Prevalence of asymptomatic malaria and its associated factors in the Al Zuhrah district, Al-Hodeidah Government, Yemen, 2022

Prevalence of asymptomatic malaria and its associated factors in the Al Zuhrah district, Al-Hodeidah Government, Yemen, 2022 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of asymptomatic malaria and its associated factors in the Al Zuhrah district, Al-Hodeidah Government, Yemen, 2022 Mohammed Ahamed Hajjam, Samar Saeed Nasher, Mohammed Abdullah Al Amad This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8532964/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Asymptomatic malaria represents a significant health issue, especially in endemic regions where asymptomatic individuals serve as reservoirs. In Yemen, the Al-Hodeidah governorate is the primary endemic area. This study aims to determine the prevalence of asymptomatic malaria and its associated factors in Al-Zuhra District, Al-Hodeidah Governorate. Methods A cross-sectional community-based study was conducted using a multistage sampling method with probability proportional to size to select villages and households. In each household, one eligible member who had not experienced malaria symptoms and had consented to participate was randomly selected. Data were collected using a semi-structured questionnaire, and blood samples were tested for malaria using the Rapid Diagnostic Test. Logistic regression was used to calculate crude and adjusted prevalence odds ratios (APOR) with 95% confidence intervals (CI). A P value < 0.05 was considered statistically significant. Results A total of 422 participants (mean age of 35.7 ± 11 years; 47% were male, and 62% were from a family with more than five members) were enrolled. The overall prevalence of symptomatic malaria was 5%, with Plasmodium falciparum accounting for 95% of infections. Absence of insecticide-treated nets (ITN) in homes (APOR 2.4, 95% CI 1.0-5.9, P = 0.04), absence of window screens (APOR 7.3, 95% CI 1.8–29.1, P = 0.001), not using ITN (APOR 2.8, 95% CI 1.1–6.7, P = 0.02), and living near stagnant water (APOR 5.7, 95% CI 1.9–16.9, P = 0.001) were significantly associated with asymptomatic malaria. Conclusion asymptomatic malaria is prevalent in Al-Zuhra District; however, the absence of or unimplemented mosquito control measures was the associated factor. To reduce malaria infection, community participation in malaria control, including increased awareness and ITN use and environmental management, is recommended. Asymptomatic malaria prevalence associated factors Al-Hodeidah Yemen Figures Figure 1 Figure 2 Introduction Malaria is still a major health concern globally and a leading cause of morbidity and mortality, particularly in low- and middle-income countries which is caused by the Plasmodium parasites and spreads to people through the bites of infected female Anopheles mosquitos. [ 1 ] The five Plasmodium species that cause malaria in humans are falciparum, vivax, ovale, knowlesi, and malariae. Plasmodium falciparum and vivax present the greatest public health risk. [ 2 ] Malaria infection is controllable and avoidable, but it can cause severe febrile illness and lead to life-threatening consequences if not treated properly [ 1 , 3 , 4 ]. Malaria's presents with a spectrum range of clinical manifestations that ranges from asymptomatic infection to life-threatening forms of the disease [ 5 ]. Asymptomatic malaria refers to he detection of the Plasmodium parasite in the blood of infected individuals who do not exhibit any clinical signs of malaria disease [ 5 ]. While symptomatic cases are more likely to be recognized and treated, asymptomatic infections are frequently overlooked and untreated, allowing infected persons to serve as silent reservoirs for ongoing malaria transmission. This buried parasite reservoir presents a poses a major obstacle to malaria elimination efforts, especially in regions where the disease is endemic [ 3 ]. Despite ongoing global control measures, malaria continues to to exert a substantial burden. In 2022, the disease was projected to affect approximately 249 million people worldwide and 608,000 deaths, compared with 244 million cases and 610,000 fatalities in 2021 [ 1 , 6 ]. It is endemic in 85 countries and regions, with a considerable proportion of the populace in these locations still at risk of infection [ 1 ]. Although the National Malaria Control Programme (NMCP) has been active since early 2000, around 64.5% of the population is still considered at risk [ 7 ]. in the Eastern Mediterranean Region (EMRO),Plasmodium falciparum accounts for more than 99% of infections, resulting in roughly 5.7 million illnesses and 12,330 deaths by 2020 [ 7 ]. Malaria is endemic in Yemen, particularly in coastal regions, where more than two-thirds of the population is at risk of contracting the disease. Consequently, it ranks among the top ten causes of morbidity and mortality in the country [ 8 ]. In 2021, there were approximately 133,494 malaria cases reported, with Al-Hodeidah governorate accounting for approximately 26,635 incidences [ 9 ]. Despite this large burden, data on silent malaria in Yemen is sparse. Understanding the frequency of asymptomatic malaria is critical for designing surveillance systems and implementing effective, targeted control and elimination measures [ 3 ]. However, the epidemiology of asymptomatic malaria in Yemen remains unknown, and no previous studies have assessed its frequency and associated characteristics in this scenario. As a result, this study aims to investigate the frequency and related characteristics of asymptomatic malaria in Al Zuhra district, Al Hodeidah governorate, Yemen. Methods Study design, setting and period This is a cross-sectional community-based study conducted from the period of November 21st to December 30th, 2022. Al Zuhrah district, located on the western coast of Hodeidah Governorate, Yemen, was selected due to its hyperendemic malaria, predominantly caused by Plasmodium falciparum with occasional P. vivax infections. According to the national malaria program, this area has a high transmission rate, making it an optimal site for assessing asymptomatic malaria and its associated factors. This site is described as a tropical area, and the Morul River passes through it with two transmission periods for malaria seasons, which are August-April and May-September. The district has an estimated population of approximately 246,042 people and includes one hospital, three health centers, and 23 health units. Most residents engaged in agriculture, fishing, or other rural livelihoods. Study population Every person aged 18 and older who had resided in the Al Zuhrah district for at least one year and was available at the time of data collection was present during the data collection period. Inclusion and exclusion criteria Participants aged 18 and older who had lived in the Al Zuhrah district for at least a year, were present during data collection, volunteered to participate in the study, and had an auxiliary body temperature of 37.5°C at the time of data collection were eligible. Participants who were unwilling to participate, had mental illness or communication impairments, resided in the Az Zuhra district for at least one year, received antimalarial therapy in the past month, or exhibited fever (≥ 38°C) or malaria-like symptoms within the previous 48–72 hours were excluded. Sample size To determine the sample size, we used the single population proportion formula: (n = Z² p(1-p) d2), where n is the required sample size, p is the expected prevalence of asymptomatic malaria (50%), Z is the standard normal value with a 95% confidence interval (Z = 1.96), and d2 is the acceptable error (5%). The minimum sample size was 384. Following that, 10% (38) was added to account for nonresponse or missing data, resulting in a total sample size of 422 individuals. Sampling approach and process A multistage sampling method was employed to choose a representative sample of the study population. Stage 1: A complete list of all villages in Al Zuhrah district was received from the District Health Office. Thirty villages were randomly selected. Stage 2: To determine the proportionate sample size for each selected village, current household demographic statistics from the local government were used. The total sample size was allocated proportionally among the selected 30 villages according to the number of households in each village. Stage 3: Within each selected village, households were selected using simple random sampling. From each selected household, one eligible adult per household (either the household head (male or female) or any adult member (≥ 18 years) present at the time of the visit) was randomly selected to participate in the study. Data collection Data were collected through face-to-face interviews using a structured questionnaire adapted from instruments that had been validated in previous studies [ 10 ], with a minor alteration to meet local cultural norms. The questionnaire was initially created in English, then translated into Arabic (the local language) and validated by subject matter experts. Each interview lasted around 15–20 minutes. The questionnaire consisted of three parts/sections. The first part consisted of questions on the participants' sociodemographic characteristics. The second part of the section included questions related to asymptomatic malaria infection, including associated factors. The third section documented laboratory test results used to confirm malaria infection status. Axillary body temperature was measured by trained health professionals and community health volunteers (CHVs) to ensure that the participants met the asymptomatic criteria (absence of fever at the time of data collection). Blood collection and analysis Malaria infection status was detected by RDT (CareStart TM Malaria HRP2/pLDH (Pf/PAN) Combo, Access Bio, New Jersey, USA), which is WHO-approved and frequently used by the National Malaria Control Programme (NMCP). Participants collected 5 µl of finger prick capillary blood with a sterile lancet and deposited it in the test cassette according to the manufacturer's instructions. After 20 minutes, the test results were examined and classified as negative, positive for Plasmodium falciparum, positive for Plasmodium vivax, or mixed. Each test cassette has a unique participant identification code. All processes followed standard operating procedures (SOPs) for biosafety and waste disposal. Study Variables Dependent variable Asymptomatic malaria infection is characterized by the detection of malaria parasites through RDT in a person who do not have a fever (< 37.5°C) and have not experienced any malaria-related symptoms either in the two days prior to the survey or at the time of the assessment [ 10 , 11 ]. Independent variable Demographic characteristics of the individuals and factors associated with asymptomatic malaria infection. Quality control The questionnaire was a pretest before the data collection. All the diagnostic procedures and result interpretations followed SOPs. Before usage, the RDT kits were checked for expiration dates, appropriate storage conditions, and physical integrity prior to use. Before the survey, data collectors (three medical laboratory technicians and seven CHVs) received two days of training on interviews and rapid diagnostic tests (RDT). Data quality was monitored by the field supervisor through daily checks of data completeness and adherence to study protocols. Statistical analysis The collected data were checked, coded, and analyzed by using SPSS version 28 software. Means and standard deviations were used to represent continuous variables, whereas frequencies and percentages were used to compute categorical variables. The associations between asymptomatic malaria infection and its associated factors were investigated using bivariate and multivariate logistic regression. The study used crude and adjusted odds ratios with 95% confidence intervals, with P values < 0.05 indicating statistical significance. Finally, the findings are presented as text, tables, and graphs. Results Sociodemographic characteristics of the study respondents Among the 422 participants, 222 (53%) were female, and 137 (33%) were in the 35-44 age group. The majority of study participants were 264 (63%) were educated, 293 (69%) were married, and 268 (64%) were employed and had an income. Additionally, 263 (62%) had more than five members in their household (see Table 1). Table 1: Sociodemographic characteristics of the study participants, 2022 socio demographic variables Frequency % Sex Male 200 47% Female 222 53% Age 18-24 62 15% 25-34 120 28% 35-44 137 33% 45-54 81 19% ≥55 22 5% Marital status Unmarried 129 31% Married 293 69% Educational status Uneducational 158 37% Educational 264 63% Occupational Unemployed 154 36% Employed 268 64% Family size <5 159 38% ≥5 263 62% Prevalence of asymptomatic malaria Among the (422) participants who were tested for malaria using the rapid test, The overall prevalence of asymptomatic malaria based on RDT was 21 (5%) (see fig. 1), with P. falciparum and mixed infection of P. falciparum and P. vivax accounting for 95% (20/21) and 5% (1/21) of infections, respectively (see fig. 2). Prevalence of asymptomatic malaria by demographic characteristics: The total prevalence of asymptomatic malaria was 5%. Of these, 13 (6%) were women and 8 (4%) were men. The prevalence rate was 8 (7%) in the 25-34 age group, compared to 2 (2%) in the 45-54 age group. The bulk of instances were from the uneducated (8%), married (6%), those who work and have a source of income (6%), and families with less than five individuals (8%). The overall prevalence of asymptomatic malaria was 5%. Of these, 13 (6%) were females and 8 (4%) were males. The prevalence rate was 8 (7%) in the 25-34 age group, while it was 2 (2%) in the 45-54 age group. The majority of cases were from among the uneducated (8%), married (6%), those who work and have a source of income (6%), and those who have less than five members in their households (8%). Table (3): Prevalence of asymptomatic malaria by demographic characteristics in Al Zuhra District, Al-Hudaydah Governorate, Yemen, 2022 socio demographic variables Total (N=422) Positive n (%) p-value Sex Male 200 8 (4%) 0.38 Female 222 13 (6%) Age 18-24 62 3 (5%) 0.77 25-34 120 8 (7%) 35-44 137 7 (5%) 45-54 81 2 (2%) ≥55 22 1 (5%) Marital status Unmarried 129 12 (8%) 0.06 Married 293 9 (3%) Educational status Uneducational 158 3 (4%) Educational 264 18 (6%) 0.49 Occupational Unemployed 154 3 (4%) 0.44 Employed 268 18 (6%) Family size <5 159 15 (8%) ≥5 263 6 (4%) 0.06 Bivariable analysis of factors associated with asymptomatic malaria In bivariate logistic regression analysis, the absence of insecticide-treated nets (ITN) in homes (APOR 2.4, 95% CI 1.0-5.9, P=0.04), not using ITN at sleep (APOR 2.8, 95% CI 1.1-6.7, P=0.02), the absence of door screens (APOR 7.3, 95% CI 1.8-29.1, P=0.001), and living close to stagnant water (APOR 5.7, 95% CI 1.9-16.9, P=0.001) were the factors significantly associated with asymptomatic malaria infection, as shown in Table 3. Table (3): Bivariate analysis of factors associated with asymptomatic malaria among study participants in Al Zuhra District, Al-Hudaydah Governorate, Yemen, 2022 Variable Positive n (%) Negative n (%) OR (95% CI) P value Absence of insecticide-treated nets (ITN) in homes Yes 12 (8) 142(92) 2.4 (1.0-5.9) 0.04* No 9 (3) 259 (97) Not using ITN Yes 11 (9) 114 (91) 2.8(1.1-6.7) 0.02* No 10 (3) 287 (97) Absence of window screen Yes 3 (25) 9 (75) 7.3(1.8-29.1) 0.001* No 18 (4) 392 (96) Use of replants Yes 1 (5) 20 ) 95 ( 0.9 (0.1-7.5) 0.96 No 20 (5) 381 (95) Stagnant water around home Yes 5 (19) 21 (81) 5.7(1.9-16.9) 0.001* No 16 (4) 380 (96) Previous malaria infection history Yes 12 (4.4) 261 (95.6) 0.72(0.29 -1.74) 0.458 No 9 (6) 140 (94) Abbreviations: OR= odds ratio, CI= confidence interval, (*) indicates significance at p<0.05. Multivariable analysis of factors associated with asymptomatic malaria infection : In the multivariate analysis, the absence of a door screen (APOR 7.3, 95% CI 1.8-29.1, P=0.001) and living close to stagnant water (APOR 5.7, 95% CI 1.9-16.9, P=0.001) were the factors significantly associated with asymptomatic malaria infection, as shown in Table 4. Table (3): multivariate analysis of factors associated with asymptomatic malaria among study participants in Al Zuhra District, Al-Hudaydah Governorate, Yemen, 2022 Variable Positive n (%) Negative n (%) OR (95% CI) P value Absence of insecticide-treated nets (ITN) in homes Yes 12 (8) 142(92) 1.2 (0.1-8.0) 0.9 No 9 (3) 259 (97) Not using ITN Yes 11 (9) 114 (91) 2.2(0.2-21.4) 0.8 No 10 (3) 287 (97) Absence of window screen Yes 3 (25) 9 (75) 15.9(1.9-129.7) 0.001* No 18 (4) 392 (96) Use of replants Yes 1 (5) 20 ) 95 ( 0.6(0.06-5.4) 0.6 No 20 (5) 381 (95) Stagnant water around home Yes 5 (19) 21 (81) 6.6 (1.9-22.6) 0.002* No 16 (4) 380 (96) Previous malaria infection history Yes 12 (4.4) 261 (95.6) 0.6(0.2 -1.5) 0.3 No 9 (6) 140 (94) Abbreviations: OR= odds ratio, CI= confidence interval, (*) indicates significance at p<0.05. Discussion Malaria is an issue of public health