{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T17:35:46Z","timestamp":1794591346491,"version":"4.9.1"},"reference-count":59,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T00:00:00Z","timestamp":1742947200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T00:00:00Z","timestamp":1742947200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV 002202"],"award-info":[{"award-number":["INV 002202"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Malar J"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Subpatent <jats:italic>Plasmodium falciparum<\/jats:italic> infections, defined as infections with parasite density below the detection limit of routine malaria diagnostic tests, contribute to infectious reservoirs, sustain transmission, and cause the failure of elimination strategies in target areas. This study assessed the prevalence of subpatent <jats:italic>P. falciparum<\/jats:italic> infections and associated risk factors in 14 regions of Mainland Tanzania.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>The study used samples randomly selected from RDT-negative dried blood spots (DBS) (n\u2009=\u20092685\/10,101) collected in 2021 at 100 health facilities across 10 regions of Mainland Tanzania, and four communities in four additional regions. The regions were selected from four transmission strata; high (five regions), moderate (three regions), low (three regions), and very low (three regions). DNA was extracted by Tween-Chelex method, and the <jats:italic>Pf18S<\/jats:italic> rRNA gene was amplified by quantitative polymerase chain reaction (qPCR). Logistic regression analysis was used to assess the associations between age groups, sex, fever status, and transmission strata with subpatent infection status, while linear regression analysis was used to assess the association between these factors and subpatent parasite density.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Of the selected samples, 525\/2685 (19.6%) were positive by qPCR for <jats:italic>P. falciparum<\/jats:italic>, and the positivity rates varied across different regions. Under-fives (aOR: 1.4, 95% CI 1.04\u20131.88; p\u2009&lt;\u20090.05) from health facilities had higher odds of subpatent infections compared to other groups, while those from community surveys (aOR: 0.33, 95% CI 0.15\u20130.72; p\u2009=\u20090.005) had lower odds. Participants from very low transmission stratum had significantly lower odds of subpatent infection compared to those from high transmission stratum (aOR\u2009=\u20090.53, 95% CI\u2009=\u20090.37\u20130.78; p\u2009&lt;\u20090.01). The log-transformed median parasite density (interquartile range) was 6.9 (5.8\u20138.5) parasites\/\u00b5L, with significantly higher parasitaemia in the low transmission stratum compared to a very low one (11.4 vs 7.0 parasites\/\u00b5L, p\u2009&lt;\u20090.001).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Even in very low transmission settings, the prevalence of subpatent infections was 13%, and in low transmission settings it was even higher at 29.4%, suggesting a substantial reservoir that is likely to perpetuate transmission but can be missed by routine malaria case management strategies. Thus, control and elimination programmes may benefit from adoption of more sensitive detection methods to ensure that a higher proportion of subpatent infections are detected.