NCBI

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• NCBINCBI •

• loncat Ke isiloncat Ke isi •

• loncat kemenuloncat kemenu •

• Sumber DayaSumber Daya •

• CaraCara •

• TENTANG NCBI AccesskeysTENTANG NCBI Accesskeys MASUK keNCBI

MASUK keNCBI

PMC

Perpustakaan NasionalUS Keokteran

National

National Institutes Institutes !ealt"!ealt"

atabasecari yan# atabasecari yan# cari $an#ka cari $an#ka cari cari • • BatasBatas • • Ma%uMa%u • • PT %urnalPT %urnal • • BantuanBantuan • • %urnal PT %urnal PT •

• Clin Microbiol &e'Clin Microbiol &e' •

• ayat () *+,- .//. 0ktober ayat () *+,- .//. 0ktober •

• PMC(.12)3PMC(.12)3

Clin Microbiol Rev. 2002 Oktober; 15 (4) :. 564-594 Clin Microbiol Rev. 2002 Oktober; 15 (4) :. 564-594 oi4

oi4(/5((.2 6 CM&7()7+7)1+8)9+7.//.(/5((.2 6 CM&7()7+7)1+8)9+7.//.

PMCI:

PMCI:PMC(.12)3PMC(.12)3

Evolusi Dan Aspek Sejarah Dari Beban Malaria

&ic"ar Carter

&ic"ar Carter ((5 :5 :DanDanKamini N7 MenisKamini N7 Menis..

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.Artikel Penyanyi has diperbaiki

.Artikel Penyanyi has diperbaiki=i"a=i"attClin Microbiol >a"yu $anuari .//?- (1Clin Microbiol >a"yu $anuari .//?- (1 (3?(3?*(,47*(,47 Artikel ini "as

Artikel ini "asikutip 0le"ikutip 0le"artikel lainnya i PMCke 47artikel lainnya i PMCke 47

A ABSTRAKSIBSTRAKSI Per#i Per#i PEDA!"#"A PEDA!"#"A

!rtikel ini !"#l#$ %&'%

!rtikel ini !"#l#$ %&'%!' i*#t #n +#l#ri# #+,#k; I% !' i*#t #n +#l#ri# #+,#k; I% /k#n l##n Peneliti#n/k#n l##n Peneliti#n Il+i#$ %&'%!

Il+i#$ %&'%!' +#l#ri#. Pen#ni ' +#l#ri#. Pen#ni +enek,lor#i b##i+#n#3 #,#n3 "#n +enek,lor#i b##i+#n#3 #,#n3 "#n I +#n#I +#n# ,#r#it +#l#ri#3 vektor n#+

,#r#it +#l#ri#3 vektor n#+/k +erek#3 #n M#n/i#3 +/nkin inter#ct /k +erek#3 #n M#n/i#3 +/nkin inter#ct #n &'!' !#n &'!' !P!P! #n erl#k/ P!! iri kit" en"iri3 t/#n M#n/i# +erek#. Pen#ni /k#n %/# #n #n erl#k/ P!! iri kit" en"iri3 t/#n M#n/i# +erek#. Pen#ni /k#n %/# #n

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M/"#$. #l Pen#ni

M/"#$. #l Pen#ni ter$#+b#t Ole$ ke/lit#n ,en/+,/l#n ter$#+b#t Ole$ ke/lit#n ,en/+,/l#n "#t# #n #"#t# #n #n %e,#t #n c#nn %e,#t #n c#n be "i#n"#lk#n #n Ole$ +##l#$ ,en#*

be "i#n"#lk#n #n Ole$ +##l#$ ,en#*ir#n +erek#. &IMP7!' ir#n +erek#. &IMP7!' !!%%! ! &IMP7!'&IMP7!' +/nkin &R&! #ri 

+/nkin &R&! #ri #n "i"irik#n #n "iteri+# #n "i"irik#n #n "iteri+# ero,er#i 7/# ero,er#i 7/# /nt/k revie8/nt/k revie8 tent#ti* !%! kontroveri#l. %!PI3 &M&'%!R! #+b#r "i**erence #b/r "i e/+l#$ tent#ti* !%! kontroveri#l. %!PI3 &M&'%!R! #+b#r "i**erence #b/r "i e/+l#$ %e+,#t3 #n#k ##$ #n *it/r +#l#ri# #n e#k P!! ,eie M#n/i# M/nc/l3 %e+,#t3 #n#k ##$ #n *it/r +#l#ri# #n e#k P!! ,eie M#n/i# M/nc/l3 bi##n# el# #n ##kn#.

bi##n# el# #n ##kn#.

#n#k ik/i iterbitk#n $# ber/r/#n &'!' Pen#l#+#n +#l#ri#3 i*#tn#3 #n #n#k ik/i iterbitk#n $# ber/r/#n &'!' Pen#l#+#n +#l#ri#3 i*#tn#3 #n #n &*ek (7I!%3 /c$ # invitin ,#rtici,#tion3 re*erence

#n &*ek (7I!%3 /c$ # invitin ,#rtici,#tion3 re*erence 55332<2<33292933=1=133=5=5334242 --44

44334>4>33>=>=3391913395953310610633111111331121123311>11>3312=12=33124124331=91=933141141331651653316>16>331>=1>=331>61>6331921923319519533200200). Merek#). Merek# In*or+#ti* #n +en/nk#,k#n3 ter/t#+# !R&'! +#in-+#in Pro"/k #ri

In*or+#ti* #n +en/nk#,k#n3 ter/t#+# !R&'! +#in-+#in Pro"/k #ri ontekontek Me"i #n M#n/i#

Me"i #n M#n/i# kee$#t#n3 Pro,ek #le kee$#t#n3 Pro,ek #le +#n#er3 ec#r# #n Penet#$/#n #ri #kt/.+#n#er3 ec#r# #n Penet#$/#n #ri #kt/. #+i #li P

#+i #li Pen#ni #lo en#ni #lo o**er Per,ekti* o**er Per,ekti* ##n /nik n /nik %&'%!%&'%!' !7 Pen#ni. ' !7 Pen#ni. #n##n# $e#rt eten#$ !b#" ter#k$ir "i b#$8# kit" $# +en#l#+i +#l#ri# &'!' 7#t#r $e#rt eten#$ !b#" ter#k$ir "i b#$8# kit" $# +en#l#+i +#l#ri# &'!' 7#t#r

el#k#n Pel##n#n ee$#t#n "#n kee$#t#n M#n/i# #n3 /nt/k revie8 e"e eb#i#n3 el#k#n Pel##n#n ee$#t#n "#n kee$#t#n M#n/i# #n3 /nt/k revie8 e"e eb#i#n3 ! 7ebi$ #ik "#ri,#"# "i &M! ener#i ebel/+n#. P!! ,erio"e #n #+#3 ! 7ebi$ #ik "#ri,#"# "i &M! ener#i ebel/+n#. P!! ,erio"e #n #+#3 kit" $# +en#kik#n ke"/# Pret#i Pror#+

kit" $# +en#kik#n ke"/# Pret#i Pror#+ Pel##n#n kee$#t#n Pert#+# "ikoor"in#ik#nPel##n#n kee$#t#n Pert#+# "ikoor"in#ik#n ero,er#i lob#l #n #n #lo +##l#$

ero,er#i lob#l #n #n #lo +##l#$ +erek#. $e#rt beber#,# "ek#"e ter#k$ir "i3 +erek#. $e#rt beber#,# "ek#"e ter#k$ir "i3 #n#n ter/t#+# %e

ter/t#+# %eknoloi enetik ter#k$ir knoloi enetik ter#k$ir "i3 ioki+i# #n +olek/ler "i3 ioki+i# #n +olek/ler /nt/k revie8 +eneli"iki/nt/k revie8 +eneli"iki Periti8# 

Periti8# ##n ! $e#rt n ! $e#rt &vol/i #n &vol/i &vol/i #n &vol/i er#+# ,#r#it +#l#ri# #n M#n/i# er#+# ,#r#it +#l#ri# #n M#n/i# $#$# /+l#$: %ere"i#.

/+l#$: %ere"i#.

berik/t Pen#ni3 Ole$ !R&'!

berik/t Pen#ni3 Ole$ !R&'! I%3 !I%3 !"#l#$ Rekontr/ki ink#t &vol/i "#l#$ Rekontr/ki ink#t &vol/i #n e#r#$#n e#r#$ +#l#ri# #n &!' eb##i kit" c#n be Meli$#t $#l +erek# P!! !8#l !b#" e -21ke :. +#l#ri# #n &!' eb##i kit" c#n be Meli$#t $#l +erek# P!! !8#l !b#" e -21ke :.

Per#i

MA#ARIA

MA#ARIAPARASITPARASIT M MA"SIAA"SIA

+#l#ri# "ieb#bk#n Ole$ In*eki #r#$ Ole$ ,#r#it ,roto?o# #ri 

+#l#ri# "ieb#bk#n Ole$ In*eki #r#$ Ole$ ,#r#it ,roto?o# #ri  en/en/ Plasmodium, Plasmodium,#n#n "it/l#rk#n #ri #t/ M#n/i# e #n

"it/l#rk#n #ri #t/ M#n/i# e #n l#in "en#nbetin#l#in "en#nbetin# Anopheles Anophelesn#+/k. &+,#t ,eien#+/k. &+,#t ,eie ,#r#it +#l#ri# +enin*ek

,#r#it +#l#ri# +enin*eki M#n/i# (%#i M#n/i# (%#belbel(%#ble1).(%#ble1). 1). 1)./# #n $#+,ir P#ti +enc#,#i/# #n $#+,ir P#ti +enc#,#i itrib/i terl/# "/ni# #n

itrib/i terl/# "/ni# #n Plasmodium vivax Plasmodium vivax#n#n Plasmodium malariae. Plasmodium malariae.'%'% or#n/t#n ero,#3 Pen#ni $# "iken#l #n "it#n"#i e#k ?#+#n $itori k/no or#n/t#n ero,#3 Pen#ni $# "iken#l #n "it#n"#i e#k ?#+#n $itori k/no (53293953

(53293953106)106)eb##i @terti#n#@eb##i @terti#n#@(P.vivax)(P.vivax)"#n @A/#rt#n@"#n @A/#rt#n@(P.malariae)(P.malariae)e+#+ ,erio"ik. @in#ke+#+ ,erio"ik. @in#k terti#n@ e+#+ #

terti#n@ e+#+ #n n "in#+#k#n "e+iki#n "in#+#k#n "e+iki#n !R&'! +erek# %I! erl#n#n#n!R&'! +erek# %I! erl#n#n#n &'!' ter+#ni*et#i P#r#$ #n erink#li ber#kib#t *#t#l #ri @/bterti#n3 #n#@ &'!' ter+#ni*et#i P#r#$ #n erink#li ber#kib#t *#t#l #ri @/bterti#n3 #n#@ e+#+ ,erio"ik

e+#+ ,erio"ik (P.falciparum).(P.falciparum).@%erti#n#@ "#n @A/#rt#n@ +en#c/ P!! Ciri $# +erek#@%erti#n#@ "#n @A/#rt#n@ +en#c/ P!! Ciri $# +erek# #ri &! e,io"e e+#+3 !%! er#n#n %ib#-%ib# !k/t3 #n +ene+b#lik#n #ri &! e,io"e e+#+3 !%! er#n#n %ib#-%ib# !k/t3 #n +ene+b#lik#n +#in-+#in &%I!P eti#

+#in-+#in &%I!P eti#(P.vivax)(P.vivax)!%! kee+,#t!%! kee+,#t(P.malariae)(P.malariae)$#ri. e+#+ +#l#ri#$#ri. e+#+ +#l#ri# #n A/#rt#n

#n A/#rt#n "ieb/t &'!' Brek/eni "ieb/t &'!' Brek/eni #n #+# $e#rt %/li#n-%/li##n #+# $e#rt %/li#n-%/li#n #ri n #ri ero,# t#r#ero,# t#r# t$ro/$ #n#k +ileni/+ k#t# l#l/ #n

t$ro/$ #n#k +ileni/+ k#t# l#l/ #n #ri el/r/$ P#nt#i 7#/t Me"iter#ni# #ri ekit#r 5#ri el/r/$ P#nt#i 7#/t Me"iter#ni# #ri ekit#r 5 M !b#" eter/n# (2934>3953106).

