Rita Marleta Dewi

Seasonal prevalence of malaria in West Sumba district, Indonesia.

BackgroundAccurate information about the burden of malaria infection at the district or provincial level is required both to plan and assess local malaria control efforts. Although many studies of malaria epidemiology, immunology, and drug resistance have been conducted at many sites in Indonesia, there is little published literature describing malaria prevalence at the district, provincial, or national level.MethodsTwo stage cluster sampling malaria prevalence surveys were conducted in the wet season and dry season across West Sumba, Nusa Tenggara Province, Indonesia.ResultsEight thousand eight hundred seventy samples were collected from 45 sub-villages in the surveys. The overall prevalence of malaria infection in the West Sumba District was 6.83% (95% CI, 4.40, 9.26) in the wet season and 4.95% (95% CI, 3.01, 6.90) in the dry. In the wet season Plasmodium falciparum accounted for 70% of infections; in the dry season P. falciparum and Plasmodium vivax were present in equal proportion. Malaria prevalence varied substantially across the district; prevalences in individual sub-villages ranged from 0–34%. The greatest malaria prevalence was in children and teenagers; the geometric mean parasitaemia in infected individuals decreased with age. Malaria infection was clearly associated with decreased haemoglobin concentration in children under 10 years of age, but it is not clear whether this association is causal.ConclusionMalaria is hypoendemic to mesoendemic in West Sumba, Indonesia. The age distribution of parasitaemia suggests that transmission has been stable enough to induce some clinical immunity. These prevalence data will aid the design of future malaria control efforts and will serve as a baseline against which the results of current and future control efforts can be assessed.

Malaria prevalence in Nias District, North Sumatra Province, Indonesia

BackgroundThe Nias district of the North Sumatra Province of Indonesia has long been known to be endemic for malaria. Following the economic crisis at the end of 1998 and the subsequent tsunami and earthquake, in December 2004 and March 2005, respectively, the malaria control programme in the area deteriorated. The present study aims to provide baseline data for the establishment of a suitable malaria control programme in the area and to analyse the frequency distribution of drug resistance alleles associated with resistance to chloroquine and sulphadoxine-pyrimethamine.MethodsMalariometric and entomology surveys were performed in three subdistricts. Thin and thick blood smears were stained with Giemsa and examined under binocular light microscopy. Blood blots on filter paper were also prepared for isolation of parasite and host DNA to be used for molecular analysis of band 3 (SAO), pfcrt, pfmdr1, dhfr, and dhps. In addition, haemoglobin measurement was performed in the second and third surveys for the subjects less than 10 years old.ResultsResults of the three surveys revealed an average slide positivity rate of 8.13%, with a relatively higher rate in certain foci. Host genetic analysis, to identify the Band 3 deletion associated with Southeast Asian Ovalocytosis (SAO), revealed an overall frequency of 1.0% among the 1,484 samples examined. One hundred six Plasmodium falciparum isolates from three sub-districts were successfully analysed. Alleles of the dhfr and dhps genes associated with resistance to sulphadoxine-pyrimethamine, dhfr C59R and S108N, and dhps A437G and K540E, were present at frequencies of 52.2%, 82.5%, 1.18% and 1.18%, respectively. The pfmdr1 alleles N86Y and N1042D, putatively associated with mefloquine resistance, were present at 31.4% and 2%, respectively. All but one sample carried the pfcrt 76T allele associated with chloroquine resistance. Entomologic surveys identified three potential anopheline vectors in the area, Anopheles barbirostris, Anopheles kochi and Anopheles sundaicus.ConclusionThe cross sectional surveys in three different sub-districts of Nias District clearly demonstrated the presence of relatively stable endemic foci of malaria in Nias District, North Sumatra Province, Indonesia. Molecular analysis of the malaria parasite isolates collected from this area strongly indicates resistance to chloroquine and a growing threat of resistance to sulphadoxine-pyrimethamine. This situation highlights the need to develop sustainable malaria control measures through regular surveillance and proper antimalarial drug deployment.

Seasonal distribution of anti-malarial drug resistance alleles on the island of Sumba, Indonesia.

