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.
“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.”
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| “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.
Eliminating malaria
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.
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.
Indeed, it was Adelia who suffered the last case of
indigenous malaria among Sabang’s 30,000 inhabitants.
“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.  |
| Adelia - the last local case of malaria was tested for the second-most-common malaria parasite – malaria vivax in 2011.. Thanks to immediate and effective treatment, Adelia, who is now 9 years old, managed to recover fully. |
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.