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%!&7 1. %!&7 1.

beber#,# itrib/i Per8#kil

beber#,# itrib/i Per8#kil#n #ri e+,#t "#l#+ ,eie #n #ri e+,#t "#l#+ ,eie ##n i#k/i ,#r#it +#l#ri#n i#k/i ,#r#it +#l#ri# M#n/i# "i /ni# ##t Pen#ni

M#n/i# "i /ni# ##t Pen#ni $#ri Pen#ni3

$#ri Pen#ni3 P P. m. malariaealariae$# e$il#n#n $# e$il#n#n o+in#i !Po+in#i !P! ,/n +/nkin P&R'! ! ,/n +/nkin P&R'! +e+iliki+e+iliki #n

#n P P. . vivaxvivax#n#n P P. . falciparumfalciparum!"#l#$ ,#r#it +#l#ri# #!"#l#$ ,#r#it +#l#ri# #n +e+/c#t n +e+/c#t #le +#n#er #le +#n#er "ite+/i"ite+/i (%#bel

(%#bel(%#ble1).(%#ble1).1).1). P. P. vivaxvivaxM#i$ "ite+/k#n ero,er#i ,or#"i "i beber#,# "#er#$ #"#l#$M#i$ "ite+/k#n ero,er#i ,or#"i "i beber#,# "#er#$ #"#l#$ berikli+ e"#n3 "i +#n# "i M## 7#l/ I%

berikli+ e"#n3 "i +#n# "i M## 7#l/ I% #n#k %e#n#k %er#"i. I# tet#,3 #n#t #le +#n#err#"i. I# tet#,3 #n#t #le +#n#er "i #n#k #er#$ %ro,i #n /btro,i. !R&'! keterb#t##n /$/ P!! %r#n+ii Ole$ "i #n#k #er#$ %ro,i #n /btro,i. !R&'! keterb#t##n /$/ P!! %r#n+ii Ole$ vektor n#+/k #n3

vektor n#+/k #n3 P P. f. falciparumalciparum bi##n# #"ir #n# "i "#er#$ #"#l#$ bi##n# #"ir #n# "i "#er#$ #"#l#$ %ro,i3 /bt%ro,i3 /btro,i3ro,i3 #n #n#t "#er#$ #"#l#$ berikli+. i "

#n #n#t "#er#$ #"#l#$ berikli+. i "#er#$ #"#l#$ %ro,i ebel/+n# ##t ini3#er#$ #"#l#$ %ro,i ebel/+n# ##t ini3 P. P. falciparum

falciparum%et#, #n#k %er#"i.%et#, #n#k %er#"i.

P#r#it +#l#ri# M#n/i# kee+,#t !"#l#$

P#r#it +#l#ri# M#n/i# kee+,#t !"#l#$ Plasmodium ovale, Plasmodium ovale,#n3 e,erti#n3 e,erti P P..viv#3 !"#l#$viv#3 !"#l#$ #en #ri

#en #ri +#l#ri# terti#n# #n #+#l#ri# terti#n# #n #n3 #lo n3 #lo e,ertie,erti P P..viv#$#ri Pen#ni3 +e+b#8# Riikoviv#$#ri Pen#ni3 +e+b#8# Riiko #n #n#t Ren"#$ #ri $#il te+/#n #n *#t#l.

#n #n#t Ren"#$ #ri $#il te+/#n #n *#t#l. P. P. ovaleovale+e+iliki itrib/i #n +e+/c#t+e+iliki itrib/i #n +e+/c#t %e

%erb#t# &M! ,#r#it +#l#ri# rb#t# &M! ,#r#it +#l#ri# M#n/i#. &M&'%!RM#n/i#. &M&'%!R! I% 7#?i+ "! I% 7#?i+ "i eb#i#n i eb#i#n e"e /b-e"e /b-#$#r# !*rik#3 !%! "iken#l eb##i en"e+ik #n# i 'e8 /ine# #n Bili,in# (122) #$#r# !*rik#3 !%! "iken#l eb##i en"e+ik #n# i 'e8 /ine# #n Bili,in# (122) e :.

e :.

Per#i

EPIDEMI$#$%I DARI PT KA#BE MA"SIA MA#ARIA EPIDEMI$#$%I DARI PT KA#BE MA"SIA MA#ARIA

&&7M kit" Mencob# /nt/k

&&7M kit" Mencob# /nt/k revie8 Mel#c#k #i#n #n &*ek +#l#ri# t$ro/$ #kt/revie8 Mel#c#k #i#n #n &*ek +#l#ri# t$ro/$ #kt/ &vol/i #n e#r#$3

&vol/i #n e#r#$3 kit" #k#n +enin#/ kit" #k#n +enin#/ Prini,-Prini, Prini,-Prini, #n +enent/k#n b##i+#n##n +enent/k#n b##i+#n# +#l#ri# +e+,en#r/$i in"ivi"/ #n ,o,/l#ike :.

+#l#ri# +e+,en#r/$i in"ivi"/ #n ,o,/l#ike :.

Per#i

PE&AKIT

PE&AKIT MMA#ARIA SA#ARIA SERIKATERIKAT

Pen#l#+#n In*eki +#l#ri# +e+iliki #n#k ent/k #n &R&!3 #n kit" k#rt/n Pen#l#+#n In*eki +#l#ri# +e+iliki #n#k ent/k #n &R&!3 #n kit" k#rt/n kot/+ M#in#n +e8#$

kot/+ M#in#n +e8#$ $ere ero,er#i #ri e#r. Pen#kit !R&'! &M! e+$ere ero,er#i #ri e#r. Pen#kit !R&'! &M! e+,#t,#t "#l#+ ,eie erb#i ,#r#it +#l#ri# e,io"e e+#+ k#r#kteritik &'!'

"#l#+ ,eie erb#i ,#r#it +#l#ri# e,io"e e+#+ k#r#kteritik &'!' kecen"er/n#n +erek# /nt/k revie8 ,#ro+ ,erio"ik bi##

kecen"er/n#n +erek# /nt/k revie8 ,#ro+ ,erio"ik bi## &'!' +eniil3&'!' +eniil3 ker#n#3 #n berkerin#t. Merek#

ker#n#3 #n berkerin#t. Merek# #lo +e+iliki #n#k e#l# ##lo +e+iliki #n#k e#l# #n #+# n #+# &'!'&'!' ,en#kit +en/l#r l#inn#3 ter+#

,en#kit +en/l#r l#inn#3 ter+#/k 'eri %/b/k 'eri %/b/$3 #kit ke,#l# #n M/#l3 #le +#n#er/$3 #kit ke,#l# #n M/#l3 #le +#n#er kele+#$#n3 #n //".

kele+#$#n3 #n //". In*eki In*eki #n %I! "iob#ti +#l#ri# "it#n"#i &'!' ,e+be#r#n#n %I! "iob#ti +#l#ri# "it#n"#i &'!' ,e+be#r#n li+,#. i

(5)

"i*/ni Pen#ni #ri or#n vit#l3 #it/3 ,#r/-,#r/3 in#l3 $#ti3 "#n3 #n +e+/c#t %erken#l3 el#+# ot#k @cerebr#l +#l#ri#.@ !ne+i# er#t c#n be %er#"i. Pen#ni !"#l#$ on"ii #n er$/b/n#n &'!' eb#i#n e"e !k/t +#l#ri# e+#ti#n. In*eki roni &'!' P. malariaec#n be +en#kib#tk#n in"ro+ 'e*rotik3 #n Pen#ni #lo3 #k$irn# c#n ber#kib#t *#t#l.

er#n#n ber/l#n #ri +#l#ri# !R&'! &%I!P ,eie ,#r#it el#+# beber#,# /nt/k revie8 bert#$/n-%#$/n #n#t +ele+#$k#n %/b/$ #n Pikir#n. C#c$ei#3 +e+b/#n-/#n #rin#n %/b/$3 berl#n/n3 #n ,e+be#r#n li+,# Men#"i *it/r ont#n. 7e/ #n &'!' *it/r cek/n #n ,/c#t3 k/r/ b#"#n3 #n /lit enk#k Per/t !"#l#$ #+b#r#n #le +#n#er #ri on"ii tereb/t. #l#+ ke#"##n Pen#ni in"ivi"/ #n terken# Menin#l !kib#t ,en#kit !%! ke/lit#n berb#rin #n $#+,ir #k#n

+en#nc#+ eeor#n $e#rt kee$#t#n #n ##r. i #8#$ &!' +#l#ri# roni3 b#ik !7I%! #n "/r#i e$i"/,#n #n #n#t berk/r#n

Pen#l#+#n eor#n in"ivi"/ +#l#ri# P!! #kt/ %ertent/3 n#+/n3 #n#t "i#t/r Ole$ eni "#n %ink#t #nti+#l#ri# kekeb#l#n b#$8# be#rbe#r#n +/nkin $# +enc#,#irevie8:..

Per#i untuk

KEKEBA#A MA#ARIA

kekeb#l#n Pelin"/n %er$#"#, +#l#ri# c#n be "i#n#, $e#rt k#teori #n &R&!. !"# "o# &'I i+/nit# klini3 $#l#t #t/ #n Men/r#ni Riiko e+#ti#n !kib#t +#l#ri# #n berb#rin #n Men/r#ni Intenit# e#l# klini. ero,er#i eti# #nti+#l#ri# kekeb#l#n Pelin"/n #nti,#r#it kekeb#l#n3 #n ero,er#i 7#n/n

Men/r#ni #nk# #kt/ ,#r#it $e#rt in"ivi"/ #n terin*eki. Pen#ni !"#l#$ e*inii e,i"e+ioloi i+/nit#. M&!'IM& el/ler #n +olek/ler #n eben#rn# kekeb#l#n +/nkin t/+,#n tin"i$ e %ink#t #n C/k/, !'%!R! k#teori Pen#ni. #nk# #kt/ inok/l#i +#l#ri# er,en#l#+#n3 #n el#n !'%!R! +erek#3 !"#l#$ it/b /nt/k revie8 +#l#ri# t#t/ kekeb#l#n in"ivi"/. #l#+ ! er#n#n

!k/t P.falciparum,+#l#ri# !"#l#$ +/nkin b#$8# %ink#t kekeb#l#n %er$#"#, beber#,# !P& #ri ,en#kit #n er#t3 #n +en#nc#+ i8# c#n be "ic#,#i Pen$#il#n ken# ,##k #n# #t/ !%! "o# In*eki(<2). '#+/n3 kekeb#l#n klini /nt/k revie8 &*ek berb#rin3 non-+en#nc#+ e$i"/,#n klini +#l#ri# Me+b/t/$k#n 7&I #n erin

inok/l#i +#l#ri# (=43191).ekeb#l#n #nti,#r#it #n &*ekti* #k#n terc#,#i Pen$#il#n ken# ,##k #n#t #n#k #n erin In*eki (101.124).

