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. 2014 Nov 18:12:217.
doi: 10.1186/s12916-014-0217-z.

Mortality attributable to Plasmodium vivax malaria: a clinical audit from Papua, Indonesia

Nicholas M Douglas  1   2 , Gysje J Pontororing  3 , Daniel A Lampah  4 , Tsin W Yeo  5 , Enny Kenangalem  6   7 , Jeanne Rini Poespoprodjo  8   9   10 , Anna P Ralph  11   12 , Michael J Bangs  13   14 , Paulus Sugiarto  15 , Nicholas M Anstey  16   17 , Ric N Price  18   19
Affiliations

Mortality attributable to Plasmodium vivax malaria: a clinical audit from Papua, Indonesia

Nicholas M Douglas et al. BMC Med. .

Abstract

Background: Plasmodium vivax causes almost half of all malaria cases in Asia and is recognised as a significant cause of morbidity. In recent years it has been associated with severe and fatal disease. The extent to which P. vivax contributes to death is not known.

Methods: To define the epidemiology of mortality attributable to vivax malaria in southern Papua, Indonesia, a retrospective clinical records-based audit was conducted of all deaths in patients with vivax malaria at a tertiary referral hospital.

Results: Between January 2004 and September 2009, hospital surveillance identified 3,495 inpatients with P. vivax monoinfection and 65 (1.9%) patients who subsequently died. Charts for 54 of these 65 patients could be reviewed, 40 (74%) of whom had pure P. vivax infections on cross-checking. Using pre-defined conservative criteria, vivax malaria was the primary cause of death in 6 cases, a major contributor in 17 cases and a minor contributor in a further 13 cases. Extreme anaemia was the most common primary cause of death. Malnutrition, sepsis with respiratory and gastrointestinal manifestations, and chronic diseases were the commonest attributed causes of death for patients in the latter two categories. There were an estimated 293,763 cases of pure P. vivax infection in the community during the study period giving an overall minimum case fatality of 0.12 per 1,000 infections. The corresponding case fatality in hospitalised patients was 10.3 per 1,000 infections.

Conclusions: Although uncommonly directly fatal, vivax malaria is an important indirect cause of death in southern Papua in patients with malnutrition, sepsis syndrome and chronic diseases, including HIV infection.

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Figures

Figure 1
Figure 1
Distribution of malaria cases, hospital admissions and deaths in Mimika District between January 2004 and September 2009 (to scale). The figures for the community case work load (overall and febrile) were generated from the hospital surveillance as well as a previous prevalence and treatment seeking survey [13]. Abbreviations: Pf; Plasmodium falciparum, Pv; Plasmodium vivax, Po; Plasmodium ovale, Pm; Plasmodium malariae, Mix; mixed Plasmodium species infection.
Figure 2
Figure 2
Age distribution of patients admitted to Mitra Masyarakat Hospital with malaria between January 2004 and September 2009 by Plasmodium species.
Figure 3
Figure 3
Death audit profile.
Figure 4
Figure 4
Relationship between anaemia and acidosis in vivax-associated deaths. Diamond = Category 1, Squares = Category 2 and Triangles = Category 3. rs = 0.45, P = 0.09.
See this image and copyright information in PMC

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