in many nations globally, including Yemen, which is still in the malaria control phase [8]. The results of this study suggest an overall prevalence of asymptomatic malaria of 21% (5%). This conclusion is similar to research conducted in Thailand (5%) [12] and Ethiopia (4.8%) [10]. Higher prevalence rates than our research were also found in studies performed in Yemen, notably in Bajil District (8.0%) [13], the community survey in Al Hudaydah (16.2%) [14], and Hadhramaut (13%) [15], as well as in other countries such as Nigeria (77.6%) [16] and Tanzania (8%) [17]. This finding is greater than those reported in studies performed in Ethiopia (3%) [18] and Haiti (1.78%) [19]. This disparity may be attributable to changes in malaria prevalence, sample size, geographic location, and climatic conditions in the research locations. Regarding the causal parasite, the majority of patients (95%) were infected with Plasmodium falciparum, comparable with earlier investigations conducted in Yemen, notably in the Bajil area (99%) [13]. This figure is greater than those found in studies performed in India (77%) [20] and Ethiopia (57.9%) [18]. In this study, the prevalence of asymptomatic malaria was greater in females (6%) compared to males (4%). This conclusion is comparable to those obtained in investigations undertaken in Ethiopia [21] and Guinea [22]. However, this conclusion contrasts research undertaken in Ethiopia [23] and Morocco [24], where malaria incidence was greater among men. This gap may be ascribed to the fact that the majority of the research population were women, perhaps due to their presence at home. According to the results of this study, majority of malaria prevalence was found in the 25-34 age group (7%), which corresponds with a prior study conducted in Ethiopia [21] and Guinea [22].Our data suggest that the lack of a mosquito net in the home and the failure to sleep beneath one at night were statistically significant contributing variables to malaria infection (P<0.05). This outcome is similar to the study conducted in Ethiopia [25]. In our study, there was a statistically significant correlation between residing near stagnant water and asymptomatic malaria infection (P<0.05). This conclusion is consistent with earlier research conducted in Yemen, notably in Bajil District [13] and Hadhramaut [15], as well as in other countries such as Ethiopia [26]. Limitations This is a cross-sectional study and therefore limited, as it does not allow for the determination of disease incidence or the measurement of risk and cause-and-effect relationships. Rapid tests were used to diagnose malaria among the local population; therefore, the results of this study could have been more accurate if confirmed using light microscopy and advanced molecular techniques such as polymerase chain reaction (PCR), which have higher detection capabilities compared to rapid tests alone. The limited time available for conducting the study also contributed to this limitation. Conclusions and recommendations The overall prevalence of asymptomatic malaria was 5% in Al Zuhrah District, Al Hudaydah Governorate, where Plasmodium falciparum was the dominant species. The prevalence of asymptomatic malaria was higher among females and those aged 25–34 years. The Absence of insecticide-treated nets (ITN) in homes, absence of window screens, not using ITN and living close to stagnant water are statistically significant contributing factors to asymptomatic malaria. It is recommended to enhance community participation in malaria control programs by increasing awareness and engaging community volunteers in the distribution of insecticide-treated nets (ITNs) and other control strategies, as well as conduct further surveys to determine the prevalence of asymptomatic malaria using advanced techniques. Abbreviations WHO World Health Organization IRS Indoor Residual Spray LLINs Long-Lasting Insecticidal Nets ITN Insecticide-Treated Net SOP Standard Operating Procedures CHV community health volunteers RDT Rapid Diagnostic Test COR Crude Odd Ratio AOR Adjusted Odd Ratio CI Confidence Interval SPSS Statistical Package for Social Science eIDEWS Electronic Integrated Disease Early Warning System and Response Declarations Acknowledgments The authors are grateful to all the study respondents who participated in this research wholeheartedly. Special thanks to go Yemen Field Epidemiology Training Program and Electronic Integrated Disease Early Warning System & Response (eIDEWS) Yemen, Health office and Enviroment in HOddidah governoment and zuhura district , health professionals and community health volunteers (CHVs) and District Health offices’ staff, Village leaders and and Study Participants for their unreserved cooperation and supports given towards the success of this study. Author contributions Mohammed Hajjam was responsible for data collection, sample analysis, and manuscript writing. The supervisor, Mohammed Alemad, made revisions to the conclusion, discussion, data analysis, and results. Samar Nasher contributed extensively from its origin up to the document preparation and its critical editing. Funding Not applicable. Conflicts of Interest No financial or commercial ties existed between the authors at the time of the research that might be considered a conflict of interest, as the authors affirm Ethical Clearance The Health Office's Ethics Committee provided ethical approval (Ref. No.:2108, Date: 13 November 2022). The study was also approved by the district health office. Ethical guidelines derived from the Declaration of Helsinki were followed throughout the research. Participation was optional, and all participants provided written informed permission after being explained the study's aims. 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PLoS ONE. 2015;10(4):e0123630. Fekadu M, Yenit MK, Lakew AM. The prevalence of asymptomatic malaria parasitemia and associated factors among adults in Dembia district, northwest Ethiopia, 2017. Archives public health. 2018;76(1):1–6. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 16 Feb, 2026 Reviews received at journal 06 Feb, 2026 Reviewers agreed at journal 03 Feb, 2026 Reviewers invited by journal 03 Feb, 2026 Editor assigned by journal 07 Jan, 2026 Submission checks completed at journal 07 Jan, 2026 First submitted to journal 06 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8532964","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":584868840,"identity":"c03f7f96-333a-47e9-bb67-1c41743d0549","order_by":0,"name":"Mohammed Ahamed Hajjam","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYFACHgYGCSDmZ2Zs//EByGdjJ1aLZHtzg+QMkBZmYrSAgMGZ4w3SYDYhLboNvAc/WMjYRTPcSGwwtvm1TZ6PmYHxw8cc3FrMDvAlS0jwJOc2zkhsSM7tu23YxszALDlzGz4tPAZALcy5zRKJDYdze24zArWwMfPi12L8Q4KnPrdNIrGx2bLntj0xWsyAtgDN5znYzMzw43YiYS2HecwsJHiO585gb2xj7G24ndzGzNiM3y/He4xvS/ZU5+4/zP6M4cef27bz25sPfviIRwsoFpgle6AcxjYw2YBHPVThhx8w5h+CikfBKBgFo2AEAgB7qE5wiGpIGgAAAABJRU5ErkJggg==","orcid":"","institution":"Hodeidah Governorate","correspondingAuthor":true,"prefix":"","firstName":"Mohammed","middleName":"Ahamed","lastName":"Hajjam","suffix":""},{"id":584868841,"identity":"cdee3268-cf8f-44a9-a0f2-fb1cf91f7c9c","order_by":1,"name":"Samar Saeed Nasher","email":"","orcid":"","institution":"Surveillance department, Ministry of Health and Environment , Sana’a City, Yemen","correspondingAuthor":false,"prefix":"","firstName":"Samar","middleName":"Saeed","lastName":"Nasher","suffix":""},{"id":584868842,"identity":"beece42c-64dc-4699-bde6-21fd6015d397","order_by":2,"name":"Mohammed Abdullah Al Amad","email":"","orcid":"","institution":"Sana’a University","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"Abdullah Al","lastName":"Amad","suffix":""}],"badges":[],"createdAt":"2026-01-06 15:38:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8532964/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8532964/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102180321,"identity":"54dd4c59-0b8d-4b16-826d-a127e13b17fa","added_by":"auto","created_at":"2026-02-09 07:12:49","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":21765,"visible":true,"origin":"","legend":"\u003cp\u003eThe overall prevalence of asymptomatic malaria\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8532964/v1/5d90eeae2789d1ed8974499c.jpg"},{"id":102180070,"identity":"c0ccc5b9-456a-435c-a563-765111c260eb","added_by":"auto","created_at":"2026-02-09 07:12:13","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":21537,"visible":true,"origin":"","legend":"\u003cp\u003eThe prevalence of plasmodium species\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8532964/v1/ecca679aaf591d99571dab2b.jpg"},{"id":102180327,"identity":"0e15978e-4a45-45d9-b94d-30eb5f6ca2ed","added_by":"auto","created_at":"2026-02-09 07:12:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":926566,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8532964/v1/4960ae1e-fcb0-4a6c-b333-8c81e2ecb9ac.