Genomic Surveillance to Estimate the burden of Sub-microscopic malaria infections, Parasite Species Composition and Implication for Elimination in Uganda; First Evidence at National Scale - 2025

Genomic Surveillance to Estimate the burden of Sub-microscopic malaria infections, Parasite Species Composition and Implication for Elimination in Uganda; First Evidence at National Scale - 2025 | 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 Genomic Surveillance to Estimate the burden of Sub-microscopic malaria infections, Parasite Species Composition and Implication for Elimination in Uganda; First Evidence at National Scale - 2025 Bosco B. Agaba, Thomas Katairo, Simon Rugera, Stephen Tukwasibwe, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8969522/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background: Malaria morbidity and mortality declined in Uganda between 2010 and 2020; however, recent reports indicate potential reversal and loss of control gains. Demonstration of the presence of malaria parasites in human populations is an essential parameter for monitoring transmission and progress of interventions in endemic settings; however, surveillance systems heavily rely on blood smear microscopy that often misses submicroscopic infections. Methods: From September 2024 to April 2025, blood samples were collected from children under 5 years old in cross-sectional surveys in all regions of Uganda. Thick blood smears and dried blood spots were collected and analysed with microscopy and real-time PCR respectively. Data were analysed, with STATA and geographical information systems (ArcGIS) and reported as proportions and geospatial maps. Results: Overall, 6298 samples were analysed out of which 819 (13%) and 1,071 (17%) were positive for malaria parasites by microscopy and real-time PCR respectively. Highest proportion of parasites was detected in children 48-50 months old (15.8% and 21.0%) by microscopy and real-time PCR respectively; Children living in rural areas (15.7% and 22.3%); Lango sub-region (31.6% and 43.7%); Children whose mothers had no education (16.9% and 21.6%) by microscopy and real-time PCR respectively. Real-time PCR confirmed the presence of P. falciparum (85%), P. malariae (4%), P. ovale (2%), P. vivax (<1%) and mixed infections (9%). The Lango sub-region recorded the highest rate of mixed infections (18%) followed by Karamoja (14.7%), Acholi (12.8%) and Tooro (9.6%). Among children who tested negative for malaria by microscopy, 7% were positive by real-time PCR. Sub-microscopic infections were most common in Lango (18%), Acholi (13%) and Teso (10.6%) and lowest in Kigezi (1.5%), Ankole (1.7%) and Kampala City (<1%). Conclusion: These findings emphasize potential for consideration and integration of molecular-based methods in malaria surveillance systems to detect sub-microscopic parasite reservoir that is often missed by blood smear microscopy. The observed occurrence and wide geographical spread of non-P. falciparum species across the country suggests the need for deployment of diagnostic tools that detect all malaria parasite species for routine diagnosis and surveillance in Uganda. Sub-microscopic parasitemia non-P. falciparum species Genomic surveillance Figures Figure 1 Figure 2 Background Malaria remains a major public health problem in Uganda, accounting for 30–50% of outpatient visits (1). At the global scale, Uganda is the third-largest contributor to global malaria cases and the tenth-largest contributor to malaria deaths (2, 3). The country has achieved substantial progress in reducing malaria burden over the past two decades. The key interventions driving progress include large-scale distribution of long-lasting insecticidal nets (LLINs), Indoor Residual Spraying (IRS), expanded community-level diagnosis and treatment and improved case management at health facilities which have largely contributed to the decline in parasite prevalence (4, 5). Between 2009 and 2018, malaria parasite prevalence among children under five declined from 42% to a single digit 9% (5). However, since 2018, progress has stalled, with parasite prevalence remaining stable, while case numbers have continued to increase. Despite the reduction in parasite prevalence observed between 2009 and 2018, routine health facility data shows indication of reversal of control gains in many of the regions with occurrence of malaria epidemics between 2020 and 2022 even in settings that are historically not classified as epidemic-prone (6). The 2022 epidemic resulted in over 3.3 million additional cases, emphasizing the fragility of previous progress and the urgent need for strategic shifts to prevent complete loss of gains. In response to potential reversal and to sustain malaria gains, the national program underwent a period of re-thinking and re-strategizing that resulted into drafting of its first-ever malaria elimination strategic plan for 2026-2030. The new Malaria Elimination Strategic Plan (UMESP) represents the country’s response, outlining a decisive pathway to accelerate progress, reclaim lost gains, maintain momentum, and move towards a malaria-free Uganda (7). However, current efforts only focus on symptomatic cases that may leave a large asymptomatic parasite reservoir within the population that constitutes a potential source of malaria infection and transmission. In addition, most previous surveillance efforts have been limited in scope and coverage and have relied on blood smear microscopy whose effectiveness may be limited to a relatively high parasitaemia detection threshold that is well above submicroscopic parasitemia (8-11). Elsewhere submicroscopic malaria infections in asymptomatic individuals have been reported to constitute an important parasite reservoir that maintains and sustains transmission (11-13). Current evidence on the burden of submicroscopic parasitemia in Uganda at national scale is lacking. Additionally, there have been unconfirmed reports of the emergence and geographical expansion of non-falciparum species across the country; however, species composition has not been well characterized using molecular tools on the national scale in Uganda. Understanding the country’s malaria parasite species composition and the burden of submicroscopic parasitemia is important for accurate burden estimation and inform current malaria control efforts in Uganda. Methods Design and setting : From November 2024 to April 2025 a malaria parasite surveillance was conducted covering the subregions of South Buganda, North Buganda, Busoga, Bukedi, Elgon, Teso, Karamoja, Lango, Acholi, West Nile, Bunyoro, Tooro, Kigezi, Ankole and Kampala City in Uganda. A total of 322 clusters located across the country were randomly selected from the national census sampling frame using probability proportional to size from which a random sample of households was selected. Study procedures In each randomly selected household, a standard electronic questionnaire translated into seven languages of English, Luganda, Luo, Lugbara, Ateso, Runyankole/Rukiga, and Runyoro/Rutoro was used to collect demographics and participant characteristics (14). From each household all children of aged 6–59 months were eligible for recruitment into the study and provided a finger prick blood sample with caretakers’ written informed consent. Thick blood smears and dried blood spots (DBS) were collected by field Laboratory technicians. Children who had symptoms of uncomplicated malaria were tested with rapid diagnostic tests and offered a full course of artemisinin-based combination therapy (ACT) by a study nurse if positive in accordance with the standard national treatment guidelines in Uganda. Data were collected on age, sex, residence, caretakers’ education, region and malaria interventions from the children’s caretakers or guardians. Geographical information system (GIS) data were collected and used to generate parasite species maps across the regions. Ethical Considerations: Caretakers or guardians provided written consent prior to participation in the study. All data and other information collected were kept confidential. The study protocol was reviewed and approved by the Uganda National Council for Science and Technology (UNCST) and the Vector Control Division Research and Ethics Committee. Laboratory Procedures The blood smears and DBS/filter papers samples were transported to the Central Public Health Laboratory (CPHL) Malaria Reference Laboratory for examination and analysis. At the malaria reference laboratory. The World Health Organisation (WHO) standard malaria microscopy procedure was followed (15) . Briefly, thick blood smears prepared and dried in a dust-free environment, were stained with Giemsa stain and examined to determine the presence or absence of Plasmodium parasites. Blood smears were considered negative if no parasites were found after 100 high-powered fields had been examined. All stained slides were read by two independent microscopists certified by the World Health Organization. Slides with discrepant results were reanalysed by a third microscopist to determine the final result. The dried blood spots (DBS) were prepared in the field by applying finger or heel blood drops to fully saturate the five designated circles on LabMate, perforated WHO recommended Whatman filter paper cards. The DBS cards were dried overnight in a dust-free environment, then sealed in plastic bags containing two to three desiccant packs to maintain sample integrity. The DBS cards were regularly transported to the CPHL Malaria reference laboratory for initial storage at −20°C and subsequently transferred to −80°C for long-term preservation. Parasite DNA extraction and real-time PCR: Parasite DNA was extracted from DBS using the Chelex-100/Tween-20 protocol. A SYBR Green-based real-time PCR assay targeting the Plasmodium 18S rRNA gene was employed to identify malaria parasite species P. falciparum, P. malariae, P. vale , and P. vivax as previously described (16). To enhance diagnostic accuracy, a serial testing algorithm was applied. Initial screening was conducted using a multiplex PCR assay with species-specific primers to simultaneously amplify all four plasmodium species. A sample was considered positive if it exhibited a sigmoidal amplification curve with a cycle threshold <35 and a melting peak within the expected temperature range. To increase specificity and enable detection of mixed-species infections, all positive samples were subjected to a second round of testing using a singleplex PCR assay for each species. A sample was confirmed positive for a given species if the singleplex assay produced a sigmoidal amplification curve, a cycle threshold <35, and a melt peak within the expected temperature range ( P. falciparum = 76 °C ± 1 °C; P. malariae = 73 °C ± 1 °C; P. ovale = 82 °C ± 1 °C; P. vivax = 79 °C ± 1 °C). Each PCR run included positive controls for all species, sourced from WHO proficiency testing panels, and nuclease-free water as the negative control. Data processing Data processing included, verification and checks for completeness and consistency. Data were edited using CSPro software. Malaria positivity by both microscopy and PCR were analysed in STATA ver and reported as proportions. Parasite species maps were generated using GIS Results Background Characteristics : During the study, a total of 6,309 children were tested with blood smear microscopy and 6,298 with real-time PCR. The 11 samples for which DNA amplification was not achieved were excluded from PCR data. Based on microscopy and real-time PCR, 13% and 17% of children aged 6–59 months were positive for malaria parasites respectively. Molecular