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12936-025-05341-6","type":"journal-article","created":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T19:17:40Z","timestamp":1743016660000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Prevalence of subpatent Plasmodium falciparum infections in regions with varying transmission intensities and implications for malaria elimination in Mainland Tanzania"],"prefix":"10.1186","volume":"24","author":[{"given":"Misago D.","family":"Seth","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary R.","family":"Popkin-Hall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashid A.","family":"Madebe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rule","family":"Budodo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Bakari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatus M.","family":"Lyimo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Giesbrecht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramadhani","family":"Moshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth B.","family":"Mbwambo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filbert","family":"Francis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dativa","family":"Pereus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doris","family":"Mbata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel P.","family":"Challe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salehe S.","family":"Mandai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gervas A.","family":"Chacha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelina J.","family":"Kisambale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Mbwambo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sijenunu","family":"Aaron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdallah","family":"Lusasi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samwel","family":"Lazaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celine I.","family":"Mandara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A.","family":"Bailey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan J.","family":"Juliano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie R.","family":"Gutman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deus S.","family":"Ishengoma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,26]]},"reference":[{"key":"5341_CR1","volume-title":"World Malaria Report 2023","author":"WHO","year":"2023","unstructured":"WHO. World Malaria Report 2023. Geneva: World Health Organization; 2023."},{"key":"5341_CR2","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1186\/s12936-022-04107-8","volume":"21","author":"CL Mitchell","year":"2022","unstructured":"Mitchell CL, Ngasala B, Janko MM, Chacky F, Edwards JK, Pence BW, et al. Evaluating malaria prevalence and land cover across varying transmission intensity in Tanzania using a cross-sectional survey of school-aged children. Malar J. 2022;21:80.","journal-title":"Malar J"},{"key":"5341_CR3","unstructured":"Ministry of Health (MoH) [Tanzania Mainland], Ministry of Health (MoH) [Zanzibar], National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), and ICF. Tanzania Demographic and Health Survey and Malaria Indicator Survey 2022 Key Indicators Report. Dodoma, Tanzania, and Rockville, Maryland, USA: MoH, NBS, OCGS, and ICF; 2023."},{"key":"5341_CR4","unstructured":"Ministry of Health. National Malaria Strategic Plan 2021\u20132025. {National Malaria Control Program}; 2020."},{"key":"5341_CR5","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1186\/s12936-020-03250-4","volume":"19","author":"SG Thawer","year":"2020","unstructured":"Thawer SG, Chacky F, Runge M, Reaves E, Mandike R, Lazaro S, et al. Sub-national stratification of malaria risk in mainland Tanzania: a simplified assembly of survey and routine data. Malar J. 2020;19:177.","journal-title":"Malar J"},{"key":"5341_CR6","doi-asserted-by":"publisher","first-page":"10600","DOI":"10.1038\/s41598-023-37669-x","volume":"13","author":"SG Thawer","year":"2023","unstructured":"Thawer SG, Golumbeanu M, Lazaro S, Chacky F, Munisi K, Aaron S, et al. Spatio-temporal modelling of routine health facility data for malaria risk micro-stratification in mainland Tanzania. Sci Rep. 2023;13:10600.","journal-title":"Sci Rep"},{"key":"5341_CR7","volume-title":"Global technical strategy for malaria 2016\u20132030","author":"WHO","year":"2015","unstructured":"WHO. Global technical strategy for malaria 2016\u20132030. Geneva: World Health Organization; 2015."