G6PD deficiency in Indonesia: a systematic review and update of prevalence and variant maps in the context of malaria elimination.
systematic_review · Level I
Where this comes from
- Record sourced from PubMed, PMID 41953713.
- Also identified by DOI 10.1016/j.lanwpc.2026.101840 and PMC identifier 13053798.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
Low-daily-dose primaquine (PQ) (0·25 mg/kg/day over 14 days) remains the first-line treatment for <i>P. vivax</i> hypnozoites in Indonesia but can trigger haemolysis in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals. Indonesia's malaria treatment guidelines do not require G6PD deficiency (G6PDd) screening prior to administering low-daily-dose PQ regimen, but future implementation of high-daily-dose PQ regimen (1 mg/kg/day over 7 days) will require G6PD screening. To date, no exhaustive assessment of G6PDd prevalence has been done in Indonesia. A systematic search of the literature was conducted (PROSPERO 2022 CRD42022368319). Studies meeting predefined criteria reporting G6PDd prevalence and genetic variants in Indonesia were identified in a systematic search and complemented with previously unpublished studies meeting the same criteria. The collected data are presented descriptively and geospatially mapped. A total of 45 studies published between 1964 and 2024 were included. The prevalences of G6PDd (<30% activity) were 0·0-19·9% across 87 sites (n = 23,166), and the prevalences of females with deficient and intermediate (30-70% activity) activities were 0·8-44·6% across 35 sites (n = 6729). G6PDd allele frequencies (males with <30% activity) were 0·0-25·9% across 82 sites (n = 10,680). Fifteen class B G6PD variants were reported, presenting oxidant-induced acute haemolytic anaemia. No relevant data were available for many areas of the country, including those with high <i>P. vivax</i> malaria incidences. Our findings support the introduction of routine G6PDd screening to guide high-daily-dose PQ treatment. However, G6PDd prevalence is heterogeneous across Indonesia, and available information is not comprehensive. This is of concern in areas with high endemicity of <i>P. vivax</i> malaria, where treatment with PQ is required. This lack of data needs to be addressed to inform and guide appropriate routine G6PDd screening to support <i>P. vivax</i> malaria elimination targets. This work was supported, in whole or in part, by the Bill & Melinda Gates Foundation (INV-024389).