testing (PCR) detected and reported more malaria cases across all age groups, type of residence (rural and urban), caretaker’s education, sub-regions and across SMC and IRS special intervention areas (Table 1). Background characteristic Malaria prevalence (Microscopy) Malaria prevalence (Real-time PCR) Positive No. of children Positive No. of children Age in months 6–8 5.5 323 8.3 322 9–11 7.0 334 9.0 332 12–17 10.1 703 15.3 702 18–23 10.0 617 15.4 617 24–35 11.9 1,411 17.5 1,410 36–47 14.7 1,467 19.6 1,464 48–59 15.8 1,454 21.0 1,451 Residence Urban 6.7 2,263 8.8 2,258 Rural 15.7 4,046 22.3 4,040 Subregion Kampala 0.4 98 1.3 98 Buganda 6.2 1,591 9.5 1,585 South Buganda 2.3 907 3.6 905 North Buganda 11.4 684 17.4 681 Busoga 20.9 573 28.4 573 Bukedi 11.9 434 17.0 434 Elgon 6.1 318 8.5 318 Teso 22.9 368 31.0 367 Lango 31.6 368 43.7 367 Acholi 23.3 268 31.7 268 Karamoja 26.3 258 31.8 258 West Nile 8.0 416 11.7 414 Bunyoro 17.6 481 21.2 481 Toro 9.2 463 15.7 463 Ankole 1.5 435 3.2 435 Kigezi 0.6 238 2.1 238 Caretaker’s education No education 16.9 510 21.6 510 Primary 13.8 2,702 20.4 2,697 Secondary 7.0 1,222 9.3 1,222 More than secondary 1.4 288 4.1 287 Intervention areas IRS districts 11.6 783 16.7 782 SMC districts 26.3 258 31.8 258 Total 12.5 6,309 17.4 6,298 SMC= Seasonal Malaria Chemoprevention, IRS= Indoor Residual Spraying Table legend Table 1: Percentage of children classified positive by Microscopy and Real-Time PCR according to background characteristics PCR detection of malaria parasite species Real-time PCR was used to identify malaria species among positive cases. Most infections were P. falciparum (85%), though P. malariae (4%), P. ovale (2%), and P. vivax (less than 1%) made and mixed infections (9%) were also observed. Among children positive for malaria by real-time PCR, the proportion of P. falciparum infections was highest in Busoga (93%), followed by Teso (91%) and West Nile (91%). Other species were most commonly observed in Tooro, Lango, Acholi, and Karamoja. The Lango subregion recorded the highest rate of mixed infections (18%) followed by Karamoja (14.7%), Acholi (12.8%) and Tooro (9.6%) – Table 2 Variable P. falciparum P. malariae P. vivax P. ovale Mixed infection No. of children Subregion Kampala * * * * * 1 Buganda 82.4 4.9 0.0 6.2 6.5 151 South Buganda * * * * * 33 North Buganda 83.4 4.2 0.0 4.0 8.3 118 Busoga 93.0 3.9 0.0 0.7 2.3 162 Bukedi 88.5 2.3 0.0 1.2 8.0 74 Elgon 81.0 0.0 2.5 2.5 13.9 27 Teso 91.1 2.0 0.0 0.0 6.9 114 Lango 78.7 2.1 1.0 0.0 18.3 160 Acholi 80.8 4.1 0.6 1.7 12.8 85 Karamoja 82.3 1.8 0.0 1.2 14.7 82 West Nile 90.9 0.0 0.0 2.0 7.1 48 Bunyoro 86.1 4.4 0.0 1.0 8.6 102 Toro 78.8 10.1 0.0 1.6 9.6 73 Ankole * * * * * 14 Kigezi * * * * * 5 Special areas IRS districts 89.9 1.6 0.7 1.4 6.4 130 SMC districts 82.3 1.8 0.0 1.2 14.7 82 High altitude areas 77.0 7.4 2.3 2.3 10.9 29 Total 84.6 3.9 0.3 1.7 9.5 1,08 *Fewer than 25 unweighted cases and has been suppressed, SMC= Seasonal Malaria Chemoprevention, IRS= Indoor Residual Spraying Legend table 2: Percent distribution of children testing positive for malaria by real-time PCR by type of Plasmodium species, according to subregion and special areas Prevalence of sub-microscopic infection by real-time PCR Among children who tested negative for malaria by microscopy, 7% tested positive by real-time PCR. One of the advantages of real-time PCR is that it can detect infections that are often missed by microscopy due to low density and sub-microscopic infections. Sub-microscopic infections were most common in Lango (18%) and Acholi (13%). Sub-microscopic infections were most common in Lango (18%), Acholi (13%), Teso (10.6%), Busoga (9.9%), Bunyoro (9.6%), Tooro (8.4%) and Karamoja (7.4%) and lowest in Kigezi (1.5%), Ankole (1.7%) and Kampala City (<1%) the low transmission areas targeted for malaria elimination. In areas covered by special interventions of IRS and SMC, sub-microscopic parasitemia was detected by Real-Time PCR in 6.7% and 7.6% respectively in children who had tested negative by blood smear microscopy – Table 3. Real-time PCR result (%) No. negative by micro­scopy Parasite species among children who tested negative for malaria by microscopy but positive by real-time PCR No. Negative by micro­scopy but positive by real-time PCR Variable Negative Positive Other P. falciparum P. ovale P. malariae P. vivax Mixed infection Age in months 6–8 95.9 3.8 0.2 305 * * * * * 12 9–11 96.9 2.6 0.5 309 * * * * * 8 12–17 92.7 7.2 0.1 632 86.8 8.2 0.0 0.0 5.1 45 18–23 93.2 6.8 0.0 554 81.3 8.9 3.6 4.1 2.1 38 24–35 93.2 6.8 0.1 1,240 86.0 7.6 0.0 1.2 5.3 84 36–47 93.2 6.5 0.2 1,250 91.5 3.9 1.8 0.0 2.8 82 48–59 92.5 7.3 0.2 1,221 92.3 2.4 0.0 1.3 4.1 89 Residence Urban 96.6 3.2 0.2 2,107 87.6 4.7 1.8 0.0 5.9 66 Rural 91.3 8.6 0.1 3,405 87.2 6.6 0.5 1.3 4.4 291 Subregion Kampala 98.7 1.3 0.0 97 * * * * * 1 Buganda 95.8 3.8 0.4 1,492 87.0 7.1 0.0 0.0 5.9 57 South Buganda 98.4 1.3 0.2 886 * * * * * 12 North Buganda 92.0 7.5 0.6 606 89.0 3.6 0.0 0.0 7.4 45 Busoga 90.1 9.9 0.0 450 88.5 11.5 0.0 0.0 0.0 44 Bukedi 92.6 7.4 0.0 382 87.7 3.1 0.0 3.1 6.1 28 Elgon 96.8 3.2 0.0 299 * * * * * 10 Teso 88.8 10.6 0.6 284 92.1 2.6 0.0 0.0 5.3 30 Lango 81.3 18.4 0.4 250 91.1 1.5 3.4 0.0 4.0 46 Acholi 87.2 12.5 0.3 206 85.4 0.0 2.1 0.0 12.5 26 Karamoja 92.4 7.6 0.0 190 93.3 0.0 0.0 0.0 6.7 14 West Nile 95.4 4.4 0.2 382 * * * * * 17 Bunyoro 90.4 9.6 0.0 395 92.3 5.1 0.0 2.6 0.0 38 Toro 91.6 8.4 0.0 420 77.2 9.8 0.0 3.3 9.8 35 Ankole 98.3 1.7 0.0 428 * * * * * 7 Kigezi 98.5 1.5 0.0 236 * * * * * 4 Special areas IRS districts 93.3 6.7 0.0 692 89.7 4.6 2.0 1.9 1.9 46 SMC districts 92.4 7.6 0.0 190 93.3 0.0 0.0 0.0 6.7 14 Total 93.3 6.5 0.2 5,512 87.3 6.3 0.8 1.0 4.6 358 *Fewer than 25 unweighted cases and has been suppressed, IRS = indoor residual spraying; SMC = seasonal malaria chemoprevention Table legend 3: Among children who tested negative for malaria by microscopy, percent distribution by real-time PCR result for any malaria species; among children who tested negative for malaria by microscopy but positive by real-time PCR, percent distribution of positive results for each Plasmodium species. Geographical Spread of malaria Parasite Species Although P. falciparum is the dominant species across the country, molecular detection confirmed the presence of non- P. falciparum species of P. malariae, P. ovale and P. vivax species that are geographically spread in all regions of Uganda (Fig 1 and Fig 2). Discussion Malaria is endemic in Uganda and transmission is high throughout the year in the entire country with exception of high-altitude areas where climatic conditions do not favour vector breeding all year round ( 17 , 18 ). Frequent exposure to infective mosquito bites contributes to development of partial immunity within the population which is not sustained and wanes off over time making individuals susceptible to symptomatic malaria ( 19 ). Many people including children can have malaria parasites in their blood without showing any signs of infection. Such asymptomatic infections not only contribute to further transmission of malaria but also increase the risk of anaemia and other associated morbidities among infected individuals ( 20 , 21 ). In this surveillance activity, all children from whom blood samples were collected were asymptomatic. Asymptomatic infections are often characterized by low parasite densities and sub-microscopic parasitaemia that are often below the detection limit of malaria microscopy ( 22 , 23 ). In this malaria parasite surveillance activity, molecular confirmation of parasite species was performed to estimate prevalence and geographical spread of malaria species and sub-microscopic infections using a nationally representative sample for the first time in Uganda. Overall, Real-Time PCR detected more malaria infections than blood smear microscopy consistent with reports elsewhere ( 9 , 10 , 24 ). This is explained by the fact that blood smear microscopy detects the presence of actual malaria parasites in infected individuals whose accuracy heavily relies on the competency of the user, the quality of the microscope, and the quality of smear preparation and staining, all of which affect its detection limit. Due to limitations of its detection limit, microscopy may miss infections with extremely low parasite density, particularly sub-microscopic infections, usually present in asymptomatic individuals ( 10 , 25 ). This explains why microscopy is usually less sensitive than real-time PCR ( 22 ). On the other hand, real-time PCR is molecular-based and detects the presence of parasite DNA in blood samples from infected individuals. Due to its precision and accuracy, it is more sensitive than other traditional diagnostic methods such as microscopy, especially in detecting low levels of parasitaemia including species identification. The detection of additional malaria infections by real-time PCR that would have been missed by microscopy has implications including its potential inclusion in future parasite surveys. Additionally, the additional malaria infections detected by real-time PCR but missed by microscopy has programmatic implications in the context of malaria transmission and surveillance particularly for areas targeted for elimination in South Western Uganda ( 9 ). Undetected parasite reservoir in asymptomatic individuals contributes to on-going malaria transmission and negatively affects efforts for transmission interruption particularly for low transmission areas targeted for elimination ( 11 , 25 ). These results also suggest that malaria surveillance and reporting systems that entirely rely on microscopy can potentially underestimate the burden of malaria which has implication for Malaria program planning. The occurrence of high proportions of sub-microscopic parasitemia in Lango, Acholi, Karamoja and Busoga is consistent with the high malaria transmission routinely reported in the routine surveillance system ( 1 , 8 ). The two sub-regions of Acholi and Lango have traditionally been habitats of some of the highly effective and efficient malaria vectors of An. gambiae , An. funestus and most recently the emergence of An. arabiensis that is largely an outdoor biter. The receptivity and vulnerability in terms of ecological, environmental and climatic parameters as well as population exposure to infective bites due to sub-optimal intervention coverage and use in these regions provide optimal and suitable conditions for all-year round malaria transmission. As the country embarks on the road to malaria elimination under the new 2026-30 malaria elimination plan, presence of sub-microscopic malaria infections in asymptomatic individuals will have programmatic implications ( 13 , 24 , 26 ). The Uganda malaria program aims to achieve malaria elimination in fifteen districts by 2030 and from all districts by 2035. However, current treatment efforts for parasite clearance are largely focused on symptomatic cases coming to health facilities leaving a large reservoir of sub-microscopic parasitemia in asymptomatic individuals in the population. This suggests the need for additional interventions including reactive case detection to target sub-microscopic parasite reservoir in asymptomatic individuals. The study conducted rigorous analysis of blood samples using molecular testing (real-time PCR) to determine and identify parasite species composition in all sub-regions using representative sample for the first time in Uganda. While P. falciparum remains the dominant species as reported previously, the current study generated molecular data showing emergence and increasing proportions of non-P. falciparum species