},{"key":"5341_CR8","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/s12936-021-03616-2","volume":"20","author":"V Mushi","year":"2021","unstructured":"Mushi V, Mbotwa CH, Zacharia A, Ambrose T, Moshi FV. Predictors for the uptake of optimal doses of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy in Tanzania: further analysis of the data of the 2015\u20132016 Tanzania demographic and health survey and malaria indicator survey. Malar J. 2021;20:75.","journal-title":"Malar J"},{"key":"5341_CR9","doi-asserted-by":"publisher","first-page":"112","DOI":"10.4269\/ajtmh.2007.77.112","volume":"77","author":"LEG Mboera","year":"2007","unstructured":"Mboera LEG, Makundi EA, Kitua AY. Uncertainty in malaria control in Tanzania: crossroads and challenges for future interventions. Am J Trop Med Hyg. 2007;77:112\u20138.","journal-title":"Am J Trop Med Hyg"},{"key":"5341_CR10","doi-asserted-by":"publisher","first-page":"1221","DOI":"10.1093\/cid\/cix131","volume":"64","author":"N Ranadive","year":"2017","unstructured":"Ranadive N, Kunene S, Darteh S, Ntshalintshali N, Nhlabathi N, Dlamini N, et al. Limitations of rapid diagnostic testing in patients with suspected malaria: a diagnostic accuracy evaluation from Swaziland, a low-endemicity country aiming for malaria elimination. Clin Infect Dis. 2017;64:1221\u20137.","journal-title":"Clin Infect Dis"},{"key":"5341_CR11","doi-asserted-by":"publisher","first-page":"1769","DOI":"10.1093\/cid\/cix625","volume":"65","author":"G Rossi","year":"2017","unstructured":"Rossi G, De Smet M, Khim N, Kindermans J-M, Menard D. Performance of rapid diagnostic testing in patients with suspected malaria in Cambodia, a low-endemicity country aiming for malaria elimination. Clin Infect Dis. 2017;65:1769\u201370.","journal-title":"Clin Infect Dis"},{"key":"5341_CR12","doi-asserted-by":"publisher","first-page":"1108","DOI":"10.1016\/S1473-3099(18)30411-0","volume":"18","author":"NE Hofmann","year":"2018","unstructured":"Hofmann NE, Gruenberg M, Nate E, Ura A, Rodriguez-Rodriguez D, Salib M, et al. Assessment of ultra-sensitive malaria diagnosis versus standard molecular diagnostics for malaria elimination: an in-depth molecular community cross-sectional study. Lancet Infect Dis. 2018;18:1108\u201316.","journal-title":"Lancet Infect Dis"},{"key":"5341_CR13","doi-asserted-by":"publisher","first-page":"1433","DOI":"10.1038\/s41467-019-09441-1","volume":"10","author":"HC Slater","year":"2019","unstructured":"Slater HC, Ross A, Felger I, Hofmann NE, Robinson L, Cook J, et al. The temporal dynamics and infectiousness of subpatent Plasmodium falciparum infections in relation to parasite density. Nat Commun. 2019;10:1433.","journal-title":"Nat Commun"},{"key":"5341_CR14","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.4269\/ajtmh.14-0355","volume":"91","author":"GH Stresman","year":"2014","unstructured":"Stresman GH, Stevenson JC, Ngwu N, Marube E, Owaga C, Drakeley C, et al. High levels of asymptomatic and subpatent Plasmodium falciparum parasite carriage at health facilities in an area of heterogeneous malaria transmission intensity in the Kenyan highlands. Am J Trop Med Hyg. 2014;91:1101\u20138.","journal-title":"Am J Trop Med Hyg"},{"key":"5341_CR15","doi-asserted-by":"publisher","first-page":"e366","DOI":"10.1016\/S2666-5247(21)00055-0","volume":"2","author":"C Whittaker","year":"2021","unstructured":"Whittaker C, Slater H, Nash R, Bousema T, Drakeley C, Ghani AC, et al. Global patterns of submicroscopic Plasmodium falciparum malaria infection: insights from a systematic review and meta-analysis of population surveys. Lancet Microbe. 