BackgroundDrug resistant malaria poses an increasing public health problem in Indonesia, especially eastern Indonesia, where malaria is highly endemic. Widespread chloroquine (CQ) resistance and increasing sulphadoxine-pyrimethamine (SP) resistance prompted Indonesia to adopt artemisinin-based combination therapy (ACT) as first-line therapy in 2004. To help develop a suitable malaria control programme in the district of West Sumba, the seasonal distribution of alleles known to be associated with resistance to CQ and SP among Plasmodium falciparum isolates from the region was investigated.MethodsPlasmodium falciparum isolates were collected during malariometric surveys in the wet and dry seasons in 2007 using two-stage cluster sampling. Analysis of pfcrt, pfmdr1, pfmdr1 gene copy number, dhfr, and dhps genes were done using protocols described previously.Results and DiscussionThe 76T allele of the pfcrt gene is nearing fixation in this population. Pfmdr1 mutant alleles occurred in 72.8% and 53.3%, predominantly as 1042D and 86Y alleles that are mutually exclusive. The prevalence of amplified pfmdr1 was found 41.9% and 42.8% of isolates in the wet and dry seasons, respectively. The frequency of dhfr mutant alleles was much lower, either as a single 108N mutation or paired with 59R. The 437G allele was the only mutant dhps allele detected and it was only found during dry season.ConclusionThe findings demonstrate a slighly higher distribution of drug-resistant alleles during the wet season and support the policy of replacing CQ with ACT in this area, but suggest that SP might still be effective either alone or in combination with other anti-malarials.

Distribution of Plasmodium vivax pvdhfr and pvdhps alleles and their association with sulfadoxine-pyrimethamine treatment outcomes in Indonesia.

AbstractBackgroundSympatric existence of Plasmodium falciparum and Plasmodium vivax, and the practice of malaria treatment without microscopic confirmation suggest that the accidental treatment of vivax malaria with sulfadoxine–pyrimethamine (SP) is common.MethodsIn this study, the frequency distribution of alleles associated with SP resistance were analysed among the P. vivax infections from malariometric surveys and its association with SP treatment failure in clinical studies in Indonesia. The dhfr and dhps alleles were detected using PCR–RFLP method.ResultsAnalysis of 159 P. vivax isolates from malariometric surveys and 69 samples from in vivo SP efficacy study revealed various the existence of various alleles of the pvdhfr and pfdhps genes including 57L/I, 58R, 61M, and 117N/T. Allele 13L of the dhfr gene and 553G of the dhps gene were not detected in any isolates examined in both studies. In the dhfr gene, tandem repeat type-A was the major tandem repeat observed in any isolates analysed. In the dhps gene, only the 383G allele was observed. Isolates carrying double, triple and quadruple mutants of dhfr gene were found in Lampung, Purworejo, Sumba, and Papua. Although this study revealed a wide distribution of dhfr and dhps alleles among the P. vivax isolates across a broad geographic regions in Indonesia, impact on SP efficacy was not observed in Sumba.ConclusionWith proper malaria diagnosis, SP may still be used as a rational anti-malarial drug either as a single prescription or in combination with artemisinin.

Brugia Rapid™ antibody responses in communities of Indonesia in relation to the results of ‘transmission assessment surveys’ (TAS) for the lymphatic filariasis elimination program

BackgroundThe Global Programme to Eliminate Lymphatic Filariasis recommends the transmission assessment survey (TAS) as the preferred methodology for determining whether mass drug administration can be stopped in an endemic area. Because of the limited experience available globally with the use of Brugia Rapid™ tests in conducting TAS in Brugia spp. areas, we explored the relationship between the antibody test results and Brugia spp. infection as detected by microfilaremia in different epidemiological settings.MethodsThe study analyzes the Brugia Rapid™ antibody responses and microfilaremia in all ages at three study sites in: i) a district which was classified as non-endemic, ii) a district which passed TAS, and iii) a district which failed TAS. Convenience sampling was done in each site, in one to three purposefully selected villages with a goal of 500 samples in each district.ResultsA total of 1543 samples were collected from residents in all three study sites. In the site which was classified as non-endemic and where MDA had not been conducted, 5 % of study participants were antibody positive, none was positive for microfilaremia, and age-specific antibody prevalence peaked at almost 8 % in the 25–34 year-old age range, with no antibody-positive results found in children under eight years of age. In the site that had passed TAS, 1 % of participants were antibody positive and none was positive for microfilaremia. In the site which failed TAS, 15 % of participants were antibody positive, 0.2 % were microfilaremic, and age-specific antibody prevalence was highest in 6–7 year olds (30 %), but above 8 % in all age levels above 8 years old.ConclusionsThese results from districts which followed the current WHO guidance for mapping, MDA, and implementing TAS, while providing antibody profiles of treated and untreated populations under programmatic settings, support the choice of antibody prevalence in the 6- and 7-year-old age group in TAS for making stopping MDA decisions. Since only one study participant was microfilaremic, no conclusions could be drawn about the relationship between antibodies and microfilaremia and further longitudinal studies are required to understand this relationship.

