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Background  Motivated by the success in malaria control that was documented over the last decade Ethiopia is aiming at malaria elimination by 2020 in selected districts. It is currently unknown if asymptomatic, submicroscopic malaria parasite carriage may form a hurdle to achieve elimination. The elimination effort may further be complicated by possible glucose-6 phosphate dehydrogenase (G6PD) deficiency which would hinder the use of 8-aminoquinolines in the elimination efforts.    Method  In February 2014 a community-based cross-sectional survey was conducted in Malo, southwest Ethiopia. Finger-prick blood samples (n = 555) were tested for presence of  Plasmodium falciparum  and  Plasmodium vivax  with microscopy, rapid diagnostic test (RDT), and nested polymerase chain reaction (nPCR). Multiplicity of  P. falciparum  infections was determined based on genotyping the polymorphic merozoite surface protein-2 ( MSP-2 ) gene. Individuals were also genotyped for mutations in the gene that produces G6PD.    Results  All study participants were malaria infection negative by microscopy and RDT. Nested PCR revealed  P. falciparum  mono-infection in 5.2% (29/555),  P. vivax  mono-infection in 4.3% (24/555) and mixed infection in 0.2% (1/555) of individuals. All parasitemic individuals were afebrile (axillary temperature <37.5°C). None of the study participants carried mutations for the  G6PD  African A-(202GA) and Mediterranean (563CT) variants. All infections, except one, were single-clone infection by  MSP-2   genotyping .    Conclusion  The detection of a substantial number of subpatent malaria infections in an apparently asymptomatic population without evidence for malaria transmission by conventional diagnostics raises questions about the path to malaria elimination. It is currently unknown how important these infections are for sustaining malaria transmission in the study sites. The absence of G6PD deficiency indicates that 8-aminoquinolines may be safely deployed to accelerate elimination initiatives.

malaria journal

Submicroscopic carriage of Plasmodium falciparum and Plasmodium vivax in a low endemic area in Ethiopia where no parasitaemia was detected by microscopy or rapid diagnostic test