Point prevalence of asymptomatic Plasmodium infection and the comparison of microscopy, rapid diagnostic test and nested PCR for the diagnosis of asymptomatic malaria among children under 5 years in Ghana

Background Plasmodiuminfection among children is a serious public health problem. Asymptomatic malaria infection among humans serves as a significant reservoir for transmittingPlasmodiumto uninfectedAnophelesmosquitoes, fueling malaria endemicity and asymptomatic malaria may progress to clinical malaria. Therefore, prompt and accurate diagnosis of malaria infection is crucial for the management and control of malaria, especially in endemic areas. This study assessed the point prevalence of asymptomatic malaria infection and evaluated the performance of malaria Rapid Diagnostic Tests (RDT), light microscopy and nested PCR (nPCR) for the diagnosis of asymptomatic malaria infection in a paediatric population in the Atwima Nwabiagya North district, Ghana. Methods This cross-sectional study enrolled 500 asymptomatic children aged <= 5 years. After consent was obtained from a parent, blood samples were collected from each participant to assess forPlasmodiuminfection based on histidine rich protein-2 (pfHRP-2)-based malaria RDT, light microscopy and nPCR. Results The point prevalence of asymptomatic malaria by microscopy, RDT, and nPCR were 116/500 (23.2%), 156/500 (31.2%), and 184/500 (36.8%), respectively. Using nPCR as the reference, RDT presented with a perfect sensitivity (100.0%), specificity (100.0%), accuracy (100.0%), and reliability (100.0%) in detecting asymptomaticP.falciparuminfection. Likewise, microscopy presented with an excellent specificity and high accuracy in detecting bothP.falciparum(100.0%; 85.6%) andP.malariae(100.0%; 100.0%). However, the sensitivity (56.4%) and reliability (56.4%) of microscopy was low for bothP.falciparum. Conclusion The findings of this study indicate a high point prevalence of asymptomaticPlasmodiuminfection among children in Atwima Nwabiagya North district, Ghana. In the absence of the more sensitive PCR, pfHRP-2-based malaria RDT provides substantial diagnostic sensitivity, specificity, accuracy and reliability and is superior to microscopy.