/# ent/k berb#rin kekeb#l#n #ri #n "i"#,#t %er$#"#, +#l#ri# #r/ "ieb/tk#n $ere. #l#$ #t/n# !"#l#$ kekeb#l#n #n c#n be +elin"/ni %er$#"#, ,#r#it #n P&R'! Men#"i "i"irik#n P!! t/#n M#n/i#3 k#t# kekeb#l#n l#inn# %er$#"#, %#$#,-%#$#, #n "i,erken#lk#n e $e#rt %/b/$ M#n/i# t$ro/$ iit#n n#+/k. Pen#ni !"#l#$ ,oro?oit #n #lo !8#l3 %#$#, ,#toenik !R&'! +erek# erke+b#n "i $#ti. &M&'%!R!

kekeb#l#n %er$#"#, ,oro?oit #n %#$#, $#ti #k$irn# c#n be erke+b#n Pen$#il#n ken# ,##k ,#,#r#n l#+# /nt/k revie8 %r#n+ii +#l#ri# inten3 I% +/nkin %I! %erl#l/ ini*ik#n "i %#$/n-%#$/n !8#l Pentin #ri ,#,#r#n. ent/k berb#rin #ri kekeb#l#n non,rotective %er$#"#, ,#r#it +#l#ri# !"#l#$ b#$8# %er$#"#, %#$#,#n #r#$

(6)

ek/#l ,#r#it. Pen#ni !"#l#$ %#$#, #n in*ekti* #i n#+/k. !ntibo"i #ntien %er$#"#, "i #+etoit #n #+et #ri ,#r#it +#l#ri# +ene+b#nk#n M/"#$ el#+# In*eki !l#+i #n +/nkin +e+iliki beber#,# &*ek P!! in#+ik# ,en/l#r#n +#l#ri# $e#rt it/#i en"e+ik %ertent/. ekeb#l#n #nti-ek/#l-%#$#,3 b##i+#n#,/n3 %I! +e+iliki relev#ni 7#n/n &'!' t#t/ in"ivi"/ e$/b/n#n &'!' Pen#l#+#n n# #ri In*eki +#l#ri# ebel/+n# ##t ini.

Penc#,#i#n kekeb#l#n ,rotekti* %er$#"#, %#$#,#n #r#$ #ek/#l ,eneb#b ,en#kit ,#r#it +#l#ri# !"#l#$ Proe #n o+,lek. %I! #n# i+/nit# e,erti ,ei*ik /nt/k

revie8 &%I!P ,eie ,#r#it3 tet#,i #lo P#ti !! n/r t#+# #ri ,#r#it

@kete#n#n@ kek$//#n /nt/k revie8 #nti+#l#ri# kekeb#l#n (1051=014<3 1<2).#n#k #ri #k/iii 7#+b#t kekeb#l#n #nti,#r#it %er#"i !R&'! in"ivi"/ bi##n# +en#l#+i

/kei inok/l#i ,#r#it #n ero,er#i enetik #n #ntienik &R&! #t/ #+# l#in. Ole$ !R&'! I%3 /nt/k revie8 +e+er#ni &%I!P In*eki3 t/#n M#n/i# #r/ ##-/n/n re,on i+/n -,eci*ic b#r/ "#n @kete#n#n@ /nt/k revie8 &%I!P ,#r#it inok/l/+ #ntien #n &R&!. #n# ketik# ,ektr/+ C/k/, 7/# ,#r#it @kete#n#n@ tereb/t $# +en#l#+i i+/nit# &*ekti* "ic#,#i %er$#"#, &M! ,#r#it $e#rt 8ilD#$ "i +#n# In*eki en"e+ik.

'#+/n3 %I! #n# ,#r#it "i inok/l#i #n &R&! ero,er#i enetik &R&! tet#,i #lo3 el#+# &%I!P In*eki3 ,#r#it #ri inok/l#i t/n#l +en#l#ni klon#l @E#ri#i #ntienik@(1=0).'% +enontrol In*eki3 t/#n r/+#$ #r/ ##-/n/n re,on i+/n ,ei*ik b#r/ /nt/k revie8 &%I!P v#ri#n #ntienik b#r/ !R&'! M/nc/l. %$ro/$ Proe Pen#ni3 In*eki +#l#ri# t/n#l c#n be "i,er,#n#n el#+# berb/l#n-b/l#n /nt/k revie8 %#$/n.

!R&'! #kt/ #n ib/t/$k#n /nt/k revie8 +enc#,#i i+/nit# #n &*ekti* /nt/k revie8 +#l#ri# $e#rt on"ii In*eki en"e+ik3 #nti+#l#ri# kekeb#l#n erin "ik#t#k#n @ter#nt/n i#.@ #l#+ #rti "i+#k/"k#n n#+/n3 #k#n 7&I !k/r#t /nt/k revie8 +en#t#k#n b#$8# I% !"#l#$ @"/r#i ,#,#r#n ter#nt/n.@ !"#3 b##i+#n#,/n3 !P&-!P& #n en#r-en#r i# ter#nt/n #ik P!! ,enc#,#i#n kekeb#l#n #n re,on ,#toloi %er$#"#, In*eki +#l#ri#. !n#k #n #n#t +/"# t#+,#kn# +e+iliki #,#it#

Mikin /nt/k revie8 +e+,erole$ kekeb#l#n #nti+#l#ri# Pelin"/n &*ekti* #ri #,#,/n3 &M&'%!R! !n#k-#n#k #n 7&I t/# #n or#n/t#n "e8## +/nkin eit/ 7&I M/"#$ (9310).#i #n #n#t +/"# 7&I rent#n %er$#"#, #ne+i# +#l#ri#3

&M&'%!R! ker/#k#n ot#k !kib#t P. falciparum+#l#ri# +en"o+in#i P!! !n#k e"ikit 7&I t/#. '#+/n on"ii P#r#$ l#inn#3 ter+#/k in#l3 $#ti3 #n e##l#n ,#r/3 #n P#lin erin terli$#t P!! or#n/t#n "e8## (6).

&%I!P in"ivi"/ terken# +#l#ri# en"e+ik e$in# Men$#"#,i Perte+,/r#n P#n#n #n erb#$## /nt/k revie8 +enc#,#i kekeb#l#n ,rotekti* %er$#"#, e#nek#r##+#n ,#r#it +#l#ri# #n #ntien +erek# #n be#rbe#r#n +/nkin terken# Men#"i. '#+/n3 #n $# "ic#,#i &'!' +enc#k/, bi## tereb/t3 kekeb#l#n #n &*ekti* M/"#$ il#n 7#i. el#n +/nkin eten#$ %#$/n e %#$/n %#n,# In*eki /l#n t#+,#kn# C/k/, /nt/k revie8 Menin#lk#n eor#n in"ivi"/ rent#n3 ek#li 7#i3 /nt/k revie8 #+,#k Pen/$ #ri In*eki +#l#ri# (15<.1<231<6;!. 7/k#3 co++/nic#tion Prib#"i). /kti 7#n/n /nt/k

(7)

revie8 ,ern#t##n Pen#ni i#k/i /lit /nt/k revie8 +ene+/k#n3 n#+/n $# l#+#

"ib/ktik#n Ole$ #nek"ot #n Pen"#,#t !$li. e$il#n#n kekeb#l#n ,rotekti* $e#rt beber#,# b/l#n %#n,# In*eki /l#n #lo M/nc/l /nt/k revie8 %er/ $e#rt k#it#nn# &'!'

kekeb#l#n ,rotekti* In*eki #n "ieb#bk#n %er$#"#, +#l#ri# P!! e8#n (R. C#rter3 ,en#+#t#n %I! iterbitk#n).

I! ,ern#t##n "i "i**erence Me+#n en#r3 M#k# #nk# #kt/3 &'I3 #n Pol# Peniri+#n inok/l#i +#l#ri#3 "en#n k#t# berb#rin ero,er#i en"e+iit# +#l#ri#3 #n eor#n in"ivi"/ terken# Men"#l#+ #r/ +e+,en#r/$i n# t#t/ kekeb#l#n #n

k#ren#n# t#t/n# ,en#kit3 e,erti #n ek#r#n "ib#$#ke :.

Per#i

EDEMISITAS MA#ARIA

Menik/ti ,en"ek#t#n M#con#l"(124)3en"e+iit# +#l#ri# c#n be "ik#teorik#n Men#"i %i# ero,er#i (%#bel(%#bel 2). 2).#l#$ #t/n# !"#l#$ &n"e+i +#l#ri# t#bil. M#l#ri# t#bil %er#"i ketik# ,o,/l#i %er/ terken# %ink#t #n C/k/, ont#n inok/l#i +#l#ri#. #teori berik/tn# !"#l#$ %I! t#bil +#l#ri# en"e+ik3 "i +#n# ,o,/l#i "iken#k#n ,en/l#r#n +#l#ri# 7&I !%! /r#n ,er+#nen tet#,i $e#rt ke#"##n "i +#n# !!

*l/kt/#i e"e $e#rt %ink#t "i +#n# inok/l#i +#l#ri# ikiri+ e in"ivi"/ $e#rt ,o,/l#i. #l#+ !7 ,en#kit #n kekeb#l#n3 *l/kt/#i Pen#ni Men#"i it/b ketik# +erek#

+eneb#bk#n in"ivi"/ +en#l#+i e"# #t/ %#$/n /nt/k revie8 beber#,# %#$/n !'%!R! inok/l#i +#l#ri#. ero,er#i eti# !"#l#$ e,i"e+i +#l#ri#. #l Pen#ni3 P!!

"##rn#3 ent/k ektre+ #ri +#l#ri# %I! t#bil. #l Pen#ni %er#"i ketik# ,o,/l#i3 !%! b#$k#n ekelo+,ok ecil in"ivi"/3 "iken#k#n ken#ik#n %ink#t ,en/l#r#n +#l#ri# "i "i**erence #n ebel/+n# !%! bi##n# +en#l#+i. etik# P. falcaparumterlib#t3 e,i"e+i +#l#ri# c#n be Men#"i $#l#t #t/ kek/#t#n #n +e+/c#t +e+#tik#n #ri #l#+.

%!&7 2.

