title: Asymptomatic and sub-microscopic malaria infection in Kayah State, eastern Myanmar.
abstract: Myanmar has the heaviest burden of malaria in the Greater Mekong Sub-region. Asymptomatic Plasmodium spp. infections are common in this region and may represent an important reservoir of transmission that must be targeted for malaria elimination.
  
  
  
  A mass blood survey was conducted among 485 individuals from six villages in Kayah State, an area of endemic but low transmission malaria in eastern Myanmar. Malaria infection was screened by rapid diagnostic test (RDT), light microscopy and real-time polymerase chain reaction (PCR), and its association with demographic factors was explored.
  
  
  
  The prevalence of asymptomatic Plasmodium spp. infection was 2.3% (11/485) by real-time PCR. Plasmodium vivax accounted for 72.7% (8/11) and Plasmodium falciparum for 27.3% (3/11) of infections. Men were at greater risk of infection by Plasmodium spp. than women. Individuals who worked as farmers or wood and bamboo cutters had an increased risk of infection.
  
  
  
  A combination of RDT, light microscopy and PCR diagnostics were used to identify asymptomatic malaria infection, providing additional information on asymptomatic cases in addition to the routine statistics on symptomatic cases, so as to determine the true burden of disease in the area. Such information and risk factors can improve malaria risk stratification and guide decision-makers towards better design and delivery of targeted interventions in small villages, representative of Kayah State.
authors.affiliation: Defence Services Medical Research Centre (DSMRC), Nay Pyi Taw, Myanmar.|Mahidol Vivax Research Unit (MVRU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Myo Thiha
authors.initials: MT
authors.lastname: Zaw
authors.affiliation: Defence Services Medical Research Centre (DSMRC), Nay Pyi Taw, Myanmar.
authors.forename: Myo
authors.initials: M
authors.lastname: Thant
authors.affiliation: Defence Services Medical Research Centre (DSMRC), Nay Pyi Taw, Myanmar.
authors.forename: Tin Maung
authors.initials: TM
authors.lastname: Hlaing
authors.affiliation: Defence Services Medical Research Centre (DSMRC), Nay Pyi Taw, Myanmar.|Loikaw Military Hospital, Loikaw, Kayah, Myanmar.
authors.forename: Naing Zin
authors.initials: NZ
authors.lastname: Aung
authors.affiliation: Loikaw Military Hospital, Loikaw, Kayah, Myanmar.
authors.forename: Min
authors.initials: M
authors.lastname: Thu
authors.affiliation: Mahidol Vivax Research Unit (MVRU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Kanit
authors.initials: K
authors.lastname: Phumchuea
authors.affiliation: Mahidol Vivax Research Unit (MVRU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Kanokwan
authors.initials: K
authors.lastname: Phusri
authors.affiliation: Mahidol Vivax Research Unit (MVRU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Teerawat
authors.initials: T
authors.lastname: Saeseu
authors.affiliation: Mahidol Vivax Research Unit (MVRU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.|Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Ritthideach
authors.initials: R
authors.lastname: Yorsaeng
authors.affiliation: Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Wang
authors.initials: W
authors.lastname: Nguitragool
authors.affiliation: Department of Medical Parasitology and Infection Biology, Swiss Tropical & Public Health Institute, Basel, Switzerland.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Felger
authors.affiliation: Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Jaranit
authors.initials: J
authors.lastname: Kaewkungwal
authors.affiliation: Department of Entomology, The Pennsylvania State University, 501 ASI Building, University Park, PA, 16801, USA. luc2@psu.edu.
authors.forename: Liwang
authors.initials: L
authors.lastname: Cui
authors.affiliation: Mahidol Vivax Research Unit (MVRU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. jetsumon.pra@mahidol.ac.th.
authors.forename: Jetsumon
authors.initials: J
authors.lastname: Sattabongkot
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003710:Demography; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D007223:Infant; D008288:Malaria / Q000175:diagnosis / Q000453:epidemiology* / Q000469:parasitology; D008297:Male; D008403:Mass Screening; D008853:Microscopy; D008875:Middle Aged; D002052:Myanmar / Q000453:epidemiology; D016273:Occupational Exposure; D018512:Parasitemia / Q000175:diagnosis / Q000453:epidemiology* / Q000469:parasitology; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D010966:Plasmodium vivax / Q000302:isolation & purification*; D015995:Prevalence; D060888:Real-Time Polymerase Chain Reaction; D012737:Sex Factors; D055815:Young Adult
keywords: Asymptomatic; Malaria; Myanmar; Sub-microscopic