High levels of asymptomatic and subpatent Plasmodium falciparum parasite carriage at health facilities in an area of heterogeneous malaria Transmission intensity in the Kenyan highlands

Gillian H. Stresman, Jennifer C. Stevenson, Nnenna Ngwu, Elizabeth Marube, Chrispin Owaga, Chris Drakeley, Teun Bousema, Jonathan Cox

Research output: Contribution to journalArticlepeer-review

Abstract

In endemic settings, health facility surveys provide a convenient approach to estimating malaria transmission intensity. Typically, testing for malaria at facilities is performed on symptomatic attendees, but asymptomatic infections comprise a considerable proportion of the parasite reservoir. We sampled individuals attending five health facilities in the western Kenyan highlands. Malaria prevalence by rapid diagnostic test (RDT) was 8.6-32.9% in the health facilities. Of all polymerase chain reaction-positive participants, 46.4% (95% confidence interval [95% CI] = 42.6-50.2%) of participants had infections that were RDT-negative and asymptomatic, and 55.9% of those infections consisted of multiple parasite clones as assessed by merozoite surface protein-2 genotyping. Subpatent infections were more common in individuals reporting the use of non-artemisinin-based antimalarials in the 2 weeks preceding the survey (odds ratio = 2.49, 95% CI = 1.04-5.92) compared with individuals not reporting previous use of antimalarials. We observed a large and genetically complex pool of subpatent parasitemia in the Kenya highlands that must be considered in malaria interventions.

Original languageEnglish (US)
Pages (from-to)1101-1108
Number of pages8
JournalAmerican Journal of Tropical Medicine and Hygiene
Volume91
Issue number6
DOIs
StatePublished - Dec 1 2014

ASJC Scopus subject areas

  • Parasitology
  • Virology
  • Infectious Diseases

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