{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:03:25Z","timestamp":1791461005691,"version":"4.3.4"},"reference-count":63,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","license":[{"start":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T00:00:00Z","timestamp":1748995200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Malaysia\u2019s malaria rate has declined but remains a public health concern, with limited investigations into malaria and coinfections with soil-transmitted helminth (STH) infections. A cross-sectional study using convenience sampling in Orang Asli villages enrolled 437 villagers aged 1\u201383 years based on their willingness to participate. Blood samples were tested microscopically for malaria, followed by nested polymerase chain reaction (PCR), and stool samples were screened microscopically for STH eggs. Body temperature, demographic, and socioeconomic data were collected. Malaria parasite was detectable only via PCR, with a 15.3% prevalence, indicating submicroscopic malaria parasitemia; none of the positive cases presented fever. The identified species included <jats:italic>Plasmodium vivax<\/jats:italic> (8.7%), <jats:italic>Plasmodium cynomolgi<\/jats:italic> (5.5%), <jats:italic>Plasmodium knowlesi<\/jats:italic> (4.3%), <jats:italic>Plasmodium falciparum<\/jats:italic> (1.8%), <jats:italic>Plasmodium inui<\/jats:italic> (0.2%), and <jats:italic>Plasmodium malariae<\/jats:italic> (0.2%). Females had significantly higher rates of submicroscopic malaria parasitemia (19.6%) compared with males (9.3%, <jats:italic>P<\/jats:italic> = 0.003). STH infections were highly prevalent (71.4%), with <jats:italic>Trichuris trichiura<\/jats:italic> (65.2%), <jats:italic>Ascaris lumbricoides<\/jats:italic> (35.0%), and hookworm (14.6%). STH infection was associated with age (<jats:italic>P<\/jats:italic> &lt;0.001), peaking in individuals aged 10\u201319 years (86.2%) and 1\u20139 years (83.0%), as well as with students (84.3% versus 60.8% in employed and 60.3% in unemployed; <jats:italic>P<\/jats:italic> &lt;0.001) and low-income households (76.4% versus 61.7% in higher-income households; <jats:italic>P<\/jats:italic> = 0.002). Submicroscopic malaria parasitemia and STH coinfections were present in 8.9% of participants, with higher rates in low-income households (12.6% versus 5.2% in higher-income, <jats:italic>P<\/jats:italic> = 0.010). The Negrito tribe exhibited the highest prevalence of submicroscopic malaria parasitemia, STH, and coinfections (<jats:italic>P<\/jats:italic> &lt;0.05). This study highlights the need for integrated malaria and STH control strategies, particularly for the Negrito tribe.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0718","type":"journal-article","created":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T19:10:22Z","timestamp":1744139422000},"page":"1391-1399","source":"Crossref","is-referenced-by-count":4,"title":["Evidence of Submicroscopic Malaria Parasitemia, Soil-Transmitted Helminths, and Their Coinfections Among Forest-Fringed Orang Asli Communities in Peninsular Malaysia"],"prefix":"10.4269","volume":"112","author":[{"given":"Nurmanisha","family":"Abdull-Majid","sequence":"first","affiliation":[{"name":"Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan Jiun","family":"Yap","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mian Zi","family":"Tee","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi Xian","family":"Er","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romano","family":"Ngui","sequence":"additional","affiliation":[{"name":"Department of Para-Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak (UNIMAS), Sarawak, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne Ai-Lian","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Front Genet","first-page":"767018","article-title":"The peopling and migration history of the natives in Peninsular Malaysia and Borneo: A glimpse on the studies over the past 100 years","volume":"13","author":"Hoh","year":"2022"},{"key":"b2","series-title":"BMC Public Health","first-page":"2090","article-title":"Diseases among Orang Asli community in Malaysia: A systematic review","volume":"22","author":"Mahmud","year":"2022"},{"key":"b3","series-title":"J Physiol Anthropol","first-page":"36","article-title":"Malaria elimination in Malaysia and the rising threat of Plasmodium knowlesi.","volume":"39","author":"Chin","year":"2020"},{"key":"b4","series-title":"Emerg Infect Dis","first-page":"2187","article-title":"Natural