The malaria control process
Malaria Control
While there are substantial resources being deployed to fight malaria on a global level, it remains a terrible problem. Health agencies have great difficulty delivering services to remote communities. Effective anti-malarial drugs supplied by The Global Fund sit in boxes at the regional hospital in Sumbawa while just over the mountain pregnant mothers and their children needlessly suffer repeated bouts of malaria during the rainy season. In such communities some 20% of children either die from malaria or are permanently disabled by it before reaching the age of 10. As a result, economic and social development are stunted while thousands of villagers suffer from treatable or preventable diseases. Health Access Sumbawa has been addressing this unmet need since 2015.
Malaria is an infectious disease caused by Plasmodium parasites which are spread by the bite of infected female Anopheles mosquitos. There are four main types of Plasmodium (P) species that infect humans, two of which, P. vivax and P. falciparum, are endemic to Eastern Indonesia. Severe malaria, primarily caused by P. falciparum, is life-threatening.
Currently, there is no vaccine available for malaria, though research is underway. Despite that, all developed countries and a growing number of developing countries have eliminated malaria by implementing prevention measures (insecticide spraying, insecticide –treated bed nets, screens on windows and doors), rigorous protocols for monitoring every incident of infection, and universal access to malaria diagnosis - treatment.
70% of Indonesian’s already live in low infection areas, primarily on the densely populated islands of Java and Bali. Indonesia has made a commitment to be malaria-free by 2030. Most of eastern Indonesia is still endemic with malaria. The 2030 goal will not be achieved without a stepped –up effort to reach remote, under-served communities.
Diagnosis of malaria involves examining blood smear slides under a microscope to identify the parasite. These tests are currently the "gold standard" for malaria detection and identification. They require examination by a trained analyst. When microscopy is not available, rapid diagnostic tests (RDT) are commonly used. These tests detect malaria antigens in a sample of a person's blood and indicate a positive result by a color change on the testing strip. They deliver a reading quicker, require less training, but are more expensive and less reliable than microscopy. They are not suitable for mass-screening of populations due to the high cost and lack of availability of bulk quantities.
There was no malaria control program on the north coast of Cempi bay when HAS began its work in 2015. Our first step was to meet with community leaders to gain support and organize volunteers. We take a complete village census and affix metal numbers to the outside of every home so patients can be tracked. A team of community volunteers then goes house -to-house, delivering and hanging treated bednets. We provide enough nets so 100% of the population has protection from mosquitoes while they sleep. The bednets, as with all our programs, are provided to the public at no cost.
In 2016 HAS built a laboratory and health clinic in Sili village so medical staff could competently diagnose & treat malaria. HAS sent two health department staff for training at The Sumba Foundation Malaria School . They became the first-ever WHO certified malaria microscopists in Sumbawa.
The HAS malaria control technique focuses on elimination of the parasite from the human population through a program of universal screening and effective treatment, thereby rendering the vector mosquito harmless. This eliminates the requirement for insecticide spray, with obvious environmental, health, and cost reduction benefits.
Our clinic currently employs three part time nurses and an administrator. The goal of controlling malaria in three off-the-grid hamlets within three years was accomplished in November 2017, protecting 1,000 people.
Scaling Up Our Malaria Control Program
HAS Triples its Bed Net Program +/- $16,500
In 2019-2020 we took a major step toward eliminating malaria in 3 towns called Mata, Panco & Tolo’oi. These communities are adjacent to the area we have been serving since 2015. Mata is the largest village. 1,500 people / 350 homes. In November 2019 we completed the census, numbered every home, and covered every bed in Mata with long lasting treated bed nets.
In December the HAS Team hung nets in Panco, a small roadless hamlet one hour boat ride from our clinic. Tolo’oi received nets and house number plates in February 2020. Tolo’oi has 852 residents / 292 homes.
Without a vaccine, malaria control is a battle that never The original 600 bednets we placed 5 years ago are in tatters today. These will have to be replaced in November 2022, before the start of the next rainy season, at a cost of about $6,000 for the materials alone. We have won the battle against malaria, but the war goes on.
Lots More To Do
Expanding Our Service Area
We run our own programs In our primary service area, the dark blue area on the map below. This covers an area within 1 hour from our clinic. We provide consulting and make grants to change-makers in a much larger area, primarily within the bright green area on the map. However, our influence is not limited to Sumbawa. We have sponsored worthy public health, nutrition, and education initiatives as far away as the island of Bali, a one hour flight to the west.
