Malaria In Indonesia Research Articles

Cerebral Malaria

Cerebral malaria is the worst complication of malaria caused by Plasmodium spp. This disease is spread in tropical and subtropical countries and can attack all age groups and genders. The peak incidence occurs in preschool children and very often causes death in children. The endemic areas of malaria in Indonesia include NTT, Maluku, West Papua and Papua. Every year, as much as 40% of the total global population lives in or visits endemic areas every year. Cerebral malaria can cause long-term neurocognitive complications that can reduce quality of life. The speed of treatment determines the patient's prognosis. Therefore, it is necessary to understand the signs of malaria and the complications that can arise. This article was written to discuss cerebral malaria as a whole based on existing literature.

The evaluation of agronomic characters and artemisinin content of EMS-mutated artemisia lines

The cases of malaria in Indonesia are high, especially in Eastern Indonesia, while the basic raw materials for malaria drugs are still imported. Artemisia (Artemisia annua L.) produces artemisinin, a sesquiterpene lactone compound, to treat malaria. Artemisinin content of Artemisia growing in Indonesia is low, therefore technological support is needed to produce new varieties of artemisia that have high artemisinin content. In vitro mutagenesis could increase plant genetic diversity which is the main requirement in plant breeding. The application of Ethyl Methane Sulphonate (EMS) to the artemisia cell population has been carried out and nine 3rd generations of artemisia mutant lines were obtained. This study aims to evaluate the growth of artemisia mutant lines based on their agronomic characters and artemisinin content. The research was conducted in Lembang, Bandung in July - December 2022. A completely randomized block design was used. The results showed that EMS affected growth characteristics that correlated with plant productivity, i.e. plant height, number of branches, stem diameter, and artemisinin content. Of the nine tested lines, at least 7 had higher plant height, number of branches, wet weight, and dry weight than the control. The artemisinin content of the mutants ranged from 0.67 to 1.02%, while the artemisinin content of the control was 0.4%. The increasing artemisinin content of these mutants reached 1.5 times compared to the control, and the mutant lines’ yields reached 2 times that of the control. The diversity of plants can also be seen from the differences in the color of the stems.

Evolution of genetic markers for drug resistance after the introduction of dihydroartemisinin–piperaquine as first-line anti-malarial treatment for uncomplicated falciparum malaria in Indonesia

BackgroundDihydroartemisinin–piperaquine has been Indonesia’s first-line anti-malarial treatment since 2008. Annual therapeutic efficacy studies (TES) done in the last 12 years showed continued high treatment efficacy in uncomplicated Plasmodium falciparum malaria. Although these studies did not show evidence for artemisinin resistance, a slight increase in Late Treatment Failure was observed over time. It is highlight to explore the evolution of genetic markers for ACT partner drug resistance since adopting DHA–PPQ.MethodsDry blood spots were identified from a mass blood survey of uncomplicated falciparum malaria patients (N = 50) in Sumba from 2010 to 2018. Analysis of genotypic profile (N = 51) and a Therapeutic Efficacy Study (TES) from Papua (N = 142) from 2020 to 2021, 42-day follow-up. PCR correction using msp1, msp2, and glurp was used to distinguish recrudescence and reinfection. Parasite DNA from DBSs was used for genotyping molecular markers for antimalaria drug resistance, including in Pfk13, pfcrt, and pfmdr1, as well as gene copy number variation in pfpm2/3 and pfmdr1.ResultsThe study revealed the absence of SNPs associated with ART resistance and several novel SNPs such as L396F, I526V, M579I and N537S (4.25%). In Sumba, the mutant haplotype SDD of pfmdr1 was found in one-third of the isolates, while only 8.9% in Papua. None of the pfcrt mutations linked to piperaquine resistance were observed, but 71% of isolates had pfcrt I356L. Amplification of the pfpm2/3 genes was in Sumba (17.02%) and Papua (13.7%), while pfmdr1 copy number prevalence was low (3.8%) in both areas. For the TES study, ten recurrences of infection were observed on days 28, 35, and 42. Late parasitological failure (LPF) was observed in 10/117 (8.5%) subjects by microscopy. PCR correction revealed that all nine cases were re-infections and one was confirmed as recrudescence.ConclusionThis study revealed that DHA–PPQ is still highly effective against P. falciparum. The genetic architecture of the parasite P. falciparum isolates during 2010–2021 revealed single copy of Pfpm2 and pfmdr1 were highly prevalent. The slight increase in DHA–PPQ LTF alerts researchers to start testing other ACTs as alternatives to DHA–PPQ for baseline data in order to get a chance of achieving malaria elimination wants by 2030.Graphical

