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Non-adherence to medication, malaria relapse, and asymptomatic reservoirs in malaria transmission: A narrative review Sahiddin, Muhamad; Ishak, Hasanuddin; Arsin, Andi Arsunan; Mallongi, Anwar; Arsyad, Muhammad; Hamid, Firdaus
Public Health of Indonesia Vol. 11 No. 4 (2025): October - December
Publisher : YCAB Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36685/phi.v11i4.1032

Abstract

Background: Malaria elimination remains a pressing global health priority, yet progress is hindered by interconnected human-driven factors that sustain residual transmission. Objectives: This review aims to integrate and analyze key factors driving residual malaria transmission, particularly non-adherence to anti-malarial medication, relapse of Plasmodium vivax and P. falciparum infections, and the persistence of asymptomatic parasite reservoirs. Methods: A narrative review was conducted by synthesizing findings from peer-reviewed studies, including observational studies, clinical trials, and program evaluations. Relevant articles were identified through PubMed, Scopus, Google Scholar, and Web of Science databases. Results: Demographic, behavioral, and health system factors were consistently associated with incomplete treatment, which in turn doubled relapse risk and extended the duration of gametocyte carriage. Biological factors, such as dormant hypnozoites and CYP2D6 polymorphisms that reduce primaquine metabolism, increased the likelihood of recurrent infections. Additionally, asymptomatic carriers disproportionately younger and mobile populations sustained transmission beyond the reach of routine surveillance. Unlike previous reviews that examined these factors separately, this review integrates them into a unified framework, emphasizing their synergistic effects on residual transmission and identifying leverage points for targeted interventions. Conclusion: Addressing residual malaria transmission requires coordinated strategies, including community-supervised or directly observed radical cure regimens, genotype-informed dosing strategies, molecular surveillance for asymptomatic infections, and culturally tailored adherence support. These interventions are essential to strengthen malaria elimination programs and advance progress toward national and global goals by 2030. Keywords: adherence medication; relapse; transmission; endemic; malaria
Larvicidal Activity of Young and Old Leaves of Ricinus communis linn (Castor) with Ethanol, Aquades, Ethyl Acetate, and N-hexane solvents against Aedes sp. Dwicahya, Bambang; Arsin, A. Arsunan; Ishak, Hasanuddin; Hamid, Firdaus; Kanan, Maria; Mallongi, Anwar; Maria, Ida Leida; Birawida, Agus Bintara; Syahrir, Muhammad
Public Health of Indonesia Vol. 12 No. 1 (2026): January - March
Publisher : YCAB Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36685/phi.v12i1.1412

Abstract

Background: Dengue fever remains a major public health problem in tropical regions, including Indonesia, where vector control relies heavily on synthetic larvicides that pose environmental and health concerns. Plant-based larvicides have emerged as promising alternatives; however, comparative evidence regarding the influence of solvent polarity and leaf developmental stage on larvicidal efficacy remains limited. Objectives: This study evaluated the larvicidal activity of young and old castor bean leaf extracts obtained using different solvents against Aedes sp. larvae. Method: A laboratory-based experimental study was conducted following WHO guidelines for mosquito larvicide testing. Young and old leaves of castor were extracted separately using n-hexane, ethyl acetate, ethanol, and distilled water through multistage maceration. Third-instar Aedes sp. larvae were exposed to graded concentrations (75–200 ppm) of each extract, with 25 larvae per treatment and three replications. Larval mortality was recorded hourly for 24 hours. Probit analysis was used to determine LC₅₀ and LC₉₀ values with 95% confidence intervals, and differences among treatments were analyzed using one-way ANOVA (p < 0.05). Results: All extracts exhibited larvicidal activity against Aedes sp., with efficacy varying according to solvent type and leaf age. Ethanol extracts of old leaves produced the highest larval mortality, while ethyl acetate extracts of young leaves showed the lowest LC₅₀ values. Phytochemical screening confirmed the presence of alkaloids, flavonoids, saponins, tannins, and steroids in most extracts. LC₅₀ values ranged from 131.403 to 410.225 ppm, whereas LC₉₀ estimates were substantially higher and exceeded the tested concentration range, indicating extrapolation beyond observed data.  Conclusion: The larvicidal effectiveness of castor leaf extracts against Aedes sp. is influenced by both solvent polarity and leaf developmental stage. Old leaves extracted with ethanol and young leaves extracted with ethyl acetate demonstrated comparatively higher larvicidal potential. These findings support the potential of castor as a botanical larvicide, although further studies incorporating standard larvicide controls, quantitative phytochemical analysis, and field validation are required before operational application.   Keywords: Aedes sp; ricinus communis linn; castor