with mixed infections accounting for up to 9%. The occurrence of non-P. falciparum species were most commonly observed in Lango, Acholi, Karamoja and Tooro with the Lango, Karamoja and Acholi subregions recording the highest rate of mixed infections. Interestingly, these are consistently high transmission areas suggesting potential contribution of non-P. falciparum species to observed transmission rates. The occurrence of non-P. falciparum in all sub-regions of Uganda has direct and immediate implication for malaria interventions deployment in Uganda ( 27 ). The country currently deploys HRP-2 based rapid diagnostic tests that currently accounts for > 80% of total routine malaria testing at health facility, however these RDTs are specific for P. falciparum and can potentially misse detection of non-P. falciparum parasite species. In view of this findings, it calls for possible rethinking and reconsideration of malaria diagnostic strategies in Uganda under the new proposed malaria elimination strategic plan 2026-30. Conclusion The findings emphasize the need for integration of molecular-based diagnostic methods in routine malaria surveillance to detect low density infection and sub-microscopic parasite reservoir that is often missed by blood smear microscopy. The observed occurrence and wide geographical spread of non-P. falciparum species across the country suggests the need for deployment of diagnostic tools that detect all malaria parasite species for both routine diagnosis and surveillance. Abbreviations ACT Artemisinin Based Combination Therapy DBS Dried blood spots DNA Deoxyribonucleic Acid GIS Geographical Information System HMIS Information Management System IRS Indoor Residual Spraying PCR Polymerase chain reaction RDT Rapid Diagnostic Tests SMC Seasonal Malaria Chemoprevention UNCST Uganda National Council for Science and Technology WHO World Health Organization Declarations Ethics approval and consent to participate Ethical approval for the study was obtained from the Vector Control Division Research and Ethics Committee and the Uganda National Council of Science and Technology ensuring that the study and procedures adhered to the declaration of Helsinki. All participants provided written informed consent before recruitment into the survey. Consent for publication Not applicable Competing interests The authors declare no competing interests Funding: The survey was supported, in whole or in part, by the Bill & Melinda Gates Foundation Grant, The former US Presidents Malaria Initiative, The Global Fund and the Government of the Republic of Uganda. The first and corresponding author of the Manuscript is the principal investigator of this surveillance activity and over-saw implementation of activities supported by this funding. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. Author Contribution BBA is the PI and designed the study. BBA, TK, IS, ST, AA did the genomic and sequencing, BBA, EA, AS, SN, supported the data analysis. GN, BA, AO, NS supported sample correction and blood smear Microscopy. BBA drafted the manuscript. BBA, SN, PC, JO, MK reviewed the manuscript. All authors read and approved the final. Acknowledgements We thank the field study teams for leading the field activities and sample collections at the facilities. We are grateful to the study participants who participated in the survey. We acknowledge the entire study teams and the DHS program for conducting the technical contribution especially in the detailed analysis. Data Availability Data for this surveillance activity is available from the corresponding author (also the survey Principal investigator) on request. The principal investigator (also the corresponding author) will facilitate the compilation and depositing of a detailed survey report online for public access on the demographic health survey website including all the raw data sets used in preparing this manuscript. References Health Management Information. System (HMIS) [Internet]. 2026. WHO. World Malaria Report 2024. WHO. WHO World malaria report. 2025. Agaba BB, Travis J, Smith D, Rugera SP, Zalwango MG, Opigo J, et al. Emerging threat of artemisinin partial resistance markers (pfk13 mutations) in Plasmodium falciparum parasite populations in multiple geographical locations in high transmission regions of Uganda. Malar J. 2024;23(1):330. Epstein A, Maiteki-Sebuguzi C, Namuganga JF, Nankabirwa JI, Gonahasa S, Opigo J, et al. Resurgence of malaria in Uganda despite sustained indoor residual spraying and repeated long lasting insecticidal net distributions. PLOS Glob Public Health. 2022;2(9):e0000676. Aregawi MW, Maiteki C, Rek JC, Agaba B, Katureebe C, Ranjbar M, et al. Malaria epidemics and its drivers in Uganda in 2022. Malar J. 2025;24(1):235. MOH. National Malaria Elimination Strategic Plan 2026. Agaba BB, Rugera SP, Mpirirwe R, Atekat M, Okubal S, Masereka K, et al. Asymptomatic malaria infection, associated factors and accuracy of diagnostic tests in a historically high transmission setting in Northern Uganda. Malar J. 2022;21(1):392. Kaaya RD, Matowo J, Kajeguka D, Tenu F, Shirima B, Mosha F, et al. The Impact of Submicroscopic Parasitemia on Malaria Rapid Diagnosis in Northeastern Tanzania, an Area with Diverse Transmission Patterns. Infect Dis Rep. 2022;14(6):798–809. Ochwedo KO, Omondi CJ, Magomere EO, Olumeh JO, Debrah I, Onyango SA, et al. Hyper-prevalence of submicroscopic Plasmodium falciparum infections in a rural area of western Kenya with declining malaria cases. Malar J. 2021;20(1):472. Hayuma PM, Wang CW, Liheluka E, Baraka V, Madebe RA, Minja DTR, et al. Prevalence of asymptomatic malaria, submicroscopic parasitaemia and anaemia in Korogwe District, north-eastern Tanzania. Malar J. 2021;20(1):424. Lin JT, Saunders DL, Meshnick SR. The role of submicroscopic parasitemia in malaria transmission: what is the evidence? Trends Parasitol. 2014;30(4):183–90. van Eijk AM, Sutton PL, Ramanathapuram L, Sullivan SA, Kanagaraj D, Priya GSL, et al. The burden of submicroscopic and asymptomatic malaria in India revealed from epidemiology studies at three varied transmission sites in India. Sci Rep. 2019;9(1):17095. DHS. Survey Standard Questionaires 2018. Agaba BB, Anderson K, Gresty K, Prosser C, Smith D, Nankabirwa JI, et al. Molecular surveillance reveals the presence of pfhrp2 and pfhrp3 gene deletions in Plasmodium falciparum parasite populations in Uganda, 2017–2019. Malar J. 2020;19(1):300. Sazed SA, Kibria MG, Alam MS. An Optimized Real-Time qPCR Method for the Effective Detection of Human Malaria Infections. Diagnostics (Basel). 2021;11(5). Nankabirwa JI, Arinaitwe E, Rek J, Kilama M, Kizza T, Staedke SG, et al. Malaria Transmission, Infection, and Disease following Sustained Indoor Residual Spraying of Insecticide in Tororo, Uganda. Am J Trop Med Hyg. 2020;103(4):1525–33. Yeka A, Gasasira A, Mpimbaza A, Achan J, Nankabirwa J, Nsobya S, et al. Malaria in Uganda: challenges to control on the long road to elimination: I. Epidemiology and current control efforts. Acta Trop. 2012;121(3):184–95. Abad P, Marín-García P, Heras M, Fobil JN, Hutchful AG, Diez A et al. Microscopic and submicroscopic infection by Plasmodium falciparum: Immunoglobulin M and A profiles as markers of intensity and exposure. Front Cell Infect Microbiol. 2022;Volume 12–2022. Katrak S, Nayebare P, Rek J, Arinaitwe E, Nankabirwa JI, Kamya M, et al. Clinical consequences of submicroscopic malaria parasitaemia in Uganda. Malar J. 2018;17(1):67. Kamau E, Maisiba R, Dear N, Esber A, Parikh AP, Iroezindu M, et al. Implications of asymptomatic malaria infections on hematologic parameters in adults living with HIV in malaria-endemic regions with varying transmission intensities. Int J Infect Dis. 2023;137:82–9. Bosco AB, Nankabirwa JI, Yeka A, Nsobya S, Gresty K, Anderson K, et al. Limitations of rapid diagnostic tests in malaria surveys in areas with varied transmission intensity in Uganda 2017–2019: Implications for selection and use of HRP2 RDTs. PLoS ONE. 2020;15(12):e0244457. Silva R, Lopes LF, Rodrigues A, Arez AP, Medeiros MM. Assessing the burden of submicroscopic Plasmodium infections in a pre-elimination malaria setting in sub-Saharan Africa, Guinea-Bissau. Malar J. 2024;23(1):316. Okell LC, Ghani AC, Lyons E, Drakeley CJ. Submicroscopic Infection in Plasmodium falciparum-Endemic Populations: A Systematic Review and Meta-Analysis. J Infect Dis. 2009;200(10):1509–17. Lo E, Zhou G, Oo W, Afrane Y, Githeko A, Yan G. Low Parasitemia in Submicroscopic Infections Significantly Impacts Malaria Diagnostic Sensitivity in the Highlands of Western Kenya. PLoS ONE. 2015;10(3):e0121763. Silva R, Lopes LF, Rodrigues A, Arez AP, Medeiros MM. Assessing the burden of submicroscopic Plasmodium infections in a pre-elimination malaria setting in sub-Saharan Africa, Guinea-Bissau. Malar J. 2024;23(1):316. Diagne A, Sambe BS, Gaba FM, Sarr I, Diatta AS, Sadio O, et al. Variable effects of non-falciparum species infections on malaria disease severity in high transmission regions in Senegal. Trop Med Health. 2024;52(1):93. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 30 Mar, 2026 Reviews received at journal 29 Mar, 2026 Reviews received at journal 28 Mar, 2026 Reviewers agreed at journal 11 Mar, 2026 Reviewers agreed at journal 08 Mar, 2026 Reviewers agreed at journal 08 Mar, 2026 Reviewers invited by journal 06 Mar, 2026 Editor invited by journal 06 Mar, 2026 Editor assigned by journal 03 Mar, 2026 Submission checks completed at journal 03 Mar, 2026 First submitted to journal 03 Mar, 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-8969522","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":604651012,"identity":"2d66acee-57c9-434a-97c0-e6de316ca04f","order_by":0,"name":"Bosco B. Agaba","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFklEQVRIiWNgGAWjYHACNgYGgwMgBuODBIN/ciDWgQcEtRSAtTAbfCg4YAzWkkBQywewFjbJGR8OJDaAmPi08Pcvfvbgh8EdOfn2wwekeQzupM8PO/wQaIudnG4Ddi0SN56ZG/YYPDM2OJOWYMxj8Cx34+00A6CWZGOzAzisuXHATILH4HDiBiCZzGPAnLtxdgJIy4HEbTi0yN84/k3yD1DL/BlAjUAt6Yaz0z/g1WJwvsdMGmRLww0ew8YZBocT5KVz8NtieIOn3FgG4pdkhg8GaYYbpHMKDiQY4PaL3Pnj2x6++QMOseM/Ev7YyMvPTt/84UOFnRxO70skoDsVrNIAh3IQ4Ec3S74Bj+pRMApGwSgYkQAAwtJsrWeu+AsAAAAASUVORK5CYII=","orcid":"","institution":"Mbarara University of Science and Technology (MUST)","correspondingAuthor":true,"prefix":"","firstName":"Bosco","middleName":"B.","lastName":"Agaba","suffix":""},{"id":604651013,"identity":"a2025edc-8beb-49be-9b7f-747bb44294de","order_by":1,"name":"Thomas Katairo","email":"","orcid":"","institution":"Infectious Diseases Research Collaboration","correspondingAuthor":false,"prefix":"","firstName":"Thomas","middleName":"","lastName":"Katairo","suffix":""},{"id":604651014,"identity":"e753026a-c70e-44c9-8f9a-b2ee255e393c","order_by":2,"name":"Simon Rugera","email":"","orcid":"","institution":"Mbarara University of Science and Technology (MUST)","correspondingAuthor":false,"prefix":"","firstName":"Simon","middleName":"","lastName":"Rugera","suffix":""},{"id":604651015,"identity":"0d11b5d1-76b7-44ad-a284-544356048d8a","order_by":3,"name":"Stephen Tukwasibwe","email":"","orcid":"","institution":"Infectious Diseases Research Collaboration","correspondingAuthor":false,"prefix":"","firstName":"Stephen","middleName":"","lastName":"Tukwasibwe","suffix":""},{"id":604651016,"identity":"5f820486-01cc-4eea-9be3-5ae82d4cde76","order_by":4,"name":"Aloysius Semaganda","email":"","orcid":"","institution":"Central Public Health Laboratory/ Malaria Reference Laboratory","correspondingAuthor":false,"prefix":"","firstName":"Aloysius","middleName":"","lastName":"Semaganda","suffix":""},{"id":604651017,"identity":"62621d3d-c600-47ed-85fd-dda14afe68f6","order_by":5,"name":"Alisen