2021;2:e366\u201374.","journal-title":"Lancet Microbe"},{"key":"5341_CR16","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0268463","volume":"17","author":"WO Otambo","year":"2022","unstructured":"Otambo WO, Omondi CJ, Ochwedo KO, Onyango PO, Atieli H, Lee M-C, et al. Risk associations of submicroscopic malaria infection in lakeshore, plateau and highland areas of Kisumu County in western Kenya. PLoS ONE. 2022;17: e0268463.","journal-title":"PLoS ONE"},{"key":"5341_CR17","doi-asserted-by":"publisher","first-page":"e1061","DOI":"10.1016\/S2214-109X(23)00194-8","volume":"11","author":"AM van Eijk","year":"2023","unstructured":"van Eijk AM, Stepniewska K, Hill J, Taylor SM, Rogerson SJ, Cottrell G, et al. Prevalence of and risk factors for microscopic and submicroscopic malaria infections in pregnancy: a systematic review and meta-analysis. Lancet Glob Health. 2023;11:e1061\u201374.","journal-title":"Lancet Glob Health"},{"key":"5341_CR18","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1186\/1475-2875-12-221","volume":"12","author":"JF Mosha","year":"2013","unstructured":"Mosha JF, Sturrock HJW, Greenhouse B, Greenwood B, Sutherland CJ, Gadalla N, et al. Epidemiology of subpatent Plasmodium falciparum infection: implications for detection of hotspots with imperfect diagnostics. Malar J. 2013;12:221.","journal-title":"Malar J"},{"key":"5341_CR19","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1186\/1475-2875-10-370","volume":"10","author":"A Manjurano","year":"2011","unstructured":"Manjurano A, Okell L, Lukindo T, Reyburn H, Olomi R, Roper C, et al. Association of sub-microscopic malaria parasite carriage with transmission intensity in north-eastern Tanzania. Malar J. 2011;10:370.","journal-title":"Malar J"},{"key":"5341_CR20","doi-asserted-by":"crossref","unstructured":"Rapp T, Amagai K, Sinai C, Basham C, Loya M, Ngasala S, et al. Micro-heterogeneity of transmission shapes the submicroscopic malaria reservoir in coastal Tanzania. medRxiv. 2023. (preprint).","DOI":"10.1101\/2023.09.06.23295089"},{"key":"5341_CR21","first-page":"6","volume":"7","author":"D Sumari","year":"2016","unstructured":"Sumari D, Mugasa J, Selemani M, Shekalaghe S, Mugittu K, Gwakisa P. Prevalence of submicroscopic Plasmodium falciparum infections in asymptomatic children in low transmission settings in Bagamoyo. Tanzania MalariaWorld J. 2016;7:6.","journal-title":"Tanzania MalariaWorld J"},{"key":"5341_CR22","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1186\/s12936-021-03952-3","volume":"20","author":"PM Hayuma","year":"2021","unstructured":"Hayuma PM, Wang CW, Liheluka E, Baraka V, Madebe RA, Minja DTR, et al. Prevalence of asymptomatic malaria, submicroscopic parasitaemia and anaemia in Korogwe District, north-eastern Tanzania. Malar J. 2021;20:424.","journal-title":"Malar J"},{"key":"5341_CR23","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1186\/s12936-021-04012-6","volume":"20","author":"KO Ochwedo","year":"2021","unstructured":"Ochwedo KO, Omondi CJ, Magomere EO, Olumeh JO, Debrah I, Onyango SA, et al. Hyper-prevalence of submicroscopic Plasmodium falciparum infections in a rural area of western Kenya with declining malaria cases. Malar J. 2021;20:472.","journal-title":"Malar J"},{"key":"5341_CR24","doi-asserted-by":"publisher","first-page":"78","DOI":"10.4103\/0972-9062.257780","volume":"56","author":"T Kaura","year":"2019","unstructured":"Kaura T, Kaur J, Sharma A, Dhiman A, Pangotra M, Upadhyay AK, et al. Prevalence of submicroscopic malaria in low transmission state of Punjab: a potential threat to malaria elimination. J Vector Borne Dis. 2019;56:78\u201384.","journal-title":"J Vector Borne Dis"},{"key":"5341_CR25","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1038\/ncomms2241","volume":"3","author":"LC Okell","year":"2012","unstructured":"Okell LC, Bousema T, Griffin JT, Ou\u00e9draogo AL, Ghani AC, Drakeley CJ. Factors determining the occurrence of submicroscopic malaria infections and their relevance for control. Nat Commun. 