Cited by 532Malaria Research and ControlBird parasitology and diseasesHemoglobinopathies and Related Disorders

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Submicroscopic Infection in Plasmodium falciparum –Endemic Populations: A Systematic Review and Meta‐Analysis

Okell, Lucy C., Ghani, Azra C., Lyons, Emily, Drakeley, Chris J.·2009·The Journal of Infectious Diseases

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Abstract

INTRODUCTION: Light microscopy examination of blood slides is the main method of detecting malaria infection; however, it has limited sensitivity. Low-density infections are most likely to be missed, but they contribute to the infectious reservoir. Quantifying these submicroscopic infections is therefore key to understanding transmission dynamics and successfully reducing parasite transmission. METHODS: We conducted a systematic review of endemic population surveys in which P. falciparum prevalence had been measured by both microscopy and a more-sensitive polymerase chain reaction (PCR)-based technique. The combined microscopy:PCR prevalence ratio was estimated by random-effects meta-analysis, and the effect of covariates was determined by meta-regression. RESULTS: Seventy-two pairs of prevalence measurements were included in the study. The prevalence of infection measured by microscopy was, on average, 50.8% (95% confidence interval [CI], 45.2%-57.1%) of that measured by PCR. For gametocyte-specific detection, the microscopy prevalence was, on average, 8.7% (95% CI, 2.8%-26.6%) of the prevalence measured by PCR. A significantly higher percentage of total infections was detected by microscopy in areas of high, compared with low, transmission (74.5% when the prevalence determined by PCR was >75% versus 12.0% when the prevalence determined by PCR was <10%). DISCUSSION: Microscopy can miss a substantial proportion of P. falciparum infections in surveys of endemic populations, especially in areas with low transmission of infection. The extent of the submicroscopic reservoir needs to be taken into account for effective surveillance and control.

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Authors: Okell, L. C., Ghani, A. C., Lyons, E., & Drakeley, C. J.
Affiliations: London School of Hygiene & Tropical Medicine (GB)
Imperial College London (GB)
Corresponding author: Okell, Lucy C.
ORCID: Okell, Lucy C.
Ghani, Azra C.
Lyons, Emily
Drakeley, Chris J.
Venue: The Journal of Infectious Diseases
Publisher: Oxford University Press (OUP)
Published: 2009-11-15
Volume: 200
Issue: 10
Pages: 1509-1517
ISSN: 0022-1899 (ISSN-L)
1537-6613
DOI: 10.1086/644781
OpenAlex: W2125263196
Cited by: 532
References: 158
Citations by year: 2026: 13 · 2025: 26 · 2024: 21 · 2023: 24 · 2022: 30 · 2021: 38 · 2020: 39 · 2019: 36 · 2018: 34 · 2017: 39 · 2016: 43 · 2015: 46 · 2014: 34 · 2013: 40 · 2012: 30
FWCI: 3.03
Type: journal article
Language: en
Open access: closed
Locations: The Journal of Infectious Diseases (publishedVersion)
PubMed (publishedVersion)
Funders: Wellcome Trust
Medical Research Council
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
Life Sciences › Immunology and Microbiology › Parasitology › Bird parasitology and diseases
Health Sciences › Medicine › Genetics (clinical) › Hemoglobinopathies and Related Disorders
Keywords: Plasmodium falciparum, submicroscopic malaria infection, malaria prevalence, PCR detection, gametocytes, infectious reservoir, transmission intensity, malaria surveillance, endemic populations
MeSH terms: Disease Reservoirs, Humans, Prevalence, Polymerase Chain Reaction, Malaria, Falciparum, Endemic Diseases

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Submicroscopic Infection in Plasmodium falciparum –Endemic Populations: A Systematic Review and Meta‐Analysis

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