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of asymptomatic malaria and its associated factors in the Al Zuhrah district, Al-Hodeidah Government, Yemen, 2022","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMalaria is still a major health concern globally and a leading cause of morbidity and mortality, particularly in low- and middle-income countries which is caused by the Plasmodium parasites and spreads to people through the bites of infected female Anopheles mosquitos. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] The five Plasmodium species that cause malaria in humans are falciparum, vivax, ovale, knowlesi, and malariae. Plasmodium falciparum and vivax present the greatest public health risk. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Malaria infection is controllable and avoidable, but it can cause severe febrile illness and lead to life-threatening consequences if not treated properly [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMalaria's presents with a spectrum range of clinical manifestations that ranges from asymptomatic infection to life-threatening forms of the disease [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Asymptomatic malaria refers to he detection of the Plasmodium parasite in the blood of infected individuals who do not exhibit any clinical signs of malaria disease [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. While symptomatic cases are more likely to be recognized and treated, asymptomatic infections are frequently overlooked and untreated, allowing infected persons to serve as silent reservoirs for ongoing malaria transmission. This buried parasite reservoir presents a poses a major obstacle to malaria elimination efforts, especially in regions where the disease is endemic [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite ongoing global control measures, malaria continues to to exert a substantial burden. In 2022, the disease was projected to affect approximately 249\u0026nbsp;million people worldwide and 608,000 deaths, compared with 244\u0026nbsp;million cases and 610,000 fatalities in 2021 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. It is endemic in 85 countries and regions, with a considerable proportion of the populace in these locations still at risk of infection [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although the National Malaria Control Programme (NMCP) has been active since early 2000, around 64.5% of the population is still considered at risk [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. in the Eastern Mediterranean Region (EMRO),Plasmodium falciparum accounts for more than 99% of infections, resulting in roughly 5.7\u0026nbsp;million illnesses and 12,330 deaths by 2020 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMalaria is endemic in Yemen, particularly in coastal regions, where more than two-thirds of the population is at risk of contracting the disease. Consequently, it ranks among the top ten causes of morbidity and mortality in the country [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In 2021, there were approximately 133,494 malaria cases reported, with Al-Hodeidah governorate accounting for approximately 26,635 incidences [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Despite this large burden, data on silent malaria in Yemen is sparse.\u003c/p\u003e \u003cp\u003eUnderstanding the frequency of asymptomatic malaria is critical for designing surveillance systems and implementing effective, targeted control and elimination measures [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, the epidemiology of asymptomatic malaria in Yemen remains unknown, and no previous studies have assessed its frequency and associated characteristics in this scenario. As a result, this study aims to investigate the frequency and related characteristics of asymptomatic malaria in Al Zuhra district, Al Hodeidah governorate, Yemen.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, setting and period\u003c/h2\u003e \u003cp\u003eThis is a cross-sectional community-based study conducted from the period of November 21st to December 30th, 2022. Al Zuhrah district, located on the western coast of Hodeidah Governorate, Yemen, was selected due to its hyperendemic malaria, predominantly caused by Plasmodium falciparum with occasional P. vivax infections. According to the national malaria program, this area has a high transmission rate, making it an optimal site for assessing asymptomatic malaria and its associated factors. This site is described as a tropical area, and the Morul River passes through it with two transmission periods for malaria seasons, which are August-April and May-September. The district has an estimated population of approximately 246,042 people and includes one hospital, three health centers, and 23 health units. Most residents engaged in agriculture, fishing, or other rural livelihoods.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eEvery person aged 18 and older who had resided in the Al Zuhrah district for at least one year and was available at the time of data collection was present during the data collection period.\u003c/p\u003e\n\u003ch3\u003eInclusion and exclusion criteria\u003c/h3\u003e\n\u003cp\u003eParticipants aged 18 and older who had lived in the Al Zuhrah district for at least a year, were present during data collection, volunteered to participate in the study, and had an auxiliary body temperature of 37.5\u0026deg;C at the time of data collection were eligible. Participants who were unwilling to participate, had mental illness or communication impairments, resided in the Az Zuhra district for at least one year, received antimalarial therapy in the past month, or exhibited fever (\u0026ge;\u0026thinsp;38\u0026deg;C) or malaria-like symptoms within the previous 48\u0026ndash;72 hours were excluded.\u003c/p\u003e\n\u003ch3\u003eSample size\u003c/h3\u003e\n\u003cp\u003eTo determine the sample size, we used the single population proportion formula: (n\u0026thinsp;=\u0026thinsp;Z\u0026sup2; p(1-p) d2), where n is the required sample size, p is the expected prevalence of asymptomatic malaria (50%), Z is the standard normal value with a 95% confidence interval (Z\u0026thinsp;=\u0026thinsp;1.96), and d2 is the acceptable error (5%). The minimum sample size was 384. Following that, 10% (38) was added to account for nonresponse or missing data, resulting in a total sample size of 422 individuals.\u003c/p\u003e\n\u003ch3\u003eSampling approach and process\u003c/h3\u003e\n\u003cp\u003eA multistage sampling method was employed to choose a representative sample of the study population.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eStage 1: A complete list of all villages in Al Zuhrah district was received from the District Health Office. Thirty villages were randomly selected.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStage 2: To determine the proportionate sample size for each selected village, current household demographic statistics from the local government were used. The total sample size was allocated proportionally among the selected 30 villages according to the number of households in each village.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStage 3: Within each selected village, households were selected using simple random sampling. From each selected household, one eligible adult per household (either the household head (male or female) or any adult member (\u0026ge;\u0026thinsp;18 years) present at the time of the visit) was randomly selected to participate in the study.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eData were collected through face-to-face interviews using a structured questionnaire adapted from instruments that had been validated in previous studies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], with a minor alteration to meet local cultural norms. The questionnaire was initially created in English, then translated into Arabic (the local language) and validated by subject matter experts. Each interview lasted around 15\u0026ndash;20 minutes.