmission can be high – but hunting the malaria parasite means that infected patients can receive treatment quickly, helping to eliminate the disease.
Amir Faisal drops staining agent onto a slide as part of a UNICEF-supported blood-testing programme that aims to eliminate malaria in the Indonesian district of Sabang. Any positive cases will receive free treatment within 24 hours.
“Using bed nets and spraying against mosquitoes all bring the caseload down to a low point – but at that stage you have to focus on finding the parasite and wiping it out before it can be transmitted again,” says UNICEF Malaria Officer Bill Hawley, who leads the organization’s malaria programme in Indonesia.
“Sabang is the first district in Indonesia to take on this approach, with a clear focus on tracing the parasite through universal testing, and then treating carriers before the disease can be spread by another mosquito,” he notes. “Ultimately, this is going to make malaria a thing of the past.”
‘Everyone wants to be healthy’
In Aneuk Laot the whole community is involved in the testing campaign. The team of six testers comes from the district, and includes a village volunteer, Saiful Bahri. His role is instrumental in securing the confidence of his neighbours and explaining why blood testing saves lives.
Ibu Suparni (centre) holds her newborn son while surrounded by other family members under an anti-malaria bed net in her home in Batee Shak village, in Indonesia's Sabang district.
“Everyone wants to be healthy,” he says. “In the team, I collect information from the villagers as they are tested. I find out what they need – like bed nets – and pass on information to the authorities. When someone from the community is involved, things are more organized, easier to manage.”
Saiful adds: “I can also help by ensuring people get proper advice and that they understand what malaria is. People used to think you could catch malaria from fruit like papaya. That’s why giving accurate information to the community is the real strength – people need to know that if they have the malaria parasite they will get sick again and again if not treated.”
Saiful is not medically trained. He is normally a daily labourer, whose income is now supplemented by the 200,000 rupiahs (approximately $20) monthly stipend that is provided to malaria volunteers in the district. It’s a small cost, considering the value that these volunteers bring to the initiative – not least in providing a trusted source of reassurance for local people.
Community volunteer Saiful Bahri wears an awareness t-shirt while talking to villagers in Aneuk Laot, Sabang district, Indonesia. Local volunteers are essential to spreading information about health issues, in this case a malaria-testing initiative.
“These volunteers are vital,” says team member Pak Hasballah, “especially for social mobilization, knowing where to find people, to identify who has been missed by the testers. And we have to reach everyone, as this is what builds confidence amongst the community.”
This team alone has tested 11,000 people in the last month, finding just nine positive cases. But Pak would like to see the initiative running on a regular basis.
“There are at least six malaria-endemic villages in the district that should be screened every three months,” he says. “We need to be more proactive if we are to stop malaria here.”
Malaria elimination is possible
The testing programme is showing results. Prior to 2005, there were an estimated 80 malaria cases for every 1,000 people in Sabang. After massive investments by organizations such as UNICEF, Care International and the Global Fund to Fight AIDS, Tuberculosis and Malaria – amongst others – that figure fell to 10 per 1,000 in 2009.
This year, the caseload has dropped even further to just 2 per 1,000. At this point, the shift in focus towards malaria elimination is of paramount importance.
Dr. Maria Meldi, a local government health official, is confident that elimination is possible.
“We organize public awareness campaigns about malaria every quarter, which result in a noticeable increase in the number of people coming to be tested,” she explains. “We have a programme of distributing bed nets for pregnant women and children, and we have plans next for malaria education in schools.”
The mass testing campaign is a model that could be introduced to other districts in the province. The Sabang initiative is being supported by UNICEF in the hope that its success – and the lessons learned from the experience – will encourage other areas to adopt the same approach, led by local government bodies.