Abstract
BackgroundMalaria remains a major public health concern in the Democratic Republic of Congo (DRC), and school-age children are relatively neglected in malaria prevalence surveys and may constitute a significant reservoir of transmission. This study aimed to understand the burden of malaria infections in school-age children in Kinshasa/DRC.MethodsA total of 634 (427 asymptomatic and 207 symptomatic) blood samples collected from school-age children aged 6 to 14 years were analysed by microscopy, RDT and Nested-PCR.ResultsThe overall prevalence of Plasmodium spp. by microscopy, RDT and PCR was 33%, 42% and 62% among asymptomatic children and 59%, 64% and 95% in symptomatic children, respectively. The prevalence of Plasmodium falciparum, Plasmodium malariae and Plasmodium ovale spp. by PCR was 58%, 20% and 11% among asymptomatic and 93%, 13% and 16% in symptomatic children, respectively. Among P. ovale spp., P. ovale curtisi, P. ovale wallikeri and mixed P. ovale curtisi + P. ovale wallikeri accounted for 75%, 24% and 1% of infections, respectively. All Plasmodium species infections were significantly more prevalent in the rural area compared to the urban area in asymptomatic infections (p < 0.001). Living in a rural as opposed to an urban area was associated with a five-fold greater risk of asymptomatic malaria parasite carriage (p < 0.001). Amongst asymptomatic malaria parasite carriers, 43% and 16% of children harboured mixed Plasmodium with P. falciparum infections in the rural and the urban areas, respectively, whereas in symptomatic malaria infections, it was 22% and 26%, respectively. Few children carried single infections of P. malariae (2.2%) and P. ovale spp. (1.9%).ConclusionSchool-age children are at significant risk from both asymptomatic and symptomatic malaria infections. Continuous systematic screening and treatment of school-age children in high-transmission settings is needed.
Highlights
Malaria remains a major public health concern in the Democratic Republic of Congo (DRC), and school-age children are relatively neglected in malaria prevalence surveys and may constitute a significant reservoir of transmission
In sub-Saharan Africa, the vast majority of malaria cases are caused by Plasmodium falciparum, with this parasite responsible for 99.7% of all cases recorded in the region in 2018 [1]
Information relating to sociodemographic characteristics of asymptomatic school‐age children and malaria preventive measures Among 227 (131 in the rural area and 96 in the urban area) asymptomatic school-age children who were interviewed, most of children (≥ 80%) lived together with their parents in both rural and urban areas, 60% had at least one mosquito bed net and 31% slept under a mosquito net the night before the interview in the rural area whereas 28% had at least one mosquito bed net and 25% slept under a mosquito net the night before in the urban area (Additional file 1: Table S3)
Summary
Malaria remains a major public health concern in the Democratic Republic of Congo (DRC), and school-age children are relatively neglected in malaria prevalence surveys and may constitute a significant reservoir of transmission. In sub-Saharan Africa, the vast majority of malaria cases are caused by Plasmodium falciparum, with this parasite responsible for 99.7% of all cases recorded in the region in 2018 [1]. Plasmodium malariae and Plasmodium ovale spp. frequently occur as mixed infections with other parasites, which can lead to underestimation of their true prevalence [2, 8,9,10,11,12]. Plasmodium malariae infection frequently results in low parasitaemia and commonly occurs in mixed infections with the more common P. falciparum or Plasmodium vivax [3, 13]. Infections with P. malariae may remain asymptomatic for long periods, but it can cause chronic nephrotic syndrome leading to mortality [14,15,16,17,18,19]
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