title: Asymptomatic carriage of plasmodium in urban Dakar: the risk of malaria should not be underestimated.
abstract: BACKGROUND
  The objective of this study was to measure the rate of asymptomatic carriage of plasmodium in the Dakar region two years after the implementation of new strategies in clinical malaria management.
  
  
  METHODS
  Between October and December 2008, 2952 households selected in 50 sites of Dakar area, were visited for interviews and blood sampling. Giemsa-stained thick blood smears (TBS) were performed for microscopy in asymptomatic adult women and children aged 2 to 10 years. To ensure the quality of the microscopy, we performed a polymerase chain reaction (PCR) with real time qPCR in all positive TBS by microscopy and in a sample of negative TBS and filter paper blood spots.
  
  
  RESULTS
  The analysis has concerned 2427 women and 2231 children. The mean age of the women was 35.6 years. The mean age of the children was 5.4 years. The parasite prevalence was 2.01% (49/2427) in women and 2.15% (48/2231) in children. Parasite prevalence varied from one study site to another, ranging from 0 to 7.41%. In multivariate analysis, reporting a malaria episode in 2008 was associated with plasmodium carriage (OR = 2.57, P = 0.002) in women; in children, a malaria episode (OR = 6.19, P<0.001) and a travel out of Dakar during last 3 months (OR = 2.27, P = 0.023) were associated with plasmodium carriage. Among the positive TBS, 95.8% (93/97) were positive by plasmodium PCR. Among the negative TBS, 13.9% (41/293) were positive by PCR. In blood spots, 15.2% (76/500) were positive by PCR. We estimated at 16.5% the parasite prevalence if PCR were performed in 4658 TBS.
  
  
  CONCLUSIONS
  Parasite prevalence in Dakar area seemed to be higher than the rate found by microscopy. PCR may be the best tool for measuring plasmodium prevalence in the context of low transmission. Environmental conditions play a major role in the heterogeneity of parasite prevalence within sites.
authors.affiliation: UMR 216-Mère et Enfant Face aux Infections Tropicales, Institut de Recherche pour le Développement, Paris, France. diallaye@yahoo.fr
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Diallo
authors.forename: Nicaise Tuikue
authors.initials: NT
authors.lastname: Ndam
authors.forename: Azizath
authors.initials: A
authors.lastname: Moussiliou
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Dos Santos
authors.forename: Alphousseyni
authors.initials: A
authors.lastname: Ndonky
authors.forename: Marion
authors.initials: M
authors.lastname: Borderon
authors.forename: Sébastien
authors.initials: S
authors.lastname: Oliveau
authors.forename: Richard
authors.initials: R
authors.lastname: Lalou
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Le Hesran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000818:Animals; D002353:Carrier State / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016015:Logistic Models; D008288:Malaria / Q000453:epidemiology* / Q000469:parasitology*; D008297:Male; D008875:Middle Aged; D010271:Parasites / Q000166:cytology / Q000502:physiology; D010961:Plasmodium / Q000166:cytology / Q000235:genetics / Q000502:physiology*; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D012675:Senegal / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult