An active and targeted survey reveals asymptomatic malaria infections among high-risk populations in Mondulkiri, Cambodia

Background: Malaria is a mosquito-borne disease that is one of the most serious public health issues globally and a leading cause of mortality in many developing countries worldwide. Knowing the prevalence of both symptomatic and asymptomatic malaria on a subnational scale allows for the estimation of the burden of parasitemia present in the transmission system, enabling targeting and tailoring of resources towards greater impact and better use of available capacity. This study aimed to determine the PCR-based point prevalence of malaria infection, by parasite species, among three high risk populations in Mondulkiri province, Cambodia: forest rangers, forest dwellers, and forest goers. Methods A cross-sectional survey was performed during the transmission season in November and December 2021. Blood samples collected on filter paper from participants (n = 1,301) from all target groups were screened for Plasmodium spp. using PCR. Results Malaria prevalence among all study participants was 6.7% for any Plasmodium species. Malaria prevalence in the forest ranger group (8.1%) was higher than that seen in forest goer (6.8%) and forest dweller (6.4%) groups; all infections were asymptomatic. Plasmodium vivax was detected in all participant groups, while the few P. falciparum infections were found in goers and dwellers. 81% of all infections were due to Plasmodium vivax , 9% were due to P. falciparum , 3% due to Plasmodium cynomolgi , and the rest (7%) remained undefined. Gender was associated with malaria infection prevalence, with male participants having higher odds of malaria infection than female participants. Passively collected malaria incidence data from the Cambodian government were also investigated. Health facility-reported malaria cases, based on rapid diagnostic tests, for the period Jan-Dec 2021 were 521 Plasmodium vivax (0.89% prevalence), 34 P. falciparum (0.06%) and four P. falciparum  + mixed (0.01%) – a total of 559 cases (0.95%) for all of Mondulkiri. Conclusion This reservoir of asymptomatic parasitemia may be perpetuating low levels of transmission, and thus, new strategies are required to realize the goal of eliminating malaria in Cambodia by 2025.