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Plasmodium Species Infecting Children Presenting with Malaria in Uganda
Victor Asua1, Stephen Tukwasibwe1, Melissa Conrad2
1Infectious Diseases Research Collaboration, Kampala, Uganda.
Insights
Non-falciparum malaria species, including Plasmodium malariae, ovale, and vivax, are significant contributors to malaria cases in Uganda. Indoor residual spraying (IRS) may influence the prevalence of these other Plasmodium species.
Area of Science:
- Medical research
- Infectious diseases
- Parasitology
Background:
- Sub-Saharan Africa faces a significant burden of malaria, primarily attributed to Plasmodium falciparum.
- The exact contribution of other Plasmodium species to human malaria in this region remains unclear.
- Understanding the prevalence of diverse Plasmodium species is crucial for effective malaria control strategies.
Purpose of the Study:
- To investigate the prevalence and distribution of Plasmodium species, beyond Plasmodium falciparum, in children diagnosed with malaria in Uganda.
- To explore the potential impact of indoor residual spraying (IRS) on the occurrence of non-falciparum malaria infections.
Main Methods:
- Blood samples were collected from children (6 months–10 years) diagnosed with malaria across 10 sites in Uganda.
- Polymerase chain reaction (PCR) amplification of 18S ribosomal RNA genes was used to identify Plasmodium species in 499 samples.
- Data were analyzed to determine the prevalence of individual Plasmodium species and mixed infections, and to assess the association with IRS history.
Main Results:
- Plasmodial infections were detected in 474 out of 499 samples (95%).
- Plasmodium falciparum was the most common species (472 samples), but non-falciparum species (Plasmodium malariae, Plasmodium ovale, Plasmodium vivax) were identified in 39 samples (8.2%).
- Non-falciparum infections were significantly more prevalent in areas that had received indoor residual spraying (IRS) compared to areas that had not (14.8% vs 4.6%, P = 0.0013).
Conclusions:
- A substantial proportion of malaria episodes in Uganda are caused by Plasmodium species other than P. falciparum.
- The findings highlight the importance of considering non-falciparum species in malaria diagnosis and treatment in Uganda.
- The association between IRS and non-falciparum malaria prevalence warrants further investigation to understand the underlying mechanisms.
Abstract:
Contributions of species other than Plasmodium falciparum to human malaria in sub-Saharan Africa are uncertain. We collected blood from children aged 6 months to 10 years diagnosed with malaria by Giemsa-stained blood smears (176 subjects) or histidine rich protein-2-based rapid diagnostic tests (323 subjects) in 2016; 50 samples from each of 10 sites across Uganda were studied to identify infecting species. Of 499 available samples, 474 demonstrated plasmodial infection by polymerase chain reaction amplification of 18S ribosomal RNA genes, including P. falciparum in 472, Plasmodium malariae in 22, Plasmodium ovale in 15, and Plasmodium vivax in four; 435 were pure P. falciparum, two did not contain P. falciparum, and the remainder were mixed infections including P. falciparum. The prevalence of nonfalciparum species varied geographically. Stratifying based on recent history of indoor residual spraying (IRS) of insecticides, nonfalciparum infections were seen in 27/189 (14.8%) samples from sites that received and 13/285 (4.6%) samples from sites that did not receive IRS since 2010 (P = 0.0013). Overall, 39/474 (8.2%) samples from individuals diagnosed with malaria included nonfalciparum infections. Thus, a substantial proportion of episodes of malaria in Uganda include infections with plasmodial species other than P. falciparum.
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