{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T17:21:43Z","timestamp":1775496103477,"version":"3.50.1"},"posted":{"date-parts":[[2026,4,3]]},"group-title":"Infectious Diseases (except HIV\/AIDS)","reference-count":35,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,4,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>\n                  Rwanda is a malaria endemic country and a focal point for emerging\n                  <jats:italic>Plasmodium falciparum<\/jats:italic>\n                  artemisinin partial resistance (ART-R). While Demographic and Health Surveys (DHS) provide both national and province-level representative data, malaria testing in Rwandan DHS (RDHS) studies has been limited to a subset of adult women and children under 5 years using RDT and\/or microscopy. Recent work using ultra-sensitive quantitative real time PCR on residual dried blood spots (DBS) from the 2014-15 RDHS revealed a significantly higher P. falciparum prevalence than detected by standard DHS diagnostics. Building on this study, we analyzed 7,127 adult DBS samples collected for HIV testing in the 2019-20 RDHS to generate updated prevalence measures. We found a national\n                  <jats:italic>P. falciparum<\/jats:italic>\n                  infection prevalence of 7.7% (95%CI [6.8%, 8.7%]), with predominantly low-density infections (median parasitemia: 7.3 parasites\/uL). We assessed covariates of\n                  <jats:italic>P. falciparum<\/jats:italic>\n                  malaria infection, identifying male sex, lower household wealth, lower educational achievement, and residence at lower elevation as significant predictors. Notably, national\n                  <jats:italic>P. falciparum<\/jats:italic>\n                  prevalence decreased 53% relative to the parallel 2014-15 RDHS study, despite reports of increasing ART-R-associated mutations in Rwanda. These findings demonstrate the utility of ultra-sensitive molecular surveillance, and suggest that national malaria control efforts have substantially reduced malaria burden in Rwanda even amid rising antimalarial parasite prevalence. Subsequent studies on this data set will provide measures of minor\n                  <jats:italic>Plasmodium<\/jats:italic>\n                  species prevalence, as well as temporospatial analysis of antimalarial resistance markers in\n                  <jats:italic>P. falciparum<\/jats:italic>\n                  positive samples.\n                <\/jats:p>","DOI":"10.64898\/2026.04.01.26349976","type":"posted-content","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T15:20:18Z","timestamp":1775229618000},"source":"Crossref","is-referenced-by-count":0,"title":["Molecular surveillance of Falciparum malaria in Rwanda: Shifts in parasite prevalence and risk factors between the 2014\u201315 and 2019\u201320 Rwanda Demographics and Health Surveys"],"prefix":"10.64898","author":[{"given":"Jenna","family":"Zuromski","sequence":"first","affiliation":[{"name":"Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, United States of America"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neeva Wernsman","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Pathology, Brown University, Providence, Rhode Island, United States of America"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre","family":"Gashema","sequence":"additional","affiliation":[{"name":"Institut d\u2019Enseignement Superieur-Ruhengeri, Ruhengeri, Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Iradukunda","sequence":"additional","affiliation":[{"name":"Institut d\u2019Enseignement Superieur-Ruhengeri, Ruhengeri, Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ntwari Jean","family":"Bosco","sequence":"additional","affiliation":[{"name":"Institut d\u2019Enseignement Superieur-Ruhengeri, Ruhengeri, Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob M","family":"Sadler","sequence":"additional","affiliation":[{"name":"Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, United States of America"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Gaither","sequence":"additional","affiliation":[{"name":"Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, United States of America"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tharcisse","family":"Munyaneza","sequence":"additional","affiliation":[{"name":"National Reference Laboratory, Rwanda Biomedical Center, Kigali, Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean Vincent","family":"Connelly","sequence":"additional","affiliation":[{"name":"Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, United States of America"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pathology, Brown University, Providence, Rhode Island, United States of America"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Varun","family":"Goel","sequence":"additional","affiliation":[{"name":"Department of Geography, University of South Carolina, Columbia, South Carolina, United States of America"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claude Mambo","family":"Muvunyi","sequence":"additional","affiliation":[{"name":"Rwanda Biomedical Centre, Kigali, Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean De","family":"Dieu Butera","sequence":"additional","affiliation":[{"name":"National Reference Laboratory, Rwanda Biomedical Center, Kigali, Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Baptiste","family":"Mazarati","sequence":"additional","affiliation":[{"name":"Institut d\u2019Enseignement Superieur-Ruhengeri, Ruhengeri, Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan J.","family":"Juliano","sequence":"additional","affiliation":[{"name":"Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, United States of America"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey A.","family":"Bailey","sequence":"additional","affiliation":[{"name":"Department of Pathology, Brown University, Providence, Rhode Island, United States of America"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2026040608500693000_2026.04.01.26349976v1.1","unstructured":"World Health Organization. World Malaria Report 2024. World Health Organization; 2024."