Background
Malaria is a major public health problem in the Central African Republic (CAR), despite the massive scale-up of control interventions. Community-based malaria is still not documented across CAR, although 100 % of its population is at risk of malaria and CAR is the 5th most affected country in Africa in terms of incidence. This study aimed to assess the prevalence of malaria parasite infections in Bangui from August to September 2022.
Methods
A community-based cross-sectional study was undertaken in Bangui, the capital of CAR. Sociodemographic data and venous blood samples were collected from each study participant. Positivity for malaria parasites was determined using malaria rapid diagnostic test (mRDT), thick blood smear microscopy and polymerase chain reaction (PCR) methods.
Results
A total of 638 participants, mean age of 26.44 years (range 1 to 75 years) and a sex ratio (M/F) of 1.22, were tested for malaria parasites using all three detection methods. The overall prevalence of Plasmodium spp. was 32.45% (95% CI 31.29 -33.61%) by PCR, 27.59% (95% CI 25.75% – 30.35%) by mRDT and 23.51% (95% CI 20.64% - 24.82%) by Giemsa-based thick blood smear microscopy. Malaria was more common in people aged 15 to 49 years, and a microspatial heterogeneity in positivity rates was observed, with the majority of cases occurring in semi-urban areas by mRDT and microscopy respectivelly. Approximately 80% of microscopy-positive subjects had a low parasite density (<1000 parasites/µl whole blood). Although P. falciparum was the most common species (98.55%), the transmission of P. ovale appears to be well established in the area, occurring either as mono-infection (1.45%) or coinfection (1.93%) with P. falciparum. In addition, a 9.56% prevalence of submicroscopic infections was observed.
Conclusions
This first study of community malaria in Bangui provides essential baseline data to guide future research on malaria parasites in the Central African Republic, particularly with regard to circulating parasite species. The high prevalence of community malaria demonstrates the persistence of malaria as a major public health challenge in the country, highlighting the need to intensify ongoing control efforts.