Ayitewala","email":"","orcid":"","institution":"Central Public Health Laboratory/ Malaria Reference Laboratory","correspondingAuthor":false,"prefix":"","firstName":"Alisen","middleName":"","lastName":"Ayitewala","suffix":""},{"id":604651018,"identity":"4aa9afc3-2512-4c78-9451-7e03cc5d50a0","order_by":6,"name":"Caroline Makhoha","email":"","orcid":"","institution":"Central Public Health Laboratory/ Malaria Reference Laboratory","correspondingAuthor":false,"prefix":"","firstName":"Caroline","middleName":"","lastName":"Makhoha","suffix":""},{"id":604651019,"identity":"fa4eeadd-3e9d-45ff-9870-a326560c4c96","order_by":7,"name":"Gertrude Nabirwa","email":"","orcid":"","institution":"Mbarara University of Science and Technology (MUST)","correspondingAuthor":false,"prefix":"","firstName":"Gertrude","middleName":"","lastName":"Nabirwa","suffix":""},{"id":604651020,"identity":"3c35f2e9-ef3e-428f-9d37-f8e6a1d67378","order_by":8,"name":"Bosco Adranya","email":"","orcid":"","institution":"Mbarara University of Science and Technology (MUST)","correspondingAuthor":false,"prefix":"","firstName":"Bosco","middleName":"","lastName":"Adranya","suffix":""},{"id":604651021,"identity":"b697152e-33e3-410b-a663-0639e4dccd76","order_by":9,"name":"Alex Ojaku","email":"","orcid":"","institution":"Mbarara University of Science and Technology (MUST)","correspondingAuthor":false,"prefix":"","firstName":"Alex","middleName":"","lastName":"Ojaku","suffix":""},{"id":604651022,"identity":"bb966a69-7198-4eca-861a-debbc08b6232","order_by":10,"name":"Susan Nabadda","email":"","orcid":"","institution":"Central Public Health Laboratory/ Malaria Reference Laboratory","correspondingAuthor":false,"prefix":"","firstName":"Susan","middleName":"","lastName":"Nabadda","suffix":""},{"id":604651023,"identity":"ede7497a-e72d-4ffd-b800-6bdcebf71fc2","order_by":11,"name":"Jimmy Opigo","email":"","orcid":"","institution":"National Malaria Elimination Division","correspondingAuthor":false,"prefix":"","firstName":"Jimmy","middleName":"","lastName":"Opigo","suffix":""},{"id":604651024,"identity":"7994800c-9650-4a1d-bb1d-dc885bbd6678","order_by":12,"name":"Moses Kamya","email":"","orcid":"","institution":"Infectious Diseases Research Collaboration","correspondingAuthor":false,"prefix":"","firstName":"Moses","middleName":"","lastName":"Kamya","suffix":""},{"id":604651025,"identity":"ad459f13-4e35-41ca-bbe7-d6183f91d25b","order_by":13,"name":"Sam Nsobya","email":"","orcid":"","institution":"Infectious Diseases Research Collaboration","correspondingAuthor":false,"prefix":"","firstName":"Sam","middleName":"","lastName":"Nsobya","suffix":""},{"id":604651026,"identity":"599ca8d5-3a85-41a8-bf65-9a2907f4c92a","order_by":14,"name":"Isaac Sewanyana","email":"","orcid":"","institution":"Infectious Diseases Research Collaboration","correspondingAuthor":false,"prefix":"","firstName":"Isaac","middleName":"","lastName":"Sewanyana","suffix":""},{"id":604651027,"identity":"4460de68-fd9f-4251-8620-823285bb184a","order_by":15,"name":"Edgar Agaba","email":"","orcid":"","institution":"National Malaria Elimination Division","correspondingAuthor":false,"prefix":"","firstName":"Edgar","middleName":"","lastName":"Agaba","suffix":""}],"badges":[],"createdAt":"2026-02-25 15:53:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8969522/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8969522/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104547157,"identity":"151f0845-d811-402e-9e89-0ed301b94720","added_by":"auto","created_at":"2026-03-13 07:33:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":119954,"visible":true,"origin":"","legend":"\u003cp\u003eSpread of \u003cem\u003eP. falciparum\u003c/em\u003e mono-infection detected by real-time PCR across all subregions\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8969522/v1/f2d58942107c3bdb52942f19.png"},{"id":104781163,"identity":"661676c1-55e5-4914-9889-3c84e0fe6b81","added_by":"auto","created_at":"2026-03-17 07:55:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":99076,"visible":true,"origin":"","legend":"\u003cp\u003eNon-\u003cem\u003efalciparum\u003c/em\u003e \u003cem\u003ePlasmodium\u003c/em\u003e species and mixed infections detected by real-time PCR across all subregions\u003cem\u003eby\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8969522/v1/a8e8ac1ee4325b944e6ffc5a.png"},{"id":104784480,"identity":"fae2959f-2aa9-4bbb-9969-5bd181d0d805","added_by":"auto","created_at":"2026-03-17 08:07:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1393826,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8969522/v1/6ed15b08-8532-4a9f-a7ef-af9aa8571864.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Genomic Surveillance to Estimate the burden of Sub-microscopic malaria infections, Parasite Species Composition and Implication for Elimination in Uganda; First Evidence at National Scale - 2025","fulltext":[{"header":"Background","content":"\u003cp\u003eMalaria remains a major public health problem in Uganda, accounting for 30\u0026ndash;50% of outpatient visits (1). At the global scale, Uganda is the third-largest contributor to global malaria cases and the tenth-largest contributor to malaria deaths (2, 3). The country has achieved substantial progress in reducing malaria burden over the past two decades. The key interventions driving progress include large-scale distribution of long-lasting insecticidal nets (LLINs), Indoor Residual Spraying (IRS), expanded community-level diagnosis and treatment and improved case management at health facilities which have largely contributed to the decline in parasite prevalence (4, 5). Between 2009 and 2018, malaria parasite prevalence among children under five declined from 42% to a single digit 9% (5).\u003c/p\u003e\n\u003cp\u003eHowever, since 2018, progress has stalled, with parasite prevalence remaining stable, while case numbers have continued to increase. Despite the reduction in parasite prevalence observed between 2009 and 2018, routine health facility data shows indication of reversal of control gains in many of the regions with occurrence of malaria epidemics between 2020 and 2022 even in settings that are historically not classified as epidemic-prone (6). The 2022 epidemic resulted in over 3.3 million additional cases, emphasizing the fragility of previous progress and the urgent need for strategic shifts to prevent complete loss of gains. In response to potential reversal and to sustain malaria gains, the national program underwent a period of re-thinking and re-strategizing that resulted into drafting of its first-ever malaria elimination strategic plan for 2026-2030. The new Malaria Elimination Strategic Plan (UMESP) represents the country\u0026rsquo;s response, outlining a decisive pathway to accelerate progress, reclaim lost gains, maintain momentum, and move towards a malaria-free Uganda (7).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, current efforts only focus on symptomatic cases that may leave a large asymptomatic parasite reservoir within the population that constitutes a potential source of malaria infection and transmission. In addition, most previous surveillance efforts have been limited in scope and coverage and have relied on blood smear microscopy whose effectiveness may be limited to a relatively high parasitaemia detection threshold that is well above submicroscopic parasitemia (8-11). Elsewhere submicroscopic malaria infections in asymptomatic individuals have been reported to constitute an important parasite reservoir that maintains and sustains transmission (11-13). Current evidence on the burden of submicroscopic parasitemia in Uganda at national scale is lacking. Additionally, there have been unconfirmed reports of the emergence and geographical expansion of non-falciparum species across the country; however, species composition has not been well characterized using molecular tools on the national scale in Uganda. Understanding the country\u0026rsquo;s malaria parasite species composition and the burden of submicroscopic parasitemia is important for accurate burden estimation and inform current malaria control efforts in Uganda.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eDesign and setting\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFrom November 2024 to April 2025 a malaria parasite surveillance was conducted covering the subregions of South Buganda, North Buganda, Busoga, Bukedi, Elgon, Teso, Karamoja, Lango, Acholi, West Nile, Bunyoro, Tooro, Kigezi, Ankole and Kampala City in Uganda. A total of 322 clusters located across the country were randomly selected from the national census sampling frame using probability proportional to size from which a random sample of households was selected.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy procedures\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn each randomly selected household, a standard electronic questionnaire translated into seven languages of English, Luganda, Luo, Lugbara, Ateso, Runyankole/Rukiga, and Runyoro/Rutoro was used to collect demographics and participant characteristics\u0026nbsp;(14). From each household all children of aged 6\u0026ndash;59 months were eligible for recruitment into the study and provided a finger prick blood sample with caretakers\u0026rsquo; written informed consent. Thick blood smears and dried blood spots (DBS) were collected by field Laboratory technicians. Children who had symptoms of uncomplicated malaria were tested with rapid diagnostic tests and offered a full course of\u0026nbsp;artemisinin-based combination therapy (ACT)\u0026nbsp;by a study nurse if positive in accordance with the standard national treatment guidelines in Uganda. Data were collected on age, sex, residence, caretakers\u0026rsquo; education, region and malaria interventions from the children\u0026rsquo;s caretakers or guardians. Geographical information system (GIS) data were collected and used to generate parasite species maps across the regions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCaretakers or guardians provided written consent prior to participation in the study. All data and other information collected were kept confidential. The study protocol was reviewed and approved by the Uganda National Council for Science and Technology (UNCST) and the Vector Control Division Research and Ethics Committee.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLaboratory Procedures\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe blood smears and DBS/filter papers samples were transported to the Central Public Health Laboratory (CPHL) Malaria Reference Laboratory for examination and analysis. At the malaria reference laboratory. \u0026nbsp;The World Health Organisation (WHO) standard malaria microscopy procedure was followed (15) . Briefly, thick blood smears prepared and dried in a dust-free environment, were stained with Giemsa stain and examined to determine the presence or absence of \u003cem\u003ePlasmodium\u003c/em\u003e parasites. Blood smears were considered negative if no parasites were found after 100 high-powered fields had been examined. All stained slides were read by two independent microscopists certified by the World Health Organization. Slides with discrepant results were reanalysed by a third microscopist to determine the final result.