2012;3:1237.","journal-title":"Nat Commun"},{"key":"5341_CR26","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1586\/eri.13.45","volume":"11","author":"KA Lindblade","year":"2013","unstructured":"Lindblade KA, Steinhardt L, Samuels A, Kachur SP, Slutsker L. The silent threat: asymptomatic parasitemia and malaria transmission. Expert Rev Anti Infect Ther. 2013;11:623\u201339.","journal-title":"Expert Rev Anti Infect Ther"},{"key":"5341_CR27","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1093\/infdis\/jiad522","volume":"229","author":"ZR Popkin Hall","year":"2024","unstructured":"Popkin Hall ZR, Seth MD, Madebe RA, Budodo R, Bakari C, Francis F, et al. Malaria species positivity rates among symptomatic individuals across regions of differing transmission intensities in Mainland Tanzania. J Infect Dis. 2024;229:959\u201368.","journal-title":"J Infect Dis"},{"key":"5341_CR28","doi-asserted-by":"publisher","first-page":"8158","DOI":"10.1038\/s41598-024-58455-3","volume":"14","author":"E Rogier","year":"2024","unstructured":"Rogier E, Battle N, Bakari C, Seth MD, Nace D, Herman C, et al. Plasmodium falciparum pfhrp2 and pfhrp3 gene deletions among patients enrolled at 100 health facilities throughout Tanzania: February to July 2021. Sci Rep. 2024;14:8158.","journal-title":"Sci Rep"},{"key":"5341_CR29","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1186\/s13071-024-06242-4","volume":"17","author":"ZR Popkin-Hall","year":"2024","unstructured":"Popkin-Hall ZR, Seth MD, Madebe RA, Budodo R, Bakari C, Francis F, et al. Prevalence of non-falciparum malaria infections among asymptomatic individuals in four regions of Mainland Tanzania. Parasit Vectors. 2024;17:153.","journal-title":"Parasit Vectors"},{"key":"5341_CR30","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1186\/s12936-021-03630-4","volume":"20","author":"NB Teyssier","year":"2021","unstructured":"Teyssier NB, Chen A, Duarte EM, Sit R, Greenhouse B, Tessema SK. Optimization of whole-genome sequencing of Plasmodium falciparum from low-density dried blood spot samples. Malar J. 2021;20:116.","journal-title":"Malar J"},{"key":"5341_CR31","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1093\/infdis\/jiab353","volume":"225","author":"A Gumbo","year":"2022","unstructured":"Gumbo A, Topazian HM, Mwanza A, Mitchell CL, Puerto-Meredith S, Njiko R, et al. Occurrence and distribution of non-falciparum malaria parasite species among adolescents and adults in Malawi. J Infect Dis. 2022;225:257\u201368.","journal-title":"J Infect Dis"},{"key":"5341_CR32","doi-asserted-by":"publisher","first-page":"1700362","DOI":"10.1002\/ejlt.201700362","volume":"120","author":"E Hewawasam","year":"2018","unstructured":"Hewawasam E, Liu G, Jeffery DW, Gibson RA, Muhlhausler BS. Estimation of the volume of blood in a small disc punched from a dried blood spot card. Eur J Lipid Sci Technol. 2018;120:1700362.","journal-title":"Eur J Lipid Sci Technol"},{"key":"5341_CR33","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1186\/s12936-024-05019-5","volume":"23","author":"SS Mandai","year":"2024","unstructured":"Mandai SS, Francis F, Challe DP, Seth MD, Madebe RA, Petro DA, et al. High prevalence and risk of malaria among asymptomatic individuals from villages with high prevalence of artemisinin partial resistance in Kyerwa district of Kagera region, north-western Tanzania. Malar J. 2024;23:197.","journal-title":"Malar J"},{"key":"5341_CR34","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/s13071-024-06639-1","volume":"18","author":"GA Chacha","year":"2025","unstructured":"Chacha GA, Francis F, Mandai SS, Seth MD, Madebe RA, Challe DP, et al. Prevalence and drivers of malaria infection among asymptomatic and symptomatic community members in five regions with varying transmission intensity in mainland Tanzania. Parasit Vectors. 