Non-falciparum malaria infections are as prevalent as P. falciparum among Tanzanian schoolchildren

Efforts to achieve malaria elimination need to consider both falciparum and non-falciparum infections. The prevalence and geographic distribution of four Plasmodium species were determined by real-time PCR using dried blood spots collected during the 2017 School Malaria Parasitological Survey of eight regions of Tanzania. Among 3,456 schoolchildren, 22% had P. falciparum , 24% P. ovale spp., 4% P. malariae , and 0.3% P. vivax . Ninety-one percent of P. ovale infections had very low parasite densities, based on amplification at later cycle thresholds. Sixty-four percent of P. ovale infections were single-species, and 35% of these were detected in low malaria endemicity regions. P. malariae infections were predominantly co-infections with P. falciparum (73%). P. vivax was largely detected in northern and eastern regions. Overall, 43% of children with P. falciparum were co-infected with at least one non-falciparum species. A large, previously under-appreciated burden of P. ovale spp. infection exists among Tanzanian schoolchildren. Article Summary A previously unrecognized burden of non-falciparum malaria infections was detected among Tanzanian schoolchildren in a 2017 cross-sectional study, with P. ovale spp. prevalence comparable to P. falciparum , and low-level prevalences of P. malariae and P. vivax detected. ### Competing Interest Statement RS was previously employed by IQVIA and employment had concluded prior to any support on this research study; JBP reports research support from NIH, WHO, Gilead Sciences, Bill and Melinda Gates Foundation, and Abbot Laboratories outside of the submitted work, travel support from WHO and lecture honorarium from Virology Education. ### Funding Statement This study was in part funded by the National Institute of Health (K24AI134990 and R01TW010870 to JJJ; T32AI070114 to CLM; R21AI152260 to JTL; R21 AI148579 to JTL and JBP; R01 AI139520 to JBP, RS, and CLM). This work was also made possible through the Global Fund support to conducting the survey and the President's Malaria Initiative via the United States Agency for International Development (USAID) Okoa Maisha Dhibiti Malaria (OMDM) (Cooperative Agreement Number: 72062118CA-00002) implemented by RTI, under the terms of an inter-agency agreement with Centers for Disease Control and Prevention (CDC) on data management and facilitation of the initial processing and exporting of the blood samples. Funding sources had no role in the study design, analysis, or writing of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Ethics committee of the Tanzania National Institute for Medical Research gave ethical approval for survey and sample collection. The Institutional Review Board of the University of North Carolina, Chapel Hill (IRB #19-1495) gave approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Data are available upon reasonable request to the authors.