title: Submicroscopic and Asymptomatic Plasmodium Parasitaemia Associated with Significant Risk of Anaemia in Papua, Indonesia.
abstract: Submicroscopic Plasmodium infections are an important parasite reservoir, but their clinical relevance is poorly defined. A cross-sectional household survey was conducted in southern Papua, Indonesia, using cluster random sampling. Data were recorded using a standardized questionnaire. Blood samples were collected for haemoglobin measurement. Plasmodium parasitaemia was determined by blood film microscopy and PCR. Between April and July 2013, 800 households and 2,830 individuals were surveyed. Peripheral parasitaemia was detected in 37.7% (968/2,567) of individuals, 36.8% (357) of whom were identified by blood film examination. Overall the prevalence of P. falciparum parasitaemia was 15.4% (396/2567) and that of P. vivax 18.3% (471/2567). In parasitaemic individuals, submicroscopic infection was significantly more likely in adults (adjusted odds ratio (AOR): 3.82 [95%CI: 2.49-5.86], p<0.001) compared to children, females (AOR = 1.41 [1.07-1.86], p = 0.013), individuals not sleeping under a bednet (AOR = 1.4 [1.0-1.8], p = 0.035), and being afebrile (AOR = 3.2 [1.49-6.93], p = 0.003). The risk of anaemia (according to WHO guidelines) was 32.8% and significantly increased in those with asymptomatic parasitaemia (AOR 2.9 [95% 2.1-4.0], p = 0.007), and submicroscopic P. falciparum infections (AOR 2.5 [95% 1.7-3.6], p = 0.002). Asymptomatic and submicroscopic infections in this area co-endemic for P. falciparum and P. vivax constitute two thirds of detectable parasitaemia and are associated with a high risk of anaemia. Novel public health strategies are needed to detect and eliminate these parasite reservoirs, for the benefit both of the patient and the community.
authors: Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
authors: Zuleima
authors: Z
authors: Pava
authors: Mimika District Health Authority, Timika, Papua, Indonesia.|Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia.|Maternal and Child Health and Reproductive Health, Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.
authors: Faustina H
authors: FH
authors: Burdam
authors: Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
authors: Irene
authors: I
authors: Handayuni
authors: Eijkman Institute for Molecular Biology, Jakarta, Indonesia.
authors: Leily
authors: L
authors: Trianty
authors: Eijkman Institute for Molecular Biology, Jakarta, Indonesia.
authors: Retno A S
authors: RA
authors: Utami
authors: Eijkman Institute for Molecular Biology, Jakarta, Indonesia.
authors: Yusrifar Kharisma
authors: YK
authors: Tirta
authors: Mimika District Health Authority, Timika, Papua, Indonesia.|Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia.
authors: Enny
authors: E
authors: Kenangalem
authors: Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia.
authors: Daniel
authors: D
authors: Lampah
authors: Eijkman Institute for Molecular Biology, Jakarta, Indonesia.
authors: Andreas
authors: A
authors: Kusuma
authors: Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
authors: Grennady
authors: G
authors: Wirjanata
authors: Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
authors: Steven
authors: S
authors: Kho
authors: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
authors: Julie A
authors: JA
authors: Simpson
authors: Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
authors: Sarah
authors: S
authors: Auburn
authors: Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.|Division of Medicine, Christchurch Hospital, Christchurch, New Zealand.
authors: Nicholas M
authors: NM
authors: Douglas
authors: Eijkman Institute for Molecular Biology, Jakarta, Indonesia.
authors: Rintis
authors: R
authors: Noviyanti
authors: Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
authors: Nicholas M
authors: NM
authors: Anstey
authors: Mimika District Health Authority, Timika, Papua, Indonesia.|Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia.|Maternal and Child Health and Reproductive Health, Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.
authors: Jeanne R
authors: JR
authors: Poespoprodjo
authors: Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
authors: Jutta
authors: J
authors: Marfurt
authors: Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.|Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.
authors: Ric N
authors: http://orcid.org/0000-0003-2000-2874
authors: RN
authors: Price
mesh_terms: D000328:Adult; D000740:Anemia / Q000150:complications*; D058070:Asymptomatic Diseases; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D018512:Parasitemia / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology; D010963:Plasmodium falciparum / Q000502:physiology; D010966:Plasmodium vivax / Q000502:physiology; D012306:Risk