Penemuan Baru Plasmodium Knowlesi pada Manusia di Kalimantan Tengah

Abstract Until 2012, four Plasmodium knowlesi malaria cases had been found in South Kalimantan. Objectives of this study were to determine the proporsion of P. knowlesi among microscopically positive malaria cases, clinical symptoms and morphology of P. knowlesi. This study is conducted in Central Kalimantan and South Kalimantan in 2013-2014. Samples were microscopically positive malaria cases obtained by surveys and passive case findings. Finger’s blood absorbed on filter papers or scraping of thick blood films were examined by polymerase chain reaction. Patients were also examined clinically and interviewed to investigate the history of infections. The results showed that among the 287 samples examined, three samples (1.05%) positive P. knowlesi. All of the three cases were infected locally, which consist of two in Central Kalimantan and one in South Kalimantan. The cases in Central Kalimantan were the first finding of Plasmodium knowlesi malaria cases in the province. Clinical symptoms in two cases were mild but in another case was rather severe. Morphology of P. knowlesi has a special characteristic although it resembles P. falciparum, P. vivax and P. malariae. Further research is needed in order to find other spreading area of P. knowlesi malaria in Indonesia. Keywords : Plasmodium knowlesi, human, clinical symptoms, morphology, Central Kalimantan. Abstrak Sampai tahun 2012, empat kasus malaria Plamodium knowlesi pada manusia yang penularannya di sekitar hutan telah ditemukan di Kalimantan Selatan. Tujuan penelitian ini adalah untuk mengetahui besarnya proporsi P. knowlesi di antara kasus malaria positif mikroskopis, gejala klinis dan morfologi P. knowlesi. Penelitian ini dilakukan di Kalimantan Tengah dan Kalimantan Selatan pada tahun 2013-2014. Sampel adalah kasus malaria positif mikroskopis yang diperoleh melalui survei dan penemuan kasus secara pasif. Serapan darah pada kertas saring atau kerokan sediaan apus darah tebal diperiksa dengan polymerase chain reaction (PCR). Penderita juga diperiksa secara klinis dan diwawancarai untuk mengetahui sejarah infeksi. Hasil menunjukkan bahwa di antara 287 sampel yang diperiksa, tiga sampel (1,05 %) positif P. knowlesi. Ketiga kasus tersebut terinfeksi secara lokal, yang terdiri dari dua di Kalimantan Tengah dan satu di Kalimantan Selatan. Kasus di Kalimantan Tengah ini merupakan penemuan pertama kasus malaria P. knowlesi di provinsi itu. Gejala klinis pada dua kasus adalah ringan sedangkan pada kasus lainnya agak berat. Morfologi P. knowlesi mempunyai ciri khusus meskipun mirip dengan P. falciparum, P. vivax dan P. malariae. Penelitian lebih lanjut diperlukan untuk menemukan wilayah sebaran lain malaria P. knowlesi di Indonesia Kata kunci : Plasmodium knowlesi, manusia, gejala klinis, morfologi, Kalimantan Tengah.

PENURUNAN EFIKASI KLOROKUIN DAN SULFADOKSIN/PIRIMETAMIN UNTUK PENGOBATAN MALARIA FALSIPARUM RINGAN DI PULAU BINTAN, PROVINSI KEPUALAUAN RIAU, TAHUN 2003