2025;18:24.","journal-title":"Parasit Vectors"},{"key":"5341_CR35","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1093\/cid\/ciac527","volume":"76","author":"B Andagalu","year":"2023","unstructured":"Andagalu B, Watson OJ, Onyango I, Opot B, Okoth R, Chemwor G, et al. Malaria transmission dynamics in a high-transmission setting of western Kenya and the inadequate treatment response to artemether-lumefantrine in an asymptomatic population. Clin Infect Dis. 2023;76:704\u201312.","journal-title":"Clin Infect Dis"},{"key":"5341_CR36","doi-asserted-by":"publisher","first-page":"1568","DOI":"10.1016\/S1473-3099(21)00072-4","volume":"21","author":"C Andolina","year":"2021","unstructured":"Andolina C, Rek JC, Briggs J, Okoth J, Musiime A, Ramjith J, et al. Sources of persistent malaria transmission in a setting with effective malaria control in eastern Uganda: a longitudinal, observational cohort study. Lancet Infect Dis. 2021;21:1568\u201378.","journal-title":"Lancet Infect Dis"},{"key":"5341_CR37","doi-asserted-by":"publisher","first-page":"2017","DOI":"10.1093\/infdis\/jit431","volume":"208","author":"KB Beshir","year":"2013","unstructured":"Beshir KB, Sutherland CJ, Sawa P, Drakeley CJ, Okell L, Mweresa CK, et al. Residual Plasmodium falciparum parasitemia in Kenyan children after artemisinin-combination therapy is associated with increased transmission to mosquitoes and parasite recurrence. J Infect Dis. 2013;208:2017\u201324.","journal-title":"J Infect Dis"},{"key":"5341_CR38","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1186\/s12936-015-0821-1","volume":"14","author":"FG Tadesse","year":"2015","unstructured":"Tadesse FG, Pett H, Baidjoe A, Lanke K, Grignard L, Sutherland C, et al. Submicroscopic carriage of Plasmodium falciparum and Plasmodium vivax in a low endemic area in Ethiopia where no parasitaemia was detected by microscopy or rapid diagnostic test. Malar J. 2015;14:303.","journal-title":"Malar J"},{"key":"5341_CR39","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1186\/s12936-017-1968-8","volume":"16","author":"MK Chourasia","year":"2017","unstructured":"Chourasia MK, Raghavendra K, Bhatt RM, Swain DK, Meshram HM, Meshram JK, et al. Additional burden of asymptomatic and sub-patent malaria infections during low transmission season in forested tribal villages in Chhattisgarh. India Malar J. 2017;16:320.","journal-title":"India Malar J"},{"key":"5341_CR40","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0182189","volume":"12","author":"M Niang","year":"2017","unstructured":"Niang M, Thiam LG, Sane R, Diagne N, Talla C, Doucoure S, et al. Substantial asymptomatic submicroscopic Plasmodium carriage during dry season in low transmission areas in Senegal: Implications for malaria control and elimination. PLoS ONE. 2017;12: e0182189.","journal-title":"PLoS ONE"},{"key":"5341_CR41","doi-asserted-by":"publisher","first-page":"1509","DOI":"10.1086\/644781","volume":"200","author":"LC Okell","year":"2009","unstructured":"Okell LC, Ghani AC, Lyons E, Drakeley CJ. Submicroscopic infection in Plasmodium falciparum-endemic populations: a systematic review and meta-analysis. J Infect Dis. 2009;200:1509\u201317.","journal-title":"J Infect Dis"},{"key":"5341_CR42","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1186\/s12936-018-2511-2","volume":"17","author":"MF Finda","year":"2018","unstructured":"Finda MF, Limwagu AJ, Ngowo HS, Matowo NS, Swai JK, Kaindoa E, et al. Dramatic decreases of malaria transmission intensities in Ifakara, south-eastern Tanzania since early 2000s. Malar J. 2018;17:362.","journal-title":"Malar J"},{"key":"5341_CR43","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1128\/CMR.00025-08","volume":"22","author":"DL Doolan","year":"2009","unstructured":"Doolan DL, Doba\u00f1o C, Baird JK. Acquired immunity to malaria. Clin Microbiol Rev. 2009;22:13\u201336.","journal-title":"Clin Microbiol Rev"},{"key":"5341_CR44","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1186\/s12936-020-03235-3","volume":"19","author":"R Mwaiswelo","year":"2020","unstructured":"Mwaiswelo R, Ngasala B. Evaluation of residual submicroscopic Plasmodium falciparum parasites 3 days after initiation of treatment with artemisinin-based combination therapy. Malar J. 2020;19:162.","journal-title":"Malar