Early and late mortality after malaria in young children in Papua, Indonesia

Patriani, Dewi; Arguni, Eggi; Kenangalem, Enny; Dini, Saber; Sugiarto, Paulus; Hasanuddin, Afdhal; Lampah, Daniel A.; Douglas, Nicholas M.; Anstey, Nicholas M.; Simpson, Julie A.; Price, Ric N.; Poespoprodjo, Jeanne Rini

doi:10.1186/s12879-019-4497-y

Cited by 23 publications

(26 citation statements)

References 27 publications

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“…The former plays an important role in both the direct and indirect mortality of P. vivax. In a cohort of children from Vanuatu, infection with P. vivax, but not P. falciparum, was a major predictor of acute malnutrition [32], and our previous analyses in Papua Indonesia have shown that malnourished children with P. vivax are at high risk of both acute and delayed mortality [2,9,21].…”

Section: Discussionmentioning

confidence: 82%

“…Previous studies have demonstrated that recurrent episodes of malaria are associated with an increased cumulative risk of anaemia, malnutrition and sepsis [9,20,21]. To explore the relationship between multiple episodes of malaria and morbidity and mortality, we used multi-state modelling to investigate how recurring episodes of malaria influence the risks of re-presentation to hospital, all-cause hospital admission and all-cause death following an initial presentation to hospital with malaria infection in Papua, Indonesia.…”

Section: Discussionmentioning

confidence: 99%

“…The differential impact of malaria control activities on the two species is likely due to the inadequate radical cure of P. vivax and prevention of multiple relapses [3]. Young children are at particularly high risk of recurrent vivax infection and associated morbidity and mortality [9].…”

Section: Discussionmentioning

confidence: 99%

“…Papua, the most easterly province of Indonesia, is coendemic for both P. falciparum and P. vivax malaria. In this region, antimalarial drug resistance has emerged in both species, and the local population is at significant risk of recurrent malaria [6][7][8][9]. The aim of this study was to determine the impact of recurrent hospital presentations on the risks of hospital admission and death.…”

Section: Introductionmentioning

confidence: 99%

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The risk of morbidity and mortality following recurrent malaria in Papua, Indonesia: a retrospective cohort study

Dini

Douglas

Poespoprodjo

et al. 2020

BMC Med

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Background: An acute episode of malaria can be followed by multiple recurrent episodes either due to reinfection, recrudescence of a partially treated parasite or, in the case of Plasmodium vivax or P. ovale, relapse from the dormant liver stage of the parasite. The aim of this study was to quantify the impact of recurrent malaria episodes on morbidity and mortality in Papua, Indonesia. Methods: We undertook a retrospective analysis of routinely collected data from malaria patients attending the primary referral hospital in Papua, Indonesia, between April 2004 and December 2013. Multi-state modelling was used to estimate the effect of recurring malaria episodes on re-presentation and admission to hospital and death. The risks of early (≤ 14 days) and late (15 to 365 days) hospital admission and death were estimated separately in our study to distinguish between the direct and indirect effects of malaria recurrence on adverse outcomes. Results: A total of 68,361 patients were included in the analysis, of whom 37,168 (54.4%) presented initially with P. falciparum, 22,209 (32.5%) with P. vivax, and 8984 (13.1%) with other species. During 12 months of follow-up after each of the first four malaria episodes, 10,868 (15.9%) patients were admitted to hospital and 897 (1.3%) died. The risk of re-presenting to the hospital with malaria increased from 34.7% (95% CI 34.4%, 35.1%) at first episode to 58.6% (57.5%, 59.6%) following the third episode of malaria. After adjusting for co-factors, infection with P. vivax was a significant risk factor for re-presentation (hazard ratio (HR) = 1.48 (95% CI 1.44, 1.51)) and late admission to hospital (HR = 1.17 (1.11, 1.22)). Patients infected with P. falciparum had a greater overall rate of mortality within 14 days (HR = 1.54 (1.25, 1.92)), but after multiple episodes of malaria, there was a trend towards a higher rate of early death in patients infected with P. vivax compared to P. falciparum (HR = 1.91 (0.73, 4.97)). Conclusions: Compared to patients initially infected with P. falciparum, those infected with P. vivax had significantly more re-presentations to hospital with malaria, and this contributed to a high risk of inpatient admission and death. These findings highlight the importance of radical cure of P. vivax to eliminate the dormant liver stages that trigger relapses.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The risk of morbidity and mortality following recurrent malaria in Papua, Indonesia: a retrospective cohort study

