A Sticky Situation: from Malaria Pre-elimination to Gene Mutation Glucose-6-Phosphate Dehydrogenase Deficiency (G6PDd) in Eastern Indonesia

In 2013, 30 000 to 38 000 deaths each year mostly in eastern Indonesia by two dominant species of malaria Plasmodium falciparum 62% and Plasmodium vivax 33% with API = 15.6 parts per thousand. MoH Republic Indonesia announced to reach the pre-elimination stage for eastern Indonesia. Primaquine is a key drug for the pre-elimination stage. However, primaquine can trig acute hemolysis for people with Glucose-6-Phosphate Dehydrogenase deficiency (G6PDd). This study will assess the prevalence G6PDd, variant gene mutation and whether eastern Indonesia should proceed with the activities of malaria pre-elimination. A survey 555 people enrolled by systematic sampling. Data collected by standard questionnaire, physical examination and laboratory tests (Hb, microscopic, nested PCR and DNA sequencing). Confirmed cases of malaria and G6PDd were map using ArcGIS V. 9.1 and SatScan analysis. Statistical analysis by univariate, bivariate and multivariate with alpha = 0.05 and 95 % confidence interval. This study result, positive number of malaria were 32.6% (181/555) with P. vivax was the dominating species 52.5% (95/181) and not using bed nets was the most significant risk factors with malaria prevalence (Exp B = 1.54 with 95 % CI = 0.99-2.38). Spatial analysis indicated three distinguish significant clusters with P = < 0.05, however, all malaria clusters were found in low cases incidence malaria. G6PDd was found in 16.6 % (92/555) the highest ever founded in Indonesia with variant Vanua Lava 10 883 T -> C and one sample with heterozygote. Malaria pre-elimination in eastern Indonesia should be delay and too early to be effective. Routine treatment to stop silent transmission, outbreak control, provide more sensitive laboratories and high-risk patients should be tested for enzyme G6PD activities, adequately informed before administration of primaquine and further regular monitoring is essential for the safe administration of primaquine are needed.