Asymptomatic School-Aged Children Are Important Drivers of Malaria Transmission in a High Endemicity Setting in Uganda

In an area of intense malaria transmission in Uganda, school-aged children (5-15 years old) and asymptomatic infections were identified as major contributors to the malaria human infectious reservoir and could be considered as important targets for malaria control interventions. Achieving malaria elimination requires a better understanding of the transmissibility of human infections in different transmission settings. This study aimed to characterize the human infectious reservoir in a high endemicity setting in eastern Uganda, using gametocyte quantification and mosquito feeding assays. In asymptomatic infections, gametocyte densities were positively associated with the proportion of infected mosquitoes (beta = 1.60; 95% CI, 1.32-1.92; P < .0001). Combining transmissibility and abundance in the population, symptomatic and asymptomatic infections were estimated to contribute to 5.3% and 94.7% of the infectious reservoir, respectively. School-aged children (5-15 years old) contributed to 50.4% of transmission events and were important drivers of malaria transmission.

Automated summary

This study in a high malaria transmission area in Uganda found that school-aged children and asymptomatic infections are major contributors to the malaria human infectious reservoir. Understanding the transmissibility of human infections in different settings is crucial for achieving malaria elimination. It was determined that asymptomatic infections had a higher impact on transmission compared to symptomatic infections.