Dini

Douglas

Poespoprodjo

et al. 2020

BMC Med

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“…[8][9][10] In a community perspective, preventing recurrent malaria must be a public health priority in this vulnerable population. 51 Preventive strategies, early diagnosis, and prompt treatment should be initiated in the correct time appropriately by all stake holder. 1 By actively reducing the number of cases seems to be easier than sustained elimination.…”

Section: Discussionmentioning

confidence: 99%

A literature study of anemia among malaria cases reported in Indonesia, from west to east: a parasito-epidemiology perspective

Siagian

2020

Int J Community Med Public Health

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Severe malarial anemia (SMA) is a potentially fatal complication of malaria, a neglected parasitic tropical disease that still become a global health problem. It occurs predominantly in vulnerable groups in the community, especially children and pregnant women living in endemic areas, including Indonesia. The data on prevalence of SMA and its contributing factors are sparse and incomplete, so the aim of this simple literature study is to provide that data. The author doing the electronic literature searching on Indonesia’s data concerning malaria related anemia and factors that might contribute or causing this complication. There are 37 studies found on this issue, from 2001 until 2019. All 37 studies reported that anemia that developed during the course of the disease (malaria) varies from asymptomatic to severe form. This study showed the condition of anemia related malaria in Indonesia, from 2001-2019. Malaria still a big parasito-epidemiology problem. Prevention by continuous health promotion and proper management of malaria should be conducted to eradicate malaria and its complication.

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Plasmodium vivax in Children: Hidden Burden and Conspicuous Challenges, a Narrative Review

Gharbi¹,

Tan²,

Martín³

et al. 2022

Infect Dis Ther

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There has been progress towards decreasing malaria prevalence globally; however, Plasmodium vivax has been less responsive to elimination efforts compared with Plasmodium falciparum . P. vivax malaria remains a serious public health concern in regions where it is the dominant species (South and South-East Asia, the Eastern Mediterranean region, and South America) and is increasingly recognized for its contribution to overall morbidity and mortality worldwide. The incidence of P. vivax decreases with increasing age owing to rapidly acquired clinical immunity and there is a disproportionate burden of P. vivax in infants and children, who remain highly vulnerable to severe disease, recurrence, and anemia with associated developmental impacts. Diagnosis is sometimes difficult owing to the sensitivity of diagnostic tests to detect low levels of parasitemia. Additionally, the propensity of P. vivax to relapse following reactivation of dormant hypnozoites in the liver contributes to disease recurrence in infants and children, and potentiates morbidity and transmission. The 8-aminoquinolines, primaquine and tafenoquine, provide radical cure (relapse prevention). However, the risk of hemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency necessitates testing prior to administration of 8-aminoquinolines, which has limited their uptake. Additional challenges include lack of availability of pediatric dose formulations and problems with adherence to primaquine owing to the length of treatment recommended. A paucity of data and studies specific to pediatric P. vivax malaria impacts the ability to deliver targeted interventions. It is imperative that P. vivax in infants and children be the focus of future research, control initiatives, and anti-malarial drug development. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-022-00713-w.

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Early and late mortality after malaria in young children in Papua, Indonesia

Cited by 23 publications

References 27 publications

The risk of morbidity and mortality following recurrent malaria in Papua, Indonesia: a retrospective cohort study

The risk of morbidity and mortality following recurrent malaria in Papua, Indonesia: a retrospective cohort study

A literature study of anemia among malaria cases reported in Indonesia, from west to east: a parasito-epidemiology perspective

Plasmodium vivax in Children: Hidden Burden and Conspicuous Challenges, a Narrative Review

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