ArticleThe Lancet. Infectious diseases2020
Association between the proportion of Plasmodium falciparum and Plasmodium vivax infections detected by passive surveillance and the magnitude of the asymptomatic reservoir in the community: a pooled analysis of paired health facility and community data.
Article in The Lancet. Infectious diseases, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- Transfusion-transmitted malaria in sub-Saharan Africa: a systematic review and meta-analysis of Plasmodium spp. carriage in blood units and confirmed transmission in recipient.Malaria journal · 2026Pooled it
- Diagnostic gaps in light microscopy for malaria case management and control in Dilla Zuria Health Facility, southern Ethiopia.Scientific reports · 2026Article
- Malaria antibody responses augment surveillance in low-transmission settings in the Upper River Region, the Gambia.Frontiers in epidemiology · 2026Article
- The probability of Plasmodium vivax acute illness following primary infection and relapse in Papua New Guinea.PLoS neglected tropical diseases · 2025Article
- Evidence-based decision making for malaria elimination applying the Freedom From Infection statistical framework in five malaria eliminating countries: an observational study.The Lancet. Global health · 2025Observational
- Bridging the Gap from Molecular Surveillance to Programmatic Decisions for Malaria Control and Elimination.The American journal of tropical medicine and hygiene · 2025Review
- Mathematical models of Plasmodium vivax transmission: A scoping review.PLoS computational biology · 2024Article
- Accelerating towardsLancet regional health. Americas · 2023Article
- Optimizing Routine Malaria Surveillance Data in Urban Environments: A Case Study in Maputo City, Mozambique.The American journal of tropical medicine and hygiene · 2023Article
- A framework for evaluating health system surveillance sensitivity to support public health decision-making for malaria elimination: a case study from Indonesia.BMC infectious diseases · 2022Article
- Addressing child health inequity through case management of under-five malaria in Nigeria: an extended cost-effectiveness analysis.Malaria journal · 2022Article
- Intestinal inflammation and increased intestinal permeability inWellcome open research · 2022Article
- Diagnostic accuracy and limit of detection of ten malaria parasite lactate dehydrogenase-based rapid tests forFrontiers in cellular and infection microbiology · 2022Article
- Factors related to human-vector contact that modify the likelihood of malaria transmission during a containedFrontiers in epidemiology · 2022Article
- Sustainable Surveillance of Neglected Tropical Diseases for the Post-Elimination Era.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- The relationship between facility-based malaria test positivity rate and community-based parasite prevalence.PloS one · 2020Article
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40 authors at 20 institutions in 17 countries.
Funding
Abstract
backgroundPassively collected malaria case data are the foundation for public health decision making. However, because of population-level immunity, infections might not always be sufficiently symptomatic to prompt individuals to seek care. Understanding the proportion of all Plasmodium spp infections expected to be detected by the health system becomes particularly paramount in elimination settings. The aim of this study was to determine the association between the proportion of infections detected and transmission intensity for Plasmodium falciparum and Plasmodium vivax in several global endemic settings.
methodsThe proportion of infections detected in routine malaria data, P(Detect), was derived from paired household cross-sectional survey and routinely collected malaria data within health facilities. P(Detect) was estimated using a Bayesian model in 431 clusters spanning the Americas, Africa, and Asia. The association between P(Detect) and malaria prevalence was assessed using log-linear regression models. Changes in P(Detect) over time were evaluated using data from 13 timepoints over 2 years from The Gambia.
findingsThe median estimated P(Detect) across all clusters was 12·5% (IQR 5·3-25·0) for P falciparum and 10·1% (5·0-18·3) for P vivax and decreased as the estimated log-PCR community prevalence increased (adjusted odds ratio [OR] for P falciparum 0·63, 95% CI 0·57-0·69; adjusted OR for P vivax 0·52, 0·47-0·57). Factors associated with increasing P(Detect) included smaller catchment population size, high transmission season, improved care-seeking behaviour by infected individuals, and recent increases (within the previous year) in transmission intensity.
interpretationThe proportion of all infections detected within health systems increases once transmission intensity is sufficiently low. The likely explanation for P falciparum is that reduced exposure to infection leads to lower levels of protective immunity in the population, increasing the likelihood that infected individuals will become symptomatic and seek care. These factors might also be true for P vivax but a better understanding of the transmission biology is needed to attribute likely reasons for the observed trend. In low transmission and pre-elimination settings, enhancing access to care and improvements in care-seeking behaviour of infected individuals will lead to an increased proportion of infections detected in the community and might contribute to accelerating the interruption of transmission.
fundingWellcome Trust.
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