The study was carried out at Rumah Sakit Mitra Masyarakat (RSMM) hospital, Timika, in the southern lowlands of Papua, Indonesia. The hospital has 110 beds with a high-dependency unit and an emergency department open 24 h a day. The outpatient department reviews approximately 300 patients per day, 6 d per week. RSMM is the only hospital in the district, servicing a population of approximately 150,000 people spread over an area of 21,522 km2. The area is largely forested with both coastal and mountainous areas. Malaria transmission is restricted to the lowland area where it is associated with three mosquito vectors: Anopheles koliensis, An. Farauti, and An. punctulatus [11 (link),12 (link)]. The annual incidence of malaria in the region is 885 per 1,000 person years, divided 62:38 between P. falciparum and P. vivax infections (unpublished data). In 2005 a household survey rate found 7.4% of respondents to be positive for P. falciparum, 6.4% for P. vivax, and 1.9% mixed infection with both species (unpublished data). Due to economic migration the ethnic origin of the local population is diverse, with highland Papuans, lowland Papuans, and non-Papuan migrants all resident in the region. Hospital policy dictates that all patients presenting with history of fever and all pregnant women irrespective of symptoms should have a blood film examination for malaria.