Journal
AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE
Volume 98, Issue 2, Pages 543-550Publisher
AMER SOC TROP MED & HYGIENE
DOI: 10.4269/ajtmh.17-0680
Keywords
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Funding
- Wellcome Trust (ICRG Wellcome Trust) [ME928457MES]
- Wellcome Trust (Senior Fellowship in Clinical Science) [200909]
- Australian National Health and Medical Research Council (NHMRC) [283321]
- Bill & Melinda Gates Foundation [OPP1054404]
- NHMRC Program Grant [1037304]
- Australian Department of Foreign Affairs and Trade
- Tracking Resistance to Artemisinins Collaboration (TRAC) programme grant from UKAID
- NHMRC Practitioner Fellowship [1042072]
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Artemisinin combination therapy is recommended for the treatment of multidrug resistant Plasmodium falciparum and Plasmodium vivax. In March 2006, antimalarial policy in Indonesia was changed to a unified treatment with dihydroartemisinin-piperaquine for all species of malaria because of the low efficacy of previous drug treatments. In 2013, a randomized cross-sectional household survey in Papua was used to collect data on demographics, parasite positivity, treatment-seeking behavior, diagnosis and treatment of malaria, and household costs. Results were compared with a similar survey undertaken in 2005. A total of 800 households with 4,010 individuals were included in the 2013 survey. The prevalence of malaria parasitemia was 12% (348/2,795). Of the individuals who sought treatment of fever, 67% (66/98) reported attending a public provider at least once compared with 46% (349/764) before policy change (P < 0.001). During the 100 visits to healthcare providers, 95% (95) included a blood test for malaria and 74% (64/86) resulted in the recommended antimalarial for the diagnosed species, the corresponding figures before policy change were 48% (433/894) and 23% (78/336). The proportion of individuals seeking treatment more than once fell from 14% (107/764) before policy change to 2% (2/98) after policy change (P = 0.005). The mean indirect cost per fever episode requiring treatment seeking decreased from US$44.2 in 2005 to US$33.8 in 2013 (P = 0.006). The implementation of a highly effective antimalarial treatment was associated with better adherence of healthcare providers in both the public and private sectors and a reduction in clinical malaria and household costs.
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