Abstract
BackgroundIntravenous artesunate and its follow on full course dihydroartemisinin–piperaquine are the standard treatment for severe malaria in Indonesia. The current policy suggests that intravenous and oral quinine could be used when standard therapy is not available. Its pragmatic use of both treatment combinations in a field hospital is evaluated.MethodsA retrospective study among hospitalized malaria patients receiving intravenous anti-malarial treatments at Mitra Masyarakat Hospital, Timika from April 2004 to December 2013 was conducted. The length of hospital stay (LoS) and the risk of malaria recurrence within 28 days after hospital admission were compared between patients receiving intravenous artesunate and oral dihydroartemisinin–piperaquine (Iv Art + DHP) and those receiving intravenous and oral quinine (Iv + Oral Qu).ResultsOf 10,514 patients requiring intravenous therapy, 2759 received Iv + Oral Qu and 7755 received Iv Art + DHP. Plasmodium falciparum infection accounted for 65.8% (6915), while Plasmodium vivax, Mixed infections, Plasmodium malariae and Plasmodium ovale were accounted for 17.0% (1789), 16.4% (1729), 0.8% (79) and 0.01% (2) of the infections, respectively. The majority of severe malaria hospital admissions were highland Papuans (78.0%, 8201/10,501). In total 49% (5158) of patients were older than 15 years and 3463 (32.9%) were children under 5 years old. The median LoS was shorter in patients receiving intravenous artesunate compared to those treated with intravenous quinine (median = 2 [IQR 1–3] versus 3 days [IQR 2–4], p < 0.0001). Patients treated with intravenous quinine had higher risk of being hospitalized longer than 2 days (aOR of 1.70 [95% CI 1.54–1.88], p < 0.0001). The risk of recurrences within 28 days after hospital admission was 1.94 times higher (95% CI aHR 1.57–2.39, p < 0.0001) in patients receiving intravenous quinine with follow on oral quinine treatment than in patients treated with DHP after intravenous artesunate therapy.ConclusionsIntravenous artesunate reduced the LoS of malaria patients and in combination with DHP reduced the risk of malaria recurrence within 28 days after hospital admission compared to those with Iv + Oral Qu treatment. Thus, ensuring continuous supply of intravenous artesunate and artemisinin-based combination therapy (ACT) should be a priority.
Highlights
Intravenous artesunate and its follow on full course dihydroartemisinin–piperaquine are the standard treatment for severe malaria in Indonesia
Intravenous artesunate reduced the length of hospital stay (LoS) of malaria patients and in combination with intravenous artesunate plus dihydroartemisinin–piperaquine (DHP) reduced the risk of malaria recurrence within 28 days after hospital admission compared to those with Iv + Oral intravenous and oral quinine (Qu) treatment
This study evaluates the use of intravenous quinine plus oral quinine (IV + Oral Qu) which was the first line treatment for severe malaria and its follow on oral treatment before treatment policy change in March 2006 and intravenous artesunate plus oral dihydroartemisinin–piperaquine (IV Art + DHP) after policy change at the local hospital in Timika (Papua-Indonesia)
Summary
Study site Timika is located in the most eastern part of Indonesia (Papua Province) with the population about 200,000 during the study period [12]. Infectious diseases are still the predominant cause of morbidity and mortality in this region followed by chronic non-infectious diseases (Annual Health Report, Mimika District-2013; RSMM Hospital Statistics Report-2013) Study design This was a retrospective study using secondary electronic data (a Q-ProTM database) containing information on patient’s clinical and demographic details and clinical diagnosis made by the attending physician of each patient presentation between April 2004 and December 2013. Risk factors for malaria recurrence analysis Kaplan–Meier survival methods was used to analyse the risk of hospital representation with malaria within 28 days after hospital admission for each of the following variables: age group (0–< 1 year, 1–< 5 years, 5–< 15 years and ≥ 15 years), sex, pregnancy status, ethnic groups (non Papuan, lowland Papuan and highland Papuan), nutritional status (normal and severe malnutrition), Plasmodium species, anaemia (Hb < 5 g/dl) and intravenous-oral anti-malarial drug received (IvArt + DHP and Iv + Oral Qu). Ethical approval The study was approved by the Medical and Health Research Ethics Committee (MHREC) Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia (KE/FK/1228/EC/2018)
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