Indonesia: Regencies improve sanitation systems to combat snail fever

Ruslan Sangadji, The Jakarta Post 4 Mar 16;

The Central Sulawesi provincial administration has set up an integrated team, directly led by Governor Longki Djanggola, to implement programs to deal with schistosomiasis, also known as snail fever.

One of the programs is to improve sanitation systems by constructing toilets on the Lindu Plain, where the dangerous worms are often found. The construction is part of a nation-wide one-million-toilet campaign to encourage residents to stop defecating in the open.

Schistosomiasis is a disease caused by parasitic worms belonging to the schistosoma genus and carried by freshwater snails. There are three types found in humans: Schistosoma japonicum, Schistosoma haematobium and Schistosoma mansoni.

In Indonesia, Schistosoma japonicum is endemic in Central Sulawesi, especially on the Lindu and Napu plains in Sigi and Poso. The number of people at risk of contracting schistosomiasis is 15,000.

The head of the provincial health agency, Ansayari Arsyad, said that although there was no medicine to cure the disease that was available in Indonesia, regular fever treatment in community health centers (Puskesmas) and hospitals had worked well.

“We have also distributed boots and will hand some more to local residents as a preventive measure,” he said.

Ansayari said that in Poso, the worms could be found in six districts: East Lore, Lore Peore, Central Lore, South Lore, North Lore and West Lore. While in Sigi regency, he said, the disease was found in five subdistricts on the Lindu Plain.

Ansayari said his agency had cooperated with the Poso and Sigi regency health agencies to conduct a survey in the relevant subdistricts to find more effective eradication measures of the schistosomiasis worms.

He added that an eradication effort last year had been successful in reducing the incidence rate of the disease in Poso to 1.39 percent and in Sigi to 0.7 percent.

“We have the target of reaching an incidence rate of zero percent this year.”

Separately, Longki said that his administration had also conducted various efforts to prevent the spread of snail fever, including assigning a special team to examine the disease-endemic regions.

Research on schistosomiasis in Indonesia began in 1940, following the finding of schistosomiasis cases in Tomado subdistrict, Lindu plain, Kulawi district, Sigi regency, in 1935.

The research found that 53 percent of 177 residents tested positive after researchers found the worms in the feces sample.

Data at the provincial health agency show that in 1972 a new endemic area of the disease was found in Napu valley, Poso regency. Ever since, snail fever continues to increase in the region.

Health Minister Nila Djuwita F. Moeloek said recently during a meeting in Palu to discuss measures to deal with the disease that the disease had attracted attention from the international health communities.

She said that she supported all programs to combat the disease, requesting local authorities to continuously disseminate information to the people on the danger of open defecation that could cause the fever.

Schistosomiasis starts with the hatching in water of Schistosoma japonicum eggs, called mirasidium, which penetrate the bodies of snails and develop into sporokista I and II, before becoming serkaria.

The serkaria will later swim in the water in search of a new host and they can survive in stagnant water for 48 hours before finding new places to grow.

Serkaria could infect 13 mammals including humans, deer, cats, hog deer, cows, horses and buffalo. Serkaria infects humans through the pores and enters the blood stream before laying eggs in the intestines.

Symptoms of snail fever include coughing and swelling of the stomach. The disease needs an incubation period of 20 years before killing a human sufferer.

The most dangerous scenario, according to Ansyari, was when serkaria reached the liver, where it could grow into adult worms. When the worms lay eggs, they make holes in the walls of the intestine and cause sufferers to defecate blood.