Prevalence and determinants of asymptomatic malaria infection among schoolchildren in Africa: insights from a systematic review and meta-analysis.

backgroundAsymptomatic school children serve as a reservoir for ongoing transmission, and asymptomatic malaria infection contributes to cognitive impairment and school absenteeism. Therefore, this review aims to determine the pooled prevalence of asymptomatic malaria infection and the factors associated with it in school children.

methodsThis systematic review and meta-analysis adhered to the PRISMA guidelines. We searched online databases, including PubMed, Google Scholar, Semantic Scholar, Directory of Open Access Journals (DOAJ), and ScienceDirect, to review the literature. The Condition, Context, and Population (COCOPO) principle-criteria were used to develop the search terms. The Joanna Briggs Institute (JBI) critical appraisal checklist for prevalence studies was used to assess the quality of the articles. EndNote (version X9) was employed to organize, evaluate, and cite relevant studies. Statistical analysis was performed using Stata software, version 18.

resultsAccording to a random effect model, the summary estimate of asymptomatic malaria infection among schoolchildren across 33 African countries was 34% (95% CI: 28-40%). However, there was substantial heterogeneity (I² = 98.9%, p < 0.001), indicating that this summary figure shows a significant difference between transmission settings. The prevalence ranged from 5% in Ethiopia to 53% in Cameroon, varying significantly by geographic region, Publication year, and diagnostic method. Reports show that species-specific P. falciparum was the most common, accounting for 29.3% (95% CI: 21.88-36.73%, I² = 99.68%, P < 0.001, n = 19), followed by mixed Plasmodium infections, P. vivax, P. malariae, and P. ovale, which were found at rates of 2% (95% CI: 1-6%, I²=98.4%, P < 0.001, n = 10), 1% (95% CI: 0-3%, I²=89.4%, P < 0.001, n = 6), 1% (95% CI: 0-2%, I²=88.5%, P < 0.001, n = 9), and 0% (95% CI: 0-2%, I²=95.6%, P < 0.001, n = 7), respectively. In this review, asymptomatic malaria infection was associated with male gender (OR = 1.26, 95% CI: 1.05-1.47, I

conclusionAsymptomatic malaria infection is common but highly variable among schoolchildren in Africa. The pooled estimate of 34% should be interpreted as a statistical summary of existing studies, not as a single applicable prevalence for all African settings. Targeted, context-specific interventions are necessary. Asymptomatic malaria infection among school children is associated with male gender, anemia, not sleeping under a bednet, and previous malaria treatment. Therefore, as part of malaria elimination efforts, targeted interventions by considering local transmission intensity, diagnostic approach, and age structure are necessary by expanding the malaria prevention package to schools and screening asymptomatic school-going children for malaria.