Oral Presentation 8th International Conference on Plasmodium vivax Research 2022

Impact of a clinic-based “Malaria Corner” on health care delivery and recurrent episodes of malaria in Timika, Papua, Indonesia (80279)

Liony Fransisca 1 2 , Faustina Helena Burdam 1 3 , Enny Kenangalem 1 4 , Annisa Rahmalia 1 5 , Reynold Rizal Ubra 3 , Benedikt Ley 2 , Christel van den Boogaard 2 , Ric Price 2 6 7 , Nick Douglas 2 , Jeanne Rini Poespoprodjo 1 4
  1. YPKMP, Timika, Papua, Indonesia
  2. Menzies School of Health Research, Darwin, North Territory, Australia
  3. Mimika Regency Health Office, Timika, Papua, Indonesia
  4. Mimika General Hospital, Timika, Papua, Indonesia
  5. Magnaka Inspirasi Inklusi, Bandung, West Java, Indonesia
  6. Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
  7. Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand

Background: Papua has the highest incidence of malaria in Indonesia. More than half of patients with P. vivax malaria have recurrent infections within 6 months of treatment. These relapses contribute to ongoing transmission, morbidity, and mortality. Effective treatment is necessary to prevent recurrence. Health system strengthening can improve access to optimal antimalarial treatment and reduce the burden of malaria.

Methods: Since 2019, health care staff at five local public clinics in Timika, Papua received training on correct antimalarial drug dosing and delivery of a package of interventions through a dedicated “Malaria Corner”, which includes education on treatment completion, first dose observation, patient referral to community health worker to promote treatment adherence and adverse event monitoring.

Findings: Between January 2019 and October 2021, 70,630 patients were diagnosed with malaria and treated at the five study clinics: 35,067 (49.6%) had P. falciparum, 30,943 (43.8%) P. vivax, and 2,704 (3.8%) mixed infections. World Health Organization guideline-concordant weight or age-based dosing of Dihydroartemisinin-Piperaquine (DHP) increased from 55.9% (2,868/5,135) in Q1 2019 to 97.6% (5,406/5,537) in Q3 2021, whilst guideline-concordant primaquine radical cure in patients with P. vivax increased from 54.4% (1,502/2,763) to 97.0% (2,829/2,915).

At 6 months, the overall risk of representation with P. vivax to the same clinic was 15.5% (95%CI:14.9-16.2%), and lower in patients who had their first dose of primaquine supervised (14.8% (95%CI:14.1-15.6%)) compared to those who did not (16.9% (95%CI:15.8-18.1%)); p<0.001. The overall risk of P. falciparum representation within 2 months was 3.0% (95%CI:2.73-3.29%), 2.9% (95%CI:2.61-3.23%) in patients who had their first dose of DHP supervised compared to 3.4% (95%CI:2.78-4.16%) for patients who did not; p=0.15.

Interpretation: Simple measures to improve prescriber and patient adherence have potential to reduce recurrent malaria and support elimination strategies. 

 

Note: Liony Fransisca and Faustina Helena Burdam are joint first authors