#r#kteritik #ri %i# k#teori %r#n+ii +#l#ri#

Perl/ "ic#t#t b#$8# %ink#t r#t# inok/l#i +#l#ri# !%! Intenit# %r#n+ii %I!

ter+#/k $e#rt e*inii #ri &%I!P eti# &'I en"e+iit# +#l#ri#. %ink#t ,en/l#r#n %ini !%! r#n"#$ c#n be3 P!! Prini,n#3 %er#"i !R&'! t#bil3 %I! t#bil3 #n e,i"e+i +#l#ri#(124)(%#bel(%#bel 2). 2). '#+/n "e+iki#n3 %ink#t inok/l#i +#l#ri# !l#+i tertini3 or#n-or#n/t#n #ri r#t/#n iit#n +en/l#r ,er in"ivi"/ ,er %#$/n3 +/nkin #n# %er#"i $e#rt on"ii &n"e+i t#bil. %#ri* inok/l#i ee"ikit #t/ !%! "o#

(8)

#lo c#n be "ite+/i $e#rt

#lo c#n be "ite+/i $e#rt on"ii &n"e+i +#l#ri# t#bilon"ii &n"e+i +#l#ri# t#bil (90).(90).&,i"e+i +#l#ri# c#n be3 #n&,i"e+i +#l#ri# c#n be3 #n +/nkin erin3 %er#"i $e#rt on"ii #n Rel#ti* r#n"#$ #+,#i e"#n %#ri* inok/l#i +/nkin erin3 %er#"i $e#rt on"ii #n Rel#ti* r#n"#$ #+,#i e"#n %#ri* inok/l#i +#l#ri# (124)

+#l#ri# (124)

Per#i

BA%AIMAA

BA%AIMAA EDEMISITASEDEMISITAS DA KEKEBA#A ITERA'T "T"K MEET"KA DA KEKEBA#A ITERA'T "T"K MEET"KA

PE%AR"!

PE%AR"! MMA#ARIAA#ARIA

Ke( .. )alaria stabil

#l#+ on"ii +#l#ri#

#l#+ on"ii +#l#ri# t#bil3 !R&'! inok/l#i %et#bil3 !R&'! inok/l#i %er#t/r "i#+,#ik#n3 r#t/r "i#+,#ik#n3 kekeb#l#n ,rotekti*kekeb#l#n ,rotekti* #n /#t %er$#"#, ,en#kit %erb/k# #n Riiko e+#ti#n !kib#t +#l#ri# %IM!3

#n /#t %er$#"#, ,en#kit %erb/k# #n Riiko e+#ti#n !kib#t +#l#ri# %IM!3 bi##n# P!

bi##n# P!! ! i# 4 !i# 4 !%%! 5 ! 5 %#%#$/n .&&7M i# Pen#ni !$/n .&&7M i# Pen#ni !! ! #n#k +orbi"it##n#k +orbi"it# #n +ort#lit#3 ter/t#+# "i $#"#,#n

#n +ort#lit#3 ter/t#+# "i $#"#,#n P P..falciparum.,falciparum.,M#l#ri# ero,er#i $itori #n M#i$M#l#ri# ero,er#i $itori #n M#i$ $#ri Pen#ni3 on"ii e,erti Pen#ni Men#n

$#ri Pen#ni3 on"ii e,erti Pen#ni Men#n ter/t#+# "i /b-#$#r# !*rik#. /ti,#nter/t#+# "i /b-#$#r# !*rik#. /ti,#n berik/t !

berik/t !"#l#$ k#r#kteritik #ri #+b#"#l#$ k#r#kteritik #ri #+b#r e#r#$ +#l#ri# "i !r e#r#$ +#l#ri# "i !*rik# %r*rik# %ro,i. @i !o,i. @i !*rik# %i*rik# %i+/r+/r 50F #ri !n#k-#n#k ,rib/+i Menin#l &&7M

50F #ri !n#k-#n#k ,rib/+i Menin#l &&7M i# 4 %#$/n3 eb#i#n e"e #rii# 4 %#$/n3 eb#i#n e"e #ri +#l#ri#@ (r/+,t3 19223 "ik/ti, $e#rt re*ereni1>6).

+#l#ri#@ (r/+,t3 19223 "ik/ti, $e#rt re*ereni1>6). ieb/t Pol#

ieb/t Pol# i# ter#nt/n #ri i# ter#nt/n #ri kekeb#l#n %ekekeb#l#n %er$#"#, +#l#ri# r$#"#, +#l#ri# "i /b-#$#r# !*rik# !"#l#$"i /b-#$#r# !*rik# !"#l#$ erin "ik#itk#n &'!' %ink#t ,en/l#r#n +#l#ri# inten "i 8ilD#$ Pen#ni. '#+/n3 erin "ik#itk#n &'!' %ink#t ,en/l#r#n +#l#ri# inten "i 8ilD#$ Pen#ni. '#+/n3 k#+i +en#r#nk#n

k#+i +en#r#nk#n b#$8# I% !"#l#$ t#bilit# %r#n+ii +#l#ri# "i b#$8# I% !"#l#$ t#bilit# %r#n+ii +#l#ri# "i !*rik# %r!*rik# %ro,i3o,i3 !R&'! *it/r bioloi #ri

!R&'! *it/r bioloi #ri Anopheles gambiae Anopheles gambiaekelo+,okvektor +#l#ri#3 &koloi +erek#3kelo+,okvektor +#l#ri#3 &koloi +erek#3 #n 7ink/n#n

#n 7ink/n#n +erek# ("ib#$# +erek# ("ib#$# "i #8#$)3 #"i #8#$)3 #n +er/,#k#n n +er/,#k#n *it/r *it/r #n 7&I Pentin#n 7&I Pentin #ri +#l#ri# "i !*rik# %r#n+

#ri +#l#ri# "i !*rik# %r#n+ii. !R&'!3 or#n/t#n #r#n ii. !R&'!3 or#n/t#n #r#n Peri 7ebi$ #ri beber#,#Peri 7ebi$ #ri beber#,# b/l#n %#

b/l#n %#n,# %#n,# %#nt#n#n +#l#ri# "i #8#$ nt#n#n +#l#ri# "i #8#$ on"ii %r#on"ii %r#n+ii t#bil3 n+ii t#bil3 !! !! e"ikit Riikoe"ikit Riiko kekeb#l#n #n3 ek#li "ic#,#i3 #k#n

kekeb#l#n #n3 ek#li "ic#,#i3 #k#n il#n 7#i. Pen#ni %et#, erl#k/ b#$k#n $e#rtil#n 7#i. Pen#ni %et#, erl#k/ b#$k#n $e#rt ,en#t/r#n %i

,en#t/r#n %ink#t C/k/, r#n"#$ %nk#t C/k/, r#n"#$ %#$/n#n +#l#ri# i#$/n#n +#l#ri# inok/l#inok/l#i(12<).(12<).!"#3 b##i+#n#,/n3!"#3 b##i+#n#,/n3 ,ereer#n 

,ereer#n #n el##n el# #ri ,en#kit +#l#ri# P#r#$ P #ri ,en#kit +#l#ri# P#r#$ P!! !! !n#k-#n#k +/"# (7&I!n#k-#n#k +/"# (7&I +/"# +/"# #ri 5 t#$/n) Men// %ink#t #n Rel#ti* M&'I'!% #ri ke"/# Rin#n

#ri 5 t#$/n) Men// %ink#t #n Rel#ti* M&'I'!% #ri ke"/# Rin#n (191)(191)#n#n P#r#$

P#r#$(1>9)(1>9) ,en#kit,#"# elo+,ok i# ,en#kit,#"# elo+,ok i# #n 7&I t#n 7&I t/# P!/# P!! ! %ink#t %ink#t inok/l#i +#l#ri#inok/l#i +#l#ri# "n er#n# +/nkin "i

"n er#n# +/nkin "i #8#$ ekit#r 10 20 iit#n #8#$ ekit#r 10 20 iit#n +en/l#r ,er %#+en/l#r ,er %#$/n. '#+/n3 $e#rt$/n. '#+/n3 $e#rt on"ii +#l#ri# t#bil "i !*rik#3 Riiko e/+/r

on"ii +#l#ri# t#bil "i !*rik#3 Riiko e/+/r i"/, #ri ,en#kit #i"/, #ri ,en#kit #n er#t3 #nn er#t3 #n k#ren#n# e+#ti#n +#l#ri# 7#n/n3 !R&'!

k#ren#n# e+#ti#n +#l#ri# 7#n/n3 !R&'! P P. . falciparumfalciparumt#+,#kn# %et#, C/k/,t#+,#kn# %et#, C/k/, ont#n "i el/r/$ ,ektr/+ %#ri* inok/l#i #ri #n#t %i

ont#n "i el/r/$ ,ektr/+ %#ri* inok/l#i #ri #n#t %ini e #n#t r#n"#$ ni e #n#t r#n"#$ (1>9) e:(1>9) e: ..

..

Per#i

TIDAK S

TIDAK STABI#TABI# DA *ABA! MA#ARIA DA *ABA! MA#ARIA

eb#likn#3 "i +#n#

eb#likn#3 "i +#n# on"ii %r#n+ion"ii %r#n+ii %I! t#bil3 Ren"#$ i %I! t#bil3 Ren"#$ #+,#i e"#n %#ri* r#t#-r#t##+,#i e"#n %#ri* r#t#-r#t# inok/l#i +#l#ri# c#n be

inok/l#i +#l#ri# c#n be #n#t erb#$## . #n#t erb#$## . #l Pen#ni !R&'! kekeb#l#n %e#l Pen#ni !R&'! kekeb#l#n %er$#"#,r$#"#, +#l#ri#3 &M&'%!R! ,erl#$#n '#ik3 !"#l#$3 e,erti #n kit" $# "i#r#nk#n3 Ce,#t +#l#ri#3 &M&'%!R! ,erl#$#n '#ik3 !"#l#$3 e,erti #n kit" $# "i#r#nk#n3 Ce,#t il#n berik/t +/nkin

il#n berik/t +/nkin eten#$ %#$/n e %#eten#$ %#$/n e %#$/n %#n,# In*eki. i+#n#,/n %ink#t$/n %#n,# In*eki. i+#n#,/n %ink#t Peniri+#n inok/l#i +#l#ri# !"#l#$ #ik Ren"#$ #n

(9)

"i,er,#n#n #ri #t/ %#$/n !%! 7&I %#n,# In*eki /l#n erin %er#"i3 "i,er,#n#n #ri #t/ %#$/n !%! 7&I %#n,# In*eki /l#n erin %er#"i3 &M&'%!R! P!! ##t #n #+# Riiko rein*eki #k$irn# %et#, %ini. #l#+ &M&'%!R! P!! ##t #n #+# Riiko rein*eki #k$irn# %et#, %ini. #l#+ ke#"##n Pen#ni3 in"ivi"/ rent#n e,#n#n i"/,

ke#"##n Pen#ni3 in"ivi"/ rent#n e,#n#n i"/, /nt/k revie8 In*eki +#l#ri# !kti*/nt/k revie8 In*eki +#l#ri# !kti* ero,er#i klini #n erin "i,en#r/$i Ole$ I%. 

ero,er#i klini #n erin "i,en#r/$i Ole$ I%. el#in I%3 &M! ,eie ,#r#itel#in I%3 &M! ,eie ,#r#it +#l#ri#3 #n /k#n #n#

