Date of Award

1-1-2019

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Michael Cappello

Abstract

As the landscape of malaria in sub-Saharan Africa changes due to improved control efforts, there is increasing interest in elucidating the epidemiology of asymptomatic P. falciparum infection and its role in disease transmission, particularly in school age children. We conducted a cross-sectional survey in the summer of 2018 of children attending 4 primary/junior high schools within a 5 km radius of HopeXchange Medical Centre in Kumasi, Ghana, a city of 2.5 million inhabitants with year-round malaria transmission. Informed consent/assent and demographic information was obtained from 634 subjects (ages 5-17 years), after which measurements of height/weight/body temperature were recorded and a blood sample was obtained for evaluation by blood film microscopy, rapid diagnostic test (RDT) and nested polymerase chain reaction (PCR) for P. falciparum. Factors associated with malaria parasitemia were analyzed using a qualitative questionnaire covering socioeconomic factors, malaria prevention behaviors, and healthcare access. The overall prevalence of asymptomatic parasitemia varied by diagnostic test (microscopy: 5.5%; RDT: 11.8%; PCR: 23.4%). Agreement between methods was highest for samples with higher levels of parasitemia as measured by microscopy. Bivariate analysis showed that factors associated with a positive malaria test included school, lack of bed net usage and age. After controlling for relevant factors, school of attendance was the single greatest predictor of a positive malaria test in the study population. Across the 4 schools, use of PCR (n=555) increased the measured prevalence of asymptomatic malaria parasitemia when compared to the prevalence measured using microscopy (1.7 vs 7.6%; 2.8 vs 10.3%; 3.2 vs 28.4%; 12.2 vs 40.1%). These data are in agreement with previously described higher sensitivity of PCR for detection of asymptomatic parasitemia. More importantly, these results capture the significant heterogeneity in asymptomatic malaria risk in Kumasi, underscoring the importance of characterizing the epidemiology of asymptomatic malaria, even across urban communities.

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This is an Open Access Thesis.

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