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Elimination of\n                      <jats:italic>P. vivax<\/jats:italic>\n                      is challenging due to relapses, presence of low density reservoirs and a high prevalence of glucose-6-phosphate dehydrogenase enzyme (G6PD) deficiency in the area, which constrains the use of 8-aminoquinoline drugs for radical cure. This study assessed the prevalence of low-density, sub-RDT (rapid diagnostic test)\n                      <jats:italic>P. vivax<\/jats:italic>\n                      infections and G6PD deficiency in 23 villages in Kayin State from 2020 to 2021.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants were screened for malaria using malaria RDT (mRDT), a reverse transcriptase real-time polymerase chain reaction (rRT-PCR), an enzyme-linked immunosorbent assay (ELISA) and their G6PD status was assessed using a quantitative point-of-care test. Prevalence estimates with 95% confidence intervals were calculated and stratified by sex and geographic area and group differences were compared using chi-square or Fisher\u2019s exact tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mRDT detection rate was very low (0.5%), with 26\n                      <jats:italic>P. vivax<\/jats:italic>\n                      and 1\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      infections detected among 5509 individuals. Positivity by rRT-PCR for\n                      <jats:italic>P. vivax<\/jats:italic>\n                      was 14.3% (317\/2219) followed by\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      8.3% (185\/2219) and unidentified\n                      <jats:italic>Plasmodium<\/jats:italic>\n                      species infections 0.8% (18\/2219). The prevalence of sub-RDT\n                      <jats:italic>P. vivax<\/jats:italic>\n                      infections (defined as rRT-PCR positive and mRDT negative) was 14.1% (311\/2211). The corresponding figure for\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      was 8.3% (184\/2218). Median village prevalence of sub-RDT\n                      <jats:italic>P. vivax<\/jats:italic>\n                      infections was 15.2% [IQR 4.0\u201323.6, range 0\u201340.4] and 6.0% [IQR 2.1\u201316.0, range 0\u201327.0] for\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      . Hpapun township (north) had a sub-RDT\n                      <jats:italic>P. vivax<\/jats:italic>\n                      prevalence six times higher than Myawaddy township (south). The overall proportion of G6PD deficiency among males was 21.7% and 10.6% in females (P\u2009&lt;\u20090.001). G6PD deficiency showed village-level variation, with a median of 14.4% (IQR 12.3\u201314.8) in Myawaddy and 17.3% (IQR 14.0\u201323.1) in Hpapun (P\u2009=\u20090.05). No association was observed between G6PD status and sub-RDT\n                      <jats:italic>P. vivax<\/jats:italic>\n                      infection in either males or females across townships.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The coexistence of sub-RDT\n                      <jats:italic>P. vivax<\/jats:italic>\n                      reservoirs and a high proportion of G6PD deficiency pose a major barrier to elimination. These findings highlight the need for high-sensitivity diagnostics to detect low-density infections and reliable point-of-care G6PD testing to effectively target\n                      <jats:italic>P. vivax<\/jats:italic>\n                      malaria in Kayin State, Myanmar.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12936-026-05952-7","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T07:30:46Z","timestamp":1780385446000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sub-RDT Plasmodium vivax infections and G6PD deficiency in Kayin State, Myanmar"],"prefix":"10.1186","volume":"25","author":[{"given":"Aung Myint","family":"Thu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aung Pyae","family":"Phyo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chanapat","family":"Pateekham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saw Hay","family":"Blu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"May Myo","family":"Thwin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ladda","family":"Kajeechiwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanitda","family":"Watthanaworawit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanada","family":"Okkararungrot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Germana","family":"Bancone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gornpan","family":"Gornsawun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paw Khu","family":"Moo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaung","family":"Klain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pyae Linn","family":"Aung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wang","family":"Nguitragool","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wirichada","family":"Pan-ngum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Nosten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"5952_CR1","doi-asserted-by":"publisher","first-page":"1916","DOI":"10.1016\/s0140-6736(18)30792-x","volume":"391","author":"J Landier","year":"2018","unstructured":"Landier J, Parker DM, Thu AM, Lwin KM, Delmas G, Nosten FH, et al. 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