+#l#ri#3 #n /k#n #n# P P..*#lci,#r/+3 Men#"i *#lci,#r/+3 Men#"i erb#$## P!! erb#$## P!! on"ii Pen#ni.on"ii Pen#ni. In*eki ber/l#n

In*eki ber/l#n &'!' ,eie &'!' ,eie ,#r#it +#l#ri# #,#r#it +#l#ri# #n #k$n #k$irn# #"i irn# #"i +ele+#$k#n +ele+#$k#n #n#n #r#,#n i"/, c#n

#r#,#n i"/, c#n be "ik/r#ni eten#$ !%be "ik/r#ni eten#$ !%! /r#n #ri I% $e#rt ! /r#n #ri I% $e#rt 7ink/n#n eb#7ink/n#n eb# +#l#ri# #n eb#likn# +ene$#tk#n konte+,orer (4>3

+#l#ri# #n eb#likn# +ene$#tk#n konte+,orer (4>3 12=).12=).it/#i Pen#ni "i#+b#rk#nit/#i Pen#ni "i#+b#rk#n Ole$ /ti,#n berik/t #

Ole$ /ti,#n berik/t #n +en#c/ n +en#c/ k#b/,#ten +#l#ri# "i k#b/,#ten +#l#ri# "i ekit#r P#nt#i Me"iter#ni# "iekit#r P#nt#i Me"iter#ni# "i !8#l !b#" ke-19. @#i#n #n +e+/c#t /b/r (It#li#) !"#l#$ M#n# (+#l#ri#); b/r/$ !8#l !b#" ke-19. @#i#n #n +e+/c#t /b/r (It#li#) !"#l#$ M#n# (+#l#ri#); b/r/$ +ene+b#r# ... $#nt/ eor#n ,ri#3 eor#n Pen"erit# #ri b/#i#n #+,#i ke li#n /b/r; +ene+b#r# ... $#nt/ eor#n ,ri#3 eor#n Pen"erit# #ri b/#i#n #+,#i ke li#n /b/r; ber/i# b#$k#n "i +## ecil3 #

ber/i# b#$k#n "i +## ecil3 #n +elet#kk#n $e#rt keen#r##n I% (ink#n +elet#kk#n $e#rt keen#r##n I% (ink#t)t) e$i"/,#n 

e$i"/,#n ##n %!n %!PI #t/ ,PI #t/ ,en#kit .... e,erti en#kit .... e,erti #lo iili#3 e,erti #r"ini# #lo iili#3 e,erti #r"ini# #n e,erti#n e,erti l#ik /n#ni. '% +en#l#ni i"/, +#ti #n #r/

l#ik /n#ni. '% +en#l#ni i"/, +#ti #n #r/ "i,oton #ri b#$k#n eten#$"i,oton #ri b#$k#n eten#$ i"/, @(12=).

i"/, @(12=). "i +#n#

"i +#n# ,/n kekeb#l#n ,/n kekeb#l#n #nti+#l#ri# $# +en/r/n3 #nti+#l#ri# $# +en/r/n3 $# il#n3 !%$# il#n3 !%! %I! P&R'!! %I! P&R'! "ic#,#i "i %e+,#t Pert#+# 3 ,o,/l#i "i

"ic#,#i "i %e+,#t Pert#+# 3 ,o,/l#i "i Pinir#n ?on# %r#n+ii +#l#ri# rent#n %er$#"#,Pinir#n ?on# %r#n+ii +#l#ri# rent#n %er$#"#, e,i"e+i +#l#ri#. etik#

e,i"e+i +#l#ri#. etik# P P. . falciparumfalciparumterlib#t $e#rt e,i"e+i3 %ink#t e+#ti#n c#n beterlib#t $e#rt e,i"e+i3 %ink#t e+#ti#n c#n be Men#"i #n#t

Men#"i #n#t %ini. &! er#n#n #%ini. &! er#n#n #n %I! n %I! "iob#ti"iob#ti t/n#l

t/n#l P P..falciparumfalciparum+#l#ri#"#l#+ in"ivi"/ +#l#ri#"#l#+ in"ivi"/ noni++/ne +e+b#8# noni++/ne +e+b#8# Riiko e+#ti#n #Riiko e+#ti#n #nn +/nkin "i +#n# ## #ri beber#,# Peren /nt/k revie8 eti"#kn# 20 #+,#i =0F e/#i +/nkin "i +#n# ## #ri beber#,# Peren /nt/k revie8 eti"#kn# 20 #+,#i =0F e/#i &'!' ke#"##n (=3123

&'!' ke#"##n (=312321).21).%ink#t #n 7&I %ini !"#l#$ &'I !nk# e+#ti#n%ink#t #n 7&I %ini !"#l#$ &'I !nk# e+#ti#n #

#n %er#"i n %er#"i el#+#el#+# P P..falciparumfalciparume,i"e+i +#l#ri# (=0345#3 4936>3>53e,i"e+i +#l#ri# (=0345#3 4936>3>53219).219)./ti,#n/ti,#n berik/t

berik/t(6>)(6>)!"#l#$ 8#kil #ri !"#l#$ 8#kil #ri Periti8# Pen#ni. @#l#+ Periti8# Pen#ni. @#l#+ &%I!P r/+#$ #&%I!P r/+#$ #n ... n ... %i#%i# !%! e+,#t "#l#+ P#ien #n +enel/$ inin3 #kit ke,#l# P#r#$3 berkerin#t3 'eri "i !%! e+,#t "#l#+ P#ien #n +enel/$ inin3 #kit ke,#l# P#r#$3 berkerin#t3 'eri "i el#k#n #n ektre+it# ...

el#k#n #n ektre+it# ... Pen$#il#n ken# ,##k Pen$#il#n ken# ,##k e+,#t "#l#+ !e+,#t "#l#+ !%%! li+# k#+b/$3 #kit! li+# k#+b/$3 #kit ke,#l# #n #kit Men#"i t#k

ke,#l# #n #kit Men#"i t#k tert#$#nk#n #i #n#k P#ien 8$ic$ #re "eliri/+tert#$#nk#n #i #n#k P#ien 8$ic$ #re "eliri/+ "i,#+erk#n el/#r #ri keter,/r/k#n &'!'

"i,#+erk#n el/#r #ri keter,/r/k#n &'!' ko+#3 er#k$ir P!! ko+#3 er#k$ir P!! eb#i#n e"e ...eb#i#n e"e ... #n ber/i# !'%!R! e+#ti#n. 5 "#n 20 %#$/n. !R&'! +erek# ber#"# ! #ri #n ber/i# !'%!R! e+#ti#n. 5 "#n 20 %#$/n. !R&'! +erek# ber#"# ! #ri b#$k#n klinik e"er$#n#3 

b#$k#n klinik e"er$#n#3 ##n er#rti %I! n er#rti %I! !! !! ke+/nkin#n +enel#+#tk#n i"/,ke+/nkin#n +enel#+#tk#n i"/, +erek#3 +erek# +#ti e,erti leb#$ $e#rt #r#n

+erek#3 +erek# +#ti e,erti leb#$ $e#rt #r#n +erokok @( #ri 7#,or#n 7#,#n#n +erokok @( #ri 7#,or#n 7#,#n#n #ri#ri e,i"e+i 195< +#l#ri# "i &t$io,i#

e,i"e+i 195< +#l#ri# "i &t$io,i#G6>H).G6>H).#l#+ #t/ M/i+3 e,i"e+i #n#t +#l#ri# $##l#+ #t/ M/i+3 e,i"e+i #n#t +#l#ri# $# Pen#ni +e+,ro"/ki ekit#r =35 /t# !

Pen#ni +e+,ro"/ki ekit#r =35 /t# ! +#l#ri# "i #nt#r#n# ke"/#+#l#ri# "i #nt#r#n# ke"/# P P.. vivax

vivax#n#n P. P.falciparumfalciparum+#l#ri##k#n #"ir; b/t/$ #+#l#ri##k#n #"ir; b/t/$ #kt/ ekit#r 150.000 kt/ ekit#r 150.000 n#8#n#8# er/,# #n %ink#t e+#ti#n +#l#ri# 7&I %ini "i#l#+i Ole$

er/,# #n %ink#t e+#ti#n +#l#ri# 7&I %ini "i#l#+i Ole$ or#n/t#n ero,#or#n/t#n ero,# +e+#/ki "#er#$

+e+#/ki "#er#$ #"#l#$ %ro,i &&7M Penen#l#n #"#l#$ %ro,i &&7M Penen#l#n kin# P!kin# P!! Perten#$#n !b#" ke-19! Perten#$#n !b#" ke-19 (203

(2034242-44.1563-44.156319>)19>)...Me+#n3 konek/eni #ri Penen#l#n or#n/t#n noni++/ne M...Me+#n3 konek/eni #ri Penen#l#n or#n/t#n noni++/ne M en#"ien#"i 8ilD#$ en"e+ik +#l#ri# !"#l#$3 P!!

8ilD#$ en"e+ik +#l#ri# !"#l#$3 P!! "##rn#3 ent/k "##rn#3 ent/k +#l#ri# e,i"e+i+#l#ri# e,i"e+i

Per#i Ke4

DASAR BI$#$%I DARI S

(10)

Perbe"##n $e#rt t#bilit# %r#n+ii +#l#ri#3 ter/t#+# !'%!R! !*rik# %ro,i #n Perbe"##n $e#rt t#bilit# %r#n+ii +#l#ri#3 ter/t#+# !'%!R! !*rik# %ro,i #n eb#i#n e"e 8ilD#$

eb#i#n e"e 8ilD#$ +#l#ri# berb#rin3 +#l#ri# berb#rin3 ##n ter/t#+# "ieb#bk#n n ter/t#+# "ieb#bk#n Ole$ Peril#k/ #nOle$ Peril#k/ #n k#r#kteritik bioloi l#inn# #ri ,eie #n "#er#$ /b,eie #ri

k#r#kteritik bioloi l#inn# #ri ,eie #n "#er#$ /b,eie #ri Anopheles Anophelesvektor"#nvektor"#n 7ink/n#n +erek#. ebi###n #

7ink/n#n +erek#. ebi###n #n /#t Pn /#t Pre*ereni M#n/i# +eniit #n re*ereni M#n/i# +eniit #n #n#t#n#t o+etik vektor !*rik# %ro,i (1>3

o+etik vektor !*rik# %ro,i (1>3=9)=9)+eneb#bk#n ont#k #n #n#t er##+ !'%!R!+eneb#bk#n ont#k #n #n#t er##+ !'%!R! +erek# #n /+ber #r#$ M#n/i#

+erek# #n /+ber #r#$ M#n/i# "i /b-#$#r# !*rik#. M#l#ri# ,en/l#r#n /nt/k revie8"i /b-#$#r# !*rik#. M#l#ri# ,en/l#r#n /nt/k revie8 on"ii Ikli+ #lo #n#t

on"ii Ikli+ #lo #n#t kon"/i*3 kon"/i*3 ##n #n#t n #n#t #n le+b#b &'!' Rel#ti* #n le+b#b &'!' Rel#ti* e"ikite"ikit *l/kt/#i. Pen#ni +en"/k/n +/r P#n#n #ri

