Malaria is one of the life threatening diseases for the people live in tropical and
sub-tropical area, especially infants, toddlers, child and pregnant women. Worldwide every year 500 millions cases are found all over the world which takes lives of 1 million people. According to the Survei Kesehatan Rumah Tangga (SKRT) 2001, 70 millions people live in malaria endemic area in Indonesia. Approximately 56,3 million of them live in the moderate to high endemic area with 15 million clinical malaria cases each year.
Malaria eradication program has been held for a long period of time, yet the
endemic area widen in the last couple years. Malaria outbreak even took place in the area that previously had overcome malaria. By the year 2003, malaria spread in 6053 villages in 226 municipals of 30 provinces. This condition worsened by the widening of chloroquine and even fansidar resistant area.
Malaria immunochrommatography test shows remarkable sensitivity and
specificity in diagnosing plasmodium antigenemia. This test is at least shows as good result as malaria microscopic examination by skillful microscopist. The advantage of the test is its ability to diagnose plasmodium antigen quickly and accurately. Another advantage is its ease of use that makes it possible to be carried out by everyone. This will be very useful for areas that lack of skillful microscopist.
Diagnostic test using immunochrommatography method has been developed
by Yayasan Hati Sehat West Nusa Tenggara Hepatitis Laboratory, Mataram to diagnose malaria and identify the Plasmodium species. The test has been helpful in diagnosing and treating malaria quickly and accurately and it might also facilitate to follow up of patient’s condition after administration of antimalarial drugs. This will enable doctors to give alternative treatment once they know that the treatment fails to bring the expected result. This innovation has started being applied by the School of Medicine, Mataram University in supporting malaria eradication program which is being carried out in the Sub districts of Jerowaru and Keruak, District of East Lombok. AIMS & GOALS Aims
• Breaking the malaria chain of transmission
• Enhancing the effectivity of malaria treatment
• Developing malaria surveillance system
Case detection using active case finding approach will be carried out by teams
called Juru Malaria Desa. They will trace the suspect in the village based on the clinical symptoms suffered by the suspect. They will also take blood smear of the suspect and, if possible, blood smears of inhabitants of five neighbouring houses around the suspect’s residence. This step will be followed by microscopic and immunochrommatographic examination in Puskesmas to detect the present of malaria antigen in the suspect’s blood. Case Management
Based on the result of the blood smear done in the previous step, the positive
results group will have another test to identify the Plasmodium species causing the disease, whether it is P falciparum, P vivax or mixed. The appropriate treatment will be given by doctor in the primary health care and private health care based on the specific Plasmodium species. The next step will be the identification of the efficacy and resistance of Plasmodium to the given antimalarial drugs. The result of the treatment will be monitored by blood smear and immunochrommatographic test several days after radical treatment. Prevention
Prevention will be done by controlling the vector of transmission.
Extermination of Anopheles mosquitoes will break the life cycle of the vector hence will control the transmission of disease. The vector control can be done by insecticides, natural predator of mosquitoes, like carper in river and lagoon, and minimizing the breeding places. Chemoprophylaxis drug will also act as a preventive measure. Surveillance
Surveillance is a continuous registration of malaria cases from time to time. It
can act as a mean of early detection of malaria outbreak. It can also be used in the evaluation of malaria eradication program in Lombok. Components
Components involved in the program are: 1) Local Community 2) Community leaders (particularly religious leaders) as the PROMOTOR of
3) Government through District Office of Health and “Puskesmas” (Center of
Community Health) as the RESPONSIBLE Institutions of the program
4) Academic Staff of the School of Medicine, Mataram University for the
RESEARCH & DEVELOPMENT of the program
5) Mass media and non-government organizations for the SOCIALIZATION &
ACTIVITIES Action Plan
The activities in the Malaria Eradication Program would be mainly based on
innovative collaboration of community, clinical and laboratory works. The first stage of the malaria eradication program is identification of the currently running activities of malaria eradication program in Jerowaru and Keruak Sub districts and building partnership with all components involved in the programs. Active case finding can be achieved by creating and training malaria cadres, and also by increasing the performance of Puskesmas as the primary health care. The next step is advocating the community and community leader to perform vector control. The following steps are socializing and advocating the community about the importance of the community involvement in the malaria eradication program. First Year Activities
In this malaria eradication program, the School of Medicine, Mataram
University received fund and diagnostic kits from Yayasan Hati Sehat West Nusa Tenggara Laboratory, Mataram; Vista Laboratory, Seattle, USA; and J. Mitra Laboratory, New Delhi, India. The innovative results achieved in the laboratory setting would be implemented in the community setting in this first year activities. The steps are:
1) Building partnership with District Office of Health, private practitioners,
local government official and community in malaria eradication program.
2) Active case finding by training paramedics in malaria examination and
Performing follow up to the positive group on 3rd, 7th, and 10th day after treatment to find the antigen persistence using immunochrommatographic test and to find the possibility of resistance.
Indicators of success • Annual Blood Examination Rate – ABER
• Slide Positive Rate–SPR and/or Immunochromatographic PositiveRate
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