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Open Access Research

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

Muhammad Karyana1, Lenny Burdarm2, Shunmay Yeung3, Enny Kenangalem24, Noah Wariker45, 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 Price89*

Author Affiliations

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

2 District Health Authority, Timika, Papua, Indonesia

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

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

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

6 Charles Darwin University, Darwin, NT, Australia

7 Mitra Masyarakat Hospital, Timika, Indonesia

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

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

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Malaria Journal 2008, 7:148  doi: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.