MOESM1 of Clinical consequences of submicroscopic malaria parasitaemia in Uganda

Additional file 1. Association between parasitaemia and documented fever

Microepidemiology of malaria in villages of varying transmission setting.

<p>In moderate/high transmission settings (A), hotspots coalesce to form a more homogeneous pattern. In lower transmission settings (B), risk becomes increasingly spatially discrete, with single households or small groups of households experiencing higher exposure. In very low transmission settings (C), risk shifts to individual households or, where transmission is occurring outside the house/village, to individuals.</p

Characteristics of Reactive and Proactive Case Detection.

<p>Characteristics of Reactive and Proactive Case Detection.</p

Potential application of different active surveillance and mass drug administration approaches to reduce transmission.

<p>Due to the resource requirements of tracing cases back to their home, reaction case detection (RACD) is best suited to lower transmission settings. Similarly, to avoid large amounts of unnecessary treatments, mass drug administration (MDA) is better suited to higher transmission settings; lower transmission areas may benefit from a more targeted approach. Where risk factors are well defined, proactive case detection (PACD) and MDA are good options. RACD and targeted mass drug administration (tMDA) are useful where risk factors are not well defined, as passively or actively detected cases can be used to identify at-risk populations. Where the proportion of asymptomatic infections is high, passive surveillance does not suffice and additional active surveillance and presumptive treatment are required. Where the proportion of sub-patent infections is high, active surveillance using current diagnostics is less likely to impact transmission, and presumptive treatment (MDA or tMDA) should therefore be considered.</p

Illustration of hotpops (hot populations).

<p>While infection may be detected in individuals at their home, they acquire their infections elsewhere. For example, individuals may be exposed to infectious mosquitoes when working in particular forests overnight (e.g., rubber tappers); when camping in the forest due to occupation (e.g., loggers, miners, and military personnel); or in their place of origin (migrant laborers). These demographic groups are at high risk of infection and can seed malaria transmission to others in receptive areas.</p

Prevalence of parasitemia (blood slide positive) by age, in three different epidemiological settings in Uganda.

<p>Prevalence of parasitemia (blood slide positive) by age, in three different epidemiological settings in Uganda.</p

Map of study sites in Uganda.

<p>Map of study sites in Uganda.</p

Prevalence of anemia (hemoglobin < 11.0 g/dL) by age, in three different epidemiological settings in Uganda.

<p>Prevalence of anemia (hemoglobin < 11.0 g/dL) by age, in three different epidemiological settings in Uganda.</p

Seroconversion to AMA-1and MSP-1₁₉ by age, in three different epidemiological settings in Uganda.

<p>Seroconversion to AMA-1and MSP-1₁₉ by age, in three different epidemiological settings in Uganda.</p

Characteristics of the passively detected cases in Swaziland investigated between December 2009 and June 2012.

<p>Characteristics of the passively detected cases in Swaziland investigated between December 2009 and June 2012.</p