Abstract
BackgroundParasite prevalence is a key metric used to quantify the burden of malaria and assess the impact of control strategies. Most published estimates of parasite prevalence are based on microscopy and likely underestimate true prevalence.MethodsThick smear microscopy was performed in cohorts of children (aged 6 month to 10 years) and adults every 90 days over 2 years, at three sites of varying transmission intensity in Uganda. Microscopy-negative samples were tested for sub-microscopic parasitaemia using loop-mediated isothermal amplification (LAMP). Generalized estimating equation models were used to evaluate associations between age and parasitaemia, factors associated with sub-microscopic infection and associations between parasitaemia and haemoglobin.ResultsA total of 9260 samples were collected from 1245 participants. Parasite prevalence among children across the three sites was 7.4, 9.4 and 28.8 % by microscopy and 21.3, 31.8 and 69.0 % by microscopy plus LAMP. Parasite prevalence among adults across the three sites was 3.1, 3.0 and 5.2 % by microscopy and 18.8, 24.2 and 53.5 % by microscopy plus LAMP. Among those with parasitaemia, adults and persons recently treated with anti-malarial therapy had the highest prevalence of sub-microscopic infection. Children with sub-microscopic or microscopic parasitaemia had lower mean haemoglobin levels compared to children with no detectable parasites.ConclusionsAcross a range of transmission intensities in Uganda, microscopy vastly underestimated parasite prevalence, especially among adults.
Highlights
Parasite prevalence is a key metric used to quantify the burden of malaria and assess the impact of control strategies
In order to estimate the prevalence of microscopic and sub-microscopic parasitaemia across different transmission intensities in Uganda, repeated sampling of a cohort of children and adults was performed with microscopy and loop-mediated isothermal amplification (LAMP) in three different epidemiologic settings over 2 years
Relationships between age and prevalence of parasitaemia, as well as between parasitaemia and mean haemoglobin, were evaluated, with the hypothesis that microscopy would underestimate parasite prevalence compared to LAMP, in all age groups and epidemiologic settings and that participants with microscopic and submicroscopic parasitaemia would have lower mean haemoglobin than those with no infection
Summary
Parasite prevalence is a key metric used to quantify the burden of malaria and assess the impact of control strategies. Rek et al Malar J (2016) 15:470 tests (RDTs), which have limited ability to detect parasitaemia
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