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Background  In endemic regions, the age distribution of malaria varies according to the infecting  Plasmodium  species. We aimed to delineate the pattern of malaria-related hospitalization from birth in Timika, Papua–an area co-endemic for  P .  falciparum  and  P .  vivaxMethods  Between April 2004 and December 2013, infants born at Mitra Masyarakat Hospital, or presenting within the first 7 days of life, were enrolled retrospectively into a cohort study and followed passively using routinely-collected hospital surveillance data. Outcomes were stratified by the presence or absence of  Plasmodium  parasitemia and included re-presentation to hospital, requirement for hospital admission and death.    Results  Overall, 11,408 infants were enrolled into the cohort. Median follow-up was 4.3 (maximum 9.7) years. In total, 7,847 (68.9%) infants made 90,766 re-presentations to hospital, 18,105 (19.9%) of which were associated with  Plasmodium  parasitemia. The incidence of re-presentations with malaria during the first year of life was 213 per 1,000 person-years (py) for  P .  vivax  and 79 per 1,000py for  P .  falciparum  (Incidence Rate Ratio (IRR) = 2.69, 95% Confidence Interval (95%CI): 2.48–2.92). After the age of 5 years, the incidence of  P .  vivax  had fallen to 77/1,000py and the incidence of  P .  falciparum  had risen to 95/1,000py (IRR = 0.80, 95%CI: 0.73–0.88). Overall, 79.7% (14,431/18,105) of malaria re-presentations were recurrences rather than initial infections. Malaria accounted for 31.7% (2,126/3,120) of all hospital admissions. The infant mortality rate in this study was 52 deaths per 1,000 live births. Beyond the early neonatal period, 13.4% of deaths were associated with  Plasmodium  parasitemia.    Conclusions  In Papua, Indonesia, malaria is a major cause of hospital presentation and admission in early life. The initial predominance of  P .  vivax  over  P .  falciparum  inverts after five years of age. Malaria is directly associated with nearly one in seven deaths after the early neonatal period.

Malaria-related hospitalization during childhood in Papua, Indonesia: A retrospective cohort study