{
  "abstract": "Zoonotic malaria caused by infection with the monkey parasite Plasmodium knowlesi has emerged across Southeast Asia, particularly in areas previously close to elimination of non-zoonotic malaria. In Indonesia, some rural and remote areas must now consider strategies which target various Plasmodium species in hard-to-reach populations. Indonesia has mostly subsidised care at local health clinics for patients with malaria and other febrile illnesses; however, patients still face out-of-pocket costs. This study estimated household cost of illness due to malaria and non-malarial febrile illness in North Kalimantan and North Sumatra, Indonesia.Household costs were estimated from individual patients as part of health facility-based cross-sectional surveys in eight health clinics across North Sumatra and North Kalimantan between January 2022 and October 2023. Direct costs due to medical and travel expenses, and indirect costs resulting from productivity losses were included. Overall, 2244 patients were recruited, including 153 (6.8%) malaria-confirmed cases. Five Plasmodium species were identified using validated PCR conducted on all participants: P. vivax (n=97), P. knowlesi (n=35), P. malariae (n=12), P. falciparum (n=3) and P. ovale (n=1), in addition to five mixed infections. Costs were inflated to 2023 Indonesian Rupiah and reported in US dollars (US$). A mean total cost of US$33 (SD=57) was reported for malaria episodes and US$17 for non-malarial fever episodes (SD=38), primarily composed of indirect productivity losses from time away from usual activities (70% and 61% of total cost for patients with malaria and other febrile illnesses, respectively). Overall, 16% of patients with malaria and 11% of patients with other febrile illnesses experienced catastrophic health expenditure from their illness episode.Despite a largely subsidised health system, patients and families face other medical, travel and indirect costs when seeking care for febrile illnesses. These costs need consideration when designing malaria control policies, particularly in near-elimination settings, with few malaria cases among broader febrile illness.",
  "authors": [
    {
      "affiliations": [
        "Centre for Health Policy, University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Patrick Abraham"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Faculty of Medicine Universitas Sumatera Utara, Medan, Indonesia",
        "Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia"
      ],
      "name": "Inke Nadia Diniyanti Lubis"
    },
    {
      "affiliations": [
        "Eijkman Research Center for Molecular Biology, Jakarta, Indonesia"
      ],
      "name": "Rintis Novivanti"
    },
    {
      "affiliations": [
        "Eijkman Research Center for Molecular Biology, Jakarta, Indonesia"
      ],
      "name": "Leily Trianty"
    },
    {
      "affiliations": [
        "Exeins Health Initiative, South Jakarta, Special Capital Region of Jakarta, Indonesia"
      ],
      "name": "Fahira Ainun Nisa"
    },
    {
      "affiliations": [
        "Exeins Health Initiative, South Jakarta, Special Capital Region of Jakarta, Indonesia"
      ],
      "name": "Pinkan Kariodimedjo"
    },
    {
      "affiliations": [
        "Exeins Health Initiative, South Jakarta, Special Capital Region of Jakarta, Indonesia"
      ],
      "name": "Ristya Amalia"
    },
    {
      "affiliations": [
        "Faculty of Medicine Universitas Sumatera Utara, Medan, Indonesia"
      ],
      "name": "Raden Andika Dwi Cahyadi"
    },
    {
      "affiliations": [
        "Faculty of Medicine Universitas Sumatera Utara, Medan, Indonesia"
      ],
      "name": "Tengku Mossadeq Al Qorny"
    },
    {
      "affiliations": [
        "Universitas Indonesia, Depok, Indonesia"
      ],
      "name": "Yudha Achmad Perlambang"
    },
    {
      "affiliations": [
        "Faculty of Medicine Universitas Sumatera Utara, Medan, Indonesia"
      ],
      "name": "Ranti Permatasari"
    },
    {
      "affiliations": [
        "Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia",
        "Infectious and Tropical Diseases Epidemiology, Public Health Program, Monash University Indonesia, Tangerang, Indonesia",
        "Oxford University Clinical Research Unit Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia"
      ],
      "name": "Henry Surendra"
    },
    {
      "affiliations": [
        "Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia"
      ],
      "name": "Nicholas M Anstey"
    },
    {
      "affiliations": [
        "Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia",
        "Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia"
      ],
      "name": "Matthew J Grigg"
    },
    {
      "affiliations": [
        "Centre for Health Policy, University of Melbourne, Melbourne, Victoria, Australia",
        "Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia"
      ],
      "name": "Angela Devine"
    }
  ],
  "title": "The household economic burden of human-only and zoonotic malaria, compared to other causes of acute febrile illness in Indonesia",
  "uid": "48e7dc03-9517-5158-86ea-b0171882868b"
}