Combined chloroquine, sulfadoxine/pyrimethamine and primaquine against Plasmodium falciparum in Central Java, Indonesia

BACKGROUND: Chloroquine (CQ) or sulfadoxine-pyrimethamine (SP) monotherapy for Plasmodium falciparum often leads to therapeutic failure in Indonesia. Combining CQ with other drugs, like SP, may provide an affordable, available and effective option where artemisinin-combined therapies (ACT) are not licensed or are unavailable. METHODS: This study compared CQ (n = 29 subjects) versus CQ + SP (with or without primaquine; n = 88) for clinical and parasitological cure of uncomplicated falciparum malaria in the Menoreh Hills region of southern Central Java, Indonesia. Gametocyte clearance rates were measured with (n = 56 subjects) and without (n = 61) a single 45 mg dose of primaquine (PQ). RESULTS: After 28 days, 58% of subjects receiving CQ had cleared parasitaemia and remained aparasitaemic, compared to 94% receiving CQ combined with SP (p < 0.001). Msp-2 genotyping permitted reinfection-adjusted cure rates for CQ and CQ combined with SP, 70% and 99%, respectively (p = 0.0006). CONCLUSION: Primaquine exerted no apparent affect on cure of asexual stage parasitaemia, but clearly accelerated clearance of gametocytes. CQ combined with SP was safe and well-tolerated with superior efficacy over CQ for P. falciparum parasitaemia in this study

PENGGUNAAN RAPID DIAGNOSTIC TEST (RDT) OLEH KADER SEBAGAI ALAT BANTU DALAM PENEMUAN KASUS MALARIA DI DESA GUNTUR, KECAMATAN BENER, KABUPATEN PURWOREJO

The Used of Rapid Diagnostic Test (RDT) as a Tool for Case Finding Activity by Malaria Trained Cadre in Guntur Village, Bener Sub-District, Purworejo District.Guntur is a village in Bener sub-district; in 2005 the annual parasite incidence (API) was 9.02%o. This village is the only a high case incidence area (HCI) left among 27 villages in this area. Geographically, is a hilly area which is also far from health facility (remote area). Malaria active case finding done by village malaria trained person (Juru malaria desa/JMD) had been abandoned since September 2005, this situation makes the accessibility to health facility became more difficult. A mobile health center has been operated in this area, with once a month visit schedule. To increase the accessibility to health facility, in October 2005 village malaria cadres had been trained to identify clinical malaria sign and symptoms, also to make malaria blood smear from a finger prick. One cadre was responsible to 40 house hold or about one dukuh (hamlet). The case findings were reported to the health center; through acertain mechanism which had been develop before according to the village situation. Parasitological confirmation was done by microscopy examination in Guntur health center. Standard anti malaria treatment was given to the positive cases. To simplify the case finding activity, the cadres also trained to use a rapid diagnostic test (RDT). The used of RDT by cadres who had been trained to identify clinical malaria cases and make a blood smear from a finer prick will be discussed. The result suggest that RDT can be used as a tool for cadres to increase the case finding activity, because this device is simple and do not need a special training program, even though since the cadres are not yet frequently expose to a delicate work, the used ofthis device should be carefully consider to prevent higher expenses as a consequences of technically fault.Keywords: malaria cadre, malaria case finding, Rapid Diagnostic Tes

Penggunaan Rapid Diagnostic Test (Rdt) Oleh Kader Sebagai Alat Bantu Dalam Penemuan Kasus Malaria Di Desa Guntur, Kecamatan Bener, Kabupaten Purworejo

The Used of Rapid Diagnostic Test (RDT) as a Tool for Case Finding Activity by Malaria Trained Cadre in Guntur Village, Bener Sub-District, Purworejo District.Guntur is a village in Bener sub-district; in 2005 the annual parasite incidence (API) was 9.02%o. This village is the only a high case incidence area (HCI) left among 27 villages in this area. Geographically, is a hilly area which is also far from health facility (remote area). Malaria active case finding done by village malaria trained person (Juru malaria desa/JMD) had been abandoned since September 2005, this situation makes the accessibility to health facility became more difficult. A mobile health center has been operated in this area, with once a month visit schedule. To increase the accessibility to health facility, in October 2005 village malaria cadres had been trained to identify clinical malaria sign and symptoms, also to make malaria blood smear from a finger prick. One cadre was responsible to 40 house hold or about one dukuh (hamlet). The case findings were reported to the health center; through acertain mechanism which had been develop before according to the village situation. Parasitological confirmation was done by microscopy examination in Guntur health center. Standard anti malaria treatment was given to the positive cases. To simplify the case finding activity, the cadres also trained to use a rapid diagnostic test (RDT). The used of RDT by cadres who had been trained to identify clinical malaria cases and make a blood smear from a finer prick will be discussed. The result suggest that RDT can be used as a tool for cadres to increase the case finding activity, because this device is simple and do not need a special training program, even though since the cadres are not yet frequently expose to a delicate work, the used ofthis device should be carefully consider to prevent higher expenses as a consequences of technically fault

Combined chloroquine, sulfadoxine/pyrimethamine and primaquine against \u3ci\u3ePlasmodium falciparum\u3c/i\u3e in Central Java, Indonesia

Background: Chloroquine (CQ) or sulfadoxine-pyrimethamine (SP) monotherapy for Plasmodium falciparum often leads to therapeutic failure in Indonesia. Combining CQ with other drugs, like SP, may provide an affordable, available and effective option where artemisinin-combined therapies (ACT) are not licensed or are unavailable. Methods: This study compared CQ (n = 29 subjects) versus CQ + SP (with or without primaquine; n = 88) for clinical and parasitological cure of uncomplicated falciparum malaria in the Menoreh Hills region of southern Central Java, Indonesia. Gametocyte clearance rates were measured with (n = 56 subjects) and without (n = 61) a single 45 mg dose of primaquine (PQ). Results: After 28 days, 58% of subjects receiving CQ had cleared parasitaemia and remained aparasitaemic, compared to 94% receiving CQ combined with SP (p \u3c 0.001). Msp-2 genotyping permitted reinfection-adjusted cure rates for CQ and CQ combined with SP, 70% and 99%, respectively (p = 0.0006). Conclusion: Primaquine exerted no apparent affect on cure of asexual stage parasitaemia, but clearly accelerated clearance of gametocytes. CQ combined with SP was safe and well-tolerated with superior efficacy over CQ for P. falciparum parasitaemia in this study