Hewan Model Pada Penelitian Penemuan Kandidat Antimalaria Sebagai Upaya Percepatan Pengendalian Malaria

Malaria is a disease that is very old from a century ago but is still found today and is the highest cause of death in the world, especially in children. Indonesia is also still not free from malaria. The protozoan parasites that cause malaria in Indonesia are Plasmodium falciparum and Plasmodium vivax, but currently the prevention of malaria in Indonesia is coupled with the presence of Simian Malaria which is zoonotic and is caused by Plasmodium knowlesi. Malaria prevention requires research in experimental animals to determine effective prevention, to know the pathogenesis of the disease, and the nature of the protozoa, and to be able to determine the appropriate antimalarial. This paper is a literature review that reviews animal models of malaria. The results of a literature search indicated that two animal models of different orders were needed to be able to determine the appropriate antimalarial and to be able to determine the nature of the protozoa in different animal models

Effectiveness of dihydroartemisinin-piperaquine after 10 years as treatment for vivax malaria in Indonesia.

Dihydroartemisin-piperaquine (DHP) is a type of artemisinin-based combination therapy (ACT) that is extensively used in Indonesia as first-line malaria treatment over the past 10 years. Therefore, DHP has been known to have high efficacy, but re-evaluation of the efficacy was needed since the treatment was being used for a long time. A cohort prospective study on pediatric and adult patients diagnosed with vivax malaria in Kualuh Leidong health centre was conducted from November 2019 - April 2020 to evaluate the efficacy of DHP for the treatment of malaria vivax. The efficacy of DHP was monitored by evaluating the clinical symptoms and serial peripheral blood smear at day 1,2,3,7,14,21 and 28. A total of 60 children and adults diagnosed with malaria vivax were enrolled for this study. Major symptoms such as fever, sweating and dizziness were found in all of subjects. The mean number of parasites on day 0 of observation in the child and adult groups was 313.33/µL and 328/µL respectively (p = 0.839). Meanwhile, the mean number of gametocytes on day 0 was 74109.33/µL in the child group and 61661.33/µL in the adult group. There was a reduction in the number of gametocytes on the 1st day of observation in the child and adult groups to 669.33/µL and 489.33/µL respectively (p = 0.512). No recrudescence occurred in either group within 28 days of observation. DHP is still efficacious and safe as a first-line treatment for vivax malaria in Indonesia, with 100% cure rate at 28 days of observation.

Malaria Infection and Socioeconomics in Malaria Endemic Areas of East Nusa Tenggara, Indonesia

More than 1.1 million people, or 20.90% of the population in East Nusa Tenggara (NTT), Indonesia, live below the poverty line, making NTT the third province with the highest number of poor people in Indonesia. The region of NTT, which is well known as one of the endemic areas for malaria in Indonesia, also has the highest number of adults with low nutritional status. This study aimed to assess the influence of socioeconomic factors on malaria-endemic areas in eastern Indonesia. A cross-sectional study was conducted in East Nusa Tenggara from January to March 2020. Bivariate and multivariate analyses were then performed on 317 population data of adults with low socioeconomic status. It was found that one of the socioeconomic factors, i.e., the age, is significantly associated with malaria (p-value = 0.031; OR = 1.684) with 40 being the age with the highest association. Thus, age is associated with malaria incidence in endemic areas.

