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. 2020 Jan 29;15(1):e0228018.
doi: 10.1371/journal.pone.0228018. eCollection 2020.

Malaria-related Hospitalization During Childhood in Papua, Indonesia: A Retrospective Cohort Study

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Free PMC article

Malaria-related Hospitalization During Childhood in Papua, Indonesia: A Retrospective Cohort Study

Nicholas M Douglas et al. PLoS One. .
Free PMC article

Abstract

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.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Cumulative risk of first re-presentation to hospital due to any cause by time from birth (with 95% confidence interval).
Fig 2
Fig 2
Total number of re-presentations divided by number of patients at risk (left) and proportion of all re-presentations by age stratified by Plasmodium species (middle). Proportion of malaria re-presentations due to the different Plasmodium species stratified by the number of previous re-presentations due to the same species (right). Abbreviations: Pv; Plasmodium vivax, Pf; Plasmodium falciparum, Mix; mixed Plasmodium species infection.
Fig 3
Fig 3. Kaplan-Meier curves showing the cumulative risk of re-presentation with a recurrent episode due to the same Plasmodium species.
Abbreviations: prev; previous, Pv; Plasmodium vivax, Pf; Plasmodium falciparum, mix; mixed Plasmodium species infection, 95%CI; 95% confidence interval.
Fig 4
Fig 4
Total number of admissions divided by number of patients at risk (left) and proportion of all admissions by age from birth stratified by Plasmodium species (middle). Proportion of malaria admissions due to the different Plasmodium species stratified by the number of previous admissions due to the same species (right). Abbreviations: Pv; Plasmodium vivax, Pf; Plasmodium falciparum, Mix; mixed Plasmodium species infection.
Fig 5
Fig 5
Total number of deaths divided by number of patients at risk (left) and proportion of all deaths by age from birth and Plasmodium species (middle). Proportion of malaria deaths due to the different Plasmodium species stratified by the number of previous malaria episodes (right). Abbreviations: Pv; Plasmodium vivax, Pf; Plasmodium falciparum, Mix; mixed Plasmodium species infection, Mal; malaria.

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