Volume 79, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


In an area with unstable malaria transmission, detection of infection in 379 symptomatic individuals was assessed by microscopy and three polymerase chain reaction (PCR) methodologies. infection was detected in 25% of patients by microscopy, 37% by nested PCR, 41% by merozoite surface protein-2 (MSP-2) PCR, and 45% by a ligase detection reaction-fluorescent microsphere assay (LDR-FMA). Of the 64 individuals who were LDR-FMA positive, microscopy negative and did not receive treatment, 8 (12.5%) had persistent symptoms and returned for treatment. Malaria attributable fraction (MAF) in symptomatic individuals was 14.6% by microscopy (95% confidence interval [CI] = 6.6–21.8%) and 28.2% by nested PCR (95% CI = 17.9–37.2%). In this highland area, infection in symptomatic individuals is detected more frequently by PCR than microscopy, and most frequently by LDR-FMA. infection appears to resolve without treatment in most LDR-FMA-positive, microscopy-negative individuals, but is persistent in a subset of these individuals and requires treatment.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Coleman RE, Sattabongkot J, Promstaporm S, Maneechai N, Tippayachai B, Kengluecha A, Rachapaew N, Zollner G, Miller RS, Vaughan JA, Thimasarn K, Khuntirat B, 2006. Comparison of PCR and microscopy for the detection of asymptomatic malaria in a Plasmodium falciparum/vivax endemic area in Thailand. Malar J 5 : 121. [Google Scholar]
  2. John CC, McHugh MM, Moormann AM, Sumba PO, Ofulla AV, 2005. Low prevalence of Plasmodium falciparum infection among asymptomatic individuals in a highland area of Kenya. Trans R Soc Trop Med Hyg 99 : 780–786. [Google Scholar]
  3. Ernst KC, Adoka SO, Kowuor DO, Wilson ML, John CC, 2006. Malaria hotspot areas in a highland Kenya site are consistent in epidemic and non-epidemic years and are associated with ecological factors. Malar J 5 : 78. [Google Scholar]
  4. Singh B, Bobogare A, Cox-Singh J, Snounou G, Abdullah MS, Rahman HA, 1999. A genus- and species-specific nested polymerase chain reaction malaria detection assay for epidemiologic studies. Am J Trop Med Hyg 60 : 687–692. [Google Scholar]
  5. Snounou G, Zhu X, Siripoon N, Jarra W, Thaithong S, Brown KN, Viriyakosol S, 1999. Biased distribution of msp1 and msp2 allelic variants in Plasmodium falciparum populations in Thailand. Trans R Soc Trop Med Hyg 93 : 369–374. [Google Scholar]
  6. McNamara DT, Kasehagen LJ, Grimberg BT, Cole-Tobian J, Collins WE, Zimmerman PA, 2006. Diagnosing infection levels of four human malaria parasite species by a polymerase chain reaction/ligase detection reaction fluorescent microsphere-based assay. Am J Trop Med Hyg 74 : 413–421. [Google Scholar]
  7. McNamara DT, Thomson JM, Kasehagen LJ, Zimmerman PA, 2004. Development of a multiplex PCR-ligase detection reaction assay for diagnosis of infection by the four parasite species causing malaria in humans. J Clin Microbiol 42 : 2403–2410. [Google Scholar]
  8. Ndao M, Bandyayera E, Kokoskin E, Gyorkos TW, MacLean JD, Ward BJ, 2004. Comparison of blood smear, antigen detection, and nested-PCR methods for screening refugees from regions where malaria is endemic after a malaria outbreak in Quebec, Canada. J Clin Microbiol 42 : 2694–2700. [Google Scholar]
  9. Mwangi TWRA, Snow RW, Marsh K, 2005. Case definitions of clinical malaria under different transmission conditions in Kilifi. J Infect Dis 191 : 8. [Google Scholar]
  10. Makler MT, Palmer CJ, Ager AL, 1998. A review of practical techniques for the diagnosis of malaria. Ann Trop Med Parasitol 92 : 419–433. [Google Scholar]
  11. Moody A, 2002. Rapid diagnostic tests for malaria parasites. Clin Microbiol Rev 15 : 66–78. [Google Scholar]
  12. Goodman CA, Mutemi WM, Baya EK, Willetts A, Marsh V, 2006. The cost-effectiveness of improving malaria home management: shopkeeper training in rural Kenya. Health Policy Plan 21 : 275–288. [Google Scholar]
  13. McCombie SC, 2002. Self-treatment for malaria: the evidence and methodological issues. Health Policy Plan 17 : 333–344. [Google Scholar]
  14. Mehlotra RKKL, Baiser M, Lorry K, Kazura JW, Bockarie MJ, Zimmerman PA, 2002. Malaria infections are randomly distributed in diverse holoendemic area of Papua New Guinea. Am J Trop Med Hyg 67 : 555–562. [Google Scholar]
  15. Roper C, Elhassan IM, Hviid L, Giha H, Richardson W, Babiker H, Satti GM, Theander TG, Arnot DE, 1996. Detection of very low level Plasmodium falciparum infections using the nested polymerase chain reaction and the reassessment of the epidemiology of unstable malaria in Sudan. Am J Trop Med Hyg 54 : 325–331. [Google Scholar]
  16. Amin AAZD, Kangwana BB, Greenfield J, Otieno DN, Akhwale WS, Snow RW, 2007. The challenges of changing national malaria drug policy to artemisinin-based combination in Kenya. Malar J 6 : 72. [Google Scholar]

Data & Media loading...

  • Received : 13 Dec 2007
  • Accepted : 10 May 2008

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error