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A recent malaria epidemic in the Menoreh Hills of Central Java has increased concern about the re-emergence of endemic malaria on Java, which threatens the island's 120 million residents. A 28-day, in-vivo test of the efficacy of treatment of malaria with antimalarial drugs was conducted among 167 villagers in the Menoreh Hills. The treatments investigated, chloroquine (CQ) and sulfadoxine-pyrimethamine (SP), constitute, respectively, the first- and second-line treatments for uncomplicated malaria in Indonesia. The prevalence of malaria among 1389 residents screened prior to enrollment was 33%. Treatment outcomes were assessed by microscopical diagnoses, PCR-based confirmation of the diagnoses, measurement of the whole-blood concentrations of CQ and desethylchloroquine (DCQ), and identification of the Plasmodium falciparum genotypes. The 28-day cumulative incidences of therapeutic failure for CQ and SP were, respectively, 47% (N = 36) and 22% (N = 50) in the treatment of P. falciparum, and 18% (N = 77) and 67% (N = 6) in the treatment of P. vivax. Chloroquine was thus an ineffective therapy for P. falciparum malaria, and the presence of CQ-resistant P. vivax and SP-resistant P. falciparum will further compromise efforts to control resurgent malaria on Java.

Original publication

DOI

10.1179/000349802125002310

Type

Journal article

Journal

Ann Trop Med Parasitol

Publication Date

10/2002

Volume

96

Pages

655 - 668

Keywords

Adolescent, Adult, Aged, Animals, Antimalarials, Child, Child, Preschool, Chloroquine, Disease Outbreaks, Drug Combinations, Drug Resistance, Female, Humans, Incidence, Indonesia, Malaria, Falciparum, Male, Middle Aged, Prevalence, Pyrimethamine, Sulfadoxine, Treatment Failure