Project Details

Non-Falciparum Malaria and Diagnostic Gaps in Children Under Five in Southwestern Uganda

Alex Mwesigwa, BSc, MSc, PhD

Summary

BACKGROUND: Malaria remains a leading cause of illness and death among children under five years of age in sub-Saharan Africa. Routine malaria diagnostics primarily detect Plasmodium falciparum and may miss low-density non-falciparum and mixed-species infections, contributing to persistent transmission, recurrent illness, and missed treatment opportunities. GAP: Routine malaria diagnostics often miss low-density non-falciparum and mixed-species infections in children under five, sustaining malaria transmission, yet data on their prevalence and diagnostic performance in low-transmission border areas remain limited. HYPOTHESIS: We hypothesize that non-falciparum and mixed-species malaria infections are common in border communities and are frequently missed by routine diagnostics. METHODS: We will conduct a cross-sectional study enrolling 800 (~400 per site) children aged 6 months to 5 years at two border health facilities, Kamungaguzi HCIII (Katuna) and Bunagana HCIII (Bunagana), in southwestern Uganda. Participants will undergo malaria testing (RDT and microscopy), and dried blood spots will be collected for PCR to detect low-density and mixed-species infections. Assuming ~10% prevalence, ~80 PCR-positive cases will permit estimation of diagnostic sensitivity and missed infections. Caregiver questionnaires will capture travel exposure, and facility surveys will assess diagnostic availability, and patient volume. Outcomes will include prevalence, diagnostic sensitivity, and misclassified infections. Multivariable logistic regression will identify factors associated with missed infections. RESULTS: Pending. IMPACT: This study will quantify non-falciparum and mixed-species malaria and under-detection by routine diagnostics in children. Integrating molecular and data, it will identify drivers of missed infections and inform improvements in diagnosis and case management to reduce transmission and improve pediatric outcomes.