human infections with Plasmodium cynomolgi, P. inui, and four other Simian Malaria Parasites, Malaysia","volume":"27","author":"Yap","year":"2021"},{"key":"b5","series-title":"Malar J","first-page":"68","article-title":"First case of a naturally acquired human infection with Plasmodium cynomolgi.","volume":"13","author":"Ta","year":"2014"},{"key":"b6","series-title":"Int J Infect Control","first-page":"68","article-title":"Naturally acquired human infections with the simian malaria parasite, Plasmodium cynomolgi, in Sarawak, Malaysian Borneo","volume":"73","author":"Singh","year":"2018"},{"key":"b7","article-title":"Annual Report 2021.","year":"2022"},{"key":"b8","article-title":"WHO Malaria Terminology.","year":"2021"},{"key":"b9","series-title":"Southeast Asian J Trop Med Public Health","first-page":"591","article-title":"Submicroscopic evidence of the simian malaria parasite, Plasmodium knowlesi, in an Orang Asli community","volume":"47","author":"Jiram","year":"2016"},{"key":"b10","series-title":"Am J Trop Med Hyg","first-page":"1107","article-title":"Prevalence of asymptomatic and\/or low-density malaria infection among high-risk groups in Peninsular Malaysia","volume":"103","author":"Noordin","year":"2020"},{"key":"b11","series-title":"Emerg Infect Dis","first-page":"2700","article-title":"Natural Plasmodium inui infections in humans and Anopheles cracens mosquito, Malaysia","volume":"27","author":"Liew","year":"2021"},{"key":"b12","series-title":"Am J Trop Med Hyg","first-page":"1081","article-title":"Evidence of submicroscopic Plasmodium knowlesi mono-infection in remote indigenous communities in Kelantan, Peninsular Malaysia","volume":"109","author":"Dian","year":"2023"},{"key":"b13","series-title":"Malar J","first-page":"156","article-title":"Evidence of asymptomatic submicroscopic malaria in low transmission areas in Belaga district, Kapit division, Sarawak, Malaysia","volume":"18","author":"Jiram","year":"2019"},{"key":"b14","series-title":"PLoS Negl Trop Dis","first-page":"e3074","article-title":"Epidemiology of intestinal polyparasitism among Orang Asli school children in rural Malaysia","volume":"8","author":"Al-Delaimy","year":"2014"},{"key":"b15","series-title":"PLoS Negl Trop Dis","first-page":"e0007331","article-title":"Prevalence, intensity, and associated risk factors of soil transmitted helminth infections: A comparison between Negritos (indigenous) in inland jungle and those in resettlement at town peripheries","volume":"13","author":"Muslim","year":"2019"},{"key":"b16","series-title":"Am J Trop Med Hyg","first-page":"361","article-title":"Patterns and risk Factors of soil-transmitted helminthiasis among Orang Asli subgroups in Peninsular Malaysia","volume":"93","author":"Ngui","year":"2015"},{"key":"b17","series-title":"PLoS One","first-page":"e0272821","article-title":"Efficacy of triple dose albendazole treatment for soil-transmitted helminth infections","volume":"17","author":"Tee","year":"2022"},{"key":"b18","series-title":"Trop Biomed","first-page":"168","article-title":"Soil-transmitted helminthiasis among indigenous communities in Malaysia: Is this the endless malady with no solution?","volume":"35","author":"Mohd-Shaharuddin","year":"2018"},{"key":"b19","series-title":"PLoS One","first-page":"e0170174","article-title":"Neglected intestinal parasites, malnutrition, and associated key factors: A population based cross-sectional study among indigenous communities in Sarawak, Malaysia","volume":"12","author":"Rajoo","year":"2017"},{"key":"b20","series-title":"Sci Rep","first-page":"4101","article-title":"Soil-transmitted helminth infections and associated risk factors in three Orang Asli tribes in Peninsular Malaysia","volume":"4","author":"Anuar","year":"2014"},{"key":"b21","series-title":"PLoS Negl Trop Dis","first-page":"e887","article-title":"Complex Interactions between soil-transmitted helminths and malaria in pregnant women on the Thai-Burmese border","volume":"4","author":"Boel","year":"2010"},{"key":"b22","series-title":"Trans R Soc Trop Med Hyg","first-page":"701","article-title":"Paradoxical associations between soil-transmitted helminths and Plasmodium falciparum infection","volume":"106","author":"Fern\u00e1ndez-Ni\u00f1o","year":"2012"},{"key":"b23","series-title":"J Trop Med","first-page":"7742960","article-title":"Asymptomatic malaria and helminths coinfection and its association with anemia among primary school children in Gedeo Zone, Southern Ethiopia: A cross-sectional