Asymptomatic malaria infection, associated factors and accuracy of diagnostic tests in a historically high transmission setting in Northern Uganda
Abstract Background Asymptomatic malaria infections are important parasite reservoirs and could sustain transmission in the population, but they are often unreported. A community-based survey was conducted to investigate the prevalence and factors associated with asymptomatic malaria infections in a...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-12-01
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| Series: | Malaria Journal |
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| Online Access: | https://doi.org/10.1186/s12936-022-04421-1 |
| _version_ | 1797977593175080960 |
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| author | Bosco B. Agaba Simon P. Rugera Ruth Mpirirwe Martha Atekat Samuel Okubal Khalid Masereka Miseal Erionu Bosco Adranya Gertrude Nabirwa Patrick B. Odong Yasin Mukiibi Isaac Ssewanyana Susan Nabadda Enoch Muwanguzi |
| author_facet | Bosco B. Agaba Simon P. Rugera Ruth Mpirirwe Martha Atekat Samuel Okubal Khalid Masereka Miseal Erionu Bosco Adranya Gertrude Nabirwa Patrick B. Odong Yasin Mukiibi Isaac Ssewanyana Susan Nabadda Enoch Muwanguzi |
| author_sort | Bosco B. Agaba |
| collection | DOAJ |
| description | Abstract Background Asymptomatic malaria infections are important parasite reservoirs and could sustain transmission in the population, but they are often unreported. A community-based survey was conducted to investigate the prevalence and factors associated with asymptomatic malaria infections in a historically high transmission setting in northern Uganda. Methods Using a cross-sectional design, 288 children aged 2–15 years were enrolled and tested for the presence of malaria parasites using rapid diagnostic tests (RDTs) and blood smear microscopy between January to May 2022. Statistical analysis was performed using the exact binomial and Fisher’s exact test with p ≤ 0.05 indicating significance. The logistic regression was used to explore factors associated with asymptomatic malaria infections. Results Overall, the prevalence of asymptomatic infection was 34.7% (95% CI 29.2–40.5) with the highest observed in children 5–10 years 45.9% (95% CI 35.0–57.0). Gweri village accounted for 39.1% (95% CI 27.6—51.6) of malaria infections. Median parasite density was 1500 parasites/µl of blood. Plasmodium falciparum was the dominant species (86%) followed by Plasmodium malariae (5%). Factors associated with asymptomatic malaria infection were sleeping under mosquito net (Adjusted Odds Ratio (aOR) 0.27; 95% CI 0.13–0.56), p = 0.001 and presence of village health teams (VHTs) (aOR 0.02; 95% CI 0.01–0.45), p = 0.001. Sensitivity and specificity were higher for the P. falciparum/pLDH RDTs compared to HRP2-only RDTs, 90% (95% CI 86.5–93.5) and 95.2% (95% CI 92.8–97.7), p = 0.001, respectively. Conclusion Asymptomatic malaria infections were present in the study population and this varied with place and person in the different age groups. Plasmodium falciparum was the dominant parasite species however the presence of P. malariae and Plasmodium ovale was observed, which may have implication for the choice and deployment of diagnostic tools. Individuals who slept under mosquito net or had presence of functional VHTs were less likely to have asymptomatic malaria infection. P.f/pLDH RDTs performed better than the routinely used HRP2 RDTs. In view of these findings, investigation and reporting of asymptomatic malaria reservoirs through community surveys is recommended for accurate disease burden estimate and better targeting of control. |
| first_indexed | 2024-04-11T05:09:34Z |
| format | Article |
| id | doaj.art-51661ad12aea4ce9b3ce245de2d36abd |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-04-11T05:09:34Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
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| series | Malaria Journal |
| spelling | doaj.art-51661ad12aea4ce9b3ce245de2d36abd2022-12-25T12:05:59ZengBMCMalaria Journal1475-28752022-12-0121111210.1186/s12936-022-04421-1Asymptomatic malaria infection, associated factors and accuracy of diagnostic tests in a historically high transmission setting in Northern UgandaBosco B. Agaba0Simon P. Rugera1Ruth Mpirirwe2Martha Atekat3Samuel Okubal4Khalid Masereka5Miseal Erionu6Bosco Adranya7Gertrude Nabirwa8Patrick B. Odong9Yasin Mukiibi10Isaac Ssewanyana11Susan Nabadda12Enoch Muwanguzi13Department of Medical Laboratory Science, Mbarara University of Science and TechnologyDepartment of Medical Laboratory Science, Mbarara University of Science and TechnologyDepartment of Statistics, Makerere UniversityDepartment of Medical Laboratory Science, Mbarara University of Science and TechnologyDepartment of Medical Laboratory Science, Mbarara University