Syahril Pasaribu

A Randomized Comparison of Dihydroartemisinin-Piperaquine and Artesunate-Amodiaquine Combined With Primaquine for Radical Treatment of Vivax Malaria in Sumatera, Indonesia

Background. A high prevalence of chloroquine-resistant Plasmodium vivax in Indonesia has shifted first-line treatment to artemisinin-based combination therapies, combined with primaquine (PQ) for radical cure. Which combination is most effective and safe remains to be established. Methods. We conducted a prospective open-label randomized comparison of 14 days of PQ (0.25 mg base/kg) plus either artesunate-amodiaquine (AAQ + PQ) or dihydroartemisinin-piperaquine (DHP + PQ) for the treatment of uncomplicated monoinfection P. vivax malaria in North Sumatera, Indonesia. Patients were randomized and treatments were given without prior testing for G6PD status. The primary outcome was parasitological failure at day 42. Patients were followed up to 1 year. Results. Between December 2010 and April 2012, 331 patients were included. After treatment with AAQ + PQ, recurrent infection occurred in 0 of 167 patients within 42 days and in 15 of 130 (11.5%; 95% confidence interval [CI], 6.6%–18.3%) within a year. With DHP + PQ, this was 1 of 164 (0.6%; 95% CI, 0.01%–3.4%) and 13 of 143 (9.1%; 95% CI, 4.9%–15.0%), respectively (P > .2). Intravascular hemolysis occurred in 5 patients, of which 3 males were hemizygous for the G6PD-Mahidol mutation. Minor adverse events were more frequent with AAQ + PQ. Conclusions. In North Sumatera, Indonesia, AAQ and DHP, both combined with PQ, were effective for blood-stage parasite clearance of uncomplicated P. vivax malaria. Both treatments were safe, but DHP + PQ was better tolerated. Clinical Trials Registration. NCT01288820.

Current status of the efficacy and effectiveness of albendazole and mebendazole for the treatment of Ascaris lumbricoides in North-Western Indonesia.

OBJECTIVE To investigate the efficacy and effectiveness of albendazole and mebendazole in the treatment of Ascaris lumbricoides (A. lumbricoides) in the North-Western Indonesia. METHODS 229 primary school children who were positive for A. lumbricoides in their stool were recruited in the study. 123 children received single-dose of 400 mg albendazole and 106 children received single-dose 500 mg of mebendazole. After 1 week, their stools were examined for the cure rate (CR) and egg reduction rate (ERR). Egg culture was also performed and observation was made on week-1, -3, -4. RESULTS have shown a non-significant difference in CR 96.7%vs. 100% and ERR of 99.3%vs. 100.0% for albendazole and mebendazole groups respectively (P>0.05). In-vitro egg culture has shown trends of decrease in the percentage of the unfertilized eggs and in ≥ 2 cell eggs in both treatment groups (P<0.05). The embryonated eggs from the albendazole groups has shown an increase from 7.3% on week-1 to 13.8% on week-4, whilst the mebendazole group has shown a constant increase during the whole 4 weeks of culture from 7.5% to 28.3% (P<0.01). CONCLUSIONS No evidence of drug resistance is noted so far from the area of North-Western part of Indonesia. In addition, although both drugs showed incomplete ovicidal effects, single-dose albendazole is better than mebendazole in sterilizing A. lumbricoides eggs.

Correlation between eosinophil count and soil-transmitted helminth infection in children

Abstract Objective To assess the prevalence of soil-transmitted helminth (STH) infection and its correlation with eosinophil counts among elementary school children within the Medan Belawan District, North Sumatera Province, Indonesia. Methods Ninety-nine subjects participated in this study (ascariasis, n = 40; trichuriasis, n = 9; mixed infection, n = 50). Stool samples were examined by using the Kato-Katz method, and blood samples were examined by using peripheral blood smears. Results The prevalence of STH infection in children from two elementary schools was 65.4%; the baseline prevalences of ascariasis, trichuriasis, and mixed infection were 37.1%, 21.9%, and 40.8%, respectively. The respective mean eosinophil counts among children with ascariasis, trichuriasis, and mixed infection were 7.18%, 8.11%, and 8.64% (P = 0.32), and the respective prevalences of eosinophilia were 47.5%, 77.8%, and 70% (P = 0.05). The eosinophil counts correlated significantly with the number of eggs per gram of feces; ascariasis correlated strongly (P Conclusions Eosinophil counts correlated strongly with ascariasis while weakly with trichuriasis. We determined that eosinophil count may be used as a marker of STH infection.