To support Malaria Control Program, on July 2002 to December 2003 monitoring the efficacy of chloroquine (CQ) and sulphadoxine/pyrimethamine (S/P) as a first and second line drugs for uncomplicated falciparum malaria treatment had been conducted using WHOs method version 2001 guideline. The study was conducted in Bintan Island -Kepulauan Riau Province, which is bordering with Singapore and Malaysia. The activities conducted in two Health Centers (Tanjung Uban and Kijang). It was found that CQ in treated patients as many as 26.67% cases showed ACPR (Adequate Clinical and Parasitological Responses), 33.33% with ETF (Early Treatment Failure) and 40% considered as LTF (Late Treatment Failure). The overall treatment failure was 73.33%. For S/P treated patients, as many as 87.5% cases showed ACPR and 12.5% cases considered as LTF. The fever clearance time (FCT) in ACPR patients mostly 88.89% occurred on day-1. As many as 7 patients had no temperature increasing since day-0 (below 37.5°C). While the parasite clearance time (PCT) on day-2 was 43.75% and on day-3 was 50%. It was concluded that there was a significant decreased of chloroquine efficacy for uncomplicated falciparum malaria in Bintan Island area, Kepulauan Riau Province compared to the efficacy status in the year of 2000. As a preliminary result, the efficacy of S/P in this area is 87.5% Considering the result of the study, the people movement and local malaria situation, this area is not suitable to be one of national sentinel sites for and malaria drug monitoring in Indonesia. Keywords: Falciparum, malaria treatment, drug efficacy.One of the efforts to decrease tuberculosis prevalence in Indonesia is to increase cure rate minimally by 85 percent. The impact of not cured or drop out of tuberculosis medication is that respondents will transmit the disease and became resistance toward the medicine. This analysis used the 2004 National Tuberculosis Prevalence Survey and the 2004 Susenas (National Socio-Economic Survey) data. This survey was household survey, cross sectional and designed for national representative. Totally, there were 20,000 households with 34,606 respondents and the respondent with the age > 15 year old were interviewed for their tuberculosis history and their medication. Limitation of this study is that the information was obtained only from their statement stated in the questionnaire. Drop out of tuberculosis medication was defined as respondents who ever diagnosed tuberculosis and stopped medication before declared cured by health provider. Percentage of respondents who ever diagnosed TB by health provider was 1.65 percent (571 from 34,606 respondents) and the percentage of drop out from tuberculosis medication of these respondents was 48 percent (274 out of the 571 respondents). The main reason of drop out was feeling better and had no money. Bivariate analysis found that five out of nine independent variables had significant value P <0.05, which were: place of living, region, household expenditure, access to health facility and health seeking behavior. Multivariate analysis (final model) showed that four variables with p value <0.05, which were: region, household expenditure, education and health seeking to health facility. Respondents in Eastern Indonesia had twice dropped out of tuberculosis treatment than those in Java and Bali. Respondents with low household expenditure had twice dropped out of tuberculosis treatment than respondents with high household expenditure. The lower their education the higher they stop medicine. Respondents who went to private practice tend to drop out comparing to respondents who went to health center and hospital. The highest drop out occurred in the private health facility. Compliance or adherence of tuberculosis treatment is the very important issue especially for low educated, poor people and living inthe Eastern Indonesia. Drug taking watcher (PMO= Pengawas Minum Obat) methods need to be improved to reach the target. Keywords: Tuberculosis, drop out of tb treatment, drug taking watcherBenzoyl phenil urea which is registered as Akuiron 100 EC is known as IGR synthetic and being introduced to control mosquito in the pre mature stadium. The research was conducted in order to determine the effectiveness of an insect growth regulator (IGR) benzoyl phenil urea against Culex quinquefasciatus larvae in Kokap District, Kulon Progo Regency, Daerah Istimewa Yogyakarta. The research used 8 concentrations of IGR, that were 0.005 ppm, 0.01 ppm, 0.1 ppm, 0.25 ppm, 0.5 ppm, 1ppm, 2.5 ppm, and 5 ppm in treated control and untreated control. Every concentration was used 3 replications. The result showed that the effectiveness of IGR to kill were: 80.84 %, 94.90%, 95.65 %, 96.85%, 100%, 92.87%, 86.13% and 76. 27% larvae Cx.quinquefasciatus with the concentration of: 0.005 ppm, 0.01 ppm, 0,1 ppm, 0,25 ppm, 0,5 ppm, 1 ppm, 2,5 ppm and 5 ppm respectively. Probit analysis test showed that the concentration level to control 50% (LC50) and 90% (LC90) larvae Cx.quinquefasciatus were 0,00064 ppm and 0,3 ppm respectively. In anova analysis had a different reduction percentage of larvae at different concentration (p < 0.05). The time needed to reach 70% reduction larvae was one day. Keywords: Culex quinquefasciatus, larvaciae, Effectivenes.One of the WHOs step of TB strategy reflects the importance of the need to improve care for children with TB. However, children with TB often are neglected to cure, even in the countries with high TB incidence. Around 20 percent children estimated with TB, caused by the spreading of adult TB, and many of them without specific symptom as adult. The aim of this study is to get information about the relation between demography, socio-economic, environmental factors, vaccination status, and contact with adult TB patient, and TB treatment practice of children aged <15 years. The sample was a cross-sectional data of TB Prevalence Survey 2004 and Susenas 2004, which had been merged. The method of analysis was multivariate. The result showed that the significant variable were Sumatera region, household expenditure, BCG scars, and contact with TB patients with log-likelihood < 0.05 (p=0.000). Final model for determinant factors of TB treatment practice for children aged < 15 years were children contact with adult TB patient in the household that had risk of 1.9 times (CI 95%: 1.26-2.89) and place of living classification (Sumatera region) that had risk of 2.6 times (CI 95%: 1.65-4.01). To handle child TB cases and their treatment, there are some actions could be applied, namely: to cure every adult TB until recovery, to conduct active case finding, to educate TB patients and their family to be discipline in taking the drug, to support financial transportation to go to health facility for TB patient in poor family, and to prevent from drop out by supervising them closely. Keywords: Determinants, tuberculosis treatment, children