of Science and TechnologyDepartment of Medical Laboratory Science, Mbarara University of Science and TechnologyDepartment of Medical Laboratory Science, Mbarara University of Science and TechnologyDepartment of Medical Laboratory Science, Mbarara University of Science and TechnologyDepartment of Medical Laboratory Science, Mbarara University of Science and TechnologyDepartment of Medical Laboratory Science, Mbarara University of Science and TechnologyUganda Institute of Allied and Management SciencesNational Malaria Reference Laboratory, Central Public Health Laboratory ServicesNational Malaria Reference Laboratory, Central Public Health Laboratory ServicesDepartment of Medical Laboratory Science, Mbarara University of Science and TechnologyAbstract Background Asymptomatic malaria infections are important parasite reservoirs and could sustain transmission in the population, but they are often unreported. A community-based survey was conducted to investigate the prevalence and factors associated with asymptomatic malaria infections in a historically high transmission setting in northern Uganda. Methods Using a cross-sectional design, 288 children aged 2–15 years were enrolled and tested for the presence of malaria parasites using rapid diagnostic tests (RDTs) and blood smear microscopy between January to May 2022. Statistical analysis was performed using the exact binomial and Fisher’s exact test with p ≤ 0.05 indicating significance. The logistic regression was used to explore factors associated with asymptomatic malaria infections. Results Overall, the prevalence of asymptomatic infection was 34.7% (95% CI 29.2–40.5) with the highest observed in children 5–10 years 45.9% (95% CI 35.0–57.0). Gweri village accounted for 39.1% (95% CI 27.6—51.6) of malaria infections. Median parasite density was 1500 parasites/µl of blood. Plasmodium falciparum was the dominant species (86%) followed by Plasmodium malariae (5%). Factors associated with asymptomatic malaria infection were sleeping under mosquito net (Adjusted Odds Ratio (aOR) 0.27; 95% CI 0.13–0.56), p = 0.001 and presence of village health teams (VHTs) (aOR 0.02; 95% CI 0.01–0.45), p = 0.001. Sensitivity and specificity were higher for the P. falciparum/pLDH RDTs compared to HRP2-only RDTs, 90% (95% CI 86.5–93.5) and 95.2% (95% CI 92.8–97.7), p = 0.001, respectively. Conclusion Asymptomatic malaria infections were present in the study population and this varied with place and person in the different age groups. Plasmodium falciparum was the dominant parasite species however the presence of P. malariae and Plasmodium ovale was observed, which may have implication for the choice and deployment of diagnostic tools. Individuals who slept under mosquito net or had presence of functional VHTs were less likely to have asymptomatic malaria infection. P.f/pLDH RDTs performed better than the routinely used HRP2 RDTs. In view of these findings, investigation and reporting of asymptomatic malaria reservoirs through community surveys is recommended for accurate disease burden estimate and better targeting of control.https://doi.org/10.1186/s12936-022-04421-1Asymptomatic malaria infectionsRapid diagnosticBlood smear microscopy |
| spellingShingle | Bosco B. Agaba Simon P. Rugera Ruth Mpirirwe Martha Atekat Samuel Okubal Khalid Masereka Miseal Erionu Bosco Adranya Gertrude Nabirwa Patrick B. Odong Yasin Mukiibi Isaac Ssewanyana Susan Nabadda Enoch Muwanguzi Asymptomatic malaria infection, associated factors and accuracy of diagnostic tests in a historically high transmission setting in Northern Uganda Malaria Journal Asymptomatic malaria infections Rapid diagnostic Blood smear microscopy |
| title | Asymptomatic malaria infection, associated factors and accuracy of diagnostic tests in a historically high transmission setting in Northern Uganda |
| title_full | Asymptomatic malaria infection, associated factors and accuracy of diagnostic tests in a historically high transmission setting in Northern Uganda |
| title_fullStr | Asymptomatic malaria infection, associated factors and accuracy of diagnostic tests in a historically high transmission setting in Northern Uganda |
| title_full_unstemmed | Asymptomatic malaria infection, associated factors and accuracy of diagnostic tests in a historically high transmission setting in Northern Uganda |
| title_short | Asymptomatic malaria infection, associated factors and accuracy of diagnostic tests in a historically high transmission setting in Northern Uganda |
| title_sort | asymptomatic malaria infection associated factors and accuracy of diagnostic tests in a historically high transmission setting in northern uganda |
| topic | Asymptomatic malaria infections Rapid diagnostic Blood smear microscopy |
| url | https://doi.org/10.1186/s12936-022-04421-1 |
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