Abstract
BackgroundGhana is among the high-burden countries for malaria infections and recently reported a notable increase in malaria cases. While asymptomatic parasitaemia is increasingly recognized as a hurdle for malaria elimination, studies on asymptomatic malaria are scarce, and usually focus on children and on non-falciparum species. The present study aims to assess the prevalence of asymptomatic Plasmodium falciparum and non-falciparum infections in Ghanaian adults in the Ashanti region during the high transmission season.MethodsAsymptomatic adult residents from five villages in the Ashanti Region, Ghana, were screened for Plasmodium species by rapid diagnostic test (RDT) and polymerase chain reaction (PCR) during the rainy season. Samples tested positive were subtyped using species-specific real-time PCR. For all Plasmodium ovale infections additional sub-species identification was performed.ResultsMolecular prevalence of asymptomatic Plasmodium infection was 284/391 (73%); only 126 (32%) infections were detected by RDT. While 266 (68%) participants were infected with Plasmodium falciparum, 33 (8%) were infected with Plasmodium malariae and 34 (9%) with P. ovale. The sub-species P. ovale curtisi and P. ovale wallikeri were identified to similar proportions. Non-falciparum infections usually presented as mixed infections with P. falciparum.ConclusionsMost adult residents in the Ghanaian forest zone are asymptomatic Plasmodium carriers. The high Plasmodium prevalence not detected by RDT in adults highlights that malaria eradication efforts must target all members of the population. Beneath Plasmodium falciparum, screening and treatment must also include infections with P. malariae, P. o. curtisi and P. o. wallikeri.
Highlights
Ghana is among the high-burden countries for malaria infections and recently reported a notable increase in malaria cases
Full list of author information is available at the end of the article
Four of the 16 samples tested positive for Plasmodium species, three were negative and nine remained malaria polymerase chain reaction (PCR) and internal control PCR (IC) negative and were excluded from the study
Summary
Ghana is among the high-burden countries for malaria infections and recently reported a notable increase in malaria cases. Ghana belongs to the eleven high-burden countries accounting for > 70% of the global malaria cases and deaths. Mass screening and treatment (MSAT) aims to detect and treat all infections, including asymptomatic Plasmodium carriers with low-density infection, to reduce the parasite reservoir [2, 3]. While RDTs are limited regarding sensitivity for Plasmodium falciparum infections with < 100 parasites/μl and non-falciparum infections [2], polymerase chain reaction (PCR) has a limit of detection as low as 0.02 parasites/μl and enables differentiation of nonfalciparum species [2, 4]. Since the proportion of submicroscopic malaria infections depends on the transmission intensity and ranges from 20 to 80%, molecular diagnostic methods are necessary to understand local malaria epidemiology [3]
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