J"},{"key":"5341_CR45","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.actatropica.2014.01.007","volume":"134","author":"DP Mawili-Mboumba","year":"2014","unstructured":"Mawili-Mboumba DP, Bouyou-Akotet MK, Kombila M. Submicroscopic infections among children with adequate clinical and parasitological response (ACPR). Acta Trop. 2014;134:29\u201332.","journal-title":"Acta Trop"},{"key":"5341_CR46","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1186\/s12936-020-03177-w","volume":"19","author":"A Assefa","year":"2020","unstructured":"Assefa A, Ahmed AA, Deressa W, Wilson GG, Kebede A, Mohammed H, et al. Assessment of subpatent Plasmodium infection in northwestern Ethiopia. Malar J. 2020;19:108.","journal-title":"Malar J"},{"key":"5341_CR47","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1186\/s12936-020-03296-4","volume":"19","author":"J Vareta","year":"2020","unstructured":"Vareta J, Buchwald AG, Barrall A, Cohee LM, Walldorf JA, Coalson JE, et al. Submicroscopic malaria infection is not associated with fever in cross-sectional studies in Malawi. Malar J. 2020;19:233.","journal-title":"Malar J"},{"key":"5341_CR48","doi-asserted-by":"publisher","first-page":"17095","DOI":"10.1038\/s41598-019-53386-w","volume":"9","author":"AM van Eijk","year":"2019","unstructured":"van Eijk AM, Sutton PL, Ramanathapuram L, Sullivan SA, Kanagaraj D, Priya GSL, et al. The burden of submicroscopic and asymptomatic malaria in India revealed from epidemiology studies at three varied transmission sites in India. Sci Rep. 2019;9:17095.","journal-title":"Sci Rep"},{"key":"5341_CR49","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-018-2221-9","author":"S Katrak","year":"2018","unstructured":"Katrak S, Nayebare P, Rek J, Arinaitwe E, Nankabirwa JI, Kamya M, et al. Clinical consequences of submicroscopic malaria parasitaemia in Uganda. Malar J. 2018. https:\/\/doi.org\/10.1186\/s12936-018-2221-9.","journal-title":"Malar J"},{"key":"5341_CR50","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1186\/s12936-018-2626-5","volume":"17","author":"P McCreesh","year":"2018","unstructured":"McCreesh P, Mumbengegwi D, Roberts K, Tambo M, Smith J, Whittemore B, et al. Subpatent malaria in a low transmission African setting: a cross-sectional study using rapid diagnostic testing (RDT) and loop-mediated isothermal amplification (LAMP) from Zambezi region, Namibia. Malar J. 2018;17:480.","journal-title":"Malar J"},{"key":"5341_CR51","doi-asserted-by":"publisher","first-page":"763","DOI":"10.4269\/ajtmh.2009.09-0042","volume":"81","author":"SD Fernando","year":"2009","unstructured":"Fernando SD, Abeyasinghe RR, Galappaththy GNL, Rajapaksa LC. Absence of asymptomatic malaria infections in previously high endemic areas of Sri Lanka. Am J Trop Med Hyg. 2009;81:763\u20137.","journal-title":"Am J Trop Med Hyg"},{"key":"5341_CR52","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1186\/1475-2875-12-352","volume":"12","author":"L Golassa","year":"2013","unstructured":"Golassa L, Enweji N, Erko B, Aseffa A, Swedberg G. Detection of a substantial number of sub-microscopic Plasmodium falciparum infections by polymerase chain reaction: a potential threat to malaria control and diagnosis in Ethiopia. Malar J. 2013;12:352.","journal-title":"Malar J"},{"key":"5341_CR53","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1186\/1475-2875-11-126","volume":"11","author":"S Zoghi","year":"2012","unstructured":"Zoghi S, Mehrizi AA, Raeisi A, Haghdoost AA, Turki H, Safari R, et al. Survey for asymptomatic malaria cases in low transmission settings of Iran under elimination programme. Malar J. 2012;11:126.","journal-title":"Malar J"},{"key":"5341_CR54","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1186\/1475-2875-9-254","volume":"9","author":"I Harris","year":"2010","unstructured":"Harris I, Sharrock WW, Bain LM, Gray K-A, Bobogare A, Boaz L, et al. A large proportion of asymptomatic Plasmodium infections with low and sub-microscopic parasite