Prevalence of Plasmodium spp. in Symptomatic BaAka Pygmies Inhabiting the Rural Dzanga Sangha Region, Central African Republic

Abstract Background: Malaria remains a diagnostic and therapeutic challenge in many endemic regions of sub-Saharan Africa. The objective of the study was to assess the prevalence of Plasmodium spp. in BaAka Pygmies with clinical symptoms of malaria, inhabitants of the rural Dzanga Sangha region in Central African Republic. Additionally, the research aimed to define the percentage distribution of infections caused by other than P. falciparum species in order to assess the need for diversification of malaria treatment protocols in the region of Central Africa. Material and methods: The study was conducted during dry and rainy season in 2018 and involved a group of 540 symptomatic BaAka Pygmies, patients of both sexes, aged 1–75 years old. Two diagnostic methods for detecting Plasmodium in the bloodstream were used: RDTs targeting HRP2–protein specific for P. falciparum and PCR assays aimed at detecting P. falciparum, P. vivax, P. ovale, P. malariae species. Results: Only 40.5% of symptomatic patients tested with RDTs for P. falciparum infections were positive. While molecular tests (PCR) confirmed P. falciparum in 94.8% of the samples and also revealed the genetic material of P. malariae (11.1%), P. ovale (9.8%), and P. vivax (0.7%). BaAka Pygmies aged <5 years old dominated in patients with positive results; the common clinical symptoms reported by the sick individuals were fever, shivers and fatigue. Conclusions: The presented study suggest the need for introducing more accurate diagnostic methods for the diagnosis of malaria and the revision of malaria treatment protocols. The assessment of the Pfhrp2/Pfhrp3 deletions is necessary for evaluating malaria epidemiology in Central Africa.