Background There is a high risk of Plasmodium vivax recurrence in patients treated for Plasmodium falciparum malaria in co-endemic areas. Primaquine radical cure has the potential to reduce P vivax recurrences in patients presenting with P falciparum as well as P vivax malaria but is undermined by poor adherence to the currently recommended 14-day regimen. We aimed to assess the efficacy and safety of supervised versus unsupervised primaquine radical cure in patients presenting with uncomplicated malaria.Methods We did a cluster-randomised, controlled, open-label superiority trial in Papua, Indonesia. 21 clusters of village health posts, matched by annual parasite index, were randomly assigned (1:1) to treat patients (age >12 months and body weight >5 kg) presenting with confirmed uncomplicated P falciparum or P vivax malaria with oral dihydroartemisinin-piperaquine plus either a supervised or unsupervised 14-day course of oral primaquine (0•5 mg/kg per day). Patients in the supervised group were supervised taking their primaquine dose on alternate days. Patients were followed-up for 6 months and those who presented again with malaria were retreated with the same drug regimen. Masking was not possible due to the nature of the study. The primary outcome was the incidence risk of P vivax malaria over 6 months, assessed in the modified intention-to-treat population (all patients who were assigned to a treatment group, excluding patients who were lost to follow-up after their first visit). This trial is now complete, and is registered with ClinicalTrials.gov, NCT02787070.

BackgroundAnaemia in children under five years old is associated with poor health, growth and developmental outcomes. In Papua, Indonesia, where the burden of anaemia in infants is high, we conducted a community survey to assess the association between Plasmodium infection, helminth carriage and the risk of anaemia.MethodsA cross sectional household survey was carried out between April and July 2013 in 16 villages in the District of Mimika using a multistage sampling procedure. A total of 629 children aged 1–59 months from 800 households were included in the study. Demographic, symptom and anthropometry data were recorded using a standardized questionnaire. Blood and stool samples were collected for examination.ResultsOf the 533 children with blood film examination, 8.8% (47) had P. vivax parasitaemia and 3.9% (21) had P. falciparum; the majority of children with malaria were asymptomatic (94.4%, 68/72). Soil transmitted helminth (STH) infection was present in 43% (105/269) of children assessed; those with STH were at significantly greater risk of P. vivax parasitaemia compared to those without STH (OR = 3.7 [95%CI 1.5–9.2], p = 0.004). Anaemia (Hb<10 g/dl) was present in 24.5% (122/497) of children and associated with P. vivax parasitaemia (OR = 2.9 [95%CI, 1.7–4.9], p = 0.001), P. falciparum parasitaemia (OR = 4.3 [95%CI, 2.0–9.4], p<0.001), hookworm carriage (OR = 2.6 [95%CI, 1.2–5.8], p = 0.026), Plasmodium–helminth coinfection (OR 4.0 [95%CI, 1.4–11.3], p = 0.008) and severe stunting (OR = 1.9 ([95%CI, 1.1–3.3], p = 0.012).ConclusionsAsymptomatic P. vivax and P. falciparum infections and hookworm all contribute to risk of paediatric anaemia in coendemic areas and should be targeted with prevention and treatment programs. The relationship between helminth infections and the increased risk of P. vivax parasitaemia should be explored prospectively.

Latar belakang. Risiko kematian pada anak dengan sindrom syok dengue (SSD) tinggi. Obesitas diduga sebagai faktor risiko SSD tetapi hasil penelitian sebelumnya masih kontroversial. Tujuan. Mengevaluasi overweight atau obes sebagai faktor risiko SSD pada anak. Metode. Penelitian case control pada anak (0-18 tahun) yang dirawat di RSUP Dr. Sardjito Yogyakarta dari bulan April 2012 sampai Maret 2015 dengan infeksi dengue, yang ditegakkan berdasarkan kriteria WHO 2011 dan hasil uji serologi darah atau NS1. Analisis statistik dikerjakan dengan analisis multivariat dan stratifikasi. Kemaknaan faktor risiko dilaporkan sebagai odds ratio (OR) dengan interval kepercayaan 95%. Hasil. Dilaporkan 264 anak terdiri dari 88 kasus (SSD) dan 176 kontrol (non SSD) diikutkan dalam penelitian ini. Anak dengan overweight atau obesitas mempunyai risiko SSD 2,29 kali dibanding bukan overweight atau obes (OR=2,29; IK95%:1,24-4,22) dan perempuan mempunyai risiko SSD 1,84 kali lebih tinggi dibanding laki-laki (OR=1,84; IK95%:1,08-3,14). Jumlah trombosit merupakan modifier, yaitu anak overweight atau obes dengan angka trombosit <20.000/µL mempunyai risiko 3,26 kali dibanding anak dengan SSD dengan overweight atau obes dengan angka trombosit ≥20.000/µL (OR=3,26; IK95%:1,22-8,72). Kesimpulan. Overweight atau obes dan jenis kelamin perempuan merupakan faktor risiko untuk SSD dan jumlah trombosit <20.000 /µL merupakan modifier. Sari Pediatri 2016;18(3):226-32Kata kunci: sindrom syok dengue, faktor risiko, overweight, obesitas, perempuan Nutritional Status as A Risk Factor for Dengue Shock SyndromeSarah Buntubatu, Eggi Arguni, Ratni Indrawanti, Ida Safitri Laksono, Endy P. Prawirohartono Background. Children with dengue shock syndrome (DSS) are at high risk for death. Obesity has long been considered as a risk factor for DSS. However, a number of studies found controversial results. Objective. To evaluate overweight or obese as a risk factor for DSS in children. Methods. We conducted a case control study in children (0-18 years old) who were admitted to Dr. Sardjito Hospital, Yogyakarta from April 2012 to March 2015 with dengue infection, which was confirmed by the 2011 WHO dengue clasification and the results of blood anti dengue serology or NS1. Statistical analysis was performed with multivariate analysis and stratification. The risk factor is presensted as odds ratio (OR) with 95% confidence interval (95% CI). Results. We included in the analysis 264 children, consisting of 88 cases (DSS) and 176 controls (non DSS). Overweight or obese children had a higher risk for DSS than those with normal nutritional status (OR=2.29; 95% CI 1.24 to 4.22), and girls had higher risk of DSS than boys (OR=1.84; 95%CI 1.08 to 3.14). We identified that platelet count was a modifier, in which overweight or obese children with platelet count <20,000/µL had higher risk for DSS (OR=3.26 95% CI 1.22 to 8.72) compared to overweight or obese children with platelet count ≥20,000/µL. Conclusions. Overweight or obese and girl are risk factors for DSS, whereas platelet...

Latar belakang. Infeksi dengue di daerah endemis dapat terjadi bersamaan dengan infeksi lain. Penelitian tentang infeksi dengue pada anak sudah banyak dilakukan, tetapi masih sedikit yang meneliti tentang kejadian sepsis pada sindrom syok dengue (SSD). Profil hematologi sebagai pemeriksaan yang mudah dilakukan, diharapkan dapat digunakan sebagai prediktor sepsis pada SSD. Tujuan. Mengetahui profil hematologi sebagai prediktor sepsis pada SSD. Metode. Penelitian kohort retrospektif pada anak usia 1 bulan-18 tahun yang diambil dari data rekam medis pasien SSD dengan sepsis maupun tidak sepsis dan dirawat di RSUP Dr. Sardjito mulai 1 Januari 2011-31 Desember 2014. Profil hematologi dan C-reactive protein (CRP) yang digunakan adalah pemeriksaan yang diambil saat pasien pertama kali masuk ke rumah sakit. Analisis statistik dikerjakan dengan analisis univariat, kemaknaan dengan Odds ratio (OR) dan interval kepercayaan 95% (IK95%). Hasil. Didapatkan 98 pasien yang memenuhi kriteria inklusi SSD, di antaranya 30 pasien SSD (30,6%) menderita sepsis. Tidak ada profil hematologi saat pasien pertama kali masuk rumah sakit menjadi prediktor sepsis pada SSD. Pemeriksaan kadar Hb (rerata 13,98±2,28 g/dL, p=0,897), hematokrit saat datang (rerata 40,5±6,6%; p=0,369), leukosit (median 5,68x 10 3 sel/µL; p= 0,619), trombosit (median 25,5x10 3 sel/µL; p=0,841). Pemeriksaan CRP dilakukan pada 40 pasien. Pasien SSD dengan sepsis 57,9% memiliki kadar CRP ≥6 mg/L signifikan lebih tinggi dibanding SSD tanpa sepsis (23,8%) dengan nilai p=0,028; OR 2,1 (IK95%: 1,1-3,9). Pemeriksaan biakan darah dilakukan pada 35 pasien, dengan biakan tumbuh pada 6 pasien DSS yang sepsis. Kesimpulan. Kadar CRP ≥6 mg/L berhubungan signifikan dengan kejadian sepsis pada SSD, sedangkan profil hematologi lain tidak. Sari Pediatri 2016;18(4):260-4