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Updated: Dec 29, 2025
Protocol for Plasmodium falciparum Infections in Mosquitoes and Infection Phenotype Determination
Published on: July 4, 2007
Malaria-related hospitalization during childhood in Papua, Indonesia: A retrospective cohort study
Nicholas M Douglas1,2, Enny Kenangalem3,4, Afdhal Hasanuddin5
1Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
Insights
Malaria significantly impacts infants in Papua, Indonesia, with Plasmodium vivax initially more common than Plasmodium falciparum. This pattern reverses after age five, and malaria contributes to infant mortality.
Area of Science:
- Tropical Medicine
- Infectious Diseases
- Pediatric Health
Background:
- Malaria's age distribution varies by Plasmodium species in endemic areas.
- Timika, Papua, is co-endemic for Plasmodium falciparum and Plasmodium vivax.
- Understanding malaria hospitalization patterns in infants is crucial.
Purpose of the Study:
- To analyze malaria-related hospitalizations from birth in Timika, Papua.
- To delineate age-specific incidence patterns for P. vivax and P. falciparum.
- To assess the impact of malaria on infant mortality.
Main Methods:
- Retrospective cohort study of infants from April 2004 to December 2013.
- Utilized routinely collected hospital surveillance data for follow-up.
- Outcomes included hospital re-presentation, admission, and death, stratified by Plasmodium parasitemia.
Main Results:
- Over 11,000 infants were enrolled; 68.9% re-presented to the hospital.
- Incidence of P. vivax malaria was higher in the first year (213/1000py) than P. falciparum (79/1000py).
- After age five, P. falciparum incidence (95/1000py) exceeded P. vivax (77/1000py); malaria caused 31.7% of admissions and 13.4% of post-neonatal deaths.
Conclusions:
- Malaria is a primary cause of hospital visits and admissions in early childhood in Papua.
- Plasmodium species predominance shifts with age, with P. vivax initially dominant, then P. falciparum.
- Malaria is a significant contributor to infant mortality in the region.
Background:
In endemic regions, the age distribution of malaria varies according to the infecting Plasmodium species. We aimed to delineate the pattern of malaria-related hospitalization from birth in Timika, Papua-an area co-endemic for P. falciparum and P. vivax.
Methods:
Between April 2004 and December 2013, infants born at Mitra Masyarakat Hospital, or presenting within the first 7 days of life, were enrolled retrospectively into a cohort study and followed passively using routinely-collected hospital surveillance data. Outcomes were stratified by the presence or absence of Plasmodium parasitemia and included re-presentation to hospital, requirement for hospital admission and death.
Results:
Overall, 11,408 infants were enrolled into the cohort. Median follow-up was 4.3 (maximum 9.7) years. In total, 7,847 (68.9%) infants made 90,766 re-presentations to hospital, 18,105 (19.9%) of which were associated with Plasmodium parasitemia. The incidence of re-presentations with malaria during the first year of life was 213 per 1,000 person-years (py) for P. vivax and 79 per 1,000py for P. falciparum (Incidence Rate Ratio (IRR) = 2.69, 95% Confidence Interval (95%CI): 2.48-2.92). After the age of 5 years, the incidence of P. vivax had fallen to 77/1,000py and the incidence of P. falciparum had risen to 95/1,000py (IRR = 0.80, 95%CI: 0.73-0.88). Overall, 79.7% (14,431/18,105) of malaria re-presentations were recurrences rather than initial infections. Malaria accounted for 31.7% (2,126/3,120) of all hospital admissions. The infant mortality rate in this study was 52 deaths per 1,000 live births. Beyond the early neonatal period, 13.4% of deaths were associated with Plasmodium parasitemia.
Conclusions:
In Papua, Indonesia, malaria is a major cause of hospital presentation and admission in early life. The initial predominance of P. vivax over P. falciparum inverts after five years of age. Malaria is directly associated with nearly one in seven deaths after the early neonatal period.