densities in the low transmission setting of Temotu Province, Solomon Islands: challenges for malaria diagnostics in an elimination setting. Malar J. 2010;9:254.","journal-title":"Malar J"},{"key":"5341_CR55","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1186\/s12936-016-1336-0","volume":"15","author":"K Phommasone","year":"2016","unstructured":"Phommasone K, Adhikari B, Henriques G, Pongvongsa T, Phongmany P, von Seidlein L, et al. Asymptomatic Plasmodium infections in 18 villages of southern Savannakhet Province, Lao PDR (Laos). Malar J. 2016;15:296.","journal-title":"Malar J"},{"key":"5341_CR56","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1186\/s12936-016-1104-1","volume":"15","author":"AF Vallejo","year":"2016","unstructured":"Vallejo AF, Garc\u00eda J, Amado-Garavito AB, Ar\u00e9valo-Herrera M, Herrera S. Plasmodium vivax gametocyte infectivity in sub-microscopic infections. Malar J. 2016;15:48.","journal-title":"Malar J"},{"key":"5341_CR57","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1016\/S1473-3099(18)30420-1","volume":"18","author":"AK Verma","year":"2018","unstructured":"Verma AK, Bharti PK, Das A. HRP-2 deletion: a hole in the ship of malaria elimination. Lancet Infect Dis. 2018;18:826\u20137.","journal-title":"Lancet Infect Dis"},{"key":"5341_CR58","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0203524","volume":"13","author":"D Adu-Gyasi","year":"2018","unstructured":"Adu-Gyasi D, Asante KP, Amoako S, Amoako N, Ankrah L, Dosoo D, et al. Assessing the performance of only HRP2 and HRP2 with pLDH based rapid diagnostic tests for the diagnosis of malaria in middle Ghana. Africa PLoS One. 2018;13: e0203524.","journal-title":"Africa PLoS One"},{"key":"5341_CR59","doi-asserted-by":"publisher","first-page":"14718","DOI":"10.1038\/s41598-017-15031-2","volume":"7","author":"KB Beshir","year":"2017","unstructured":"Beshir KB, Sep\u00falveda N, Bharmal J, Robinson A, Mwanguzi J, Busula AO, et al. Plasmodium falciparum parasites with histidine-rich protein 2 (pfhrp2) and pfhrp3 gene deletions in two endemic regions of Kenya. Sci Rep. 2017;7:14718.","journal-title":"Sci Rep"}],"container-title":["Malaria Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-025-05341-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12936-025-05341-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-025-05341-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T09:11:58Z","timestamp":1743325918000},"score":1,"resource":{"primary":{"URL":"https:\/\/malariajournal.biomedcentral.com\/articles\/10.1186\/s12936-025-05341-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,26]]},"references-count":59,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["5341"],"URL":"https:\/\/doi.org\/10.1186\/s12936-025-05341-6","relation":{},"ISSN":["1475-2875"],"issn-type":[{"value":"1475-2875","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,26]]},"assertion":[{"value":"27 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 March 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was part of the MSMT project, whose protocol was submitted to, reviewed and approved by the Medical Research Coordinating Committee (MRCC) of NIMR, Tanzania (NIMR\/HQ\/R.8a\/Vol.IX\/3579). Research participants were asked and provided individual consent (or assent for children aged 7\u201317\u00a0years) for their participation in the survey and biobanking for future research. For children under the legal age of adulthood in Tanzania (<\u200918\u00a0years), consent was obtained from a parent or guardian. An informed consent form was developed in English, translated into Kiswahili and used to obtain consent both verbally and in writing from all participants. All participants agreed and signed the consent or assent form or provided a thumbprint in conjunction with the signature of an independent witness in case the study participant was illiterate.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"101"}}