ENVIRONMENTAL QUALITY FACTORS AND DENSITY OF ANOPHELES LARVAE AGAINST MALARIA ENDEMICITY IN INDONESIA. A SYSTEMATIC REVIEW

Malaria is still a serious problem of health in tropical and subtropical climates. The potential for malaria has become a global concern with increasing morbidity and mortality rates. Millions of people die every year, and 80% of them occur in children. Indonesia is included in the highest level of malaria excess in the world, after India in 2020. In 2021, malaria in Indonesia reached 94,610 cases. Of 34 provinces in Indonesia, 31 provinces still have confirmed cases of malaria. Malaria is caused by the female Anopheles mosquito containing plasmodium. Anopheles mosquitoes have preferred behavior in the process of breeding, resting, and biting, according to the environmental conditions of their habitat. Therefore, this literature discusses several environmental quality factors (temperature, humidity, rainfall, wall conditions, gauze wire on ventilation, ceiling of the house, presence of bushes, and presence of standing water) and the density of Anopheles larvae on the incidence of malaria. This research was conducted in the form of a literature review using the Sinta database as reference material. Based on a study of 16 scientific journals, there were 11 scientific journals regarding significant risk factors for the incidence of malaria and 5 journals regarding Anopheles larvae density.Malaria is still a serious problem of health in tropical and subtropical climates. The potential for malaria has become a global concern with increasing morbidity and mortality rates. Millions of people die every year, and 80% of them occur in children. Indonesia is included in the highest level of malaria excess in the world, after India in 2020. In 2021, malaria in Indonesia reached 94,610 cases. Of 34 provinces in Indonesia, 31 provinces still have confirmed cases of malaria. Malaria is caused by the female Anopheles mosquito containing plasmodium. Anopheles mosquitoes have preferred behavior in the process of breeding, resting, and biting, according to the environmental conditions of their habitat. Therefore, this literature discusses several environmental quality factors (temperature, humidity, rainfall, wall conditions, gauze wire on ventilation, ceiling of the house, presence of bushes, and presence of standing water) and the density of Anopheles larvae on the incidence of malaria. This research was conducted in the form of a literature review using the Sinta database as reference material. Based on a study of 16 scientific journals, there were 11 scientific journals regarding significant risk factors for the incidence of malaria and 5 journals regarding Anopheles larvae density.

ENVIRONMENTAL QUALITY FACTORS AND DENSITY OF ANOPHELES LARVAE AGAINST MALARIA ENDEMICITY IN INDONESIA. A SYSTEMATIC REVIEW

Malaria is still a serious problem of health in tropical and subtropical climates. The potential for malaria has become a global concern with increasing morbidity and mortality rates. Millions of people die every year, and 80% of them occur in children. Indonesia is included in the highest level of malaria excess in the world, after India in 2020. In 2021, malaria in Indonesia reached 94,610 cases. Of 34 provinces in Indonesia, 31 provinces still have confirmed cases of malaria. Malaria is caused by the female Anopheles mosquito containing plasmodium. Anopheles mosquitoes have preferred behavior in the process of breeding, resting, and biting, according to the environmental conditions of their habitat. Therefore, this literature discusses several environmental quality factors (temperature, humidity, rainfall, wall conditions, gauze wire on ventilation, ceiling of the house, presence of bushes, and presence of standing water) and the density of Anopheles larvae on the incidence of malaria. This research was conducted in the form of a literature review using the Sinta database as reference material. Based on a study of 16 scientific journals, there were 11 scientific journals regarding significant risk factors for the incidence of malaria and 5 journals regarding Anopheles larvae density.Malaria is still a serious problem of health in tropical and subtropical climates. The potential for malaria has become a global concern with increasing morbidity and mortality rates. Millions of people die every year, and 80% of them occur in children. Indonesia is included in the highest level of malaria excess in the world, after India in 2020. In 2021, malaria in Indonesia reached 94,610 cases. Of 34 provinces in Indonesia, 31 provinces still have confirmed cases of malaria. Malaria is caused by the female Anopheles mosquito containing plasmodium. Anopheles mosquitoes have preferred behavior in the process of breeding, resting, and biting, according to the environmental conditions of their habitat. Therefore, this literature discusses several environmental quality factors (temperature, humidity, rainfall, wall conditions, gauze wire on ventilation, ceiling of the house, presence of bushes, and presence of standing water) and the density of Anopheles larvae on the incidence of malaria. This research was conducted in the form of a literature review using the Sinta database as reference material. Based on a study of 16 scientific journals, there were 11 scientific journals regarding significant risk factors for the incidence of malaria and 5 journals regarding Anopheles larvae density.

