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Prevalence of asymptomatic malaria in high- and low-transmission areas of Tanzania: The role of asymptomatic carriers in malaria persistence and the need for targeted surveillance and control efforts

Ernest Mazigo1,2orcid, Hojong Jun1orcid, Wang-Jong Lee1orcid, Johnsy Mary Louis1orcid, Fadhila Fitriana1orcid, Jadidan Hada Syahada1orcid, Fauzi Muh3orcid, Feng Lu4orcid, Md Atique Ahmed5orcid, Seok Ho Cha6orcid, Wanjoo Chun7orcid, Won Sun Park8orcid, Se Jin Lee9orcid, Sunghun Na9orcid, Joon-Hee Han10orcid, Nyalali Kija11orcid, Smart Geodfrey12orcid, Eun-Teak Han1orcid, Jim Todd13,14orcid, Alphaxard Manjurano2orcid, Winifrida Kidima15orcid, Jin-Hee Han1,3,16,*orcid
Parasites, Hosts and Diseases 2025;63(1):57-65.
Published online: February 25, 2025

1Department of Medical Environmental Biology and Tropical Medicine, School of Medicine, Kangwon National University, Chuncheon 24341, Korea

2Department of Parasitic Diseases, National Institute for Medical Research, Dar es Salaam 11101, Tanzania

3Department of Epidemiology and Tropical Diseases, Faculty of Public Health, Universitas Diponegoro, Semarang 50275, Indonesia

4Department of Pathogen Biology and Immunology, School of Medicine, Yangzhou University, Yangzhou 225009, China

5ICMR-Regional Medical Research Centre, NER, Dibrugarh, Assam 786001, India

6Department of Parasitology and Tropical Medicine, Inha University School of Medicine, Incheon 22212, Korea

7Department of Pharmacology, School of Medicine, Kangwon National University, Chuncheon 24341, Korea

8Department of Physiology, School of Medicine, Kangwon National University, Chuncheon 24341, Korea

9Department of Obstetrics and Gynecology, Kangwon National University Hospital, Chuncheon 24289, Korea

10Institute of Biological Resources, Chuncheon Bioindustry Foundation, Chuncheon 24232, Korea

11Department of Monitoring, Evaluation and Learning, Afya Plus, Dar es Salaam 31011, Tanzania

12Department of Paediatrics and Child Health, Kigoma Regional Referral Hospital, Kigoma 16, Tanzania

13Department of Biostatistics, Catholic University of Health and Allied Sciences (CUHAS), Mwanza 1464, Tanzania

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*Correspondence: (han.han@kangwon.ac.kr)
• Received: November 7, 2024   • Accepted: December 18, 2024

© 2025 The Korean Society for Parasitology and Tropical Medicine

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Prevalence of asymptomatic malaria in high- and low-transmission areas of Tanzania: The role of asymptomatic carriers in malaria persistence and the need for targeted surveillance and control efforts
Parasites Hosts Dis. 2025;63(1):57-65.   Published online February 25, 2025
DOI: https://doi.org/10.3347/PHD.24077
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Prevalence of asymptomatic malaria in high- and low-transmission areas of Tanzania: The role of asymptomatic carriers in malaria persistence and the need for targeted surveillance and control efforts
Parasites Hosts Dis. 2025;63(1):57-65.   Published online February 25, 2025
DOI: https://doi.org/10.3347/PHD.24077
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Prevalence of asymptomatic malaria in high- and low-transmission areas of Tanzania: The role of asymptomatic carriers in malaria persistence and the need for targeted surveillance and control efforts
Image Image
Fig. 1 Tanzania map. (A) Tanzania map showing regions (Geita and Kigoma for high transmission setting, and Arusha from low transmission setting) and districts (Geita: Chato and Nyang’hwale, Kigoma: Kasulu and Kibondo, and Arusha: Arusha DC and Meru) that were involved in the study. Patterns of color indicate the distribution and prevalence of malaria cases in 2022 as were reported by the President Malaria Report, 2023. (B) Prevalence of asymptomatic malaria from studied villages and prevalence of symptomatic malaria cases from health facilities within respective villages as recorded from the District Health Information System 2 from December 2022 to July 2023, a period when the study was conducted. Asymptomatic malaria cases from villages positively correlated with symptomatic malaria cases reported in village health facilities by correlational analysis.
Fig. 2 Prevalence of asymptomatic malaria by demographic information. (A) By age, overall prevalence was significantly higher in school aged children (5–15 years) than other age groups by one-way ANOVA (P=0.0001), followed by young children (<5 years) then prevalence significantly decreased by the increase in age of participants. (B) By sex, prevalence of asymptomatic malaria was significantly higher in males than females in both settings by paired sampled t-test (P<0.0001). (C) By economic activities, prevalence of asymptomatic malaria was significantly higher students and crop cultivating participants. Statistical significance was indicated by *P<0.05, **P<0.01, and ***P<0.001 using one-way ANOVA analysis. (D) By education level, prevalence of asymptomatic malaria was significantly high to participants without formal education and those with primary education, then gradually decreased with the increase in education level to tertiary education. Statistical significance was indicated by *P<0.05, **P<0.01, and ***P<0.001 using one-way ANOVA analysis. (E) By experience of clinic visiting, the experience of participants visiting health facilities for malaria symptoms was higher in asymptomatic cases with co-infections (Multi-) than those with mono-infections (Mono-). GNN, Nyangalamila; GNK, Kayenze; GCR, Rwantaba; GCI, Ihanga; KKK, Kumuhasha; KKB, Bunyambo; KKN, Nyamnyusi; KKM, Mugombe; AMM, Maji ya chai; AMN, Ngurudoto; AAB, Bwawani; AAT, Themi ya simba.

