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Demographic Risk Factors for Severe and Fatal Vivax and Falciparum Malaria Among Hospital Admissions in Northeastern Indonesian Papua

Between January 1998 and December 2000, the Jayapura Provincial Public Hospital in northeastern Indonesian New Guinea (Papua) admitted 5,936 patients with a diagnosis of malaria. The microscopic diagnosis at admission was Plasmodium falciparum (3,976, 67%), Plasmodium vivax (1,135, 19%), Plasmodium malariae (8, < 1%), and mixed species infections (817, 14%). Approximately 9% (367) of patients were classified as having severe malaria (277 P. falciparum, 36 P. vivax, 53 mixed infections, and 1 P. malariae) and 88 died (79 P. falciparum/mixed infections and 9 P. vivax). Risk of fatal outcomes among severe malaria patients was indistinguishable between those with falciparum versus vivax malaria (OR = 0.89; P = 0.771). Compared with non-pregnant women, pregnant women showed no higher risk of severe malaria (P = 0.643) or death caused by severe malaria (P = 0.748). This study compares admissions per population (based on census data), parasitemia, morbidity, and mortality among children versus adults, pregnant versus non-pregnant women, and urban/suburban versus rural residents.

Received May 6, 2007. Accepted for publication July 15, 2007.

Acknowledgments: The authors gratefully acknowledge the advice and assistance of many officers in the provincial health service of Papua, especially W. Kalalo, Health Services Director, and Claudia Surjadjaja, health service liaison officer. We also appreciate the technical assistance of Agus Rahmat at US NAMRU-2 in Jakarta, and the valuable assistance of Rosye Tanjung, Patriot Karubuy, and Fabianus Giay in Jayapura. Robert W. Taylor at the Oxford University Clinical Research Unit in Hanoi provided a thoughtful review of the manuscript.

Financial support: This work was supported in part by the US Department of Defense Global Emerging Infections Surveillance and Response System.

^* Address correspondence to Mazie J. Barcus, 2061 Winged Foot Court, Reston, VA 20191. E-mail: mazie_barcus{at}yahoo.com

The views and opinions expressed here are those of the authors and do not purport to represent those of the US Navy or of the US Department of Defense.

Authors’ addresses: Mazie Barcus, 2061 Winged Foot Court, Reston, VA 20191. Hasan Basri, Family Health International, Komplek Ditjen PP4PL RI, Jl. Percetakan Negara No. 29, Jakarta 10560, Indonesia, E-mail: hbasri{at}fhi.or.id. Helena Picarima, Family Health International, Kota Jayapura, Papua 99920, Indonesia. C. Manyakori, R.S. Persahabatan, Jl. Persahabatan Raya, Rawamangun, Jakarta, Indonesia. Sekartui, Puslitbang Biomedis & Farmasi, Jl. Percetakan Negara No. 29, Jakarta 10560, Indonesia. Iqbal Elyazar, Parasitology Department Program, U.S. NAMRU-2, American Embassy Jakarta, Unit 8132, FPO AP 96520-8132. Michael J. Bangs, Public Health and Malaria Control Department, Freeport, Jl. Kertajasa, Kuala Kencana, Papua 99920, Indonesia. Jason D. Maguire, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 2370. J. Kevin Baird, Eijkman-Oxford Clinical Research Unit, Eijkman Institute, Jl. Diponegoro No. 69, Jakarta 10430, Indonesia.