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Background  Ghana is among the high-burden countries for malaria infections and recently reported a notable increase in malaria cases. While asymptomatic parasitaemia is increasingly recognized as a hurdle for malaria elimination, studies on asymptomatic malaria are scarce, and usually focus on children and on non-falciparum species. The present study aims to assess the prevalence of asymptomatic  Plasmodium falciparum  and non-falciparum infections in Ghanaian adults in the Ashanti region during the high transmission season.    Methods  Asymptomatic adult residents from five villages in the Ashanti Region, Ghana, were screened for  Plasmodium  species by rapid diagnostic test (RDT) and polymerase chain reaction (PCR) during the rainy season. Samples tested positive were subtyped using species-specific real-time PCR. For all  Plasmodium ovale  infections additional sub-species identification was performed.    Results  Molecular prevalence of asymptomatic  Plasmodium  infection was 284/391 (73%); only 126 (32%) infections were detected by RDT. While 266 (68%) participants were infected with  Plasmodium falciparum,  33 (8%) were infected with  Plasmodium malariae  and 34 (9%) with  P. ovale.  The sub-species  P. ovale curtisi  and  P. ovale wallikeri  were identified to similar proportions. Non-falciparum infections usually presented as mixed infections with  P. falciparum.Conclusions  Most adult residents in the Ghanaian forest zone are asymptomatic  Plasmodium  carriers. The high  Plasmodium  prevalence not detected by RDT in adults highlights that malaria eradication efforts must target all members of the population. Beneath  Plasmodium falciparum,  screening and treatment must also include infections with  P. malariae ,  P. o. curtisi  and  P. o. wallikeri .

High prevalence of asymptomatic malaria infections in adults, Ashanti Region, Ghana, 2018