Risk Factors for Soil-Transmitted Helminthiasis in Preschool Children Living in Farmland, North Sumatera, Indonesia

Background Disease burden from soil-transmitted helminthiasis (STH) is mainly attributed to its chronic and insidious impact on health and quality of life. Strategy recommended by World Health Organization (WHO) to control it was previously focused on school-aged children, but now preschool-aged children are involved. This study was intended to determine STH infection risk factors in preschool children. Methods A cross-sectional study was conducted in Suka Village, North Sumatera, Indonesia, from October to December 2016. Subjects were children aged 1 to 5 years without history of taking antihelminthic. Subjects were obtained by consecutive sampling. Demographic data and risk factors for helminthiasis were collected using questionnaire-based interview. Subjects were divided into two groups, positive and negative STH infection, based on Kato Katz method. Analysis was done using chi-square and logistic regression test. p value < 0.05 was considered significant. Results We enrolled 90 subjects in this study, with the mean age being 31.7 months. STH infection prevalence was 34.4%. Statistical analysis revealed that mother/caregiver hand washing habit (p = 0.007), mother/caregiver nail trimming habit (p = 0.018), and children nail trimming habit (p = 0.022) were significant risk factors for STH infection. Conclusion Mother/caregiver hand washing habit is the most influential risk factor for STH infection in preschool children.

Hemolytic anemia in falciparum and vivax malarial patients based on serum bilirubin examination

Objective To examine hemolysis in falciparum and vivax malarial patients based on serum bilirubin examination. Methods A cross sectional study was conducted on children younger than 15 years of age who visited public health center in the district of Mandailing Natal with complaints of fever, shivering, pale, jaundice, diarrhea, or headache between April 9 th and April 19 th 2001. Variables recorded were age, gender, body weight, body height, symptoms and signs, anti malarial drugs, and laboratory test results. Thin and thick blood smears were done as diagnostic tools of malaria. Thin blood smear was also performed to deter- mine the level of malaria parasites in blood (parasitemia) and to examine the morphology of red blood cells. Hemolysis was deter- mined by bilirubin examination. Results In P. falciparum malaria, there was a moderate correlation (r=0.68, p<0.0001) between parasitemia and indirect bilirubin con- centration. While in P. vivax malaria, there was only a weak corre- lation (r=0.46, p=0.007) between parasitemia and indirect bilirubin concentration. It was also found that in falciparum malaria, para- sitemia, total and indirect bilirubin concentrations were significantly higher than that in vivax malaria, with p values of 0.009, 0.015 and 0.003, respectively. Conclusion Hemolysis in falciparum malaria is more severe than that in P. vivax malaria, with marked elevation of indirect bilirubin. The elevation of serum bilirubin correlated with parasitemia

The correlation between platelet count and parasite density in children with malaria infection

Abstract Objective To assess the correlation between platelet count and parasite density. Methods A cross-sectional study of febrile children was conducted in Batubara Regency, North Sumatra, Indonesia. We used rapid diagnostic tests and blood smears to identify children with malaria infection. Platelet counts and measurement of parasite density were performed manually using a microscope. Results A total of 72 children with positive malaria infection were enrolled in the study. Sixty one children had Plasmodium vivax , two children had Plasmodium falciparum , and nine children had mixed infection. The mean platelet count from all patients was (230 940.00 ± 96 611.53)/µL and the mean parasite density was (2 254.83 ± 1 432.55)/µL. There was a weak negative correlation between the platelet count and the parasitemia count ( r = –0.145). The platelet count in the mixed infection group was significantly lower [(175 444.44 ± 48 093.95)/µL] than that in the vivax malaria group [(231 927.87 ± 99 475.28)/µL] (P = 0.024). Children with splenomegaly had a significantly lower platelet count [(189 655.56 ± 80 115.76)/µL versus (245 230.77 ± 98 380.74)/µL, P = 0.04] and a higher parasite density [(3 635.78 ± 1 623.70)/µL versus (1 789.88 ± 927.29)/µL, P Conclusions There was a weak negative correlation between the platelet count and parasite count.