*l/kt/#i. Pen#ni +en"/k/n +/r P#n#n #ri n#+/k vektor #n Perke+b#n#nn#+/k vektor #n Perke+b#n#n #

#n Ce,#t #ri ,#r#it $e#rt iri +erek#. n Ce,#t #ri ,#r#it $e#rt iri +erek#.  e+/# *it/r Pen#ni +en#b/nk#n  e+/# *it/r Pen#ni +en#b/nk#n /nt/k/nt/k revie8 ree, /nt/k revie8 %r#n+ii +#l#ri# t#bil #n3 Me+#n3 inten /+/+n#.

revie8 ree, /nt/k revie8 %r#n+ii +#l#ri# t#bil #n3 Me+#n3 inten /+/+n#. i %e

i %e+,#t berb#rin3 %ro,i "i /ni#3 +,#t berb#rin3 %ro,i "i /ni#3 /btro,i3 #n e"#n3 /btro,i3 #n e"#n3 #ri betin# eb#i#n#ri betin# eb#i#n e"e

e"e Anopheles Anopheles,eie+e+iliki Pre*ereni /nt/k revie8 e8#n "#ri,#"# ont#k M#n/i#,eie+e+iliki Pre*ereni /nt/k revie8 e8#n "#ri,#"# ont#k M#n/i# "#n +e+iliki 7&I e"ikit #l#+ 'eeri ,etern#k#n3 beritir#$#t3 #n ebi###n

"#n +e+iliki 7&I e"ikit #l#+ 'eeri ,etern#k#n3 beritir#$#t3 #n ebi###n Peneb#r#n #ri vektor !*rik#. Ikli+ #n ter/t#+#

Peneb#r#n #ri vektor !*rik#. Ikli+ #n ter/t#+# +icrocli+#te "i#l#+i Ole$ n#+/k+icrocli+#te "i#l#+i Ole$ n#+/k vektor Pen#ni bi##n#

vektor Pen#ni bi##n# inin3 kerin3 #n inin3 kerin3 #n 7&I erv#ri#i "#ri,#"# "i !*rik# %ro,i37&I erv#ri#i "#ri,#"# "i !*rik# %ro,i3 #

#n +en#r#$ e n +en#r#$ e i"/, i"/, ##n 7&I n 7&I P#ti #ri n#+/k P#ti #ri n#+/k "#n Pene+b#n#n /r#n "#n Pene+b#n#n /r#n c#nc#n be "i#n"#lk#n #ri ,#r#it $e#

be "i#n"#lk#n #ri ,#r#it $e#rt iri +erek#. Pen#ni rt iri +erek#. Pen#ni !"#l#$ on"ii !"#l#$ on"ii ##n +eneb#bk#nn +eneb#bk#n ont#k #n #n#t %I! +enent/ !'%!R! vektor ,oteni#l +#l#ri# M#n/i# "#n t/#n ont#k #n #n#t %I! +enent/ !'%!R! vektor ,oteni#l +#l#ri# M#n/i# "#n t/#n M#n/i# "#n Peniri+#n

M#n/i# "#n Peniri+#n e #n#t %I! %er#t/r inok/l#i +#l#ri#3 "en#n k#t#e #n#t %I! %er#t/r inok/l#i +#l#ri#3 "en#n k#t# berb#rin3 /nt/k revie8 %

berb#rin3 /nt/k revie8 %r#n+ii +#l#ri# r#n+ii +#l#ri# %I! t#bil.%I! t#bil.

&,i"e+i +#l#ri# M/nc/l $e#rt it/#i "i +#n# b#r/ !%! M&'I'!% ,en/l#r#n +#l#ri# &,i"e+i +#l#ri# M/nc/l $e#rt it/#i "i +#n# b#r/ !%! M&'I'!% ,en/l#r#n +#l#ri# #,#it# %ib#-%

#,#it# %ib#-%ib# "i+#/kk#n e ib# "i+#/kk#n e $e#rt ,o,/l#i &'!' %ink#t +e+#"#i kekeb#l#n$e#rt ,o,/l#i &'!' %ink#t +e+#"#i kekeb#l#n #

#n c#n be n c#n be "i/n#k#n /nt/k revie8 +ener#,n#. e#"##n "i "i/n#k#n /nt/k revie8 +ener#,n#. e#"##n "i +#n# !7 Pen#ni c#n be+#n# !7 Pen#ni c#n be %e

%er#"i #n#t r#"i #n#t er##+er##+(192).(192).i##n# +erek# +elib#tk#n ,o,/l#i noni++/ne i 7ok#ii##n# +erek# +elib#tk#n ,o,/l#i noni++/ne i 7ok#i "in#t#k#n ,r#b##r beb#

"in#t#k#n ,r#b##r beb# +#l#ri# +#l#ri# ##n ber"ek#t#n n ber"ek#t#n &'!' "#er#$ #"#l#$ &n"e+i&'!' "#er#$ #"#l#$ &n"e+i +#l#ri#. &,i"e+i %er

+#l#ri#. &,i"e+i %er#"i ketik# C/#c# #"i ketik# C/#c# #ti,ik#l3 /c$ # #ti,ik#l3 /c$ # invitin ,#rtici,#tion3 kekerin#n3invitin ,#rtici,#tion3 kekerin#n3 elebi$#n c/r#$ $/#n3

elebi$#n c/r#$ $/#n3 #n 7&I %ini #ri /$/ #n 7&I %ini #ri /$/ bi##n#3 cre#te on"ii #bi##n#3 cre#te on"ii #nn tr#nien +en"/k/n %r#n+ii +#l#ri#. '#+/n3 ,e,er#n#n3 ,erinti3

tr#nien +en"/k/n %r#n+ii +#l#ri#. '#+/n3 ,e,er#n#n3 ,erinti3 #n Penen"#li#n#n Penen"#li#n +#l#ri#3 !'%!R! !%IEI%! M#n/i# l#inn#3 &M! $# bert#n/n #8#b /nt/k +#l#ri#3 !'%!R! !%IEI%! M#n/i# l#inn#3 &M! $# bert#n/n #8#b /nt/k revie8 ,enci,t##n e,i"e+i +#l#ri#ke :.

revie8 ,enci,t##n e,i"e+i +#l#ri#ke :.

Per#i

K

KEMATIAEMATIA TIDAK # TIDAK #A%S"%A%S"% MA#ARIA MA#ARIA

#8#$ !P! ,/n on"ii +#l#ri# en"e+iit# %er#"i3 #n#k3 #n e/#i &'!' /kti #8#$ !P! ,/n on"ii +#l#ri# en"e+iit# %er#"i3 #n#k3 #n e/#i &'!' /kti #nk# #

#nk# #kt/ #n#lii3 /+/+n# kt/ #n#lii3 /+/+n# e"e eb#i#n (>41=41423e"e eb#i#n (>41=41423 219)3219)3#ri e+#ti#n#ri e+#ti#n

erl#n#n#n +#l#ri# "i M## 7#l/ P&R'! !kib#t %I! 7#n/n #ri &*ek In*eki erl#n#n#n +#l#ri# "i M## 7#l/ P&R'! !kib#t %I! 7#n/n #ri &*ek In*eki +#l#ri# "iko+bin#ik#n &'!' In*eki #n on"ii l#in. i+#n#,/n interveni $# +#l#ri# "iko+bin#ik#n &'!' In*eki #n on"ii l#in. i+#n#,/n interveni $# "il#k/k#n /nt/k revie8 &A/it ,en/l#r#n +#l#ri#3 &A/it !nk# e+#ti#n keel/r/$#n $# "il#k/k#n /nt/k revie8 &A/it ,en/l#r#n +#l#ri#3 &A/it !nk# e+#ti#n keel/r/$#n $# beber#,# #li 7&I e"e #ri

beber#,# #li 7&I e"e #ri %ink#t e%ink#t e+#ti#n erl#n#n#n +#l#ri# e,er+#ti#n erl#n#n#n +#l#ri# e,erti ti ##nn "i,erkir#k#n &&7M interveni (=3

"i,erkir#k#n &&7M interveni (=31=4).1=4).eber#,# Perbe"##n Pen#ni +/nkineber#,# Perbe"##n Pen#ni +/nkin

!R&'! e##l#n /nt/k revie8 +en"eteki !%! #k/n /nt/k e+/# e+#ti#n "i +#n# !R&'! e##l#n /nt/k revie8 +en"eteki !%! #k/n /nt/k e+/# e+#ti#n "i +#n# +#l#ri# #k#n

(11)

erl#n#n#n &'!' ke$#"ir#n +#l#ri#3 tet#,i %I! el# !R&'! +#l#ri#3 c#n be "ik#itk#n &'!' ,eneb#b %ert/n"# !%! %I! 7#n/n. Pen#ni c#n be

+enc#k/, ne*ro,#ti #nk# P#n#n P.malariaeIn*eki(>4). '#+/n3 Reeller #le +#n#er3 e+#ti#n !"#l#$ !R&'! &*ek ,re"i,oii +#l#ri# +#ti #ri on"ii berb#rin e,erti In*eki ,ern#,##n(>4)#n #n/#n n/trii (219) e :.

Per#i

K$SEK"ESI KESE!ATA TIDAK MEMATIKA $, EDEMIS MA#ARIA

"i ?#+#n e#r#$3 #n b#r/-b#r/ Pen#ni !8#l in# Perten#$#n !b#" ke-20 "i !i# el#t#n3 In*eki +#l#ri# %er/-+ener/ #n rein*eki +e+iliki ,en#r/$ #n #n#t b/r/k P!! on"ii +ent#l3 Biik3 oi#l3 #n &kono+i #ri in"ivi"/ M##r#k#t #n #n #+,#k terken# . el#in orb#n e+#ti#n #n +orbi"it# #le +#n#er3 !! beber#,# *it/r #ri &!' +#l#ri# #n +en#+in +eneb/tk#n ,ei*ik.

