Background Malaria control activities can have a disproportionately greater impact on Plasmodium falciparum than on P . vivax in areas where both species are coendemic. We investigated temporal trends in malaria-related morbidity and mortality in Papua, Indonesia, before and after introduction of a universal, artemisinin-based antimalarial treatment strategy for all Plasmodium species. Methods and findings A prospective, district-wide malariometric surveillance system was established in April 2004 to record all cases of malaria at community clinics and the regional hospital and maintained until December 2013. In March 2006, antimalarial treatment policy was changed to artemisinin combination therapy for uncomplicated malaria and intravenous artesunate for severe malaria due to any Plasmodium species. Over the study period, a total of 418,238 patients presented to the surveillance facilities with malaria. The proportion of patients with malaria requiring admission to hospital fell from 26.9% (7,745/28,789) in the pre–policy change period (April 2004 to March 2006) to 14.0% (4,786/34,117) in the late transition period (April 2008 to December 2009), a difference of −12.9% (95% confidence interval [CI] −13.5% to −12.2%). There was a significant fall in the mortality of patients presenting to the hospital with P . falciparum malaria (0.53% [100/18,965] versus 0.32% [57/17,691]; difference = −0.21% [95% CI −0.34 to −0.07]) but not in patients with P . vivax malaria (0.28% [21/7,545] versus 0.23% [28/12,397]; difference = −0.05% [95% CI −0.20 to 0.09]). Between the same periods, the overall proportion of malaria due to P . vivax rose from 44.1% (30,444/69,098) to 53.3% (29,934/56,125) in the community clinics and from 32.4% (9,325/28,789) to 44.1% (15,035/34,117) at the hospital. After controlling for population growth and changes in treatment-seeking behaviour, the incidence of P . falciparum malaria fell from 511 to 249 per 1,000 person-years (py) (incidence rate ratio [IRR] = 0.49 [95% CI 0.48–0.49]), whereas the incidence of P . vivax malaria fell from 331 to 239 per 1,000 py (IRR = 0.72 [95% CI 0.71–0.73]). The main limitations of our study were possible confounding from changes in healthcare provision, a growing population, and significant shifts in treatment-seeking behaviour following implementation of a new antimalarial policy. Conclusions In this area with high levels of antimalarial drug resistance, adoption of a universal policy of efficacious artemisinin-based therapy for malaria infections due to any Plasmodium ...

fThe 4-aminoquinoline naphthoquine (NQ) and the thiazine dye methylene blue (MB) have potent in vitro efficacies against Plasmodium falciparum, but susceptibility data for P. vivax are limited. The species-and stage-specific ex vivo activities of NQ and MB were assessed using a modified schizont maturation assay on clinical field isolates from Papua, Indonesia, where multidrugresistant P. falciparum and P. vivax are prevalent. Both compounds were highly active against P. falciparum . Stage-specific drug susceptibility assays revealed significantly greater IC 50 s in parasites exposed at the trophozoite stage than at the ring stage for NQ in P. falciparum (26.5 versus 5.1 nM, P ‫؍‬ 0.021) and P. vivax (341.6 versus 6.5 nM, P ‫؍‬ 0.021) and for MB in P. vivax (10.1 versus 1.6 nM, P ‫؍‬ 0.010). The excellent ex vivo activities of NQ and MB against both P. falciparum and P. vivax highlight their potential utility for the treatment of multidrug-resistant malaria in areas where both species are endemic.

h Chloroquine (CQ) has been the mainstay of malaria treatment for more than 60 years. However, the emergence and spread of CQ resistance now restrict its use to only a few areas where malaria is endemic. The aim of the present study was to investigate whether a novel combination of a CQ-like moiety and an imipramine-like pharmacophore can reverse CQ resistance ex vivo. Between March to October 2011 and January to September 2013, two "reversed chloroquine" (RCQ) compounds (PL69 and PL106) were tested against multidrug-resistant field isolates of Plasmodium falciparum (n ‫؍‬ 41) and Plasmodium vivax (n ‫؍‬ 45) in Papua, Indonesia, using a modified ex vivo schizont maturation assay. The RCQ compounds showed high efficacy against both CQ-resistant P. falciparum and P. vivax field isolates. For P. falciparum, the median 50% inhibitory concentrations (IC 50 s) were 23.2 nM for PL69 and 26.6 nM for PL106, compared to 79.4 nM for unmodified CQ (P < 0.001 and P ‫؍‬ 0.036, respectively). The corresponding values for P. vivax were 19.0, 60.0, and 60.9 nM (P < 0.001 and P ‫؍‬ 0.018, respectively). There was a significant correlation between IC 50 s of CQ and PL69 (Spearman's rank correlation coefficient [r s ] ‫؍‬ 0.727, P < 0.001) and PL106 (r s ‫؍‬ 0.830, P < 0.001) in P. vivax but not in P. falciparum. Both RCQs were equally active against the ring and trophozoite stages of P. falciparum, but in P. vivax, PL69 and PL106 showed less potent activity against trophozoite stages (median IC 50 s, 130.2 and 172.5 nM) compared to ring stages (median IC 50 s, 17.6 and 91.3 nM). RCQ compounds have enhanced ex vivo activity against CQ-resistant clinical isolates of P. falciparum and P. vivax, suggesting the potential use of reversal agents in antimalarial drug development. Interspecies differences in RCQ compound activity may indicate differences in CQ pharmacokinetics between the two Plasmodium species.

World Health Organitation (WHO) dalam Global Tuberculosis Report 2016 menyatakan bahwa Indonesia dengan jumlah penduduk 254.831.222, menempati posisi kedua dengan beban Tuberkulosis (TB) tertinggi di dunia setelah India. Menurut data dan informasi profil kesehatan Indonesia 2016 yang dikeluarkan oleh kementrian kesehatan RI pada Maret 2017. Jumlah kasus baru TB paru BTA positif tahun 2016 tercatat 156.723. Di Kabupaten Kuningan persoalan TB merupakan persoalan tingkat wilayah penemuan kasus case detection rate (CDR) mencapai 45,38% telah menyebar hingga 32 Kecamatan. Angka keberhasilan pengobatan yaitu 88,4% (2016). Tujuan penelitian ini untuk mengetahui peran Pengawasan Minum Obat (PMO) terhadap keberhasilan pengobatan TB paru dan mengetahui tingkat keberhasilan pengobatan TB  dengan adanya PMO. Jenis penelitian ini menggunakan survey analitik dengan pendekatan studi retrospektif. Tempat penelitian adalah Kecamatan Maleber yang dilaksanakan pada 1 – 30 Juni 2018 dengan jumlah sampel pasien TB sebanyak 41 orang. Pengumpulan data dilakukan dengan kuisioner dan dokumentasi data pengobatan pasien TB dari puskesmas Maleber untuk mengetahui pengaruh peranan PMO terhadap keberhasilan pengobatan pasien TB paru. Dari hasil penelitian ini didapat nilai p value 0,792 (p > 0, 05) maka H0 diterimadan H1ditolak yang berarti ada pengaruh peranan PMO terhadap keberhasilan pengobatan pasien TB paru. Untuk mencapai target Kementrian Kesehatan “Indonesia Bebas TB Tahun 2050” diperlukan kerjasama yang baik antara petugas kesehatan, pengawas minum obat, masyarakat, puskesmas dan Dinas kesehatan