LocationsA Breakthrough Initiative by UNDP and the Ministry of Health of Indonesia
In a notable step towards effective malaria detection, the United Nations Development Programme (UNDP) and the Ministry of Health of Indonesia has introduced the Malaria Slide Standard initiative, revolutionizing the accuracy of diagnosis and enhancing microscopic examinations. Malaria is a preventable and treatable disease. However, it remains a major public health problem in Indonesia. According to the World Health Organization (WHO), it caused an estimated 409,000 deaths globally in 2019. The WHO recommends a number of strategies to control and eliminate malaria, including early diagnosis and treatment of malaria cases. Indonesia, ranking as the second-largest contributor to malaria cases in Southeast Asia, with an estimated 800,000 cases in 2021, is set to benefit from this groundbreaking development.
Development and Collaboration
(Left to right) Hana Apsari Pawestri, M.Sc., Ph.D., Center for Health Systems Policy and Health Resources. Dr. Helen Dewi Prameswari, Head of Malaria Control Program. Siprianus Bate Soro, Head of Democratic Governance and Poverty Reduction Unit, UNDP Indonesia.
The UNDP, in partnership with the Ministry of Health of Indonesia, played a leading role in the creation of a significant initiative between 2022 and 2023. This initiative focused on the development of 20,000 standard slides aimed at enhancing the understanding and diagnosis of malaria in the region. Malaria is a widespread disease caused by the Plasmodium parasite, transmitted through the bites of infected mosquitoes.
The 20,000 standard slides represent a comprehensive resource designed to facilitate the identification and differentiation of various Plasmodium species. These species include falciparum, vivax, malariae, ovale, and knowlesi, which are the primary causative agents of malaria. Each species has distinct characteristics, and accurate identification is crucial for effective treatment and management of the disease.
The Process of Blood Slide Standardization
Examination of a malaria blood slide in a laboratory in Jayapura, Papua.
The initial step involves extracting a blood sample. The Ministry of Health, specifically the Center for Health Resilience Systems and Health Resources Policy Team (Pusat Kebijakan Sistem Ketahanan Kesehatan dan Sumber Daya Kesehatan), conducted the collection of blood samples across various locations in Aceh, Jakarta, Jayapura and Timika.
The choice of sampling locations is crucial to capturing the diverse landscape of malaria species. Jayapura was specifically selected due to the high prevalence of both falciparum and vivax, while Timika serves as the focus for ovale and malariae species. Aceh is designated for the detection of knowlesi, a species with its unique challenges, and Jakarta is chosen for negative samples. Specimen collection occurs in hospitals, community health centers, and through mass blood surveys (MBS), ensuring a comprehensive representation of the population.
Examination Activities
Examination of a blood smear under microscope.
Following specimen collection, the Center for Health Resilience Systems and Health Resources Policy Team engages in microscopic activities to identify and quantify parasites. The process commences with the creation of thick and thin blood smears, which are subsequently stained using Giemsa solution. After drying, expert microscopists conduct the crucial steps of parasite identification and calculation of parasite density. Standard slides are organized into predetermined compositions, facilitating systematic analysis.
The collected blood samples underwent microscopic activities, starting with thick and thin blood smears stained using Giemsa solution. Subsequently, identification and calculation of parasite density were carried out, followed by arranging the standard slides into predefined compositions.
Quality assurance was ensured through rigorous validation processes, including RT-PCR for 150 slides and validation by an ECCAM certified level-1 microscopist for 12.5% of the total slides. The evaluation encompassed species identification, presence or absence of gametocytes, and parasite density.
The final step involved applying a permanent label to each validated slide, complete with a barcode label for easy identification and traceability.
Contribution to Malaria Elimination by 2030
Indonesia has set an ambitious target for Malaria Elimination by 2030, aiming to break the chain of local transmission in specific areas. Strengthening malaria surveillance through accurate diagnoses is a pivotal aspect of this initiative. Microscopic malaria examination, considered the "gold standard," has faced challenges due to its low reliability, leading to misdiagnosis.
The Malaria Slide Standard emerges as a crucial tool in achieving the Malaria Elimination Program's success. By incorporating the slide standard in periodic training and test panels for microscopy, diagnostic accuracy receives a significant boost. This, in turn, supports the seamless implementation of the malaria elimination target by 2030.
In summary, the Malaria Slide Standard initiative marks a pivotal moment in Indonesia's fight against malaria, bringing forth a tool that promises not only accurate diagnoses but also strengthens the nation's resolve to eliminate malaria by 2030. With a sustained commitment, this initiative will enhance life quality and well-being for millions of people and leave no one behind.