\u003c/p\u003e \u003cp\u003eThe questionnaire consisted of three parts/sections. The first part consisted of questions on the participants' sociodemographic characteristics. The second part of the section included questions related to asymptomatic malaria infection, including associated factors. The third section documented laboratory test results used to confirm malaria infection status.\u003c/p\u003e \u003cp\u003eAxillary body temperature was measured by trained health professionals and community health volunteers (CHVs) to ensure that the participants met the asymptomatic criteria (absence of fever at the time of data collection).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eBlood collection and analysis\u003c/h3\u003e\n\u003cp\u003eMalaria infection status was detected by RDT (CareStart TM Malaria HRP2/pLDH (Pf/PAN) Combo, Access Bio, New Jersey, USA), which is WHO-approved and frequently used by the National Malaria Control Programme (NMCP). Participants collected 5 \u0026micro;l of finger prick capillary blood with a sterile lancet and deposited it in the test cassette according to the manufacturer's instructions. After 20 minutes, the test results were examined and classified as negative, positive for Plasmodium falciparum, positive for Plasmodium vivax, or mixed. Each test cassette has a unique participant identification code. All processes followed standard operating procedures (SOPs) for biosafety and waste disposal.\u003c/p\u003e\n\u003ch3\u003eStudy Variables\u003c/h3\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDependent variable\u003c/h2\u003e \u003cp\u003eAsymptomatic malaria infection is characterized by the detection of malaria parasites through RDT in a person who do not have a fever (\u0026lt;\u0026thinsp;37.5\u0026deg;C) and have not experienced any malaria-related symptoms either in the two days prior to the survey or at the time of the assessment [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eIndependent variable\u003c/h2\u003e \u003cp\u003eDemographic characteristics of the individuals and factors associated with asymptomatic malaria infection.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eQuality control\u003c/h2\u003e \u003cp\u003eThe questionnaire was a pretest before the data collection. All the diagnostic procedures and result interpretations followed SOPs. Before usage, the RDT kits were checked for expiration dates, appropriate storage conditions, and physical integrity prior to use. Before the survey, data collectors (three medical laboratory technicians and seven CHVs) received two days of training on interviews and rapid diagnostic tests (RDT). Data quality was monitored by the field supervisor through daily checks of data completeness and adherence to study protocols.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe collected data were checked, coded, and analyzed by using SPSS version 28 software. Means and standard deviations were used to represent continuous variables, whereas frequencies and percentages were used to compute categorical variables. The associations between asymptomatic malaria infection and its associated factors were investigated using bivariate and multivariate logistic regression. The study used crude and adjusted odds ratios with 95% confidence intervals, with P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicating statistical significance. Finally, the findings are presented as text, tables, and graphs.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSociodemographic\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;characteristics of the study respondents\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the\u0026nbsp;422 participants, 222 (53%) were\u0026nbsp;female,\u0026nbsp;and 137 (33%) were in the 35-44 age group. The majority of study participants were 264 (63%) were educated, 293 (69%) were married, and 268 (64%) were employed and had an income. Additionally, 263 (62%) had more than five members in their household (see Table 1).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 567px;\"\u003e\n \u003cp\u003eTable 1: Sociodemographic characteristics of the study \u0026nbsp;participants, 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 304px;\"\u003e\n \u003cp\u003e\u003cstrong\u003esocio demographic variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 189px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e47%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e53%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e18-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e25-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e28%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e35-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e33%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e45-54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e19%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026ge;55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 189px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e31%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e69%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 189px;\"\u003e\n \u003cp\u003eEducational status\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eUneducational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e37%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eEducational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e63%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 189px;\"\u003e\n \u003cp\u003eOccupational\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e36%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e64%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 189px;\"\u003e\n \u003cp\u003eFamily size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026lt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e38%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026ge;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e62%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of asymptomatic malaria\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the (422) participants who were tested for malaria using the rapid test, The overall prevalence of asymptomatic malaria based on RDT was 21 (5%) (see fig. 1), with P. falciparum and mixed infection of P. falciparum and P. vivax accounting for 95% (20/21) and 5% (1/21) of infections, respectively (see fig. 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of asymptomatic malaria by demographic characteristics:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe total prevalence of asymptomatic malaria was 5%. Of these, 13 (6%) were women and 8 (4%) were men. The prevalence rate was 8 (7%) in the 25-34 age group, compared to 2 (2%) in the 45-54 age group. The bulk of instances were from the uneducated (8%), married (6%), those who work and have a source of income (6%), and families with less than five individuals (8%).\u003c/p\u003e\n\u003cp\u003eThe overall prevalence of asymptomatic malaria was 5%. Of these, 13 (6%) were females and 8 (4%) were males. The prevalence rate was 8 (7%) in the 25-34 age group, while it was 2 (2%) in the 45-54 age group. The majority of cases were from among the uneducated (8%), married (6%), those who work and have a source of income (6%), and those who have less than five members in their households (8%).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"635\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 635px;\"\u003e\n \u003cp\u003eTable (3): Prevalence of asymptomatic malaria by demographic characteristics in Al Zuhra District, Al-Hudaydah Governorate, Yemen, 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 292px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; socio demographic variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eTotal (N=422)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003ePositive n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 165px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e8 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e13 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 165px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\n \u003cp\u003e18-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e3 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\n \u003cp\u003e25-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e8 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\n \u003cp\u003e35-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e7 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\n \u003cp\u003e45-54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e2 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026ge;55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e1 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 