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Abstract Background Chloroquine (CQ) or sulfadoxine-pyrimethamine (SP) monotherapy for Plasmodium falciparum often leads to therapeutic failure in Indonesia. Combining CQ with other drugs, like SP, may provide an affordable, available and effective option where artemisinin-combined therapies (ACT) are not licensed or are unavailable. Methods This study compared CQ (n = 29 subjects) versus CQ + SP (with or without primaquine; n = 88) for clinical and parasitological cure of uncomplicated falciparum malaria in the Menoreh Hills region of southern Central Java, Indonesia. Gametocyte clearance rates were measured with (n = 56 subjects) and without (n = 61) a single 45 mg dose of primaquine (PQ). Results After 28 days, 58% of subjects receiving CQ had cleared parasitaemia and remained aparasitaemic, compared to 94% receiving CQ combined with SP (p < 0.001). Msp-2 genotyping permitted reinfection-adjusted cure rates for CQ and CQ combined with SP, 70% and 99%, respectively (p = 0.0006). Conclusion Primaquine exerted no apparent affect on cure of asexual stage parasitaemia, but clearly accelerated clearance of gametocytes. CQ combined with SP was safe and well-tolerated with superior efficacy over CQ for P. falciparum parasitaemia in this study.

Abstract Background Sets of Giemsa-stained, blood smear slides with systematically verified composite diagnoses would contribute substantially to development of externally validated quality assurance systems for the microscopic diagnosis of malaria. Methods whole blood from Plasmodium-positive donors in Cambodia and Indonesia and individuals with no history of risk for malaria was collected. Using standard operating procedures, technicians prepared Giemsa-stained thick and thin smears from each donor. One slide from each of the first 35 donations was distributed to each of 28 individuals acknowledged by reputation as having expertise in the microscopic diagnosis of malaria. These reference readers recorded presence or absence of Plasmodium species and parasite density. A composite diagnosis for each donation was determined based on microscopic findings and species-specific small subunit ribosomal RNA (ssrRNA) DNA polymerase chain reaction (PCR) amplification. Results More than 12, 000 slides were generated from 124 donations. Reference readers correctly identified presence of parasites on 85% of slides with densities 350 parasites/μl. Percentages of agreement with composite diagnoses were highest for Plasmodium falciparum (99%), followed by Plasmodium vivax (86%). Conclusion Herein, a standardized method for producing large numbers of consistently high quality, durable Giemsa-stained blood smears and validating composite diagnoses for the purpose of creating a malaria slide repository in support of initiatives to improve training and competency assessment amidst a background of variability in diagnosis is described.

Public administration services for the population are very important for management, safe data, good storage, easy search when needed. This condition has not been fulfilled if data management is done manually with large amounts of data. Sukawening village, located in the southern part of Bogor, experiences this condition, the management of population data is done manually with the help of Microsoft Excel, which is an obstacle in realizing resident administrative services, including SKU, births, deaths, moving and arrival files. Solutions are needed to realize fast, efficient, and safe services for residents from lost and damaged conditions. The solution to the problem used in this research is to build an application system that is intended to manage population data. The system is built based on the web with the RAD model, a Codeigniter framework tool. With the realization of the application system, the management of population data in the Sukawening village is as expected.

Land use patterns and the occurrence of Anopheles species larvae were studied in Sukabumi District, West Java, Indonesia, from October 2004 to September 2005. Two land use maps derived using remote sensing were used. One map derived from Quickbird satellite images of 150 km² of the Simpenan and Ciemas subdistricts (106° 27'53"-106° 38'38" E and 6° 59'59"-7° 8'46" S) in Sukabumi and one using ASTER images covering 4,000 km² of Sukabumi District from 106° 22'15"-107° 4'1" E and 6° 42'50"-7° 26'13" S. There was a total of 11 Anopheles spp. collected from 209 sampling locations in the area covered by the Quickbird image and a total of 15 Anopheles spp. collected from 1,600 sampling locations in the area covered by the ASTER map. For the area covered by the land use maps, ten species were found to have statistically positive relationships between land use class and species presence: Anopheles aconitus, An. annularis, An. barbirostris. An. flavirostris, An. insulaeflorum, An. kochi, An. maculatus, An. subpictus, An. sundaicus, and An. vagus. Quickbird and ASTER satellite images both produced land maps that were adequate for predicting species presence in an area. The land use classes associated with malaria vector breeding were rice paddy (An. aconitus, An. subpictus), plantation located near or adjacent to human settlements (An. maculatus), bush/shrub (An. aconitus, An. maculatus, An. sundaicus), bare land, and water body land use on the coast located ≤ 250 m of the beach (An. sundaicus). Understanding the associations of habitat and species in one area, predictions of species presence or absence can be made prior to a ground survey allowing for accurate vector survey and control planning. [ABSTRACT FROM AUTHOR]