study","volume":"2021","author":"Wudneh","year":"2021"},{"key":"b24","series-title":"Trans R Soc Trop Med Hyg","first-page":"18","article-title":"Epidemiology of helminth infections and their relationship to clinical malaria in southwest Uganda","volume":"99","author":"Shapiro","year":"2005"},{"key":"b25","series-title":"Trop Biomed","first-page":"710","article-title":"Soil-transmitted helminth infections among malaria patients determined by microscopy and real-time PCR methods at two district hospitals in Sarawak, Malaysia","volume":"32","author":"Othman","year":"2015"},{"key":"b26","series-title":"Acta Trop","first-page":"200","article-title":"Pattern and predictors of soil-transmitted helminth reinfection among aboriginal schoolchildren in rural Peninsular Malaysia","volume":"107","author":"Al-Mekhlafi","year":"2008"},{"key":"b27","series-title":"BMC Med Res Methodol","first-page":"209","article-title":"Sample size calculation for prevalence studies using Scalex and ScalaR calculators","volume":"22","author":"Naing","year":"2022"},{"key":"b28","series-title":"Indian J Pediatr","first-page":"1482","article-title":"Sample size estimation in prevalence studies","volume":"79","author":"Arya","year":"2012"},{"key":"b29","article-title":"Sample Size Determination in Health Studies: A Practical Manual: World Health Organization.","author":"Lwanga","year":"1991"},{"key":"b30","article-title":"Preparation of Giemsa Working Solution.","year":"2016"},{"key":"b31","series-title":"Am J Trop Med Hyg","first-page":"687","article-title":"A genus- and species-specific nested polymerase chain reaction malaria detection assay for epidemiologic studies","volume":"60","author":"Singh","year":"1999"},{"key":"b32","series-title":"Lancet","first-page":"1017","article-title":"A large focus of naturally acquired Plasmodium knowlesi infections in human beings","volume":"363","author":"Singh","year":"2004"},{"key":"b33","series-title":"PLoS Pathog","first-page":"e1002015","article-title":"Plasmodium knowlesi: Reservoir hosts and tracking the emergence in humans and macaques","volume":"7","author":"Lee","year":"2011"},{"key":"b34","series-title":"J Clin Pathol","first-page":"545","article-title":"Further observations on the formol-ether concentration technique for faecal parasites","volume":"23","author":"Allen","year":"1970"},{"key":"b35","series-title":"Trop Doct","first-page":"178","article-title":"Performance evaluation of direct saline stool microscopy, formol ether concentration, and Kato-Katz diagnostic methods for intestinal parasitosis in the absence of gold standard methods","volume":"45","author":"Hailu","year":"2015"},{"key":"b36","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"815","article-title":"Comparison of the Kato-Katz method and ether-concentration technique for the diagnosis of soil-transmitted helminth infections in the framework of a randomized controlled trial","volume":"33","author":"Speich","year":"2014"},{"key":"b37","series-title":"Trop Med Infect Dis","first-page":"93","article-title":"Diagnostic techniques of soil-transmitted helminths: Impact on control measures","volume":"5","author":"Mbong Ngwese","year":"2020"},{"key":"b38","series-title":"PLoS Negl Trop Dis","first-page":"e0008505","article-title":"The global progress of soil-transmitted helminthiases control in 2020 and World Health Organization targets for 2030","volume":"14","author":"Montresor","year":"2020"},{"key":"b39","series-title":"Clin Microbiol Rev","first-page":"13","article-title":"Acquired immunity to malaria","volume":"22","author":"Doolan","year":"2009"},{"key":"b40","series-title":"Am J Trop Med Hyg","first-page":"470","article-title":"Submicroscopic Plasmodium falciparum gametocyte densities frequently result in mosquito infection","volume":"76","author":"Schneider","year":"2007"},{"key":"b41","series-title":"Front Immunol","first-page":"780525","article-title":"\u2018Bouncing back\u2019 from subclinical malaria: Inflammation and erythrocytosis after resolution of P. falciparum infection in Gambian children","volume":"13","author":"Mooney","year":"2022"},{"key":"b42","series-title":"Clin Infect Dis","first-page":"638","article-title":"Invasive Salmonella infections in areas of high and low malaria transmission intensity in Tanzania","volume":"58","author":"Biggs","year":"2014"},{"key":"b43","series-title":"Infect Genet Evol","first-page":"243","article-title":"Characterizing the genetic diversity of the monkey malaria parasite Plasmodium cynomolgi.","volume":"40","author":"Sutton","year":"2016"},{"key":"b44","series-title":"Emerg