M#l#ri# +en#ik#n +##l#$ %ertent/ el#+# e$#+il#n. #l Pen#ni +/nkin "ieb#bk#n3 eti"#kn# eb#i#n3 t#t/ &'!' @i+/no/,rei@ #ri 8#nit# $#+il. #$k#n P!! 8#nit# "in#t#k#n #n#t +#l#ri# keb#l3 Riiko In*eki +#l#ri# P!! e$#+il#n #n %ini3 &'!' ,enink#t#n Riiko er#t #"#n l#$ir r#n"#$3

ke//r#n3 e+#ti#n b#i(14)3#n +orbi"it# #n +ort#lit# P!! 8#nit# $#+il. @M#l#ri# +e+berik#n ,en#r/$ #n C/k/, e"e $e#rt Men/r#ni el#$ir#n #n +enink#tk#n #nk# #kt/ el#$ir#n M#i$ $e#rt J+##r#k#t@ (entle3 19113 "ik/ti, $e#rt

re*ereni1>6).

ero,er#i $itori3 @kek#n#k-k#n#k#n@ "i ke"/# eni el#+in #n i+,oteni P!! l#ki-l#ki #n er$/b/n#n &'!' "#er#$ #"#l#$ +#l#ri#(5).@#l#$ #t/ #ri "o# e"e !"#l#$ i+,oteni e$in# #n#k "ite+/k#n "i "e#-"e# teren"#+ #ir (#n) #n

"i$#ilk#n #ri ker/#k#n kee$#t#n #n "i$#ilk#n Ole$ er#n#n ont#n e+#+ #n #"#n# ,e+be#r#n li+,#@ (on3 1<953 "ik/ti, $e#rt Re*ereni1>6).er#+# &'!' +##l#$ +#l#ri# P!! e$#+il#n #n e+#ti#n b#i3 Pen#ni +en#+b#$k#n in# &A/it *ek/n"it# $e#rt e"e ,o,/l#i #n3 i 7ok#i #n terken# #+,#k terb/r/k3 +e+berik#n kontrib/i e"e %er$#"#, "e,o,/l#i #8#$ ,en#r/$ +#l#ri#. @i k#b/,#ten $i,eren"e+i #n #n#t en"e+ik (+#l#ri# /nt/k revie8) "i In"i# kecen"er/n#n !"#l#$ /nt/k revie8 Pen"/"/k +en/r/n@ (91).

i !'%!R! #n +e+/c#t +enin"# #n3 $#ri Pen#ni3 eti"#kn# "i$#r#i &*ek +#l#ri# !"#l#$ b#$8# P!! ke#"##n Pen"erit# +ent#l. Pen#+#t #ri #n#k #kt/ #n

&R&! #n %e+,#t3 ter+#/k

i,,ocr#te(95)3M#cc/lloc$(12=)3one(106)3!n"eron(5)3#n inton(1>6)3#n #n#t koniten $e#rt ,en#+b#r#n +erek# %&'%!' on"ii Pen"/"/k "#er#$ #"#l#$ +#l#ri# ter/t#+# "i ero,# !%! !i#. Merek# +en#+b#rk#n in"ivi"/ M##r#k#t #n "i #ri ne#r#-#tr# %ek#n#n +ent#l #n #n ,ikoloi el# i #8#$ ,en#r/$ &n"e+i M#l#ri# #n el#l/ %I! t#bil !%! r#n"#$ %r#n+ii. erik/t Pen#ni !"#l#$ $# tereb/t. @i#,#,/n #n $# "i,er$#tik#n &'!' ek#+# ! +#l#ri# %I! !P!% ##l /nt/k revie8 +en#"#ri "#+,#kn# P!! +ent#lit# !%IEI%! t/+,/l Pen"erit#-+ent#l3 ik#8#tirk#n +#r#$ +#r#$ !"#l#$ !t/r#n3 Inii#ti* /r#n3 e,/t/#n

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+en/n"# !%! +enc#,#i &'!' ke/lit#n3 ber#+bii e$il#n#n #n "e,rei

+er/,#k#n e#l# #n+enonol@(1>6@!n#k-#n#k ekol#$ "i %r#nv##l terin*eki +#l#ri# roni i8# eb##i "iolonk#n@ 7e+#$ Pikir#n @@ (7ei,ol"t et #l3 19213 "ik/ti, $e#rt Re*ereni);..1>6)#l#+ /ni# ek#r#n Pen#ni ! 7&I e$#t3 it/#i #n Cocok "ekri,i +erek# +encolok &'!' keti"#k$#"ir#n +erek#. '#+/n "e+iki#n3 #n

%I! Men#"i bin/n &'!' konek/eni 7#n/n #ri In*eki +#l#ri# iri P!! ke#"##n +ent#l3 ,ro,ori #n ini*ik#n #ri ,#r# orb#n In*eki +#l#ri# M#i$ +e+b#8# "e*iit !%! i8# ne/roloi (9>) e :.

Per#i PE%AR"! MA#ARIA PADA S$SIA# DA PEMBA%"A EK$$MI

&! ik/i #n +e+#"#i #ri &*ek &kono+i #ri +#l#ri# !"#l#$ "i 7/#r link/, #rtikel Pen#ni. Po,/l#i terken# #+,#k t#k $enti-$entin# +#l#ri# #r/  el#l/ i"/, #n Menin#l "i e+ikin#n #ri #t/ "er##t !%! #n l#in. i ?#+#n e#r#$3 /#$# &kono+i $# /lit #n erin %I! +/nkin "i $#"#,#n +#l#ri# (1>6).M#l#ri# en"iri $# erin C/k/, /nt/k revie8 ,## ecel#k##n "i ,erinti3 ,ert#ni#n3 #n %eknik i,il3

e,erti #n "i#+b#rk#n Ole$ /ti,#n Per8#kil#n berik/t. @i,eren"e+i il##$ (+#l#ri# /nt/k revie8)3 +eki,/n #r#n "i$/ni3 erink#li "#er#$ #"#l#$ "i +#n#

Perkeb/n#n e"e #n /#$# In"/tri e"e ber#"# #n #n3 Ole$ !R&'! I%3 erin it/ #ri ,o,/l#i i+ir#n #n C/k/, #n Ce,#t "i,oton e #8#$.@ (M#l#ri# o+ii 7i# #n#-#n#3 19=03 "ik/ti, $e#rt Re*ereni 1>6);@Meki,/n !! t#n#$ #n #ik "i on/lt#i ee$#t#n3 /k/+ el#t#n e,erti "i t#r#3 t#n#$ "i t#r# Men/#l ekit#r 12 #+,#i 20 #li $#r#3 Perbe"##n !"#l#$ ter/t#+# !R&'! +#l#ri#@ (C#rter3 19223 "ik/ti, $e#rt Re*ereni1>6);.@ontr/ki R#il8# "i "#er#$ #"#l#$ %ro,i $#+,ir el#l/ "ik#itk#n &'!' e,i"e+i */l+inent #ri +#l#ri#-@ e+#ti#n ti"/r @!"#l#$ ener#li#i P!! e#"i#n@ (enior-P/ti$3 192<3 "ik/ti, $e#rt re*ereni1>6)

e,#n#n e#r#$(1>6)#n e $#ri Pen#ni(>0)3"i +#n# ,/n #n b##i+#n#,/n I% +/nkin ter8//"3 +#l#ri# el#l/ "iken#k#n $#l#t #t/ terber#t #+b#t#n /nt/k revie8 Pe+b#n/n#n oi#l #n ekono+ike :.

Per#i

T!E -MA#ARIA !IP$TESIS- DA E$#"SI MA"SIA TERBAR"

#l Pen#ni c#n be %I! +en$er#nk#n3 !R&'! I%3 b#$8# ,#r#it +#l#ri# #r/ +e+iliki #+,#k #n Men"#l#+ P!! &vol/i M#n/i# b#r/-b#r/ Pen#ni (2>).I'I !"#l#$ ,ro,oii #ri @+#l#ri# $i,otei3@ #n +en#t#k#n b#$8# ,oli+or*i+e enetik M#n/i# %ertent/3 ter/t#+# #n +e+,en#r/$i el-el #r#$ +er#$ (el #r#$ +er#$)3 $# "i,ili$ /nt/k revie8 Brek/eni %ini !R&'! +erek# $# "ilin"/ni %er$#"#, &*ek #ri In*eki +#l#ri#. Me+#n3 Reeller #n#k ,oli+or*i+e enetik M#n/i# "ii"enti*ik#i +e+en/$i beber#,# !%! &M! #r#,#n $i,otei +#l#ri# "ib#n"ink#n c#n be "ik#itk#n &'!' eleki i #8#$ #en t/n#l l#inn# (2>).

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Pern#t##n Pert#+# #ri $i,otei +#l#ri# ib/#t P!! %#$/n 194< Ole$ 

#l"#ne(<6)3#n +en//lk#n I% eb##i Penel##n /nt/k revie8 Brek/eni %ini t$#l#e+i# ekit#r P#nt#i 7#/t Me"iter#ni#3 "i +#n# +#l#ri# $ # l#+# en"e+ik. M/nkin %I! "iket#$/i #l"#ne P!! ##t I%3 /b/n#n #n +/nkin !'%!R!

$e+olobino,#ti berb#rin "i8#rik#n3 i*#t el #bit3 #n Perlin"/n#n %er$#"#, +#l#ri# /"#$ "ic#t#t. P!! %#$/n 19463 $e#rt &! t/"i +en#b#rk#n #ri P#ien r#8#t in#, "i r/+#$ #kit "#er#$ #"#l#$ "i 'ort$ern R$o"ei#3 ek#r#n K#+bi#3 &! eet $# +enc#t#t %ink#t #n 7&I r#n"#$ #ri In*eki +#l#ri# !'%!R! ,e+b#8# i*#t el #bit #ri #l#n#n nonickler (11).

erik/t Pen#ni3 kit" +e+b#$# /kti. /nt/k revie83 #n i+,lik#i #n %i+b/l #ri3 #n"i"#t t#+# ,oli+or*i+e M#n/i# #t/$ $e#rt !7 $i,otei +#l#ri#

Per#i Ke4

T!A#ASSEMIA

%$e t#l#e+i# !"#l#$ el# #ne+i# #n "ieb#bk#n kel#in#n P!! en #n +enko"ek#n $e+olobin. Merek# +elib#tk#n $il#nn# &*ekti* #ik #l,$# (#l,$#

t$#l#e+i#) !%! bet# (bet# t$#l#e+i#) R#nt#i +olek/l Pen#ni (92.1<53 19<).#n#k M/t#i ,ei*ik #n &R&! $e#rt en /nt/k revie8 #l*# #n bet# $e+olobin R#nt#i "i8#kili !'%!R! t$#l#e+i# "iken#l (65).

i ero,#3 Brek/eni %ini t$#l#e+i# #n "ite+/k#n "i ekit#r P#nt#i 7#/t Me"iter#ni#3 e,erti #l"#ne $# +enc#t#t (653 <6).i %e+,#t berb#rin3 t$#l#e+i# %er#"i P!!

Brek/eni %ini P!! ,o,/l#i t$ro/$ eb#i#n e"e !*rik#3 %i+/r %en#$ #n !i# %en#$3 e+en#n/n !r#b3 !n#k en/# In"i#3 !i# %en#r#3 Cin# el#t#n3 #n ,/l#/- ,/l#/ "i P#i*ik #r#t #ri Bili,in# "i t#r# e 7#/t %i+or "i el#t#n #n ke 'e8 /ine#

#n ,/l#/-,/l#/ Mel#nei# "i ti+/r (2>3653119319<).$in# ekit#r 2.000 t#$/n #n l#l/3 ini #"#l#$ b#t# lob#l #n ke+/nkin#n "i +#n# +#l#ri# #"#l#$ en"e+ik.

"##r "#ri "/##n e+/l# #l"#ne(<6)tel#$ "ikon*ir+#i "#n "i,erl/# "#l#+ beber#,# t/"i #n +en/n/kk#n #oi#i t$#l#e+i# "en#n ,#,#r#n l#+# ,en"/"/k /nt/k ke$#"ir#n +#l#ri# (li$#t3 +i#ln#3 re*ereni 66"#n215).!n #,,roi+#tel 50F re"/ction in t$e rik o* +#l#ri#l "ie#e $# recentl been $o8n *or bot$ $ereto?ote #n" $o+o?ote *or cert#in #l,$#Lt$#l#e+i# (1).