165px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e12 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e9 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 165px;\"\u003e\n \u003cp\u003eEducational status\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eUneducational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e3 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eEducational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e18 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 165px;\"\u003e\n \u003cp\u003eOccupational\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e3 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e18 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 165px;\"\u003e\n \u003cp\u003eFamily size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026lt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e15 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026ge;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e6 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eBivariable analysis of factors associated with asymptomatic malaria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn bivariate logistic regression analysis, the absence of insecticide-treated nets (ITN) in homes (APOR 2.4, 95% CI 1.0-5.9, P=0.04), not using ITN at sleep (APOR 2.8, 95% CI 1.1-6.7, P=0.02), the absence of door screens (APOR 7.3, 95% CI 1.8-29.1, P=0.001), and living close to stagnant water (APOR 5.7, 95% CI 1.9-16.9, P=0.001) were the factors significantly associated with asymptomatic malaria infection, as shown in Table 3.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"680\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 680px;\"\u003e\n \u003cp\u003eTable (3): Bivariate analysis of factors associated with asymptomatic malaria\u0026nbsp;among\u0026nbsp;study participants\u0026nbsp;in Al Zuhra District, Al-Hudaydah Governorate, Yemen, 2022\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3464%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.9771%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 243px;\"\u003e\n \u003cp\u003eAbsence of insecticide-treated nets (ITN) in homes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3464%;\"\u003e\n \u003cp\u003e12 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.9771%;\"\u003e\n \u003cp\u003e142(92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2.4 (1.0-5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3464%;\"\u003e\n \u003cp\u003e9 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.9771%;\"\u003e\n \u003cp\u003e259 (97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNot using ITN\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3464%;\"\u003e\n \u003cp\u003e11 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.9771%;\"\u003e\n \u003cp\u003e114 (91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2.8(1.1-6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.02*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3464%;\"\u003e\n \u003cp\u003e10 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.9771%;\"\u003e\n \u003cp\u003e287 (97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 243px;\"\u003e\n \u003cp\u003eAbsence\u0026nbsp;of window screen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3464%;\"\u003e\n \u003cp\u003e3 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.9771%;\"\u003e\n \u003cp\u003e9 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.3(1.8-29.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3464%;\"\u003e\n \u003cp\u003e18 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.9771%;\"\u003e\n \u003cp\u003e392 (96)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 243px;\"\u003e\n \u003cp\u003eUse of replants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3464%;\"\u003e\n \u003cp\u003e1 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.9771%;\"\u003e\n \u003cp\u003e20\u003cspan dir=\"RTL\"\u003e) \u0026nbsp;\u003c/span\u003e95\u003cspan dir=\"RTL\"\u003e\u0026nbsp;(\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.9 (0.1-7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3464%;\"\u003e\n \u003cp\u003e20 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.9771%;\"\u003e\n \u003cp\u003e381 (95)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 243px;\"\u003e\n \u003cp\u003eStagnant water around home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3464%;\"\u003e\n \u003cp\u003e5 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.9771%;\"\u003e\n \u003cp\u003e21 (81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e5.7(1.9-16.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3464%;\"\u003e\n \u003cp\u003e16 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.9771%;\"\u003e\n \u003cp\u003e380 (96)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 243px;\"\u003e\n \u003cp\u003ePrevious malaria infection history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3464%;\"\u003e\n \u003cp\u003e12 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.9771%;\"\u003e\n \u003cp\u003e261 (95.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.72(0.29 -1.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.458\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3464%;\"\u003e\n \u003cp\u003e9 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.9771%;\"\u003e\n \u003cp\u003e140 (94)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: OR= odds ratio, CI= confidence interval,\u0026nbsp;(*) indicates significance at p\u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultivariable analysis of factors associated with asymptomatic malaria infection\u003c/strong\u003e\u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e:\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the multivariate analysis, the absence of a door screen (APOR 7.3, 95% CI 1.8-29.1, P=0.001) and living close to stagnant water (APOR 5.7, 95% CI 1.9-16.9, P=0.001) were the factors significantly associated with asymptomatic malaria infection, as shown in Table 4.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"671\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 671px;\"\u003e\n \u003cp\u003eTable (3): multivariate analysis of factors associated with asymptomatic malaria among study participants in Al Zuhra District, Al-Hudaydah Governorate, Yemen, 2022\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 215px;\"\u003e\n \u003cp\u003eAbsence of insecticide-treated nets (ITN) in homes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e12 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e142(92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.2 (0.1-8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e9 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e259 (97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 215px;\"\u003e\n \u003cp\u003eNot using ITN\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e11 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e114 (91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2.2(0.2-21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e10 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e287 (97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 215px;\"\u003e\n \u003cp\u003eAbsence of window screen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e3 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e9 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e15.9(1.9-129.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e18 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e392 (96)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 215px;\"\u003e\n \u003cp\u003eUse of replants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e20\u003cspan dir=\"RTL\"\u003e) \u0026nbsp;\u003c/span\u003e95\u003cspan dir=\"RTL\"\u003e\u0026nbsp;(\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.6(0.06-5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e20 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e381 (95)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 215px;\"\u003e\n \u003cp\u003eStagnant water around home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e5 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e21 (81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6.6 (1.9-22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e16 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e380 (96)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 215px;\"\u003e\n \u003cp\u003ePrevious malaria infection history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e12 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e261 (95.