title: Low parasitemia in submicroscopic infections significantly impacts malaria diagnostic sensitivity in the highlands of Western Kenya.
abstract: Asymptomatic malaria infections represent a major challenge in malaria control and elimination in Africa. They are reservoirs of malaria parasite that can contribute to disease transmission. Therefore, identification and control of asymptomatic infections are important to make malaria elimination feasible. In this study, we investigated the extent and distribution of asymptomatic malaria in Western Kenya and examined how varying parasitemia affects performance of diagnostic methods including microscopy, conventional PCR, and quantitative PCR. In addition, we compared parasite prevalence rates and parasitemia levels with respect to topography and age in order to explore factors that influence malaria infection. Over 11,000 asymptomatic blood samples from children and adolescents up to 18 years old representing broad areas of Western Kenya were included. Quantitative PCR revealed the highest parasite positive rate among all methods and malaria prevalence in western Kenya varied widely from less than 1% to over 50%. A significantly lower parasitemia was detected in highland than in lowland samples and this contrast was also observed primarily among submicroscopic samples. Although we found no correlation between parasitemia level and age, individuals of younger age group (aged <14) showed significantly higher parasite prevalence. In the lowlands, individuals of aged 5-14 showed significantly higher prevalence than those under age 5. Our findings highlight the need for a more sensitive and time-efficient assay for asymptomatic malaria detection particularly in areas of low-transmission. Combining QPCR with microscopy can enhance the capacity of detecting submicroscopic asymptomatic malaria infections.
authors: Program in Public Health, College of Health Sciences, University of California at Irvine, Irvine, CA, 92697, United States of America.
authors: Eugenia
authors: E
authors: Lo
authors: Program in Public Health, College of Health Sciences, University of California at Irvine, Irvine, CA, 92697, United States of America.
authors: Guofa
authors: G
authors: Zhou
authors: Program in Public Health, College of Health Sciences, University of California at Irvine, Irvine, CA, 92697, United States of America.
authors: Winny
authors: W
authors: Oo
authors: Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, 40100, Kenya.
authors: Yaw
authors: Y
authors: Afrane
authors: Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, 40100, Kenya.
authors: Andrew
authors: A
authors: Githeko
authors: Program in Public Health, College of Health Sciences, University of California at Irvine, Irvine, CA, 92697, United States of America.
authors: Guiyun
authors: G
authors: Yan
mesh_terms: D000293:Adolescent; D058345:Asymptomatic Infections / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D016054:DNA, Protozoan / Q000032:analysis; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000453:epidemiology* / Q000469:parasitology; D018512:Parasitemia / Q000175:diagnosis* / Q000453:epidemiology; D010963:Plasmodium falciparum / Q000235:genetics*; D016133:Polymerase Chain Reaction / Q000379:methods*; D015995:Prevalence; D012680:Sensitivity and Specificity
chemical_list: D016054:DNA, Protozoan