Oral chloroquine is the treatment of choice for uncomplicated Plasmodium malariae infections worldwide. We did a prospective 28-day in-vivo assessment of the efficacy of chloroquine for treatment of P malariae on Legundi Island in Lampung Bay, Sumatra, Indonesia. Of 28 patients, one had recurrent parasitaemia on day 28, and two had persistent parasitaemia to day 8. Whole-blood chloroquine and desethylchloroquine concentrations were at ordinarily effective levels (≥100 μg/L) on day 8 in both cases of persistent parasitaemia. These findings suggest that clinical resistance to chloroquine by P malariae occurs in the Indonesian archipelago of southeast Asia. [Copyright &y& Elsevier]

The article discusses a study on mosquito larval collection records of Culex species with an emphasis on Japanese encephalitis vectors in rice fields in Sukabumi in West Java, Indonesia. The large-scale mosquito larval distribution study was conducted due to a malaria outbreak in 2003. A table is presented that compares the number of rice fields, mean rice plant height and the range of rice plant heights for four of five Culex species.

Unemployment became a social problem for the community, so they could not meet their life needs. One cause because they do not have special skills, so it is difficult to get a job. Therefore, in every local government through the UPTD Balai Tenaga Kerja, it often conducts work training for those who need it. However, the system applied in the UPTD Bogor area is still conventional. Causing problems such as data readings are less obvious; form storage and documents are not neatly arranged, so some documents are missing and lost. It resulted in a loss for the participants who would participate in job training. So it takes the development of the system to solve the problem. To improve the existing system, that is from conventional to computerized. For the development of this system, it is necessary to take steps such as those in the waterfall model. The result of the development of this system is the design of a web-based work training acceptance system that can facilitate participants to access online in the selection of the desired work exercises, and the storage of documents will be stored neatly in a database.

Dalam daur hidup obat dikenal tiga periode yaitu periode penemuan obat, periode pengembangan obat dan periode pemasaran obat. Dalam periode pengembangan, obat diuji melalui serangkaian pengujian klinis (clinical trial). Pengujian klinis ini terdiri atas tiga rangkaian yaitu fase I, fase II, dan fase III. Didalam melaksanakan pengujian ini, peneliti dan pihak-pihak terkait terikat kepada standar mutu ilmiah dan etika yang berlaku secara internasional, dinamakan dengan Good Clinical Practice (GCP). GCP merupakan jaminan kepada publik bahwa hak-hak, keselamatan dan kehidupan dari subjek yang diteliti telah mendapatkan perlindungan. GCP menyebutkan secara tegas peranan statisi mulai dari tahap desain penelitian, rekruitmen pasien, pengumpulan data, mengelola data, menganalisis, melaporkan hasil penelitian dan kegiatan monitoring. Tulisan ini mencoba untuk mengungkapkan seluk beluk uji klinis dan peranan statisi dalam suatu pengujian klinis serta tantangan ke depan dalam industri farmasi.

Investigates the effectiveness of chloroquine (CQ) and sulfadoxine-pyrimethamine (SP) for the treatment of uncomplicated malaria in Indonesia. Prevalence of malaria; Cumulative incidence of therapeutic failure of SP and CQ; Resistance of Plasmodium falciparum to CQ and SP.

Examines the incidence of chloroquine-resistant Plasmodium vivax malaria in Nias Island, Northern Sumatra, Indonesia. Effectiveness of antimalarials in the island; Disease transmission potential; Abundance of asymptomatic carriers in the island.

Background: Chloroquine (CQ) or sulfadoxine-pyrimethamine (SP) monotherapy for Plasmodium falciparum often leads to therapeutic failure in Indonesia. Combining CQ with other drugs, like SP, may provide an affordable, available and effective option where artemisinin-combined therapies (ACT) are not licensed or are unavailable., Methods: This study compared CQ (n = 29 subjects) versus CQ + SP (with or without primaquine; n = 88) for clinical and parasitological cure of uncomplicated falciparum malaria in the Menoreh Hills region of southern Central Java, Indonesia. Gametocyte clearance rates were measured with (n = 56 subjects) and without (n = 61) a single 45 mg dose of primaquine (PQ)., Results: After 28 days, 58% of subjects receiving CQ had cleared parasitaemia and remained aparasitaemic, compared to 94% receiving CQ combined with SP (p < 0.001). Msp-2 genotyping permitted reinfection-adjusted cure rates for CQ and CQ combined with SP, 70% and 99%, respectively (p = 0.0006)., Conclusion: Primaquine exerted no apparent affect on cure of asexual stage parasitaemia, but clearly accelerated clearance of gametocytes. CQ combined with SP was safe and well-tolerated with superior efficacy over CQ for P. falciparum parasitaemia in this study.

Background: Sets of Giemsa-stained, blood smear slides with systematically verified composite diagnoses would contribute substantially to development of externally validated quality assurance systems for the microscopic diagnosis of malaria., Methods: whole blood from Plasmodium-positive donors in Cambodia and Indonesia and individuals with no history of risk for malaria was collected. Using standard operating procedures, technicians prepared Giemsa-stained thick and thin smears from each donor. One slide from each of the first 35 donations was distributed to each of 28 individuals acknowledged by reputation as having expertise in the microscopic diagnosis of malaria. These reference readers recorded presence or absence of Plasmodium species and parasite density. A composite diagnosis for each donation was determined based on microscopic findings and species-specific small subunit ribosomal RNA (ssrRNA) DNA polymerase chain reaction (PCR) amplification., Results: More than 12,000 slides were generated from 124 donations. Reference readers correctly identified presence of parasites on 85% of slides with densities <100 parasites/microl, which improved to 100% for densities >350 parasites/microl. Percentages of agreement with composite diagnoses were highest for Plasmodium falciparum (99%), followed by Plasmodium vivax (86%)., Conclusion: Herein, a standardized method for producing large numbers of consistently high quality, durable Giemsa-stained blood smears and validating composite diagnoses for the purpose of creating a malaria slide repository in support of initiatives to improve training and competency assessment amidst a background of variability in diagnosis is described.

Objectives: To conduct malaria surveillance near Jakarta where only imported malaria has been described over the past two decades and to characterize endemicity and risk to heavily populated peri-urban locations., Methods: Standard cross-sectional malariometric surveys and mosquito collections at the Thousand Islands District and developing peri-urban areas of Jakarta., Results: During October 2000 outbreak investigations in the Tidung Island group, the slide positive rate was 47% (38%Plasmodium falciparum, 7%P. vivax, and 2% mixed infections) among 733 persons screened. Very few parasitemic inhabitants were symptomatic (<1%), and native residents were more commonly infected than immigrants (odds ratio 1.72), consistent with endemic autochthonous transmission. Adult and larval mosquito collections detected Anopheles sundaicus. In June 2001, prevalence of parasitemia at Pari Island, where sampling was adequate for comparison, remained high, 32%vs. 43% previously. Among 1377 individuals screened at nearby Tangerang District, a heavily populated mainland suburb dominated by fishponds through which many islanders travel to Jakarta, only 19 malaria infections were identified, all imported from Pari Island. Entomological surveillance in Tangerang identified An. subpictus, An. vagus, and An. barbirostris, all considered minor malaria vectors on Java., Conclusions: Malaria is endemic in the Tidung Island group. Imported malaria occurs in the heavily populated Tangerang District where coastal development is increasing and vector breeding sites and demographic patterns lend increasingly to malaria importation and risk of emergent malaria. Careful attention to the impact of coastal development activities on vector populations and efforts to prevent introduction of An. sundaicus are warranted.

Thirty-eight of 295 subjects participating in a randomized, double-blind, placebo-controlled trial of the efficacy of daily administration of atovaquone/proguanil for malaria prevention developed malaria at some time during the 20-week prophylaxis period. These subjects (3 atovaquone/proguanil recipients and 35 placebo recipients) were treated with 4 tablets of atovaquone/proguanil per day for 3 days. Atovaquone/proguanil provided safe, well-tolerated, and effective therapy for uncomplicated malaria in nonimmune Indonesians.