},{"key":"2026040608500693000_2026.04.01.26349976v1.2","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-11-236"},{"key":"2026040608500693000_2026.04.01.26349976v1.3","unstructured":"World Health Organization. World Malaria Report 2017. World Health Organization; 2017."},{"key":"2026040608500693000_2026.04.01.26349976v1.4","unstructured":"World Health Organization. World Malaria Report 2021. World Health Organization; 2021."},{"key":"2026040608500693000_2026.04.01.26349976v1.5","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-020-03407-1"},{"key":"2026040608500693000_2026.04.01.26349976v1.6","doi-asserted-by":"publisher","DOI":"10.3390\/atmos15050609"},{"key":"2026040608500693000_2026.04.01.26349976v1.7","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-025-05278-w"},{"key":"2026040608500693000_2026.04.01.26349976v1.8","doi-asserted-by":"publisher","DOI":"10.1038\/s43247-024-01717-9"},{"key":"2026040608500693000_2026.04.01.26349976v1.9","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-024-05097-5"},{"key":"2026040608500693000_2026.04.01.26349976v1.10","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.23-0881"},{"key":"2026040608500693000_2026.04.01.26349976v1.11","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.23-0317"},{"key":"2026040608500693000_2026.04.01.26349976v1.12","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-025-05696-w"},{"key":"2026040608500693000_2026.04.01.26349976v1.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.actatropica.2011.09.009"},{"key":"2026040608500693000_2026.04.01.26349976v1.14","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-024-04981-4"},{"key":"2026040608500693000_2026.04.01.26349976v1.15","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-020-1005-2"},{"key":"2026040608500693000_2026.04.01.26349976v1.16","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00498-09"},{"key":"2026040608500693000_2026.04.01.26349976v1.17","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiae475"},{"key":"2026040608500693000_2026.04.01.26349976v1.18","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(21)00142-0"},{"key":"2026040608500693000_2026.04.01.26349976v1.19","doi-asserted-by":"publisher","DOI":"10.1128\/aac.01299-23"},{"key":"2026040608500693000_2026.04.01.26349976v1.20","doi-asserted-by":"publisher","DOI":"10.1038\/nature12876"},{"key":"2026040608500693000_2026.04.01.26349976v1.21","doi-asserted-by":"publisher","DOI":"10.1128\/mbio.01981-23"},{"key":"2026040608500693000_2026.04.01.26349976v1.22","unstructured":"Rwanda Demographic and Health Survey 2019-20 Final Report. Kigali, Rwanda, and Rockville, Maryland, USA: NISR and ICF: National Institute of Statistics of Rwanda (NISR) [Rwanda], Ministry of Health (MOH) [Rwanda], and ICF; 2021."},{"key":"2026040608500693000_2026.04.01.26349976v1.23","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-022-04103-y"},{"key":"2026040608500693000_2026.04.01.26349976v1.24","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-023-04506-5"},{"key":"2026040608500693000_2026.04.01.26349976v1.25","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0330480"},{"key":"2026040608500693000_2026.04.01.26349976v1.26","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.42.12.5636-5643.2004"},{"key":"2026040608500693000_2026.04.01.26349976v1.27","doi-asserted-by":"publisher","DOI":"10.1101\/2024.01.09.24301054"},{"key":"2026040608500693000_2026.04.01.26349976v1.28","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.19-0094"},{"key":"2026040608500693000_2026.04.01.26349976v1.29","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-7519(02)00111-X"},{"key":"2026040608500693000_2026.04.01.26349976v1.30","doi-asserted-by":"publisher","DOI":"10.15780\/G2JQ0P"},{"key":"2026040608500693000_2026.04.01.26349976v1.31","unstructured":"President\u2019s Malaria Initiative. Rwanda Malaria Operational Plan FY 2018. President\u2019s Malaria Initiative; 2017."},{"key":"2026040608500693000_2026.04.01.26349976v1.32","unstructured":"Rwanda Malaria Strategic Plan 2020-2024. Kigali, Rwanda: Rwanda Ministry of Health; 2020."},{"key":"2026040608500693000_2026.04.01.26349976v1.33","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-018-2220-x"},{"key":"2026040608500693000_2026.04.01.26349976v1.34","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0211205"},{"key":"2026040608500693000_2026.04.01.26349976v1.35","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-12-416"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.04.01.26349976","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T15:50:15Z","timestamp":1775490615000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.04.01.26349976"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,3]]},"references-count":35,"URL":"https:\/\/doi.org\/10.64898\/2026.04.01.26349976","relation":{},"subject":[],"published":{"date-parts":[[2026,4,3]]},"subtype":"preprint"}}