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe dried blood spots (DBS) were prepared in the field by applying finger or heel blood drops to fully saturate the five designated circles on LabMate, perforated WHO recommended Whatman filter paper cards. The DBS cards were dried overnight in a dust-free environment, then sealed in plastic bags containing two to three desiccant packs to maintain sample integrity. The DBS cards were regularly transported to the CPHL Malaria reference laboratory for initial storage at \u0026minus;20\u0026deg;C and subsequently transferred to \u0026minus;80\u0026deg;C for long-term preservation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParasite DNA extraction and real-time PCR: Parasite DNA was extracted from DBS using the Chelex-100/Tween-20 protocol. A SYBR Green-based real-time PCR assay targeting the\u003cem\u003e\u0026nbsp;Plasmodium\u003c/em\u003e 18S rRNA gene was employed to identify malaria parasite species \u003cem\u003eP. falciparum, P. malariae, P. vale\u003c/em\u003e, and \u003cem\u003eP. vivax\u003c/em\u003e as previously described (16). To enhance diagnostic accuracy, a serial testing algorithm was applied. Initial screening was conducted using a multiplex PCR assay with species-specific primers to simultaneously amplify all four plasmodium species. A sample was considered positive if it exhibited a sigmoidal amplification curve with a cycle threshold \u0026lt;35 and a melting peak within the expected temperature range. To increase specificity and enable detection of mixed-species infections, all positive samples were subjected to a second round of testing using a singleplex PCR assay for each species. A sample was confirmed positive for a given species if the singleplex assay produced a sigmoidal amplification curve, a cycle threshold \u0026lt;35, and a melt peak within the expected temperature range (\u003cem\u003eP. falciparum\u003c/em\u003e = 76 \u0026deg;C \u0026plusmn; 1 \u0026deg;C; \u003cem\u003eP.\u0026nbsp;malariae\u003c/em\u003e = 73 \u0026deg;C \u0026plusmn; 1 \u0026deg;C; \u003cem\u003eP. ovale\u003c/em\u003e = 82 \u0026deg;C \u0026plusmn; 1 \u0026deg;C; \u003cem\u003eP. vivax\u003c/em\u003e = 79 \u0026deg;C \u0026plusmn; 1 \u0026deg;C). Each PCR run included positive controls for all species, sourced from WHO proficiency testing panels, and nuclease-free water as the negative control.\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData processing\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc412460132\"\u003eData processing included, verification and checks for completeness and consistency. Data were edited using CSPro software. Malaria positivity by both microscopy and PCR were analysed in STATA ver and reported as proportions. Parasite species maps were generated using GIS\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBackground Characteristics\u003c/strong\u003e\u003cstrong\u003e: \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the study, a total of 6,309 children were tested with blood smear microscopy and 6,298 with real-time PCR. The 11 samples for which DNA amplification was not achieved were excluded from PCR data. \u0026nbsp;Based on microscopy and real-time PCR, 13% and 17% of children aged 6\u0026ndash;59 months were positive for malaria parasites respectively. \u0026nbsp;Molecular testing (PCR) detected and reported more malaria cases across all age groups, type of residence (rural and urban), caretaker\u0026rsquo;s education, sub-regions and across SMC and IRS special intervention areas (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"102%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eBackground\u003cbr\u003e\u0026nbsp;characteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 216px;\"\u003e\n \u003cp\u003eMalaria prevalence\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(Microscopy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMalaria prevalence\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(Real-time PCR)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;Positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003eNo. of children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eNo. of children\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge in months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\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: 228px;\"\u003e\n \u003cp\u003e6\u0026ndash;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e322\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e9\u0026ndash;11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e332\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e12\u0026ndash;17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e703\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e702\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e18\u0026ndash;23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e617\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e617\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e24\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e1,411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e17.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1,410\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e36\u0026ndash;47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e1,467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1,464\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e48\u0026ndash;59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e1,454\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1,451\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\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: 228px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e2,263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e2,258\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e4,046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e22.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4,040\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\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: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubregion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\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: 228px;\"\u003e\n \u003cp\u003eKampala\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eBuganda\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e1,591\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1,585\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eSouth Buganda\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e907\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e905\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eNorth Buganda\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e681\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eBusoga\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e20.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e28.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e573\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eBukedi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e17.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e434\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eElgon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e318\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e318\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eTeso\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e22.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e368\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e31.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e367\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eLango\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e31.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e368\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e43.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e367\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eAcholi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e31.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e268\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eKaramoja\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e26.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e258\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e31.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e258\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eWest Nile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e414\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eBunyoro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e17.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e21.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e481\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eToro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e463\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e463\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eAnkole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e435\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eKigezi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e238\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCaretaker\u0026rsquo;s education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\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: 228px;\"\u003e\n \u003cp\u003eNo education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e510\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e510\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e2,702\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e20.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e2,697\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e1,222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1,222\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eMore than secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e287\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention areas\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\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: 228px;\"\u003e\n \u003cp\u003eIRS districts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e783\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e782\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eSMC districts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e26.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e258\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e31.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e258\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\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: 228px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e6,309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e6,298\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSMC= Seasonal Malaria Chemoprevention, IRS= Indoor Residual Spraying\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable legend Table 1: Percentage of children classified positive by Microscopy and Real-Time PCR according to background characteristics\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePCR detection of malaria parasite species \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eReal-time PCR was used to identify malaria species among positive cases. Most infections were \u003cem\u003eP.