Edukasi Penyakit Malaria pada Ibu Hamil

Malaria is one of the highest causes of death in the world, including Indonesia. Even though in 2020 there has been a decrease incidence of malaria in Indonesia, several regions in Indonesia, especially the eastern part of Indonesia, are still malaria endemic areas. The Ministry of Health hopes that more areas will become malaria elimination and target Indonesia to be free of malaria by 2030. One of the provinces with a high incidence of malaria is West Papua, especially in the Manokwari Regency area. In 2021, of the 7,628 cases of malaria in West Papua, around 56% will occur in Manokwari Regency. Malaria is a disease that can attack anyone, groups that are more vulnerable and have a severe impact on malaria are pregnant women and children. The purpose of this community service is to provide education to increase pregnant women's knowledge about malaria so that they can carry out prevention and early detection of signs of malaria so that treatment can be carried out before it has a worse impact on pregnancy and the condition of the fetus.
 

Narrative Review: Quintuple Helixs Model for Malaria Elimination in Indonesia

Malaria continues to impact the health and economies of people around the world. Further steps need to be taken in accordance with the Global Technical Strategy for malaria to prevent malaria transmission. Quintuple helix model is an integrated effort that involves cross-sector in controlling malaria cases in an area. The implementation of the quintuple helix model is expected to be used as consideration and input for policy makers in an effort to achieve malaria elimination in Indonesia by 2030. The purpose of this study is to eliminate malaria in Indonesia with the quintuple helix model. This study uses a systematic review narrative method that is used to identify study topics selectively on interesting and recent issues. Malaria control in Indonesia is carried out using the national resilience approach. The results obtained from the academic aspect for malaria control must be met, both in terms of educational background qualifications, from the industrial aspect of the economic system included in the quintuple helix model, from the government aspect the control program must be compiled under the Ministry of Health, from the media aspect where the media is one of the an important index in the management of malaria in an area, and from an environmental aspect that aims to prevent, limit vector breeding and reduce mosquito contact with humans. The quintuple helix model is expected to be an innovation in malaria control in Indonesia. By involving academia and social community, industry, government, environmental engineering and the media. It is hoped that each sector can provide roles that are in accordance with their duties and functions

The Effect of Susceptible Immigrants in a System Dynamic on the Spread of Malaria in Indonesia

The spread of malaria is a serious public health problem, including in Indonesia. The mathematical model is formulated to describe the dynamic nature of the spread of malaria. The model used in this article is the SIR-SI model. This article discusses the stability of the fixed point analyzed using the Jacobian matrix and Routh-Hurwitz criteria, bifurcation analysis using the Castillo-Chaves and Song Theorem, and numerical simulation of the effect of the rate of susceptible immigrants on the dynamics of the malaria by using data on malaria cases in Indonesia. The results of the analysis show that the stability of the fixed point is related to the basic reproduction number determined by the next-generation matrix, and bifurcation occurs when the basic reproduction number is equal to one. The results of numerical simulations show that in order to suppress the spread of malaria, it is necessary to reduce the rate of susceptible immigrants.

