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

Douglas, Nicholas M., Pontororing, Gysje, Lampah, Daniel A., Yeo, Tsin W., Kenangalem, Enny, Poespoprodjo, Jeanne, Ralph, Anna P., Bangs, Michael J., Sugiarto, Paulus, Anstey, Nicholas M. and Price, Ric N. (2014). Mortality attributable to Plasmodium vivax malaria: a clinical audit from Papua, Indonesia. BMC Medicine,12(Article No. 217).

Document type: Journal Article
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IRMA ID 84473293xPUB144
NHMRC Grant No. 496600
Title Mortality attributable to Plasmodium vivax malaria: a clinical audit from Papua, Indonesia
Author Douglas, Nicholas M.
Pontororing, Gysje
Lampah, Daniel A.
Yeo, Tsin W.
Kenangalem, Enny
Poespoprodjo, Jeanne
Ralph, Anna P.
Bangs, Michael J.
Sugiarto, Paulus
Anstey, Nicholas M.
Price, Ric N.
Journal Name BMC Medicine
Publication Date 2014
Volume Number 12
Issue Number Article No. 217
ISSN 1741-7015   (check CDU catalogue open catalogue search in new window)
Total Pages 13
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
HERDC Category C1 - Journal Article (DIISR)
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.


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.


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.


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.
Keywords Plasmodium
DOI   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
Additional Notes This is an Open Access article distributed under the terms of the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Description for Link Link to CC Attribution 4.0 License

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