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Abstrak :
[ABSTRAK
Tingkat bebas parasit dini merupakan gambaran fungsi dari aktivitas artemisinin. Beberapa faktor yang dianggap berperan terhadap bebas parasit hari pertama setelah pengobatan salah satunya adalah kepadatan parasit sebelum pengobatan. Penelitian ini bertujuan untuk mengetahui hubungan antara kepadatan parasit sebelum pengobatan dengan bebas parasit pada hari pertama setelah pengobatan dihidroartemisinin-piperakuin pada anak dengan malaria tanpa komplikasi di enam propinsi di Indonesia. Desain penelitian ini adalah kohort retrospektif yang dianalisis dengan cox regression dan menggunakan data sekunder efikasi dan keamanan obat dihidroartemisinin-piperakuin (DP) di enam propinsi di Indonesia. Kejadian tidak bebas parasit pada penelitian ini sebesar 31,74%. Terdapat hubungan yang bermakna secara statistik antara kepadatan parasit sebelum pengobatan dengan kejadian bebas parasit setelah hari pertama setelah pengobatan, dimana kepadatan parasit >20000/μl mempunyai risiko tidak bebas parasit sebesar 2,327 kali (CI 95% 1,418-3,820, p-value = 0,001) dibandingkan kepadatan parasit <4000/μl dan kepadatan parasit 4000-20000/μl berisiko tidak bebas parasit sebesar 1,669 kali (CI 95% 1,099-2,533, p-value = 0,016) dibandingkan kepadatan parasit <4000/μl setelah dikendalikan faktor jenis parasit dan wilayah. Kepadatan parasit (μl) dapat dijadikan pemeriksaan standar penderita malaria dan penilaian pengobatan.

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ABSTRACT
Early parasite clearance is the function of artemisinin?s activity. One of the factors that are related to parasite clearance on the first day after treatment is parasite density pre treatment. The aim of this study was to determine the relationship between parasite density pre treatment and parasite clearance on first day after treatment in children with uncomplicated malaria at six provinces in Indonesia. The design of this study was retrospective cohort and analyzed with cox regression and used the secondary data of efficacy and safety of dihydroartemisinin-piperaquine (DP) at six provinces in Indonesia. The proportion of uncleared parasite in this study was 31,74%. There was statically relationship between parasite density pre treatment and parasite clearance on the first day after treatment, where parasite density >20000/μl had uncleared parasite? risk 2,327 times (CI 95% 1,418-3,820, p-value = 0,001) more than parasite density <4000/μl and parasite density 4000-20000/μl had uncleared parasite? risk 1,669 times (CI 95% 1,099-2,533, p-value = 0,016) more than parasite density <4000/μl after controlled by Plasmodium species and region. Parasite density (μl) can be used as standard tests for patients with malaria and treatment evalution., Early parasite clearance is the function of artemisinin’s activity. One of the factors that are related to parasite clearance on the first day after treatment is parasite density pre treatment. The aim of this study was to determine the relationship between parasite density pre treatment and parasite clearance on first day after treatment in children with uncomplicated malaria at six provinces in Indonesia. The design of this study was retrospective cohort and analyzed with cox regression and used the secondary data of efficacy and safety of dihydroartemisinin-piperaquine (DP) at six provinces in Indonesia. The proportion of uncleared parasite in this study was 31,74%. There was statically relationship between parasite density pre treatment and parasite clearance on the first day after treatment, where parasite density >20000/μl had uncleared parasite’ risk 2,327 times (CI 95% 1,418-3,820, p-value = 0,001) more than parasite density <4000/μl and parasite density 4000-20000/μl had uncleared parasite’ risk 1,669 times (CI 95% 1,099-2,533, p-value = 0,016) more than parasite density <4000/μl after controlled by Plasmodium species and region. Parasite density (μl) can be used as standard tests for patients with malaria and treatment evalution.]

Abstrak :
ABSTRAK Sebanyak 120 sampel Dried Blood Spot (DBS) malaria falciparum yang diperoleh dari studi efikasi obat DHP pada 5 wilayah di Indonesia dianalisis dengan Polymerase Chain Reaction (PCR) dan sekuensing, untuk melihat varian SNPs K13 dan alel FcγRIIa -131 serta hubungannya dengan densitas parasit dan efikasi Dihidroartemisinin-Piperakuin. Hasil penelitian tidak menemukan mutasi gen K13 pada seluruh isolat P. falciparum yang diperiksa. Artemisinin masih efektif untuk pengobatan malaria di Indonesia. Analisis gen FcγRIIa menunjukkan bahwa genotip RH memiliki frekuensi yang paling tinggi (50,8%) dibandingkan RR (17,5%) dan HH (31,7%). Alel R131 gen FcγRIIa menunjukkan efek protektif terhadap High Density Parasitemia (HDP) (>5000 parasit/μL; odds ratio [OR]= 0.133, 95% confidence interval [CI]= 0.053?0.334, P< 0.001) dan berkaitan dengan keberadaan gametosit yang lebih lama pada inang (> 72 jam.

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ABSTRACT Relative Risk [RR]= 1,571, 95% confidence interval [CI]= 1,005?2,456, P= 0.090).;A total of 120 samples of Dried Blood Spot (DBS) falciparum malaria acquired from DHP drug efficacy studies in 5 regions in Indonesia were analyzed by Polymerase Chain Reaction (PCR) and sequencing, to look at variants of K13 SNPs and FcγRIIa-131 allele and its Association with Parasite Density and Efficacy of Dihydroartemisinin- Piperaquine. No mutations in the K13 gene was found in any of the isolates examined. Artemisinin is still effective for the treatment of malaria in Indonesia. The FcγRIIa gene analysis indicated that genotype RH has the highest frequency (50.8%) compared to RR (17.5%) and HH (31.7%). Allele R131 showed a protective effect against High Density Parasitemia (HDP) (>5000 parasites/μL; odds ratio [OR]= 0.133, 95% confidence interval [CI]= 0.053?0.334, P< 0.001) and associated with longer gametocytes carrier clearance time (> 72 hours; Relative Risk [RR]= 1,571, 95% confidence interval [CI]= 1,005?2,456, P= 0.090).