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PLoS One. 2015 Jul 24;10(7):e0134061. doi: 10.1371/journal.pone.0134061. eCollection 2015.

School-Age Children Are a Reservoir of Malaria Infection in Malawi.

Author information

1
Center for Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America.
2
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America.
3
Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi.
4
Michigan State University, East Lansing, Michigan, United States of America.
5
National Malaria Control Program, Ministry of Health, Lilongwe, Malawi.
6
Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America.

Abstract

Malaria surveillance and interventions in endemic countries often target young children at highest risk of malaria morbidity and mortality. We aimed to determine whether school-age children and adults not captured in surveillance serve as a reservoir for malaria infection and may contribute to malaria transmission. Cross-sectional surveys were conducted in one rainy and one dry season in southern Malawi. Demographic and health information was collected for all household members. Blood samples were obtained for microscopic and PCR identification of Plasmodium falciparum. Among 5796 individuals aged greater than six months, PCR prevalence of malaria infection was 5%, 10%, and 20% in dry, and 9%, 15%, and 32% in rainy seasons in Blantyre, Thyolo, and Chikhwawa, respectively. Over 88% of those infected were asymptomatic. Participants aged 6-15 years were at higher risk of infection (OR=4.8; 95%CI, 4.0-5.8) and asymptomatic infection (OR=4.2; 95%CI, 2.7-6.6) than younger children in all settings. School-age children used bednets less frequently than other age groups. Compared to young children, school-age children were brought less often for treatment and more often to unreliable treatment sources.

CONCLUSION:

School-age children represent an underappreciated reservoir of malaria infection and have less exposure to antimalarial interventions. Malaria control and elimination strategies may need to expand to include this age group.

PMID:
26207758
PMCID:
PMC4514805
DOI:
10.1371/journal.pone.0134061
[Indexed for MEDLINE]
Free PMC Article

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