Research

Malaria morbidity in Papua Indonesia, an area with multidrug resistant Plasmodium vivax and Plasmodium falciparum

Muhammad Karyana¹ , Lenny Burdarm² , Shunmay Yeung³ , Enny Kenangalem^2,4 , Noah Wariker^4,5 , Rilia Maristela⁵ , Ketut Gde Umana⁵ , Ram Vemuri⁶ , Maurits J Okoseray² , Pasi M Penttinen⁵ , Peter Ebsworth⁵ , Paulus Sugiarto⁷ , Nicholas M Anstey⁸ , Emiliana Tjitra¹ and Richard N Price^8,9

¹National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia

²District Health Authority, Timika, Papua, Indonesia

³Mahidol-Oxford Tropical Medicine Research Unit Faculty of Tropical Medicine Mahidol University, Bangkok, Thailand

⁴Menzies School of Health Research-National Institute of Health Research and Development Malaria Research Program, Timika, Indonesia

⁵Public Health Malaria Control, International SOS, Tembagapura, Papua, Indonesia

⁶Charles Darwin University, Darwin, NT, Australia

⁷Mitra Masyarakat Hospital, Timika, Indonesia

⁸International Health Division, Menzies School of Health Research, Darwin, Australia

⁹Centre for Vaccinology & Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, UK

author email corresponding author email

Malaria Journal 2008, 7:148doi:10.1186/1475-2875-7-148

Published:	2 August 2008

Abstract

Background

Multidrug resistance has emerged to both Plasmodium vivax and Plasmodium falciparum and yet the comparative epidemiology of these infections is poorly defined.

Methods

All laboratory-confirmed episodes of malaria in Timika, Papua, Indonesia, presenting to community primary care clinics and an inpatient facility were reviewed over a two-year period. In addition information was gathered from a house-to-house survey to quantify the prevalence of malaria and treatment-seeking behaviour of people with fever.

Results

Between January 2004 and December 2005, 99,158 laboratory-confirmed episodes of malaria were reported, of which 58% (57,938) were attributable to P. falciparum and 37% (36,471) to P. vivax. Malaria was most likely to be attributable to pure P. vivax in children under one year of age (55% 2,684/4,889). In the household survey, the prevalence of asexual parasitaemia was 7.5% (290/3,890) for P. falciparum and 6.4% (248/3,890) for P. vivax. The prevalence of P. falciparum infection peaked in young adults aged 15–25 years (9.8% 69/707), compared to P. vivax infection which peaked in children aged 1 to 4 years (9.5% 61/642). Overall 35% (1,813/5,255) of people questioned reported a febrile episode in the preceding month. Of the 60% of people who were estimated to have had malaria, only 39% would have been detected by the surveillance network. The overall incidence of malaria was therefore estimated as 876 per 1,000 per year (Range: 711–906).

Conclusion

In this region of multidrug-resistant P. vivax and P. falciparum, both species are associated with substantial morbidity, but with significant differences in the age-related risk of infection.