Treatment-seeking behaviour and associated costs for malaria in Papua, Indonesia.
BACKGROUND
Malaria remains a significant public health issue in Eastern Indonesia, where multidrug resistant Plasmodium falciparum and Plasmodium vivax are highly prevalent. The objective of this study was to describe treatment-seeking behaviour and household costs prior to a change to a unified treatment policy of dihydroartemisinin-piperaquine in Mimika district, Papua province in 2006.


METHODS
In 2005 a randomized cross-sectional household survey was conducted to collect data on demographics, socio-economic status (SES), treatment-seeking, case management, and household costs. Information on the cost of illness was also collected from patients exiting health facilities, in order to compare the cost of episodes diagnosed as P. vivax compared with those diagnosed as P. falciparum.


RESULTS
825 households were included in the survey. Of the 764 individuals who sought treatment for fever outside the home in the last month, 46% (349/764) went to a public health facility. Of the 894 reported visits to healthcare providers, 48% (433) resulted in a blood test, of which 78% (337) were reportedly positive. Only 10% (17/177) of individuals who reported testing positive for P. falciparum or mixed infection received the first-line treatment of chloroquine with SP, and 38% (61/159) of those with a diagnosis of P. vivax reportedly received the first-line treatment of chloroquine and primaquine. Overall, public facilities were more likely to prescribe the correct prevailing first-line drug combinations than private providers (OR = 3.77 [95% CI 2.31-6.14], p < 0.001). The mean cost to the household of an episode of P. vivax was similar to the cost of P. falciparum [US$44.50 (SD: 46.23) vs US$48.58 (SD: 64.65)].


CONCLUSIONS
Private providers were a popular source of treatment for malaria, but adherence to the national guidelines was low and the economic burden of malaria for both P. falciparum and P. vivax infections was substantial. Engagement with the private sector is needed to ensure that patients have access to affordable good quality, effective diagnostics and anti-malarials for both P. falciparum and P. vivax.
National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia.
Muhammad
M
Karyana
Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.|Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
Angela
A
Devine
Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia.|Mimika District Health Authority, Timika, Papua, Indonesia.
Enny
E
Kenangalem
Mimika District Health Authority, Timika, Papua, Indonesia.
Lenny
L
Burdarm
Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia.|Mimika District Health Authority, Timika, Papua, Indonesia.|Department of Child Health, Faculty of Medicine, University Gadjah Mada, Yogyakarta, Indonesia.
Jeanne Rini
JR
Poespoprodjo
Business School, Charles Darwin University, Darwin, Australia.
Ram
R
Vemuri
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
Nicholas M
NM
Anstey
National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia.
Emiliana
E
Tjitra
Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK. rprice@menzies.edu.au.|Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia. rprice@menzies.edu.au.
Ric N
RN
Price
Department of Clinical Research, Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, UK. shunmay.yeung@lshtm.ac.uk.
Shunmay
S
Yeung
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000962:Antimalarials / Q000191:economics* / Q000627:therapeutic use*; D037621:Artemisinins / Q000191:economics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D019983:Guideline Adherence; D005102:Health Expenditures; D006801:Humans; D007214:Indonesia; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D016780:Malaria, Vivax / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011804:Quinolines / Q000191:economics / Q000627:therapeutic use; D011897:Random Allocation; D055815:Young Adult; D010879:Piperazines
D000962:Antimalarials; D037621:Artemisinins; D011804:Quinolines; C039060:artenimol; C034759:piperaquine; D010879:Piperazines
Adherence; Anaemia; Cost; Falciparum; Indonesia; Malaria; Malariae; Primaquine; Treatment-seeking; Vivax