Performance of Malaria Rapid Diagnostic Test in Asymptomatic Malaria Cases in Stable Transmission Area in Kisantu, Democratic Republic of Congo

Abstract Background. Malaria remains a major public health concern in Democratic Republic of Congo (DRC), and school-age children are relatively neglected in malaria prevalence surveys and may constitute a significant reservoir of transmission. This study aimed to understand the burden of malaria infections in school-age children in Kinshasa/DRC.Methods. 634 (427 asymptomatic and 207 symptomatic) blood samples were collected from a cross-sectional survey of school-age children aged 6 to 14 years both without and with malaria symptoms. Nested-PCR was performed for malaria parasite species typing. Results. The overall prevalence of Plasmodium spp., Plasmodium falciparum, Plasmodium malariae and Plasmodium ovale was 62.3, 58.1, 19.9 and 10.8% among asymptomatic whereas it was 94.4, 93.2, 12.6 and 15.9% in symptomatic children, respectively. All Plasmodium species infections were significantly more prevalent in the rural area compared to the urban area in asymptomatic infections (p<0.001). Living in a rural as opposed to an urban area was associated with a five-fold greater risk of asymptomatic malaria parasite carriage (p<0.001). Amongst asymptomatic malaria parasite carriers, 43% of children in the rural area were co-infected with two or more species with P. falciparum + P. malariae the most common (24%) whereas in the urban setting, fewer children carried co-infections (16%) with P. falciparum + P. malariae again the most common (9%). A fifth of rural-dwelling symptomatic children were co-infected with two or more species with P. falciparum + P. ovale the most common (14%), while a quarter of symptomatic children in the urban area carried multiple species, with co-infections of P. falciparum + P. malariae the most common (11%). Conclusion. School-age children are at significant risk from both asymptomatic and symptomatic malaria parasite infections. Continuous systematic screening and treatment of school-age children in high-transmission settings across the country may reinforce malaria intervention measures.

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Malaria parasite species composition of Plasmodium infections among asymptomatic and symptomatic school-age children in rural and urban areas of Kinshasa, Democratic Republic of Congo

Malaria Journal ◽

10.1186/s12936-021-03919-4 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Sabin S. Nundu ◽

Richard Culleton ◽

Shirley V. Simpson ◽

Hiroaki Arima ◽

Jean-Jacques Muyembe ◽

...

Keyword(s):

Urban Area ◽

Urban Areas ◽

Malaria Parasite ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

School Age Children ◽

Asymptomatic Malaria ◽

School Age ◽

Republic Of Congo ◽

Symptomatic Malaria

Abstract Background Malaria remains a major public health concern in the Democratic Republic of Congo (DRC), and school-age children are relatively neglected in malaria prevalence surveys and may constitute a significant reservoir of transmission. This study aimed to understand the burden of malaria infections in school-age children in Kinshasa/DRC. Methods A total of 634 (427 asymptomatic and 207 symptomatic) blood samples collected from school-age children aged 6 to 14 years were analysed by microscopy, RDT and Nested-PCR. Results The overall prevalence of Plasmodium spp. by microscopy, RDT and PCR was 33%, 42% and 62% among asymptomatic children and 59%, 64% and 95% in symptomatic children, respectively. The prevalence of Plasmodium falciparum, Plasmodium malariae and Plasmodium ovale spp. by PCR was 58%, 20% and 11% among asymptomatic and 93%, 13% and 16% in symptomatic children, respectively. Among P. ovale spp., P. ovale curtisi, P. ovale wallikeri and mixed P. ovale curtisi + P. ovale wallikeri accounted for 75%, 24% and 1% of infections, respectively. All Plasmodium species infections were significantly more prevalent in the rural area compared to the urban area in asymptomatic infections (p < 0.001). Living in a rural as opposed to an urban area was associated with a five-fold greater risk of asymptomatic malaria parasite carriage (p < 0.001). Amongst asymptomatic malaria parasite carriers, 43% and 16% of children harboured mixed Plasmodium with P. falciparum infections in the rural and the urban areas, respectively, whereas in symptomatic malaria infections, it was 22% and 26%, respectively. Few children carried single infections of P. malariae (2.2%) and P. ovale spp. (1.9%). Conclusion School-age children are at significant risk from both asymptomatic and symptomatic malaria infections. Continuous systematic screening and treatment of school-age children in high-transmission settings is needed.

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