Margie Mason – More than a year after the tsunami swallowed thousands of lives and homes in Indonesia, many survivors still lack of basic health and sanitation needs despite billions of dollars in disaster aid, a new study found.

Children and those living on the remote island of Simeulue – located closest to the epicenter of the Dec. 26, 2004 earthquake – remained most vulnerable, while access to clean drinking water and proper sanitation continued to be poor in some areas, according to the study published Friday by the US Centers for Disease Control and Prevention.

The survey was conducted last July and August in three districts of Aceh province. It found that 40 percent of the stored drinking water sampled was contaminated and half of the children under 5 years old were anemic, while about 75 percent of school-age children surveyed on Simeulue island and in Aceh Besar district were infected with intestinal parasites.

Dr. Endang Widyastuti, who overseas aid group CARE International's medical programs in Indonesia and participated in the joint study with the CDC, said many of the findings were not surprising, and that awareness and intervention campaigns are in the works.

"For the worm infection, it is no wonder," she said, referring to the many who remain homeless. "These cases in Banda Aceh and Simeulue, it's no wonder because of the (poor) access to toilets and the environment."

Access to toilets was lacking on Simeulue, with more than 50 percent of households without facilities, the survey found.

Widyastuti said a de-worming campaign is planned and that mothers in Banda Aceh and Aceh Besar districts are being encouraged to breast feed to help lessen anemia. A measles vaccination campaign will also be conducted after the findings showed poor coverage from an earlier push.

On Simeulue, where malnutrition was highest, Widyastuti said logistics likely played a role. More than 90 percent of the households surveyed received some type of food aid, and more than half also received nutritional supplements.

But she said distribution that came in the first months following the tsunami trailed off because aid workers' efforts were diverted elsewhere. Simeulue lost only a handful of its 75,000 people to the waves, largely because most residents ran to the hills after the 9.0-magnitude earthquake because of stories passed down about a tsunami that occurred there a century ago.

The bulk of the more than 131,000 people who died in Indonesia were in the provincial capital, Banda Aceh, but Simeulue lost the most homes – more than 80 percent were partially or completely destroyed by the tsunami or by the earthquake that rocked neighboring Nias island last March.