The increasing prevalence of resistance to antimalarial drugs reduces options for malaria prophylaxis. Atovaquone/proguanil (Malarone; GlaxoSmithKline) has been >95% effective in preventing Plasmodium falciparum malaria in lifelong residents of areas of holoendemicity, but data from persons without clinical immunity or who are at risk for Plasmodium vivax malaria have not been described. We conducted a randomized, double-blinded study involving 297 people from areas of nonendemicity in Indonesia who migrated to Papua (where malaria is endemic) < or =26 months before the study period. Subjects received prophylaxis with 1 Malarone tablet (250 mg of atovaquone and 100 mg of proguanil hydrochloride; n=148) or placebo (n=149) per day for 20 weeks. Hematologic and clinical chemistry values did not change significantly. The protective efficacy of atovaquone/proguanil was 84% (95% confidence interval [CI], 44%-95%) for P. vivax malaria, 96% (95% CI, 72%-99%) for P. falciparum malaria, and 93% (95% CI, 77%-98%) overall. Atovaquone/proguanil was well tolerated, safe, and effective for the prevention of drug-resistant P. vivax and P. falciparum malaria in individuals without prior malaria exposure who migrated to Papua, Indonesia.

After more than 50 years of effective management, resurgent malaria threatens residents in the Menoreh Hills and the foothills of the Dieng Plateau of Central Java, Indonesia. The Dieng Plateau dominates the highland center of Central Java. The steep Menoreh Hills, surrounded by rice paddy habitats, cover approximately 500 km2 with no peaks greater than 1,000 m. We studied epidemic malaria in Purworejo district, one of the three districts containing the Menoreh Hills. Between 1986 and 1995, the annual parasite incidence (API) in Purworejo ranged from 2 to 11 cases per 1,000 residents per year and was typically approximately 5 per 1,000. In 2000 the API was 44.5. This sharp increase was confined to subdistricts in and around the Menoreh Hills and Dieng Plateau foothills. The primary vectors of malaria, those favoring steep, forested hillsides on Java, were Anopheles maculatus and Anopheles balabacensis. Deterioration of vector control activity, followed by a severe economic downturn in 1997, may explain the epidemic. Malaria in the Menoreh Hills and lower Dieng Plateau threatens surrounding areas of rice paddy inhabited by Anopheles aconitus as well as a nearby coastal habitat where the even more efficient vector Anopheles sundaicus occurs in abundance. Most of the 130 million people living on Java never experienced the hyper- and holoendemic malaria that occurred throughout most of the island before the effective DDT spraying and chloroquine treatment campaigns of the 1950s. Reintroduced endemic malaria threatens the island of Java.

Malaria causes illness or death in unprotected travelers. Primaquine prevents malaria by attacking liver-stage parasites, a property distinguishing it from most chemoprophylactics and obviating 4-week postexposure dosing. A daily adult regimen of 30 mg primaquine prevented malaria caused by Plasmodium falciparum and P. vivax for 20 weeks in 95 of 97 glucose-6-phosphate dehydrogenase (G6PD)-normal Javanese transmigrants in Papua, Indonesia. In comparison, 37 of 149 subjects taking placebo in a parallel trial became parasitemic. The protective efficacy of primaquine against malaria was 93% (95% confidence interval [CI] 71%-98%); against P. falciparum it was 88% (95% CI 48%-97%), and >92% for P. vivax (95% CI >37%-99%). Primaquine was as well tolerated as placebo. Mild methemoglobinemia (mean of 3.4%) returned to normal within 2 weeks. Blood chemistry and hematological parameters revealed no evidence of toxicity. Good safety, tolerance, and efficacy, along with key advantages in dosing requirements, make primaquine an excellent drug for preventing malaria in nonpregnant, G6PD-normal travelers.

This report describes one of the few remaining foci of endemic malaria on the island of Java, the Kokap subdistrict, near the Southcentral coast. Kokap was hypoendemic in June 1994 with prevalence of parasitemia at 0.98% (n = 10,606 of 40,246 residents). Plasmodium vivax comprised 63% of infections and P. falciparum all others. The incidence of indigenous infection during 1993 was 48 cases/1,000 person-years (p-yr), and it was relatively uniform among age groups (38 to 53/1,000 p-yr). Nine deaths due to malaria had been recorded in the past three years (8.3 deaths per 100,000 p-yr); the case fatality rate was 0.17%. Subdistricts adjoining Kokap to the north, east, and south reported incidence rates of < 2 cases/1,000 p-yr. To the west, Purworejo District had a high case incidence (11 cases/1,000 p-yr) but other districts to the west did not (< 1.2 cases/1,000 p-yr). The highest case incidence village area within Kokap (169 cases/1,000 p-yr) bordered the district of Purworejo to the west. Endemic malaria in Kokap and Purworejo coincided with where steep hills and narrow valleys dominated the terrain.