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Title: Early and late mortality after malaria in young children in Papua, Indonesia
Authors: Dewi Patriani
Eggi Arguni
Enny Kenangalem
Saber Dini
Paulus Sugiarto
Afdhal Hasanuddin
Daniel Adrian Lampah
Nicholas M. Douglas
Nicholas M. Anstey
Julie Anne Simpson
Ric N. Price
Jeanne Rini Poespoprodjo
Melbourne School of Population and Global Health
Mitra Masyarakat Hospital, Indonesia
Universitas Gadjah Mada
Menzies School of Health Research
Mahidol University
Nuffield Department of Clinical Medicine
Royal Darwin Hospital
Papuan Health and Community Development Foundation
Mimika District Health Authority
Keywords: Medicine
Issue Date: 30-Oct-2019
Citation: BMC infectious diseases. Vol.19, No.1 (2019), 922
Abstract: BACKGROUND: In southern Papua, Indonesia, malaria is highly prevalent in young children and is a significant cause of morbidity and early mortality. The association between malaria and delayed mortality is unknown. METHODS: Routinely-collected hospital surveillance data from southern Papua, Indonesia, were used to assess the risk of recurrent malaria and mortality within 12 months of an initial presentation with malaria in all children younger than 5 years old attending the local hospital. Analysis was primarily by Kaplan Meier and Cox regression methods. RESULTS: In total 15,716 children presenting with malaria between April 2004 and December 2013 were included in the analysis; 6184 (39.3%) with Plasmodium falciparum, 7499 (47.7%) with P. vivax, 203 (1.3%) with P. malariae, 3 with P. ovale and 1827 (11.6%) with mixed infections. Within 1 year, 48.4% (7620/15,716) of children represented a total of 16,957 times with malaria (range 1 to 11 episodes), with the incidence of malaria being greater in patients initially presenting with P. vivax infection (1334 [95%CI 1307-1361] per 1000 patient years) compared to those with P. falciparum infection (920 [896-944]). In total 266 (1.7%) children died within 1 year of their initial presentation, 129 (48.5%) within 30 days and 137 (51.5%) between 31 and 365 days. There was no significant difference in the mortality risk in patients infected with P. vivax versus P. falciparum either before 30 days (Hazard Ratio (HR) 1.02 [0.69,1.49]) or between 31 and 365 days (HR = 1.30 [0.90,1.88]). Children who died had a greater incidence of malaria, 2280 [95%CI 1946-2671] per 1000 patient years preceding their death, compared to 1141 [95%CI 1124-1158] per 1000 patient years in those surviving. CONCLUSIONS: Children under-5 years old with P. vivax malaria, are at significant risk of multiple representations with malaria and of dying within 1 year of their initial presentation. Preventing recurrent malaria must be a public health priority in this vulnerable population.
ISSN: 14712334
Appears in Collections:Scopus 2019

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