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Background  The Mount Cameroon area has experienced a 57.2% decline in confirmed malaria cases between 2006 and 2013 with the implementation of different control measures but, the disease is still of public health concern. The objective of the study was to assess the burden of asymptomatic and sub-microscopic  Plasmodium  infection, altitudinal influence on it, their effect on haematological parameters as well as identify the risk factors of infection.    Methodology  A cross-sectional community-based survey involving 1319 children of both sexes aged 6 months to 14 years was conducted between July 2017 and May 2018. Malaria parasitaemia was confirmed by Giemsa-stained microscopy, sub-microscopic  Plasmodium  infection by 18S mRNA using nested PCR and full blood count analysis was done using an auto haematology analyser.    Results  Malaria parasite, asymptomatic malaria parasitaemia and sub-microscopic  Plasmodium  infection and anaemia were prevalent in 36.4%, 34.0%, 43.8% and 62.3% of the children, respectively. The risk of having sub-microscopic  Plasmodium  infection was highest in children 5‒9 (OR = 3.13, P < 0.001) and 10‒14 years of age (OR = 8.18, P < 0.001), non-insecticide treated net users (OR = 1.69, P < 0.04) and those anaemic (OR = 9.01, P < 0.001). Children with sub-microscopic infection had a significantly lower mean haemoglobin (9.86 ± 1.7 g/dL, P < 0.001), red blood cell counts (4.48 ± 1.1 × 10 12 /L, P < 0.001), haematocrit (31.92%, P < 0.001), mean corpuscular haemoglobin concentration (313.25 ± 47.36, P = 0.035) and platelet counts (280.83 ± 112.62, P < 0.001) than their negative counterparts. Children < 5 years old (73.8%), having asymptomatic (69.8%) and sub-microscopic  Plasmodium  infection (78.3%) as well as resident in the middle belt (72.7%) had a higher prevalence of anaemia than their peers.    Conclusion  The meaningful individual-level heterogeneity in the burden of asymptomatic and sub-microscopic  Plasmodium  infection in addition to its corollary on haematological variables among children in the different attitudinal sites of the Mount Cameroon Region accentuate the need for strategic context specific planning of malaria control and preventative measures.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12936-021-03916-7.

malaria journal

Asymptomatic and sub-microscopic Plasmodium falciparum infection in children in the Mount Cameroon area: a cross-sectional study on altitudinal influence, haematological parameters and risk factors