Go to4 %#"'$SE/0/P!$SP!ATE DE!&DR$%EASE DE,I'IE'&

O* bro#"l i+il#r lob#l "itrib/tion to t$e t$#l#e+i# #re # ro/, o* +/t#tion in t$e e-linke" ene *or l/coe-6-,$o,$#te "e$"roen#e (6P) 8$ic$ ive rie to t$e 6P "e*iciencie (119). 6P "e*iciencie 8ere oriin#ll reconi?e" # # clinic#l con"ition kno8n # *#vi+3 o c#lle" bec#/e o* t$e $e+oltic crii t$#t c#n be c#/e" in t$oe

#**ecte"3 b t$e con/+,tion o* oi"#nt *oo" /c$ # *#v# be#n. %o"#3 6P "e*icienc i # reconie" $#?#r" in +#l#rio/ reion bec#/e o* t$e #oci#te" rik o* oi"#nt tre *ro+ t#kin #nti+#l#ri#l "r/ /c$ # ,ri+#A/ine. In $etero?o/ #n" $e+i?o/

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co+bin#tion3 6P "e*icienc $# no8 been $o8n to be #oci#te" 8it$ # level o*

,rotection o* #bo/t 50F ##int evere P. falciparum+#l#ri# (>6316<). %$ere*ore3 $i$ r#te o* 6P "e*icienc in +#n ,#rt o* t$e 8orl" c#n ,rob#bl be #cco/nte" *or # t$e re/lt o* election b +#l#ri#.

Recent evi"ence in"ic#te t$#t t$e #llele *or 6P "e*icienc 8ere electe" in !*ric#n ,o,/l#tion bet8een 43000 #n" 123000 e#r #o (1<<). %$i ,erio" coinci"e 8it$ o+e

eti+#te *or t$e ti+e o* e+erence o* P. falciparum# # +#or $/+#n ,#t$oen #t #ro/n" 43000 e#r #o (1593194). &A/#ll3 $o8ever3 t$e election *or 6P "e*icienc +# $#ve ,rece"e" t$i event #n" overl#,,e" # ti+e 8$en P. vivax+#l#ri# co/l" till $#ve been # +#or

elective *orce in !*ric# (ee belo8). o 8$ic$ ,#r#ite co/l" $#ve b een re,onible *or t$e election o* 6P "e*icienc in t$e !*ric#n ,o,/l#tion

It +# o*ten #,,e#r t$#t t$e +#l#ri# $,ot$ei $o/l" be t#ken to #,,l +#inl3 or olel3 to P. falciparum.o8ever3 # 8e $#ll */rt$er e,lore3 t$e $,ot$ei i eA/ #ll v#li" *or P. vivax#n" ,er$#, *or ot$er ,ecie o* $/+#n +#l#ri# ,#r#ite # 8ell. %$#t P. vivax+#l#ri# +# re,reent # *orce *or t$e election o* 6P "e*icienc i conitent 8it$ t$e ,reence o* elev#te" *reA/encie o* 6P "e*icienc in # ,o,/l#tion in nort$ern oll#n" ( 2>)3 8$ere P. vivax+#l#ri#3 b/t #l+ot cert#inl not P. falciparum+#l#ri#3 8# ,rev#lent *or #t le#t 500 e#r. e /et t$#t eit$er or bot$ o* P. falciparum#n" P. vivaxco/l" $#ve /,,lie" t$e *orce t$#t *irt electe" *or 6P "e*icienc in !*ric#n ,o,/l#tion.

Go to4 SI'K#E 'E## TRAIT

'eit$er t$e t$#l#e+i# nor 6P "e*icienc i $i$l ,rotective ##int "e#t$ *ro+ P.

falciparum+#l#ri#3 8it$ e#c$ #,,e#rin to re"/ce t$e rik b #bo/t 50F. %$ere #re3 $o8ever3 $/+#n +/t#tion 8$ic$ ive #t le#t 90F ,rotection ##int t$e +ort#lit o* +#l#ri#l

in*ection. %$ee incl/"e t$e ene *or ickle cell $e+olobin3 or $e+olobin . %$e ,oible ,rotective e**ect o* t$e ickle cell tr#it ##int P. falciparum+#l#ri# 8ere3 # +entione"

#bove3 *irt note" b eet in 1946 (11). %$e 8ere net etenivel e,lore" clinic#ll #n" e,i"e+ioloic#ll b !llion (4) #n" /beA/entl b +#n ot$er.

%$e ickle cell tr#it i "/e to # inle ,oint +/t#tion in t$e ene *or t$e bet# c$#in o*

$e+olobin in 8$ic$ t$e l/t#+#te #t ,oition 6 i re,l#ce" 8it$ # v#line ( 119). It re/lt in # $e+olobin +olec/le3 $e+olobin 3 8$ic$3 in t$e $o+o?ote3 ive rie to ickle cell #ne+i#. %o"# in t$e nite" t#te3 /c$ in"ivi"/#l co++onl re#c$ +i""le #"/lt$oo" (19<). In t$e ,re+o"ern 8orl"3 $o8ever3 t$oe #**ecte" 8it$ ickle cell "ie#e 8o/l"

,rob#bl r#rel $#ve /rvive" to ,/bert (4). In re,ro"/ctive ter+3 t$e cot to # $e+olobin  $o+o?ote 8o/l" $#ve been # lo o* *itne o* ne#rl 100F. /c$ # +/t#tion co/l" $#ve been /t#ine" onl i* t$e $etero?ote3 t$oe c#rrin one $e+olobin  ene #n" one

nor+#l3 $e+olobin !3 ene3 $#" #n #"v#nt#e re#t eno/$ to b#l#nce t$e cot o* t$e $o+o?ote to t$e ,o,/l#tion. It $# been */ll con*ir+e" t$#t t$i #"v#nt#e i ,rotection ##int t$e rik o* "e#t$ *ro+ in*ection 8it$ P. falciparum+#l#ri#. C$il"ren in et !*ric# 8$o #re $etero?o/ *or t$e ickle cell ene #re #t #,,roi+#tel 1N10 o* t$e rik o* "e#t$ *ro+ P. falciparum+#l#ri# # #re c$il"ren 8$o #re $o+o?o/ *or t$e nor+#l ene ( >6394).

(15)

e+olobin  cle#rl */l*il t$e con"ition o* t$e +#l#ri# $,ot$ei. In +#n ,#rt o*

!*ric#3 t$e *reA/enc o* t$e ickle ene ecee" =0F ( 432>31193120). %$e re,ro"/ctive loe 8$ic$ t$ee *reA/encie i+,oe t$ro/$ $o+o?oit *or t$i ene #**ect #t le#t 1 birt$ in 10. %$e re*lect t$e cot o* en"e+ic P. falciparum+#l#ri# to # $/+#n ,o,/l#tion.

Go to4 !EM$%#$BI '

%$e ene *or $e+olobin C i #llelic 8it$ t$#t *or ickle cell $e+olobin b/t co"e *or # line inte#" o* # l/t#+#te ($e+olobin !) or # v#line ($e+olobin  ) #t ,oition 6 in t$e bet# c$#in o* $e+olobin. In t$e $o+o?o/ c#rrier3 $e+olobin C con*er # lo o* *itne

8$ic$ i +/c$ le t$#n t$#t #oci#te" 8it$ t$e ickle cell tr#it ($o+o?o/ $ e+olobin )3 bein #,,#rentl co+,#r#ble to t$#t o* # +il" *or+ o* t$#l#e+i# (1193120).

e+olobin C i *o/n" onl 8it$in cert#in et !*ric#n ,o,/l#tion3 8$ere t$e *reA/enc o* t$e #llele re#c$e3 #n" o+eti+e even ecee"3 10 to 20F ( 1193120). %$ere i no8 little "o/bt t$#t t$i ,ol+or,$i+ $# been3 #n" in"ee" i ,rob#bl till bein3 electe" /n"er t$e e**ect o* P. falciparum+#l#ri# in et !*ric# (1==). o8ever3 t$e n#t/re o* t$e ,rotection b $e+olobin C i ver "i**erent *ro+ t$#t #oci#te" 8it$ $ e+olobin . In t$e c#e o*

$e+olobin 3 t$e $etero?o/ t#te con*er # $i$ level o* ,rotection ##int "e#t$ *ro+ P. falciparum+#l#ri#. In t$#t o* $e+olobin C3 i+il#r $i$ level o* ,rotection3 re#ter t$#n

90F ##int in*ection #n" t$ere*ore ##int t$e rik o* "e#t$ b P. falciparum+#l#ri#3 #re #c$ieve" onl in t$e $o+o?ote (1==). %$e ,rotective e**ect o* $e+olobin C in # $etero?o/ co+bin#tion #re3 #t #bo/t =0F3 rel#tivel 8e#k.

'o83 t$e r#te o* election o* #n #llele 8$oe #"v#nt#e i e,ree" +#inl in t$e

$o+oo/ t#te3 # i t$e c#e *or $e+olobin C3 i lo8 co+,#re" to t$#t o* #n #llele3 /c$ # t$#t *or $e+olobin 3 8$ic$ c#rrie # i+il#r #"v#nt#e b/t in # $etero?o/ co+bin#tion. %$i ,rinci,le i "ic/e" +ore */ll in rel#tion to election *or RC /** ne#tivit (ee belo8). n"er t$e in*l/ence o* t$e #+e elective *orce3 t$ere*ore3

$e+olobin  8o/l" be e,ecte" #t *irt to #c$ieve $i$er *reA/encie t$#n $e+olobin C. o8ever3 bec#/e t$e b#l#ncin cot o* $e+olobin C i lo8 #n" t$#t o* t$e #llelic

$e+olobin  i $i$3 $e+olobin C $o/l" event/#ll re,l#ce $e+olobin  in ,o,/l#tion e,oe" to election b P. falciparum.In et !*ric# t$i $# cle#rl not et $#,,ene"

(431193120)3 #n" it /et t$#t P. falciparum+#l#ri# +# $#ve #rrive" onl recentl 8it$in t$e et !*ric#n ,o,/l#tion.

$en3 t$ere*ore3 +i$t t$i recent #rriv#l o* P. falciparumin et !*ric# $#ve t#ken ,l#ce %$e rel#tive *itnee o* t$e "i**erent $#e+olobin #llele3 !3 3 #n" C3 in t$e et !*ric#n it/#tion c#n no8 be iven (>639431==)3 #n" t$e relev#nt c#lc/l#tion c#n be +#"e ( 119). e /,ect t$#t t$e 8o/l" $o8 t$#t t$e $e+olobin C #llele $o/l" #,,ro#c$ ,o,/l#tion

eA/ilibri/+ 8it$in ever#l t$o/#n" e#r3 #n" #l+ot cert#inl 8it$in le t$#n ten o* t$o/#n" o* e#r3 o* election /n"er P. falciparum+#l#ri#3 #3 in"ee"3 $# #lre#" been /ete" (1193120). %$ere*ore3 b t$i line o* #r/+ent3 bec#/e $e+olobin C $# not et re#c$e" it e,ecte" eA/ilibri/+ *reA/enc3 P. falciparum$# been # elective *orce in et !*ric# *or le t$#n t$i ti+e3 ie3 ,rob#bl *or le t$#n # *e8 ten o* t$o/#n" o* e#r.