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.6(0.2 -1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e9 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e140 (94)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: OR= odds ratio, CI= confidence interval, (*) indicates significance at p\u0026lt;0.05.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMalaria is an issue of public health in many nations globally, including Yemen, which is still in the malaria control phase [8]. The results of this study suggest an overall prevalence of asymptomatic malaria of 21% (5%). This conclusion is similar to research conducted in Thailand (5%) [12] and Ethiopia (4.8%) [10]. Higher prevalence rates than our research were also found in studies performed in Yemen, notably in Bajil District (8.0%) [13], the community survey in Al Hudaydah (16.2%) [14], and Hadhramaut (13%) [15], as well as in other countries such as Nigeria (77.6%) [16] and Tanzania (8%) [17]. This finding is greater than those reported in studies performed in Ethiopia (3%) [18] and Haiti (1.78%) [19]. This disparity may be attributable to changes in malaria prevalence, sample size, geographic location, and climatic conditions in the research locations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding the causal parasite, the majority of patients (95%) were infected with Plasmodium falciparum, comparable with earlier investigations conducted in Yemen, notably in the Bajil area (99%) [13]. This figure is greater than those found in studies performed in India (77%) [20] and Ethiopia (57.9%) [18].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this study, the prevalence of asymptomatic malaria was greater in females (6%) compared to males (4%). This conclusion is comparable to those obtained in investigations undertaken in Ethiopia [21] and Guinea [22]. However, this conclusion contrasts research undertaken in Ethiopia [23] and Morocco [24], where malaria incidence was greater among men. This gap may be ascribed to the fact that the majority of the research population were women, perhaps due to their presence at home.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to the results of this study, \u0026nbsp;majority of malaria prevalence was found in the 25-34 age group (7%), which corresponds with a prior study conducted in Ethiopia [21] and Guinea [22].Our data suggest that the lack of a mosquito net in the home and the failure to sleep beneath one at night were statistically significant contributing variables to malaria infection (P\u0026lt;0.05). This outcome is similar to the study conducted in Ethiopia [25]. In our study, there was a statistically significant correlation between residing near stagnant water and asymptomatic malaria infection (P\u0026lt;0.05). This conclusion is consistent with earlier research conducted in Yemen, notably in Bajil District [13] and Hadhramaut [15], as well as in other countries such as Ethiopia [26].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a cross-sectional study and therefore limited, as it does not allow for the determination of disease incidence or the measurement of risk and cause-and-effect relationships. Rapid tests were used to diagnose malaria among the local population; therefore, the results of this study could have been more accurate if confirmed using light microscopy and advanced molecular techniques such as polymerase chain reaction (PCR), which have higher detection capabilities compared to rapid tests alone. The limited time available for conducting the study also contributed to this limitation.\u003c/p\u003e"},{"header":"Conclusions and recommendations","content":"\u003cp\u003eThe overall prevalence of asymptomatic malaria was 5% in Al Zuhrah District, Al Hudaydah Governorate, where Plasmodium falciparum was the dominant species. The prevalence of asymptomatic malaria was higher among females and those aged 25\u0026ndash;34 years. The Absence of insecticide-treated nets (ITN) in homes, absence of window screens, not using ITN and living close to stagnant water are statistically significant contributing factors to asymptomatic malaria. It is recommended to enhance community participation in malaria control programs by increasing awareness and engaging community volunteers in the distribution of insecticide-treated nets (ITNs) and other control strategies, as well as conduct further surveys to determine the prevalence of asymptomatic malaria using advanced techniques.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eWHO World Health Organization\u003c/p\u003e\n\u003cp\u003eIRS Indoor Residual Spray\u003c/p\u003e\n\u003cp\u003eLLINs Long-Lasting Insecticidal Nets\u003c/p\u003e\n\u003cp\u003eITN Insecticide-Treated Net\u003c/p\u003e\n\u003cp\u003eSOP Standard Operating Procedures\u003c/p\u003e\n\u003cp\u003eCHV\u0026nbsp;\u0026nbsp;community health volunteers\u003c/p\u003e\n\u003cp\u003eRDT Rapid Diagnostic Test\u003c/p\u003e\n\u003cp\u003eCOR Crude Odd Ratio\u003c/p\u003e\n\u003cp\u003eAOR Adjusted Odd Ratio\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCI Confidence Interval\u003c/p\u003e\n\u003cp\u003eSPSS Statistical Package for Social Science\u003c/p\u003e\n\u003cp\u003eeIDEWS \u0026nbsp; Electronic Integrated Disease Early Warning System and Response\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to all the study respondents who participated in this research wholeheartedly. Special thanks to go Yemen \u0026nbsp;Field Epidemiology Training Program and Electronic Integrated Disease Early Warning System \u0026amp; Response (eIDEWS) Yemen, Health office and Enviroment in HOddidah governoment and zuhura district , health professionals and community health volunteers (CHVs) and District Health offices\u0026rsquo; staff, Village leaders and and Study Participants for their unreserved cooperation and supports given towards the success of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMohammed Hajjam was responsible for data collection, sample analysis, and manuscript writing. The supervisor, Mohammed Alemad, made revisions to the conclusion, discussion, data analysis, and results. Samar Nasher contributed extensively from its origin up to the document preparation and its critical editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo financial or commercial ties existed between the authors at the time of the research that might be considered a conflict of interest, as the authors affirm\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Clearance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Health Office\u0026apos;s Ethics Committee provided ethical approval (Ref. No.:2108, Date: 13 November 2022). The study was also approved by the district health office. Ethical guidelines derived from the Declaration of Helsinki were followed throughout the research. \u0026nbsp;Participation was optional, and all participants provided written informed permission after being explained the study\u0026apos;s aims. Participants\u0026apos; confidentiality and privacy were ensured throughout the study. All asymptomatic malaria patients were sent to the nearest health unit or facility for suitable care according with national malaria treatment guidline.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. World malaria report 2023. World Health Organization; 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Awadhi M, Ahmad S, Iqbal J. Current status and the epidemiology of malaria in the Middle East Region and beyond. Microorganisms. 2021;9(2):338.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilwamba W, Chisompola D, Nzobokela J, Chakulya M, Kabwe L, Tembo K. Hidden reservoirs of infection: prevalence and risk factors of asymptomatic malaria in a high-endemic region of Zambia. Malar J. 2025;24(1):221.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBiruksew A, Demeke A, Birhanu Z, Golassa L, Getnet M, Yewhalaw D. Schoolchildren with asymptomatic malaria are potential hotspot for malaria reservoir in Ethiopia: implications for malaria control and elimination efforts. Malar J. 2023;22(1):311.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLindblade KA, Steinhardt L, Samuels A, Kachur SP, Slutsker L. The silentthreat: asymptomatic parasitemia and malaria transmission. Expert RevAnti-infect Ther. 2013;11:623\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. World Malaria Report 2022; World Health Organization: Geneva, Switzerland, 2022. Available online: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2022\u003c/span\u003e\u003cspan address=\"https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2022\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed on 20 August 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. World Malaria Report 2021. Geneva: World Health Organization; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIOM. Malaria in Yemen: Needs assessment. 