A case report of 4-year-old child with biliary ascariasis successfully treated with single dose of albendazole

Abstract Most cases of biliary ascariasis require endoscopic management or surgical intervention. When the procedure is difficult to perform due to many reasons and the case is without complication, conservative treatment can be an option. We report a case of biliary ascariasis in 4-year-old girl who complained of abdominal pain and subfebrile fever. The diagnosis was made using ultrasonography. The patient was successfully treated with a single dose of 400 mg albendazole. We found one dead adult female Ascaris lumbricoides from the feces after treatment. Repeated ultrasonography was made to evaluate the treatment.

Parental knowledge, attitude and practice on malaria in Mandailing Natal district

Background Malaria is still considered to be an important health problem in Indonesia. Malaria has been found in islands with different degree of endemicity. Behavior of the community is one of the factors affecting the incidence of malaria in Mandailing Natal district. Objective To know the parental knowledge, attitude, and practice among parents whose children suffered from malaria or not. Methods A cross sectional study was conducted in six primary schools and one health centre in October 2004. Subjects were parents whose children were malaria positive and malaria negative based on laboratory examination. Sample size was 85 parents for each group. Selected respondents were interviewed using structured questionnaire. Degree of knowledge, attitude, and practice on malaria were established using scoring system within three categories: good, less, and poor. Data were collected and presented using chi-square and P<0.05 was considered as a level of significant. Results The mean age of 85 parents whose children were positive malaria, was 38.47 years (SD 6.67) and the mean age of those whose children were negative malaria was 40.41 years (SD 8.05). Parent’s education level was 62.9% primary school and 90% of their children were school-aged. There were significant differences on parental knowledge, attitude and practice in each group (P<0.05). There was also a significant correlation between occupation and knowledge, but not between parental education level and parental age. Parental knowledge and attitude on the incidence of malaria in Mandailing Natal district were good, though their practice were poor. Conclusion There are significant differences on parental knowledge, attitude and practice, between parents whose children were positive and negative for malaria.

Albendazole versus combined pyrantel pamoate-mebendazole in the treatment of mixed infection of soil-transmitted helminthiasis

Background Soil transmitted helminthiasis is still highly prevalent in Indonesia, especially in rural area and among poor socio-economic population. Helminthiasis is frequently found as a single or mixed infection. It is difficult to get a medication with better efficacy, low cost, and simple administration for all types of worms. Objective The aim of this sudy was to compare the effectiveness of albendazole and pyrantel pamoate-mebendazole combination in treating soil-transmitted helminthiasis. Methods A randomized clinical trial was perionned in September until November 1995 on students of a primary school in Tanjung Anom Village whose stool examinations showed mixed infection of helminthiasis. Subjects were randomly allocated into two groups. The A group was treated with 400 mg oral albendazole as a single dose, while the B group was treated with the combination of pyrantel pamoate 10 mg/kg body weight as a single dose and mebendazole 100 mg twice a day for three consecutive days. Cure was considered if in the stool examination, no wonn eggs were found. Statistical analysis was periormed by Chi-square test with confidence interval of 95% and p value of < 0.05 was considered significant. Results Out of 541 children, mixed infection of soil-transmitted helminthiasis was found in 374 children (69%). Three hundreds sixty-six children completed the study, consisted of 182 children in group A and 184 in group B. At 3 weeks after treatment, the cure rate in the A group was significantly better compared to that in B group. Conclusions Albendazole was more effective than the combination of pyrantel pamoate - mebendazole for treating mixed infection of soil-transmitted helminthiasis. Besides the administration was simpler and caused minimal side effect.