\u0026nbsp;falciparum\u003c/em\u003e (85%), though \u003cem\u003eP. malariae\u003c/em\u003e (4%), \u003cem\u003eP. ovale\u003c/em\u003e (2%), and \u003cem\u003eP. vivax\u003c/em\u003e (less than 1%) made and mixed infections (9%) were also observed. Among children positive for malaria by real-time PCR, the proportion of \u003cem\u003eP. falciparum\u003c/em\u003e infections was highest in Busoga (93%), followed by Teso (91%) and West Nile (91%). Other species were most commonly observed in Tooro, Lango, Acholi, and Karamoja. The Lango subregion recorded the highest rate of mixed infections (18%) followed by Karamoja (14.7%), Acholi (12.8%) and Tooro (9.6%) \u0026nbsp;\u0026ndash; Table 2\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"714\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cem\u003eP. falciparum\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP. malariae\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003cem\u003eP. vivax\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP. ovale\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMixed infection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of children\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubregion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\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: 138px;\"\u003e\n \u003cp\u003eKampala\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eBuganda\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e82.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eSouth Buganda\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eNorth Buganda\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e83.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eBusoga\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e93.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eBukedi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e88.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eElgon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e81.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eTeso\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e91.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eLango\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e78.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e18.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eAcholi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e80.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eKaramoja\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e82.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eWest Nile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e90.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eBunyoro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e86.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eToro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e78.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eAnkole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eKigezi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpecial areas\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\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: 138px;\"\u003e\n \u003cp\u003eIRS districts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e89.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eSMC districts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e82.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eHigh altitude areas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e77.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e84.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1,08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;*Fewer than 25 unweighted cases and has been suppressed, SMC= Seasonal Malaria Chemoprevention, IRS= Indoor Residual Spraying\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLegend table 2: Percent distribution of children testing positive for malaria by real-time PCR by type of Plasmodium species, according to subregion and special areas\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of sub-microscopic infection by real-time PCR\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong children who tested negative for malaria by microscopy, 7% tested positive by real-time PCR. One of the advantages of real-time PCR is that it can detect infections that are often missed by microscopy due to low density and sub-microscopic infections. Sub-microscopic infections were most common in Lango (18%) and Acholi (13%). Sub-microscopic infections were most common in Lango (18%), Acholi (13%), Teso (10.6%), Busoga (9.9%), Bunyoro (9.6%), Tooro (8.4%) and Karamoja (7.4%) and lowest in Kigezi (1.5%), Ankole (1.7%) and Kampala City (\u0026lt;1%) the low transmission areas targeted for malaria elimination. In areas covered by special interventions of IRS and SMC, sub-microscopic parasitemia was detected by Real-Time PCR in 6.7% and 7.6% respectively in children who had tested negative by blood smear microscopy \u0026ndash; Table 3. \u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"111%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\" style=\"width: 157px;\"\u003e\n \u003cp\u003eReal-time PCR result (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNo. negative by micro\u0026shy;scopy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"bottom\" style=\"width: 265px;\"\u003e\n \u003cp\u003eParasite species among children who tested negative for malaria by microscopy but positive by real-time PCR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo. Negative by micro\u0026shy;scopy but positive by real-time PCR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eVariable\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003cem\u003eP. falciparum\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cem\u003eP. ovale\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cem\u003eP. malariae\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cem\u003eP. vivax\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003eMixed infection\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge in months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\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: 102px;\"\u003e\n \u003cp\u003e6\u0026ndash;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e95.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e9\u0026ndash;11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e96.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e12\u0026ndash;17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e92.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e632\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e86.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e18\u0026ndash;23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e93.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e554\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e81.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e24\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e93.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1,240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e86.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e36\u0026ndash;47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e93.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1,250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e91.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e48\u0026ndash;59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e92.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1,221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e92.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\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: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\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: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\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: 102px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e96.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2,107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e87.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e91.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3,405\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e87.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e291\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubregion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\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: 102px;\"\u003e\n \u003cp\u003eKampala\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e98.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eBuganda\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e95.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1,492\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e87.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eSouth Buganda\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e98.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e886\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNorth Buganda\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e92.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e606\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e89.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eBusoga\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e90.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e450\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e88.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eBukedi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e92.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e382\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e87.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eElgon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e96.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eTeso\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e88.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e92.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eLango\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e81.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e18.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e91.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eAcholi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e87.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e85.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eKaramoja\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e92.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e93.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eWest Nile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e95.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e382\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eBunyoro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e90.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e92.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eToro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e91.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e77.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eAnkole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e98.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e428\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eKigezi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e98.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpecial areas\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\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: 102px;\"\u003e\n \u003cp\u003eIRS districts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e93.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e692\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e89.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eSMC districts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e92.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e93.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\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: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e93.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e5,512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e87.