title: Malaria morbidity in Papua Indonesia, an area with multidrug resistant Plasmodium vivax and Plasmodium falciparum.
abstract: BACKGROUND
  Multidrug resistance has emerged to both Plasmodium vivax and Plasmodium falciparum and yet the comparative epidemiology of these infections is poorly defined.
  
  
  METHODS
  All laboratory-confirmed episodes of malaria in Timika, Papua, Indonesia, presenting to community primary care clinics and an inpatient facility were reviewed over a two-year period. In addition information was gathered from a house-to-house survey to quantify the prevalence of malaria and treatment-seeking behaviour of people with fever.
  
  
  RESULTS
  Between January 2004 and December 2005, 99,158 laboratory-confirmed episodes of malaria were reported, of which 58% (57,938) were attributable to P. falciparum and 37% (36,471) to P. vivax. Malaria was most likely to be attributable to pure P. vivax in children under one year of age (55% 2,684/4,889). In the household survey, the prevalence of asexual parasitaemia was 7.5% (290/3,890) for P. falciparum and 6.4% (248/3,890) for P. vivax. The prevalence of P. falciparum infection peaked in young adults aged 15-25 years (9.8% 69/707), compared to P. vivax infection which peaked in children aged 1 to 4 years (9.5% 61/642). Overall 35% (1,813/5,255) of people questioned reported a febrile episode in the preceding month. Of the 60% of people who were estimated to have had malaria, only 39% would have been detected by the surveillance network. The overall incidence of malaria was therefore estimated as 876 per 1,000 per year (Range: 711-906).
  
  
  CONCLUSIONS
  In this region of multidrug-resistant P. vivax and P. falciparum, both species are associated with substantial morbidity, but with significant differences in the age-related risk of infection.
authors.affiliation: International Health Division, Menzies School of Health Research, Darwin, Australia. mkaryana@litbang.depkes.go.id
authors.forename: Muhammad
authors.initials: M
authors.lastname: Karyana
authors.forename: Lenny
authors.initials: L
authors.lastname: Burdarm
authors.forename: Shunmay
authors.initials: S
authors.lastname: Yeung
authors.forename: Enny
authors.initials: E
authors.lastname: Kenangalem
authors.forename: Noah
authors.initials: N
authors.lastname: Wariker
authors.forename: Rilia
authors.initials: R
authors.lastname: Maristela
authors.forename: Ketut Gde
authors.initials: KG
authors.lastname: Umana
authors.forename: Ram
authors.initials: R
authors.lastname: Vemuri
authors.forename: Maurits J
authors.initials: MJ
authors.lastname: Okoseray
authors.forename: Pasi M
authors.initials: PM
authors.lastname: Penttinen
authors.forename: Peter
authors.initials: P
authors.lastname: Ebsworth
authors.forename: Paulus
authors.initials: P
authors.lastname: Sugiarto
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Anstey
authors.forename: Emiliana
authors.initials: E
authors.lastname: Tjitra
authors.forename: Richard N
authors.initials: RN
authors.lastname: Price
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002648:Child; D002675:Child, Preschool; D018432:Drug Resistance, Multiple; D005260:Female; D006306:Health Surveys; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010963:Plasmodium falciparum / Q000187:drug effects*; D010966:Plasmodium vivax / Q000187:drug effects*; D011247:Pregnancy; D015995:Prevalence; D012720:Severity of Illness Index; D055815:Young Adult