Fig. 1

Fig. 2

Prevalence of asymptomatic malaria in high- and low-transmission areas of Tanzania: The role of asymptomatic carriers in malaria persistence and the need for targeted surveillance and control efforts

Distribution of samples, age, sex of participants and asymptomatic malaria results within studied sites by mRDT and LM

Region District Village Strata Samples n (%) Median age, n (IQR) Sex distribution, n (%) mRDT n (%) LM n (%)
Males Females
Geita Nyang’hwale Nyangalamila High 276 16.5 (7.0–32.8) 177 (64.1) 99 (35.9) 84 (30.4) 46 (16.7)
Kayenze High 327 17.0 (6.0–30.0) 154 (47.1) 173 (52.9) 77 (23.6) 53 (16.2)
Chato Rwantaba High 278 11.0 (5.0–27.3) 98 (35.3) 180 (64.7) 133 (47.8) 78 (28.1)
Ihanga High 339 13.0 (7.0–32.0) 154 (45.4) 185 (54.6) 169 (49.9) 76 (22.4)
Total 1,220 (34.9) 583 (47.8) 637 (52.2) 463 (37.9) 253 (22.6)
Kigoma Kibondo Kumuhasha High 293 13.0 (9.0–22.5) 99 (33.8) 194 (66.2) 104 (35.5) 53 (18.1)
Bunyambo High 303 10.0 (4.0–20.0) 101 (33.3) 202 (66.7) 87 (28.7) 55 (18.2)
Kasulu Nyamnyusi High 259 14.0 (7.0–31.0) 102 (39.4) 157 (60.6) 98 (37.8) 91 (35.1)
Mugombe High 290 10.5 (7.0–24.0) 123 (42.4) 167 (57.6) 90 (31.0) 88 (30.3)
Total 1,145 (32.8) 425 (37.1) 720 (62.9) 379 (33.1) 287 (25.1)
Arusha Meru Maji ya chai Low 279 37.0 (19.0–50.0) 125 (44.8) 154 (55.2) 10 (3.6) 2 (0.7)
Ngurudoto Low 282 40.0 (13.0–59.3) 115 (40.8) 167 (59.2) 5 (1.8) 3 (1.1)
Arusha DC Bwawani Low 284 22.5 (8.0–44.0) 126 (44.4) 158 (55.6) 14 (4.9) 5 (1.8)
Themi simba Low 279 21.0 (8.0–45.0) 153 (54.8) 126 (45.2) 3 (1.1) 2 (0.7)
Total 1,124 (32.2) 519 (46.2) 605 (53.8) 32 (2.8) 12 (1.1)
Total 3,489 (100.0) 1,527 (43.8) 1,962 (56.2) 874 (25.1) 552 (15.8)

From each region, 2 districts were selected.

mRDT, malaria rapid diagnostic test; LM, light microscope.

Table 1 Distribution of samples, age, sex of participants and asymptomatic malaria results within studied sites by mRDT and LM

From each region, 2 districts were selected.

mRDT, malaria rapid diagnostic test; LM, light microscope.

Table 1

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