@article{Ben:2023:cid/ciac527,
author = {Ben, A and Watson, OJ and Onyango, I and Opot, B and Okoth, R and Chemwor, G and Sifuna, P and Juma, D and Cheruiyot, A and Yeda, R and Okudo, C and Wafubwa, J and Yalwala, S and Abuom, D and Ogutu, B and Cowden, J and Akala, HM and Kamau, E},
doi = {cid/ciac527},
journal = {Clinical Infectious Diseases},
pages = {704--712},
title = {Malaria transmission dynamics in a high-transmission setting of western Kenya and the inadequate treatment response to artemether-lumefantrine in an asymptomatic population},
url = {http://dx.doi.org/10.1093/cid/ciac527},
volume = {76},
year = {2023}
}

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TY  - JOUR
AB  - BackgroundAssessing the infectious reservoir is critical in malaria control and elimination strategies. We conducted a longitudinal epidemiological study in a high-malaria-burden region in Kenya to characterize transmission in an asymptomatic population.Methods488 study participants encompassing all ages in 120 households within 30 clusters were followed for 1 year with monthly sampling. Malaria was diagnosed by microscopy and molecular methods. Transmission potential in gametocytemic participants was assessed using direct skin and/or membrane mosquito feeding assays, then treated with artemether-lumefantrine. Study variables were assessed using mixed-effects generalized linear models.ResultsAsexual and sexual parasite data were collected from 3792 participant visits, with 903 linked with feeding assays. Univariate analysis revealed that the 6–11-year-old age group was at higher risk of harboring asexual and sexual infections than those <6 years old (odds ratio [OR] 1.68, P < .001; and OR 1.81, P < .001), respectively. Participants with submicroscopic parasitemia were at a lower risk of gametocytemia compared with microscopic parasitemia (OR 0.04, P < .001), but they transmitted at a significantly higher rate (OR 2.00, P = .002). A large proportion of the study population who were infected at least once remained infected (despite treatment) with asexual (71.7%, 291/406) or sexual (37.4%, 152/406) parasites. 88.6% (365/412) of feeding assays conducted in individuals who failed treatment the previous month resulted in transmissions.ConclusionsIndividuals with asymptomatic infection sustain the transmission cycle, with the 6–11-year age group serving as an important reservoir. The high rates of artemether-lumefantrine treatment failures suggest surveillance programs using molecular methods need to be expanded for accurate monitoring and evaluation of treatment outcomes.
AU  - Ben,A
AU  - Watson,OJ
AU  - Onyango,I
AU  - Opot,B
AU  - Okoth,R
AU  - Chemwor,G
AU  - Sifuna,P
AU  - Juma,D
AU  - Cheruiyot,A
AU  - Yeda,R
AU  - Okudo,C
AU  - Wafubwa,J
AU  - Yalwala,S
AU  - Abuom,D
AU  - Ogutu,B
AU  - Cowden,J
AU  - Akala,HM
AU  - Kamau,E
DO  - cid/ciac527
EP  - 712
PY  - 2023///
SN  - 1058-4838
SP  - 704
TI  - Malaria transmission dynamics in a high-transmission setting of western Kenya and the inadequate treatment response to artemether-lumefantrine in an asymptomatic population
T2  - Clinical Infectious Diseases
UR  - http://dx.doi.org/10.1093/cid/ciac527
VL  - 76
ER  - 

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