G6PD deficiency in Indonesia: a systematic review and update of prevalence and variant maps in the context of malaria elimination.

Background: Low-daily-dose primaquine (PQ) (0·25 mg/kg/day over 14 days) remains the first-line treatment for Methods: 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prevalence and genetic variants in Indonesia were identified in a systematic search and complemented with previously unpublished studies meeting the same criteria.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. Findings: 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 Interpretation: 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 Funding: This work was supported, in whole or in part, by the Bill & Melinda Gates Foundation (INV-024389).