Observation of Malaria Treatment with Dihydroartemisinin-Piperaquine Combination at Primary Health Care

Dihydroartemisinin-Piperaquine (DHP) combination is the first-line treatment for uncomplicated malaria in Indonesia and has been used since 2010. This study was conducted to determine the efficacy of DHP combination for uncomplicated malaria treatment in a community-based evaluation. Recruitment was done by active or passive case detection. All uncomplicated malaria patients were treated with DHP once a day, for 3 days, administered orally (as is done in primary health care). Patients were followed up until day 28 post-treatment. The primary end point was a 28-day cure rate. In this study, 484 subjects were screened through active and passive cases detection. A total of 45 subjects infected by P. vivax and 2 subjects infected by P. falciparum agreed to participate through written informed consent. There was no difference between clinical malaria and asymptomatic malaria in all analyzed characteristics. One patient had a D3 parasite density greater than 25% D0, although no parasites were found on the following day (D4). This study found 46 patients (97.9%) who had adequate clinical and parasitological responses. No adverse event was reported during the follow up of this study. DHP was effective, safe, and well tolerated in the treatment of uncomplicated malaria at primary health care.

Gambaran Histopatologi Hepar Mencit (Mus musculus Balb/C) yang Diinfeksi dengan Plasmodium berghei

Background: The most common cause of death by malaria in Indonesia is Plasmodium falciparum, which is analogous to Plasmodium berghei, which lives as a parasite in the liver of mice. The damage caused is seen in severe hepatocyte cell damage, which can be prevented by immunization, but the right type of immunization has not been found.
 Objective: This study aims to see whether immunization with Anopheles sundaicus salivary gland extract in mice can reduce liver damage in mice that have been infected with Plasmodium berghei.
 Methods: This research was conducted at the Anatomical Pathology Laboratory, Faculty of Medicine, Andalas University, from May - September 2020. The research method was descriptive with a quantitative approach. View and compare the histopathological picture of the liver of mice, which were infected with Plasmodium berghei after being immunized with Anopheles sundaicus salivary gland extract, in the pellet extract and supernatant extract groups, and the control group who were not immunized. The preparations were viewed using a microscope (Binocular Olympus BX 51 DIC), the number of hepatocytes was counted using the Image J application and the percentage of damage was calculated using the formula by Baldatina (2008).
 Results: The percentage of hepatocyte cell damage in the mencit control group was 96.27%, pellet extract 88.88% and supernatan extract 85.93%.
 Conclusion: The highest percentage of hepatocyte cell damage was found in the mencit control group and the lowest damage percentage in the supernatan extract group.

Efficacy and safety of dihydroartemisinin\u2013piperaquine for the treatment of uncomplicated Plasmodium falciparum and Plasmodium vivax malaria in Papua and Sumatra, Indonesia

BackgroundDihydroartemisinin–piperaquine (DHA–PPQ) has been adopted as first-line therapy for uncomplicated falciparum malaria in Indonesia since 2010. The efficacy of DHA–PPQ was evaluated in 2 sentinel sites in Keerom District, Papua and Merangin District, Jambi, Sumatra from April 2017 to April 2018.MethodsClinical and parasitological parameters were monitored over a 42-day period following the World Health Organization standard in vivo protocol and subjects meeting the inclusion criteria were treated with DHA–PPQ once daily for 3 days, administered orally.ResultsIn Papua, 6339 subjects were screened through active and passive cases detection. Of the 114 falciparum and 81 vivax cases enrolled, 102 falciparum and 80 vivax cases completed the 42 day follow up, and 12 falciparum and 1 vivax cases were either lost to follow up or withdrawn. Kaplan–Meier analysis of microscopy readings of 102 falciparum cases revealed 93.1% (95% CI 86.4–97.2) as Adequate Clinical and Parasitological Response (ACPR). No delay in parasite clearance nor severe adverse reaction was observed. Recurrent parasites of Plasmodium falciparum were detected in 7 cases and categorized as late treatment failures (LTF) at days 21, 35, and 42 and one of which was reinfected by Plasmodium vivax at day 42. Two cases were confirmed as recrudescent infection and 4 were re-infection. The PCR-corrected DHA–PPQ efficacy for P. falciparum was 97.9% (95% CI 92.7–99.7). Of the 80 cases of P. vivax that were followed up, 71 cases were completely cured and classified as ACPR (88.8%, 95% CI 79.7–94.7) and 9 cases showed recurrent infection at days 35 and 42, and classified as LTF. In Sumatra, of the 751 subjects screened, 35 vivax subjects enrolled, 34 completed the 42 day follow up. Thirty-three cases were completely cured and classified as ACPR (97.1%, 95% CI 84.7–99.9) and 1 recurrent infection was observed and classified as LTF. No delay in parasite clearance nor severe adverse reaction was observed. Analysis of the Pfk13 gene in P. falciparum cases from Papua revealed no mutations associated with artemisinin resistance in the 20 SNPs previously reported. Analysis of the Pfpm2 gene at day 0 and day of recurrence in recrudescent cases revealed the same single copy number, whereas 3 of the 4 re-infection cases carried 2–3 Pfpm2 gene copy numbers.ConclusionTreatment of falciparum and vivax malaria cases with DHA–PPQ showed a high efficacy and safety.

