title: Characteristics of asymptomatic Plasmodium spp. parasitaemia in Kwahu-Mpraeso, a malaria endemic mountainous district in Ghana, West Africa.
abstract: BACKGROUND
  Malaria control efforts in Ghana have reduced the countrywide average malaria prevalence from 71% in 2000 to about 51% in 2012; however, its main focus is on symptomatic malaria. If further progress is to be made, parasite reservoirs in asymptomatic carriers need to be moved into focus. This study profiles asymptomatic Plasmodium spp. parasitaemia amongst residents of mountainous Kwahu-Mpraeso in the Eastern region of Ghana.
  
  
  METHODS
  A cross-sectional study of 360 residents was carried out from October to December 2013. This included recording demographics, malaria testing of asymptomatic residents, and gathering of their malaria history. Assessment of malaria transmission was done with molecular identification of vectors, determination of sporozoite rate, insecticide resistance status and biting pattern. Univariate and multivariate analysis were used to establish risk determinants.
  
  
  RESULTS
  In Mpraeso, in the Kwahu highland of Eastern Region, children were at higher risk of asymptomatic parasitaemia, thereby contributing to the parasite reservoir and hence sustained malaria transmission. As well, findings suggested Hb AC genotype influenced susceptibility to asymptomatic malaria with 8.03-fold increase in odds (univariate) and 11.92-fold higher odds (multivariate) than the normal Hb AA. The mosquito vector predominant in the area was Anopheles gambiae sensu stricto of the homozygous pyrethroid resistant form (RR); with biting mainly occurring indoors.
  
  
  CONCLUSIONS
  For an effective malaria control in this area, interventions should be formulated and implemented to target asymptomatic parasite reservoirs; especially in children and people with Hb AC. The dominant vector species An. gambiae s.s. and its feeding patterns of biting indoors should also be considered.
authors.affiliation: Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Centre, Centre of Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands. edampaduowusu@ug.edu.gh.|Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana. edampaduowusu@ug.edu.gh.|Department of Parasitology, KIT Biomedical Research Institute, Amsterdam, The Netherlands. edampaduowusu@ug.edu.gh.
authors.forename: Ewurama D A
authors.initials: ED
authors.lastname: Owusu
authors.affiliation: Medical Laboratory Department, Atibie Government Hospital, Kwahu-Atibie, Ghana. buabeng2b@yahoo.com.
authors.forename: Vincent
authors.initials: V
authors.lastname: Buabeng
authors.affiliation: Medical Entomology Unit, Department of Parasitology, Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana. sdadzie@noguchi.ug.edu.gh.
authors.forename: Samuel
authors.initials: S
authors.lastname: Dadzie
authors.affiliation: Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana. cabrown@chs.edu.gh.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Brown
authors.affiliation: Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Centre, Centre of Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands. m.p.grobusch@amc.uva.nl.|Centre de Recherches Médicales de Lambaréné (CERMEL), Hôpital Albert Schweitzer, Lambaréné, Gabon. m.p.grobusch@amc.uva.nl.|Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany. m.p.grobusch@amc.uva.nl.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Grobusch
authors.affiliation: Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Centre, Centre of Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands. P.Mens@kit.nl.|Department of Parasitology, KIT Biomedical Research Institute, Amsterdam, The Netherlands. P.Mens@kit.nl.
authors.forename: Petra
authors.initials: P
authors.lastname: Mens
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000852:Anopheles / Q000469:parasitology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005869:Ghana; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000469:parasitology; D008297:Male; D018512:Parasitemia / Q000175:diagnosis* / Q000469:parasitology; D010961:Plasmodium / Q000472:pathogenicity*; D055815:Young Adult