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e358\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Fewer than 25 unweighted cases and has been suppressed, IRS = indoor residual spraying; SMC = seasonal malaria chemoprevention\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable legend 3: Among children who tested negative for malaria by microscopy, percent distribution by real-time PCR result for any malaria species; among children who tested negative for malaria by microscopy but positive by real-time PCR, percent distribution of positive results for each Plasmodium species.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeographical Spread of malaria Parasite Species\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough \u003cem\u003eP. falciparum\u003c/em\u003e is the dominant species across the country, molecular detection confirmed the presence of non-\u003cem\u003eP. falciparum\u003c/em\u003e species of \u003cem\u003eP. malariae, P. ovale\u003c/em\u003e and \u003cem\u003eP. vivax\u003c/em\u003e species that are geographically spread in all regions of Uganda (Fig 1 and Fig 2).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMalaria is endemic in Uganda and transmission is high throughout the year in the entire country with exception of high-altitude areas where climatic conditions do not favour vector breeding all year round (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Frequent exposure to infective mosquito bites contributes to development of partial immunity within the population which is not sustained and wanes off over time making individuals susceptible to symptomatic malaria (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Many people including children can have malaria parasites in their blood without showing any signs of infection. Such asymptomatic infections not only contribute to further transmission of malaria but also increase the risk of anaemia and other associated morbidities among infected individuals (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In this surveillance activity, all children from whom blood samples were collected were asymptomatic. Asymptomatic infections are often characterized by low parasite densities and sub-microscopic parasitaemia that are often below the detection limit of malaria microscopy (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In this malaria parasite surveillance activity, molecular confirmation of parasite species was performed to estimate prevalence and geographical spread of malaria species and sub-microscopic infections using a nationally representative sample for the first time in Uganda.\u003c/p\u003e \u003cp\u003eOverall, Real-Time PCR detected more malaria infections than blood smear microscopy consistent with reports elsewhere (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This is explained by the fact that blood smear microscopy detects the presence of actual malaria parasites in infected individuals whose accuracy heavily relies on the competency of the user, the quality of the microscope, and the quality of smear preparation and staining, all of which affect its detection limit. Due to limitations of its detection limit, microscopy may miss infections with extremely low parasite density, particularly sub-microscopic infections, usually present in asymptomatic individuals (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). This explains why microscopy is usually less sensitive than real-time PCR (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). On the other hand, real-time PCR is molecular-based and detects the presence of parasite DNA in blood samples from infected individuals. Due to its precision and accuracy, it is more sensitive than other traditional diagnostic methods such as microscopy, especially in detecting low levels of parasitaemia including species identification. The detection of additional malaria infections by real-time PCR that would have been missed by microscopy has implications including its potential inclusion in future parasite surveys. Additionally, the additional malaria infections detected by real-time PCR but missed by microscopy has programmatic implications in the context of malaria transmission and surveillance particularly for areas targeted for elimination in South Western Uganda (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Undetected parasite reservoir in asymptomatic individuals contributes to on-going malaria transmission and negatively affects efforts for transmission interruption particularly for low transmission areas targeted for elimination (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). These results also suggest that malaria surveillance and reporting systems that entirely rely on microscopy can potentially underestimate the burden of malaria which has implication for Malaria program planning.\u003c/p\u003e \u003cp\u003eThe occurrence of high proportions of sub-microscopic parasitemia in Lango, Acholi, Karamoja and Busoga is consistent with the high malaria transmission routinely reported in the routine surveillance system (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The two sub-regions of Acholi and Lango have traditionally been habitats of some of the highly effective and efficient malaria vectors of \u003cem\u003eAn. gambiae\u003c/em\u003e, \u003cem\u003eAn. funestus\u003c/em\u003e and most recently the emergence of \u003cem\u003eAn. arabiensis\u003c/em\u003e that is largely an outdoor biter. The receptivity and vulnerability in terms of ecological, environmental and climatic parameters as well as population exposure to infective bites due to sub-optimal intervention coverage and use in these regions provide optimal and suitable conditions for all-year round malaria transmission. As the country embarks on the road to malaria elimination under the new 2026-30 malaria elimination plan, presence of sub-microscopic malaria infections in asymptomatic individuals will have programmatic implications (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The Uganda malaria program aims to achieve malaria elimination in fifteen districts by 2030 and from all districts by 2035. However, current treatment efforts for parasite clearance are largely focused on symptomatic cases coming to health facilities leaving a large reservoir of sub-microscopic parasitemia in asymptomatic individuals in the population. This suggests the need for additional interventions including reactive case detection to target sub-microscopic parasite reservoir in asymptomatic individuals.\u003c/p\u003e \u003cp\u003eThe study conducted rigorous analysis of blood samples using molecular testing (real-time PCR) to determine and identify parasite species composition in all sub-regions using representative sample for the first time in Uganda. While \u003cem\u003eP. falciparum\u003c/em\u003e remains the dominant species as reported previously, the current study generated molecular data showing emergence and increasing proportions of non-P. falciparum species with mixed infections accounting for up to 9%. The occurrence of non-P. falciparum species were most commonly observed in Lango, Acholi, Karamoja and Tooro with the Lango, Karamoja and Acholi subregions recording the highest rate of mixed infections. Interestingly, these are consistently high transmission areas suggesting potential contribution of non-P. falciparum species to observed transmission rates. The occurrence of non-P. falciparum in all sub-regions of Uganda has direct and immediate implication for malaria interventions deployment in Uganda (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The country currently deploys HRP-2 based rapid diagnostic tests that currently accounts for \u0026gt;\u0026thinsp;80% of total routine malaria testing at health facility, however these RDTs are specific for P. falciparum and can potentially misse detection of non-P. falciparum parasite species. In view of this findings, it calls for possible rethinking and reconsideration of malaria diagnostic strategies in Uganda under the new proposed malaria elimination strategic plan 2026-30.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings emphasize the need for integration of molecular-based diagnostic methods in routine malaria surveillance to detect low density infection and sub-microscopic parasite reservoir that is often missed by blood smear microscopy. The observed occurrence and wide geographical spread of non-P. falciparum species across the country suggests the need for deployment of diagnostic tools that detect all malaria parasite species for both routine diagnosis and surveillance.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eACT\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eArtemisinin Based Combination Therapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eDBS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDried blood spots\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eDNA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDeoxyribonucleic Acid\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGIS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGeographical Information System\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHMIS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInformation Management System\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eIRS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIndoor Residual Spraying\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePCR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePolymerase chain reaction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eRDT\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRapid Diagnostic Tests\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSMC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSeasonal Malaria Chemoprevention\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eUNCST\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUganda National Council for Science and Technology\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eWHO\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e Ethical approval for the study was obtained from the Vector Control Division Research and Ethics Committee and the Uganda National Council of Science and Technology ensuring that the study and procedures adhered to the declaration of Helsinki. All participants provided written informed consent before recruitment into the survey.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests\u003c/p\u003e \u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThe survey was supported, in whole or in part, by the Bill \u0026amp; Melinda Gates Foundation Grant, The former US Presidents Malaria Initiative, The Global Fund and the Government of the Republic of Uganda. The first and corresponding author of the Manuscript is the principal investigator of this surveillance activity and over-saw implementation of activities supported by this funding. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eBBA is the PI and designed the study. BBA, TK, IS, ST, AA did the genomic and sequencing, BBA, EA, AS, SN, supported the data analysis. GN, BA, AO, NS supported sample correction and blood smear Microscopy. BBA drafted the manuscript. BBA, SN, PC, JO, MK reviewed the manuscript. All authors read and approved the final.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eWe thank the field study teams for leading the field activities and sample collections at the facilities. We are grateful to the study participants who participated in the survey. We acknowledge the entire study teams and the DHS program for conducting the technical contribution especially in the detailed analysis.