ABSTRACT
After decades of successful artemisinin regimen in combating malaria, its effectiveness has decreased since parasite resistance to the treatment regimen has begun to appear. Adherence to artemisinin combination therapy (ACT) in a population is considered to be the key factor contributing to such resistance phenomenon. Although several studies have tried to demonstrate adherence to several ACT types in a population, only a limited number of studies demonstrated adherence to dihyrdroartemisinin + piperaquine (DHP) regimen. The present study was conducted in two localities representing low and high endemic areas in Indonesia. Active case detection (ACD) and passive case detection (PCD) have been applied to screen for malaria case in the localities. At day 3, patients were visited in the house to be interviewed using structured questionnaire. Capillary sample of each patient was also collected on Whatman® filter paper at day 60 to observe the piperaquine metabolite of the patients. 47 and 91 (out of 62 and 138) patients from Jambi and Sumba, respectively, were successfully enrolled in this study. In Jambi, the level of adherence was 66%, while that in Sumba was 79.1%. The associated factors of adherence in our study settings are patient age group (OR = 1.65 [CI: 0.73-3.73]) and patients' knowledge of malaria prevention measure (OR = 0.29 [CI: 0.09-0.9]). Our study suggested that the adherence to ACT medication among population in our study setting is considered to be less than 80%, which needs to be elevated to avoid the growing trend of treatment failure as seen globally. Additionally, our study found that metabolite at day 60 after prescription of piperaquine could be a potential marker for monitoring adherence to piperaquine drug in a population.
ABSTRACT
Background: Malaria is a significant health burden for many countries worldwide. Insecticide-treated bed nets and mosquito repellent are considered effective methods for preventing Anopheles bites. However, changes in the biological properties of the vector have led to a reduction in their effectiveness. Most published studies have only investigated the human population factor, not the dynamics of vector behavior. Therefore, this study aims to investigate the importance of primary vector activity for selecting an appropriate malaria protection strategy. Methods: Initially, active case detection (ACD) was carried out in western and eastern parts of Indonesia, Jambi and Sumba, to confirm their endemicity level. According to the 2016 national health report of Indonesia, Jambi has an annual parasite index (API) of 0.14 and Sumba has an API of 5.41. A series of entomological observations were carried out to compare the biting activity of Anopheles vector in two localities, with a total of 216 houses and 216 catchers (108 in each study site). Results: The results indicated that endemicity at the sub-district level is higher than that at the provincial level. Only Anopheles balabacensi was found to be exophagic. Multiple comparisons found different biting times between the sites, suggesting that early evening (18.00-20.00) is most likely to be the time when mosquitoes transmit the Plasmodium parasite in Jambi, while during sleeping hours (21.00-01.00) is the peak biting time of Anopheles mosquitoes in Sumba. Conclusions: The study demonstrates the importance of Anopheles species blood feeding patterns in selecting an appropriate malaria protection strategy.
