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@article{Okell:2021:10.1016/S2666-5247(21)00055-0,
author = {Okell, L and Whittaker, C and Ghani, A and Slater, H and Nash, R and Bousema, T and Drakeley, C},
doi = {10.1016/S2666-5247(21)00055-0},
journal = {The Lancet Microbe},
pages = {e366--e374},
title = {Global patterns of submicroscopic Plasmodium falciparum malaria infection: insights from a systematic review and meta-analysis of population surveys},
url = {http://dx.doi.org/10.1016/S2666-5247(21)00055-0},
volume = {2},
year = {2021}
}

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TY  - JOUR
AB  - Background: Adoption of molecular techniques to detect Plasmodium falciparum infection has revealed many previously undetected (by microscopy) yet transmissible low-density infections. The proportion of these infections is typically highest in low transmission settings, but drivers of submicroscopic infection remain unclear. Here, we update a previously conducted systematic review of asexual P. falciparum prevalence by microscopy and polymerase chain reaction (PCR) in the same population. We conduct a meta-analysis to explore potential drivers of submicroscopic infection and identify the locations where submicroscopic infections are most common. Methods: PubMed and Web of Science databases were searched up to 11th October 2020 for cross-sectional studies reporting data on asexual P.falciparum prevalence by both microscopy and PCR. Surveys of pregnant women, where participants had been chosen based on symptoms/treatment or that did not involve a population from a defined location were excluded. Both the number of individuals tested and positive by microscopy and PCR for P. falciparum infection were extracted from each reference. Bayesian regression modelling was used to explore determinants of the size of the submicroscopic reservoir including geography, seasonality, age, methodology and current/historical patterns of transmission.Findings: A total of 166 references containing 551 cross-sectional survey microscopy/PCR prevalence pairs were included. Our results highlight that submicroscopic infections predominate in low transmission settings across all settings, but also reveal marked geographical variation, with the proportion of infections that are submicroscopic being highest in South American surveys and lowest in West African studies. Whilst current transmission levels partly explain these results, we find that historical transmission intensity also represents a crucial determinant of the size of the submicroscopic reservoir, as does the demographic structure of
AU  - Okell,L
AU  - Whittaker,C
AU  - Ghani,A
AU  - Slater,H
AU  - Nash,R
AU  - Bousema,T
AU  - Drakeley,C
DO  - 10.1016/S2666-5247(21)00055-0
EP  - 374
PY  - 2021///
SN  - 2666-5247
SP  - 366
TI  - Global patterns of submicroscopic Plasmodium falciparum malaria infection: insights from a systematic review and meta-analysis of population surveys
T2  - The Lancet Microbe
UR  - http://dx.doi.org/10.1016/S2666-5247(21)00055-0
UR  - https://www.sciencedirect.com/science/article/pii/S2666524721000550?via%3Dihub
UR  - http://hdl.handle.net/10044/1/88251
VL  - 2
ER  -

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