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMOPH. An electronic disease early warning system in Sana\u0026rsquo;a, Yemen, annual report.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbebaw A, Aschale Y, Kebede T, Hailu A. The prevalence of symptomatic and asymptomatic malaria and its associated factors in Debre Elias district communities, Northwest Ethiopia. Malar J. 2022;21(1):167.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKorzeniewski K, Bylicka-Szczepanowska E, Lass A. Prevalence of asymptomatic malaria infections in seemingly healthy children, the rural Dzanga Sangha region, Central African Republic. Int J Environ Res Public Health. 2021;18(2):814.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eImwong M, Nguyen TN, Tripura R, Peto TJ, Lee SJ, Lwin KM, et al. The epidemiology of subclinical malaria infections in South-East Asia: findings from cross-sectional surveys in Thailand\u0026ndash;Myanmar border areas, Cambodia, and Vietnam. Malar J. 2015;14(1):1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlwajeeh TS, Abdul-Ghani R, Allam AF, Farag HF, Khalil SS, Shehab AY, et al. Uncomplicated falciparum malaria among schoolchildren in Bajil district of Hodeidah governorate, west of Yemen: association with anaemia and underweight. Malar J. 2020;19(1):1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohamed TAM, Hassan KB, Zeinab SAH, Abdel Ghany EM, Hanan ZS. Malaria status in Al-Hodeidah Governorate, Yemen: malariometric parasitic survrey and chloroquine resistance P. falciparum local strain. 2003.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohanna B, Bin Ghouth A, Raja'a Y. Malaria signs and infection rate among asymptomatic schoolchildren in Hajr Valley, Yemen. EMHJ-Eastern Mediterranean Health Journal, 13 (1), 35\u0026ndash;40, 2007. 2007.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIgwe NM, Joannes UOU, Chukwuma OB, Chukwudi OR, Oliaemeka EP, Maryrose AU, et al. Prevalence and parasite density of asymptomatic malaria parasitemia among unbooked paturients at Abakaliki, Nigeria. J Basic Clin Reproductive Sci. 2014;3(1):44\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSumari D, Mwingira F, Selemani M, Mugasa J, Mugittu K, Gwakisa P. Malaria prevalence in asymptomatic and symptomatic children in Kiwangwa, Bagamoyo district, Tanzania. Malar J. 2017;16(1):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMelese Y, Alemu M, Yimer M, Tegegne B, Tadele T. Asymptomatic Malaria in Households and Neighbors of Laboratory Confirmed Cases in Raya Kobo District, Northeast Ethiopia. Ethiop J Health Sci. 2022;32(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElbadry MA, Al-Khedery B, Tagliamonte MS, Yowell CA, Raccurt CP, Existe A, et al. High prevalence of asymptomatic malaria infections: a cross-sectional study in rural areas in six departments in Haiti. Malar J. 2015;14(1):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumari P, Sinha S, Gahtori R, Yadav CP, Pradhan MM, Rahi M, et al. Prevalence of asymptomatic malaria parasitemia in Odisha, India: a challenge to malaria elimination. Am J Trop Med Hyg. 2020;103(4):1510.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuguma T, Tekalign E, Muleta D, Simieneh A. Malaria prevalence and risk factors among patients visiting Mizan Tepi University Teaching Hospital, Southwest Ethiopia. PLoS ONE. 2022;17(7):e0271771.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoadu I, Nsemani W, Ubachukwu P, Okafor F. Knowledge and Prevalence of Malaria among Rural Households in Ghana. J Community Med Health Educ. 2020;10(673):2. Available online at ISSN: 2161\u0026thinsp;\u0026ndash;\u0026thinsp;0711.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorku L, Damtie D, Endris M, Getie S, Aemero M. Asymptomatic malaria and associated risk factors among school children in Sanja town, Northwest Ethiopia. International Scholarly Research Notices. 2014;2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKimbi HK, Keka F, Nyabeyeu H, Ajeagah H, Tonga C, Lum E, et al. An update of asymptomatic falciparum malaria in school children in Muea, Southwest Cameroon. J Bacteriol Parasitol. 2012;3(154):2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNega D, Dana D, Tefera T, Eshetu T. Prevalence and predictors of asymptomatic malaria parasitemia among pregnant women in the rural surroundings of Arbaminch Town, South Ethiopia. PLoS ONE. 2015;10(4):e0123630.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFekadu M, Yenit MK, Lakew AM. The prevalence of asymptomatic malaria parasitemia and associated factors among adults in Dembia district, northwest Ethiopia, 2017. Archives public health. 2018;76(1):1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Asymptomatic malaria, prevalence, associated factors, Al-Hodeidah, Yemen","lastPublishedDoi":"10.21203/rs.3.rs-8532964/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8532964/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAsymptomatic malaria represents a significant health issue, especially in endemic regions where asymptomatic individuals serve as reservoirs. In Yemen, the Al-Hodeidah governorate is the primary endemic area. This study aims to determine the prevalence of asymptomatic malaria and its associated factors in Al-Zuhra District, Al-Hodeidah Governorate.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional community-based study was conducted using a multistage sampling method with probability proportional to size to select villages and households. In each household, one eligible member who had not experienced malaria symptoms and had consented to participate was randomly selected. Data were collected using a semi-structured questionnaire, and blood samples were tested for malaria using the Rapid Diagnostic Test. Logistic regression was used to calculate crude and adjusted prevalence odds ratios (APOR) with 95% confidence intervals (CI). A P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 422 participants (mean age of 35.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11 years; 47% were male, and 62% were from a family with more than five members) were enrolled. The overall prevalence of symptomatic malaria was 5%, with Plasmodium falciparum accounting for 95% of infections. Absence of insecticide-treated nets (ITN) in homes (APOR 2.4, 95% CI 1.0-5.9, P\u0026thinsp;=\u0026thinsp;0.04), absence of window screens (APOR 7.3, 95% CI 1.8\u0026ndash;29.1, P\u0026thinsp;=\u0026thinsp;0.001), not using ITN (APOR 2.8, 95% CI 1.1\u0026ndash;6.7, P\u0026thinsp;=\u0026thinsp;0.02), and living near stagnant water (APOR 5.7, 95% CI 1.9\u0026ndash;16.9, P\u0026thinsp;=\u0026thinsp;0.001) were significantly associated with asymptomatic malaria.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003easymptomatic malaria is prevalent in Al-Zuhra District; however, the absence of or unimplemented mosquito control measures was the associated factor. To reduce malaria infection, community participation in malaria control, including increased awareness and ITN use and environmental management, is recommended.\u003c/p\u003e","manuscriptTitle":"Prevalence of asymptomatic malaria and its associated factors in the Al Zuhrah district, Al-Hodeidah Government, Yemen, 2022","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 07:09:28","doi":"10.21203/rs.3.rs-8532964/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-17T02:30:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-06T09:23:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"74024436497970342650141020481128992915","date":"2026-02-03T08:10:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-03T07:26:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-08T01:11:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-07T16:40:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"Malaria Journal","date":"2026-01-06T15:15:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9e86ec8a-ed08-4a90-9a62-d280ff2d7e49","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T21:53:15+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 07:09:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8532964","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8532964","identity":"rs-8532964","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}