Thursday, June 8, 2023 | 08:22 WIB

Time for zero malaria

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Jakarta, IO – The WHO estimates that Plasmodium vivax causes 41% of the malaria burden outside of Africa, with 48% of the world’s population at risk from the parasite’s infection. Globally, the number of Plasmodium vivax malaria cases decreased from 25 million in 2000 to 14 million in 2017. India, Indonesia, and Pakistan account for just over 80% of the global vivax malaria case burden. 

According to the Ministry of Health’s data on the malaria situation in Indonesia in 2020, no less than 62% of our territory, or 318 regencies and townships in our country are malaria-free, with no less than 80.4% of Indonesian citizens living in this area. The number of malaria cases showed a downward turn in 2010-2014, but remained stagnant ever since. This indicates that malaria mitigation has reached the hardest stage – i.e. maintaining a constant reduction of the disease in high-infection areas, while simultaneously maintaining the cleanliness of malaria-free areas. 

This ties in with the global target of malaria eradication by 2030. “The data on the proportion of parasite-based malaria in Indonesia shows that 58% of malaria cases in 2017 was caused by Plasmodium falciparum. However, Plasmodium vivax malarial infection for the same year was quite high too, at 35%. Under these circumstances, compliance with a medical regimen is more crucial than ever,” declared dr. Ayodhia Pitaloka Pasaribu, Sp.A(K), MKed(Ped), Ph.D, (CTM), of the North Sumatra University Faculty of Medicine, in the “Time to Deliver Zero Malaria: Invest, Innovate, Implement” webinar held on 28 April 2023, to commemorate the World Malaria Day (25 April), in line with this year’s theme of “Working Together for a Malaria-free Asia Pacific”. 

By age, 60% of malaria cases attack people 15-64 years old, 1% happen to people 64 years or older, and the remaining 39% attack children (2% attacking babies 0-11 months old, 13% attacking toddlers 1-4 years old, 14% attacking children 5-9 years old, and 10% attacking children 10-14 years old). “Infants and children in endemic areas have not yet acquired clinical immunity. They are vulnerable to severe form Plasmodium vivax malaria, recurrence, and anemia associated with development impacts. Children bear nonspecific symptoms: fever, headache, malaise, chills, anemia, abdominal discomfort, respiration problem under 5 years old and diarrhea. Plasmodium vivax is a major cause of morbidity in early infancy. Preventive strategies, early diagnosis, and prompt treatment should be initiated in the perinatal period,” dr. Ayodhia said. 

A possibly fatal disease 

Malaria is treated by administering 0.25 ml Primaquine per kg body weight a day to the patient for 14 consecutive days. Primaquine may only be administered for a maximum of eight consecutive weeks, with due monitoring of the patient’s urine color and hemoglobin levels. When the urine darkens, the medication must be stopped immediately. 

“Malarial medication in our country is largely ineffective, as patient compliance towards the treatment is below 30%. This is a shame, as studies show that medication compliance lowers the possibility of relapse/recurrence by more than 80%. A caveat, though: it is not recommended for pregnant and nursing women, and for babies younger than 6 months. Age-based dosing regimens tend to lead to underdosing. This is another way the treatment’s effectiveness is undermined, while malaria medication must be completed. Otherwise, it might trigger anemia and obstruct children’s growth,” dr. Ayodhia said. 

Read: World Malaria Day – The challenges in achieving the target of malaria elimination

At the same event, dr. Jeanne Rini Poespoprodjo, Sp.A, M.Sc, Ph.D, a pediatric consultant at the Timika Research Foundation, Papua, declared that clinical experience shows the continued existence of malaria cases, even though it is much lower in number than in the 80’s. “Doctors should understand what malaria is, especially in endemic regions. The danger is that it is a disease with non-specific symptoms, mostly asymptomatic. Anemia and respiratory distress among patients are common. Any signs and symptoms with positive blood malaria smear are diagnosed as malaria. We need to properly analyze whether the signs and symptoms are associated with malaria or co-morbidity, as it is difficult to convincingly differentiate. Untreated or mistreated malaria can be fatal,” dr. Rini, her nickname, stated. 

As a take-home message, dr. Rini emphasize that early diagnosis and prompt effective treatment for malaria can save lives; severe malaria is a medical emergency, intravenous artesunate should be given promptly (within 30 minutes after diagnosis), supportive treatment should be given according to signs of severity, monitoring of patient with severe malaria is very important to avoid death. (est)

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