Mid-term evaluation of a pilot study of community participation for malaria control in West Timor, Indonesia

In general, the pilot project was proceeding according to plans. The provincial health authorities and the USAID direct hire personnel had done an outstanding job. It is expected that a great deal will be learned about approaches to involving villagers and the rural health delivery system in joint efforts to control malaria. The midterm status of major segments of the project is as follows: Training: Modules have been developed for Puskesmas (health center) physicians (training methods), village volunteers (recognition, treatment, and reporting of clinical malaria), and village inhabitants (malaria biology and control). Programs have been successfully implemented at each of these levels. Village Malaria Surveillance and Treatment: Volunteers have been trained and are functioning well in the villages selected for this activity. Support systems for this activity from the Puskesmas are working well with only minor problems in supplying drugs. Correlation of clinical symptoms and malaria parasitemias: Blood specimens are being collected from the three clinically defined groups of patients coming to selected health centers. Blood slides are being collected, stained and accurately examined. Some mid-course changes have been suggested for this part of the program, including: l) Adding two subPuskesmas to the blood specimen collecting program in order to have health center activities closer to study villages; 2) Increasing the number of subjects in the afebrile clinical group; 3) Recording parasites in positive blood smears in a more standard format; and 4) Recruiting an additional microscopist. Bed net study: Bed nets have been distributed and insecticide treatment schedules followed. Initial surveys indicate that the majority of villagers involved in this activity use the nets. Mosquito catches have been initiated in both experimental and control villages. Clearly village support for bed net use as a means of interrupting transmission can be developed and utilized. Evaluation of this effort will be difficult. Additional studies on vector identification and biology as well as evaluation technology will be required. (Author abstract)