2019
DOI: 10.1038/s41598-019-53386-w
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The burden of submicroscopic and asymptomatic malaria in India revealed from epidemiology studies at three varied transmission sites in India

Abstract: Malaria in India, while decreasing, remains a serious public health problem, and the contribution of submicroscopic and asymptomatic infections to its persistence is poorly understood. We conducted community surveys and clinic studies at three sites in India differing in their eco-epidemiologies: Chennai (Tamil Nadu), Nadiad (Gujarat), and Rourkela (Odisha), during 2012–2015. A total of 6,645 subject blood samples were collected for Plasmodium diagnosis by microscopy and PCR, and an extensive clinical question… Show more

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Cited by 49 publications
(63 citation statements)
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“…Malaria diagnosis at the study PHCs, and throughout Meghalaya, is mainly performed using slide microscopy and RDTs. Due to declining Plasmodium transmission, microscopy and RDTs may not be sensitive enough to detect all cases of parasitaemia [22] resulting in underestimation of true prevalence, particularly if infection is increasingly subpatent and asymptomatic [23]. PCR detects more than twice the number of Plasmodium infections compared to microscopy and RDTs [24] and is very effective at detecting low-density infections [25].…”
Section: Discussionmentioning
confidence: 99%
“…Malaria diagnosis at the study PHCs, and throughout Meghalaya, is mainly performed using slide microscopy and RDTs. Due to declining Plasmodium transmission, microscopy and RDTs may not be sensitive enough to detect all cases of parasitaemia [22] resulting in underestimation of true prevalence, particularly if infection is increasingly subpatent and asymptomatic [23]. PCR detects more than twice the number of Plasmodium infections compared to microscopy and RDTs [24] and is very effective at detecting low-density infections [25].…”
Section: Discussionmentioning
confidence: 99%
“…In a study recently conducted by our group, almost all infections in both clinic and community surveys at another site in Gujarat were detectable by microscopy. Because the area has a history of low malaria prevalence, residents can be expected to have low immunity, which may explain why most infections will develop parasitemia not only detectable by microscopy but also will lead to clinical episodes [ 26 ]. The proportion of Pv- positive cases in this other site was 85.9% (61/71) and 83.3% (55/66) by microscopy and PCR, respectively [ 26 ], which aligns with 78% (32/41) of Pv cases reported in the present study.…”
Section: Discussionmentioning
confidence: 99%
“…Because the area has a history of low malaria prevalence, residents can be expected to have low immunity, which may explain why most infections will develop parasitemia not only detectable by microscopy but also will lead to clinical episodes [ 26 ]. The proportion of Pv- positive cases in this other site was 85.9% (61/71) and 83.3% (55/66) by microscopy and PCR, respectively [ 26 ], which aligns with 78% (32/41) of Pv cases reported in the present study. Collectively, these findings suggest that the recent decline in malaria transmission in India has not affected the overall ratio of Pv: Pf in Gujarat, which was reported to be 80:20 in 2014 [ 12 ].…”
Section: Discussionmentioning
confidence: 99%
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