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Title: Assessment of subpatent Plasmodium infection in northwestern Ethiopia
Authors: Ashenafi Assefa
Ahmed Ali Ahmed
Wakgari Deressa
G. Glenn Wilson
Amha Kebede
Hussein Mohammed
Maruon Sassine
Mebrahtom Haile
Dereje Dilu
Hiwot Teka
Matthew W. Murphy
Sheila Sergent
Eric Rogier
Zhou Zhiyong
Brian S. Wakeman
Chris Drakeley
Ya Ping Shi
Lorenz Von Seidlein
Jimee Hwang
Federal Ministry of Health - Ethiopia
Addis Ababa University
London School of Hygiene & Tropical Medicine
Centers for Disease Control and Prevention
Syddansk Universitet
Mahidol University
United States Agency for International Development
Ethiopian Public Health Institute
African Society for Laboratory Medicine
Keywords: Immunology and Microbiology;Medicine
Issue Date: 4-Mar-2020
Citation: Malaria Journal. Vol.19, No.1 (2020)
Abstract: © 2020 The Author(s). Background: Ethiopia has set a goal for malaria elimination by 2030. Low parasite density infections may go undetected by conventional diagnostic methods (microscopy and rapid diagnostic tests) and their contribution to malaria transmission varies by transmission settings. This study quantified the burden of subpatent infections from samples collected from three regions of northwest Ethiopia. Methods: Sub-samples of dried blood spots from the Ethiopian Malaria Indicator Survey 2015 (EMIS-2015) were tested and compared using microscopy, rapid diagnostic tests (RDTs), and nested polymerase chain reaction (nPCR) to determine the prevalence of subpatent infection. Paired seroprevalence results previously reported along with gender, age, and elevation of residence were explored as risk factors for Plasmodium infection. Results: Of the 2608 samples collected, the highest positive rate for Plasmodium infection was found with nPCR 3.3% (95% CI 2.7-4.1) compared with RDT 2.8% (95% CI 2.2-3.5) and microscopy 1.2% (95% CI 0.8-1.7). Of the nPCR positive cases, Plasmodium falciparum accounted for 3.1% (95% CI 2.5-3.8), Plasmodium vivax 0.4% (95% CI 0.2-0.7), mixed P. falciparum and P. vivax 0.1% (95% CI 0.0-0.4), and mixed P. falciparum and Plasmodium malariae 0.1% (95% CI 0.0-0.3). nPCR detected an additional 30 samples that had not been detected by conventional methods. The majority of the nPCR positive cases (61% (53/87)) were from the Benishangul-Gumuz Region. Malaria seropositivity had significant association with nPCR positivity [adjusted OR 10.0 (95% CI 3.2-29.4), P < 0.001]. Conclusion: Using nPCR the detection rate of malaria parasites increased by nearly threefold over rates based on microscopy in samples collected during a national cross-sectional survey in 2015 in Ethiopia. Such subpatent infections might contribute to malaria transmission. In addition to strengthening routine surveillance systems, malaria programmes may need to consider low-density, subpatent infections in order to accelerate malaria elimination efforts.
ISSN: 14752875
Appears in Collections:Scopus 2020

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