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData for this surveillance activity is available from the corresponding author (also the survey Principal investigator) on request. The principal investigator (also the corresponding author) will facilitate the compilation and depositing of a detailed survey report online for public access on the demographic health survey website including all the raw data sets used in preparing this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHealth Management Information. System (HMIS) [Internet]. 2026.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. World Malaria Report 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. WHO World malaria report. 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgaba BB, Travis J, Smith D, Rugera SP, Zalwango MG, Opigo J, et al. Emerging threat of artemisinin partial resistance markers (pfk13 mutations) in Plasmodium falciparum parasite populations in multiple geographical locations in high transmission regions of Uganda. Malar J. 2024;23(1):330.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEpstein A, Maiteki-Sebuguzi C, Namuganga JF, Nankabirwa JI, Gonahasa S, Opigo J, et al. Resurgence of malaria in Uganda despite sustained indoor residual spraying and repeated long lasting insecticidal net distributions. PLOS Glob Public Health. 2022;2(9):e0000676.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAregawi MW, Maiteki C, Rek JC, Agaba B, Katureebe C, Ranjbar M, et al. Malaria epidemics and its drivers in Uganda in 2022. Malar J. 2025;24(1):235.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMOH. National Malaria Elimination Strategic Plan 2026.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgaba BB, Rugera SP, Mpirirwe R, Atekat M, Okubal S, Masereka K, et al. Asymptomatic malaria infection, associated factors and accuracy of diagnostic tests in a historically high transmission setting in Northern Uganda. Malar J. 2022;21(1):392.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaaya RD, Matowo J, Kajeguka D, Tenu F, Shirima B, Mosha F, et al. The Impact of Submicroscopic Parasitemia on Malaria Rapid Diagnosis in Northeastern Tanzania, an Area with Diverse Transmission Patterns. Infect Dis Rep. 2022;14(6):798\u0026ndash;809.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOchwedo KO, Omondi CJ, Magomere EO, Olumeh JO, Debrah I, Onyango SA, et al. Hyper-prevalence of submicroscopic Plasmodium falciparum infections in a rural area of western Kenya with declining malaria cases. Malar J. 2021;20(1):472.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHayuma PM, Wang CW, Liheluka E, Baraka V, Madebe RA, Minja DTR, et al. Prevalence of asymptomatic malaria, submicroscopic parasitaemia and anaemia in Korogwe District, north-eastern Tanzania. Malar J. 2021;20(1):424.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin JT, Saunders DL, Meshnick SR. The role of submicroscopic parasitemia in malaria transmission: what is the evidence? Trends Parasitol. 2014;30(4):183\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Eijk AM, Sutton PL, Ramanathapuram L, Sullivan SA, Kanagaraj D, Priya GSL, et al. The burden of submicroscopic and asymptomatic malaria in India revealed from epidemiology studies at three varied transmission sites in India. Sci Rep. 2019;9(1):17095.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDHS. Survey Standard Questionaires 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgaba BB, Anderson K, Gresty K, Prosser C, Smith D, Nankabirwa JI, et al. Molecular surveillance reveals the presence of pfhrp2 and pfhrp3 gene deletions in Plasmodium falciparum parasite populations in Uganda, 2017\u0026ndash;2019. Malar J. 2020;19(1):300.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSazed SA, Kibria MG, Alam MS. An Optimized Real-Time qPCR Method for the Effective Detection of Human Malaria Infections. Diagnostics (Basel). 2021;11(5).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNankabirwa JI, Arinaitwe E, Rek J, Kilama M, Kizza T, Staedke SG, et al. Malaria Transmission, Infection, and Disease following Sustained Indoor Residual Spraying of Insecticide in Tororo, Uganda. Am J Trop Med Hyg. 2020;103(4):1525\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYeka A, Gasasira A, Mpimbaza A, Achan J, Nankabirwa J, Nsobya S, et al. Malaria in Uganda: challenges to control on the long road to elimination: I. Epidemiology and current control efforts. Acta Trop. 2012;121(3):184\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbad P, Mar\u0026iacute;n-Garc\u0026iacute;a P, Heras M, Fobil JN, Hutchful AG, Diez A et al. Microscopic and submicroscopic infection by Plasmodium falciparum: Immunoglobulin M and A profiles as markers of intensity and exposure. Front Cell Infect Microbiol. 2022;Volume 12\u0026ndash;2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKatrak S, Nayebare P, Rek J, Arinaitwe E, Nankabirwa JI, Kamya M, et al. Clinical consequences of submicroscopic malaria parasitaemia in Uganda. Malar J. 2018;17(1):67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKamau E, Maisiba R, Dear N, Esber A, Parikh AP, Iroezindu M, et al. Implications of asymptomatic malaria infections on hematologic parameters in adults living with HIV in malaria-endemic regions with varying transmission intensities. Int J Infect Dis. 2023;137:82\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBosco AB, Nankabirwa JI, Yeka A, Nsobya S, Gresty K, Anderson K, et al. Limitations of rapid diagnostic tests in malaria surveys in areas with varied transmission intensity in Uganda 2017\u0026ndash;2019: Implications for selection and use of HRP2 RDTs. PLoS ONE. 2020;15(12):e0244457.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilva R, Lopes LF, Rodrigues A, Arez AP, Medeiros MM. Assessing the burden of submicroscopic Plasmodium infections in a pre-elimination malaria setting in sub-Saharan Africa, Guinea-Bissau. Malar J. 2024;23(1):316.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkell LC, Ghani AC, Lyons E, Drakeley CJ. Submicroscopic Infection in Plasmodium falciparum-Endemic Populations: A Systematic Review and Meta-Analysis. J Infect Dis. 2009;200(10):1509\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLo E, Zhou G, Oo W, Afrane Y, Githeko A, Yan G. Low Parasitemia in Submicroscopic Infections Significantly Impacts Malaria Diagnostic Sensitivity in the Highlands of Western Kenya. PLoS ONE. 2015;10(3):e0121763.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilva R, Lopes LF, Rodrigues A, Arez AP, Medeiros MM. Assessing the burden of submicroscopic Plasmodium infections in a pre-elimination malaria setting in sub-Saharan Africa, Guinea-Bissau. Malar J. 2024;23(1):316.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiagne A, Sambe BS, Gaba FM, Sarr I, Diatta AS, Sadio O, et al. Variable effects of non-falciparum species infections on malaria disease severity in high transmission regions in Senegal. Trop Med Health. 2024;52(1):93.\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":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Sub-microscopic parasitemia, non-P. falciparum species, Genomic surveillance","lastPublishedDoi":"10.21203/rs.3.rs-8969522/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8969522/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eMalaria morbidity and mortality declined in Uganda between 2010 and 2020; however, recent reports indicate potential reversal and loss of control gains. Demonstration of the presence of malaria parasites in human populations is an essential parameter for monitoring transmission and progress of interventions in endemic settings; however, surveillance systems heavily rely on blood smear microscopy that often misses submicroscopic infections.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e From September 2024 to April 2025, blood samples were collected from children under 5 years old in cross-sectional surveys in all regions of Uganda. Thick blood smears and dried blood spots were collected and analysed with microscopy and real-time PCR respectively. Data were analysed, with STATA and geographical information systems (ArcGIS) and reported as proportions and geospatial maps.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Overall, 6298 samples were analysed out of which 819 (13%) and 1,071 (17%) were positive for malaria parasites by microscopy and real-time PCR respectively. Highest proportion of parasites was detected in children 48-50 months old (15.8% and 21.0%) by microscopy and real-time PCR respectively; Children living in rural areas (15.7% and 22.3%); Lango sub-region (31.6% and 43.7%); Children whose mothers had no education (16.9% and 21.6%) by microscopy and real-time PCR respectively. Real-time PCR confirmed the presence of \u003cem\u003eP. falciparum\u003c/em\u003e(85%), \u003cem\u003eP. malariae\u003c/em\u003e (4%), \u003cem\u003eP. ovale\u003c/em\u003e (2%), \u003cem\u003eP. vivax\u003c/em\u003e (\u0026lt;1%) and mixed infections (9%). The Lango sub-region recorded the highest rate of mixed infections (18%) followed by Karamoja (14.7%), Acholi (12.8%) and Tooro (9.6%). Among children who tested negative for malaria by microscopy, 7% were positive by real-time PCR. Sub-microscopic infections were most common in Lango (18%), Acholi (13%) and Teso (10.6%) and lowest in Kigezi (1.5%), Ankole (1.7%) and Kampala City (\u0026lt;1%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThese findings emphasize potential for consideration and integration of molecular-based methods in malaria surveillance systems to detect sub-microscopic parasite reservoir that is often missed by blood smear microscopy. The observed occurrence and wide geographical spread of non-P. falciparum species across the country suggests the need for deployment of diagnostic tools that detect all malaria parasite species for routine diagnosis and surveillance in Uganda.\u003c/p\u003e","manuscriptTitle":"Genomic Surveillance to Estimate the burden of Sub-microscopic malaria infections, Parasite Species Composition and Implication for Elimination in Uganda; First Evidence at National Scale - 2025","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-13 07:33:40","doi":"10.21203/rs.3.rs-8969522/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-30T09:03:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-29T16:10:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-28T07:18:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"328093286539006096726563975565032859699","date":"2026-03-11T19:07:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151046400864795492533912428132779159721","date":"2026-03-08T16:44:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"157570660513835694649616180613609680873","date":"2026-03-08T15:29:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-06T13:28:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-06T12:22:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-03T19:54:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-03T13:00:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2026-03-03T08:53:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dd33a908-fec0-4f2f-8d04-82b913236f0f","owner":[],"postedDate":"March 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T14:38:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-13 07:33:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8969522","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8969522","identity":"rs-8969522","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}