Maternal and child health in Papua-Indonesia

: the epidemiology of malaria and strategies for its treatment and prevention

Abstract

Multidrug resistant P. falciparum and P. vivax infections are associated with high morbidity and mortality in Timika, Papua (Indonesia). This thesis sets out to define the burden of malaria in pregnant women and infants and determine the impact of better treatment protocols in reducing these. We established a systematic surveillance system at a local hospital. From April 2004 to June 2009, clinical and laboratory data on more than 6000 pregnant women and 1500 infants attending the hospital were collected.

We found that pregnant women and infants in this region are affected by the adverse outcomes of malaria, including those with P. vivax infections. Maternal peripheral parasitaemia at delivery is associated with maternal severe anaemia (OR=1.9), low birth weight babies (OR=1.9), preterm delivery (OR=1.5), stillbirths (OR=2.3) and congenital malaria (OR=4.5). The risk of malaria starts at birth and it is often without symptoms. The majority of symptomatic malaria in the first 6 months of life is associated with P. vivax infections. Severe anaemia is the main determinant of severe disease in both 93% of pregnant women and 77% of infants.

Malaria control programs in this region focus on the early detection and prompt treatment of malaria. In March 2006 malaria treatment policy in Timika was changed from chloroquine (CQ) ± sulfadoxine-pyrimethamine (SP) to dihydroartemisininpiperaquine (DHP). Our observation cohort documented that DHP in the second and third trimesters of pregnancy is well tolerated and safe. In addition, DHP has an excellent post treatment prophylaxis effect in pregnancy reducing the risk of malaria at delivery by 3 fold and congenital malaria by 16 fold.

After more than 3 years of DHP deployment, we observe an encouraging effect of treatment policy change in improving maternal and infant’s health outcomes. The results of this study suggests that an important next step will be identifying the most effective method of service delivery of ACT in order to scale up treatment and prevention programs. Universal coverage is likely to impact further in reducing malaria associated morbidity and mortality in pregnant women and infants in this region.

Date of Award	Dec 2011
Original language	English
Awarding Institution	Charles Darwin University (CDU)
Supervisor	Ric Price (Supervisor)