Faktor Risiko Perilaku dan Bitting Activity Anopheles Sp. Dengan Kejadian Malaria di Indonesia: Literature Review

Malaria is one of the vector-borne diseases that affect the morbidity and mortality of people in the world. Malaria cases recorded in 2017 were 219 million cases worldwide. In 2020, In the southeast Asian region, Indonesia was the highest contributor to confirmed malaria cases at 49.6%, followed by India at 36.4% and Myanmar at 11.5%. The purpose of this study was to determine the risk factors for people's behavior and the activity of biting Anopheles with the incidence of malaria in Indonesia. This research uses the literature review method by analyzing 22 scientific articles related to the research. The results of this study showed that the behavior of not using mosquito nets when sleeping at night, the habit of going out at night, not using mosquito repellent, and not using long clothes are risk factors for malaria events. The peak bites Anopheles at night at 20.00-05.00 WIB and is exofagic. People in endemic areas are expected to be able to use mosquito nets, reduce activities outside the home at night, use mosquito repellent, and use long clothes, especially at night.

Faktor Risiko Penyebab Terjadinya Malaria di Indonesia : Literature Review

Malaria is one of the leading causes of disease and death worldwide. Around 2.4 billion people are at risk of malaria. In Indonesia, malaria is still a serious public health problem and is often found outside Java and Bali. The risk of malaria is determined by many factors, especially the type of Anopheles mosquito species, human behavior, and the presence of malaria parasites. A change of any of the factors will affect the risk of malaria. The purpose of this study is to see an overview of the problem of malaria the factors that cause malaria and how to prevent and treat malaria in Indonesia and the world. This research method is a descriptive observational study using a literature review design, with databases Google Scholar. The search results that meet the criteria are then analyzed for articles. Malaria is still a disease with high cases in Indonesia every year. Malaria can occur due to several factors. These factors are behavioral factors and community attitudes (night activities, use of mosquito repellent, use of mosquito nets), home environment factors (existence of cattle pens, presence of bushes, and presence of watery rice fields); physical environmental factors of the house (temperature, humidity, the presence of wires in the ventilation, the presence of the ceiling of the house, and the density of the walls of the house).

Open Clinical Trial of Sambiloto (Andrographis paniculata) Ethanolic Extract Capsules in Treatment of Malaria Patients in Batubara District, Indonesia.