Infect Dis","first-page":"590","article-title":"Plasmodium cynomolgi coinfections among symptomatic malaria patients, Thailand","volume":"27","author":"Putaporntip","year":"2021"},{"key":"b45","series-title":"Emerg Infect Dis","first-page":"1801","article-title":"Naturally acquired human Plasmodium cynomolgi and P. knowlesi infections, Malaysian Borneo","volume":"26","author":"Raja","year":"2020"},{"key":"b46","series-title":"J Med Entomol","first-page":"417","article-title":"Mixed-species Plasmodium infections of Anopheles (Diptera:Culicidae)","volume":"34","author":"McKenzie","year":"1997"},{"key":"b47","series-title":"Malar J","first-page":"90","article-title":"Activation of the hypnozoite: A part of Plasmodium vivax life cycle and survival","volume":"10","author":"Hulden","year":"2011"},{"key":"b48","series-title":"Malar J","first-page":"411","article-title":"Detection of mixed infection level of Plasmodium falciparum and Plasmodium vivax by SYBR Green I-based real-time PCR in North Gondar, Northwest Ethiopia","volume":"13","author":"Tajebe","year":"2014"},{"key":"b49","series-title":"Sci Rep","first-page":"11068","article-title":"Plasmodium spp. mixed infection leading to severe malaria: A systematic review and meta-analysis","volume":"10","author":"Kotepui","year":"2020"},{"key":"b50","series-title":"Emerg Infect Dis","first-page":"201","article-title":"Association between landscape factors and spatial patterns of Plasmodium knowlesi infections in Sabah, Malaysia","volume":"22","author":"Fornace","year":"2016"},{"key":"b51","series-title":"Lancet Planet Health","first-page":"e97","article-title":"Individual-level factors associated with the risk of acquiring human Plasmodium knowlesi malaria in Malaysia: A case-control study","volume":"1","author":"Grigg","year":"2017"},{"key":"b52","series-title":"Malar J","first-page":"55","article-title":"Updates on malaria incidence and profile in Malaysia from 2013 to 2017","volume":"19","author":"Hussin","year":"2020"},{"key":"b53","series-title":"Int J Infect Dis","first-page":"68","article-title":"Prevalence of malaria and its risk factors in Sabah, Malaysia","volume":"91","author":"Ramdzan","year":"2020"},{"key":"b54","article-title":"UNDP Discussion Paper: Gender and Malaria.","year":"2015"},{"key":"b55","series-title":"PLoS Negl Trop Dis","first-page":"e974","article-title":"Prevalence and risk factors of intestinal parasitism in rural and remote West Malaysia","volume":"5","author":"Ngui","year":"2011"},{"key":"b56","series-title":"Parasit Vectors","first-page":"242","article-title":"The burden of moderate-to-heavy soil-transmitted helminth infections among rural Malaysian aborigines: An urgent need for an integrated control programme","volume":"4","author":"Ahmed","year":"2011"},{"key":"b57","series-title":"PLoS One","first-page":"e0160917","article-title":"Asymptomatic vivax and falciparum parasitaemia with helminth coinfection: Major risk factors for anaemia in early life","volume":"11","author":"Burdam","year":"2016"},{"key":"b58","series-title":"Trans R Soc Trop Med Hyg","first-page":"672","article-title":"Malaria and soil-transmitted intestinal helminth coinfection and its effect on anemia: A meta-analysis","volume":"107","author":"Naing","year":"2013"},{"key":"b59","series-title":"Am J Trop Med Hyg","first-page":"88","article-title":"Epidemiology of Plasmodium-helminth coinfection in Africa: Populations at risk, potential impact on anemia, and prospects for combining control","volume":"77","author":"Brooker","year":"2007"},{"key":"b60","series-title":"J Bacteriol Parasitol","article-title":"Co-infections of asymptomatic malaria and soil-transmitted helminths in school children in localities with different levels of urbanization in the Mount Cameroon Region","volume":"3","author":"Kimbi","year":"2012"},{"key":"b61","series-title":"J Public Health Epidemiol","first-page":"253","article-title":"Prevalence of malaria and soil-transmitted helminth infections and their association with undernutrition in schoolchildren residing in Mfou health district in Cameroon","volume":"4","author":"Tchinda","year":"2012"},{"key":"b62","series-title":"Ann Trop Med Parasitol","first-page":"551","article-title":"Malaria and helminth interactions in humans: An epidemiological viewpoint","volume":"100","author":"Mwangi","year":"2006"},{"key":"b63","article-title":"Budget Speech 2025.","year":"2024"}],"container-title":["The American Journal of Tropical Medicine and 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