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Carriage of sub-microscopic sexual and asexual Plasmodium falciparum stages in the dry season at Navrongo, Ghana

Geoffrey R. Atelu
Nancy Duah
Michael D Wilson


Background: We investigated the prevalence of sub-microscopic Plasmodium falciparum infections and gametocyte carriage in asymptomatic individuals in Navrongo in northern Ghana, an area of seasonal malaria transmission.

Design: A cross sectional study of 209 randomly selected participants of all age-groups was conducted in February and March, 2015.

Methods: Capillary blood samples collected from these individuals were used for the detection of both asexual and gametocyte stage parasites by microscopy, reverse transcriptase polymerase chain reaction (RT-PCR) and conventional nested PCR methods. The prevalence data as determined by microscopy and molecular methods were compared
using chi-square tests.

Results: Parasitaemia from these asymptomatic infections ranged from 40 to 3,520 parasites/?l of blood (geometric mean parasitaemia = 732 parasites/?l). The prevalence of asymptomatic P. falciparum carriage was 4.8% (10/209) and 13.9% (29/209) using microscopy and RT-PCR respectively. The overall prevalence of sub-microscopic infections
in the total number of samples analysed was 9.1% (19/209) and 66% (19/29) of the asymptomatic infections. P. falciparum gametocytemia detected by microscopy was 1% (2/209) and 3.8% (8/209) by PCR.

Conclusion: This is the first report of sub-microscopic asexual and gametocytes infections in the dry season in a seasonal malaria transmission area in Ghana. It has established that persistent latent malaria infections occur and that these could supply the source of parasites for the next transmission season. The findings highlight the presence of sub-microscopic infections and therefore the need for active case detection surveillance to eliminate "asymptomatic reservoir" parasites and consequently break the transmission of the disease in Ghana.

Funding: Bill and Melinda Gates Foundation grant awarded to Noguchi Memorial Institute for Medical Research Postdoctoral and Postgraduate Training in Infectious Diseases Research (Global Health Grant # OPP52155); National Institutes of Health grant (NIH-NIAID RO1 # 1RO1AI099623) to MDW; European Developing Countries Clinical Trials Partnership (EDCTP)-West African Network of Excellence for Clinical Trials in TB, AIDS and Malaria (WANETAM) (Project code CB.07.41700.007).

Keywords: Plasmodium falciparum, asymptomatic infections, sub-microscopic infections, microscopy, reverse transcriptase PCR, Navrongo