Malaria infection is still a public health problem in Indonesia. One of the problems in combating malaria in Indonesia is the limited kind of antimalarial drugs provided by the government. Sambiloto (Andrographis paniculata) extract has been shown to have antimalarial activity in human clinical trials. To assess the ability of a single A. paniculata ethanolic extract capsule to treat malaria in humans caused by Plasmodium falciparum or P. vivax alone or mixed infections of both. An open clinical trial was conducted in Batubara District, Sumatra Utara Province, Indonesia, a malaria-endemic area. Sixty-nine malaria patients found in the field were diagnosed microscopically as malaria vivax, malaria falciparum, and mixed infections uncomplicated malaria with 12 years old and above. Previously all patients signed informed consent. All patients have been treated with A. paniculata ethanolic extract capsules 250 mg thrice a day for five days. Parasite density was calculated from D0, D1, D2, D3, D7, D14, and D28. The efficacy of A . paniculata ethanolic extract capsules 250 mg thrice a day for five days against malaria vivax, malaria falciparum, and mixed malaria patients was 94.2%. There are no side effects were found during treatment. A. paniculata ethanolic extract can be used as an alternative antimalarial candidate derived from native Indonesian medicinal plants or as an adjunct in standard treatment for malaria.

Modeling Annual Parasite Incidence of Malaria in Indonesia of 2017 using Spatial Regime

Malaria is an infectious disease caused by the Plasmodium parasite and transmitted through infected female Anopheles mosquitoes. The morbidity of malaria is determined by Annual Parasite Incidence (API) per year. A region with high malaria cases can spread malaria to other regions. Therefore, the purpose of this study is to determine the spatial regimes and factors that significantly influence the spread of malaria in Indonesia of 2017. Spatial regime is a method obtained by clustering the coefficient values from the well-known method in modeling spatial varying relationship namely geographically weighted regression (GWR). The data used in this study are malaria Passive Case Detection (PCD) from Puskesmas throughout Indonesia in 2017. The results show three groups which can be classified as regencies/cities with low, medium moderate and high API, while slide positivity rate and annual blood examination are predictors who influent API numbers in Indonesia significantly.

Use of Combination Therapy in Malaria Treatment and Prevention in Indonesia

Malaria is still a health problem in Indonesia. Treatment of malaria often encounters obstacles. Resistance to various malaria drugs in some areas causes an increase in morbidity and mortality due to malaria. Rational use of malaria drugs that are still effective and available is important. Therefore, this article will review the use of combination therapy in the treatment of malaria in Indonesia. The purpose of using combination therapy is to increase the efficacy of treatment and slow down the occurrence of resistance to each component in the drug. From this article, it can be concluded that artemisinin-based combinations using artemisinin derivatives are still effective for use as combination therapy against malaria. This combination can be a fixed combination or co-administered. The drugs that can be combined are 4-aminoquinoline, antifolate, 4-quinoline-methanol, artemisinin and its derivatives, antibiotics, and atovaquone-proguanil. It is hoped that the combination of these drugs can still be used for a long period of time, remain safe, effective and affordable by the community.

EFEK ANTI-MIKROBIAL PADA EKSTRAK CINNAMOMUM VERUM (KAYU MANIS) SEBAGAI TERAPI ADJUVANT PADA MALARIA FALCIPARUM

Malaria is a major public health problem in the world, especially in Indonesia. The prevalence of malaria in Indonesia reaches 6 percent, which is mostly caused by plasmodium falciparum. Various treatment options for malaria falciparum have been developed, but due to various factors, such as the adherence to taking medication from patients are not monitored so that it can increase the risk of resistance to current malaria therapy. Therefore, the researchers conducted further research on alternative malaria therapies. Cinnamomum verum or cinnamon is known to contain cinnamaldehyde compounds which have an antimicrobial effect. The purpose of this study was to determine the anti-microbial effect of Cinnamomum verum extract or cinnamon extract as adjuvant therapy in malaria falciparum. This type of study is a literature review with the method of collecting reading results from 25 articles of case reports, research articles, and literature reviews. This study concludes that the cinnamaldehyde compound in Cinnamomum verum extraction has an antimicrobial effect which can inhibit the denaturation potential of amino acids, inhibits β-hematin formation and activity of the reductase enzyme on Plasmodium falciparum enoyl-ACP reductase, where it is known that these four have an important role. in the pathogenesis of falciparum malaria.