Adults infected with Plasmodium spp. in endemic areas need to be re-evaluated in light of global malaria elimination goals. They potentially undermine malaria interventions but remain an overlooked aspect of public health strategies. This study aimed to estimate the prevalence of Plasmodium spp. infections, to identify underlying parasite species, and to assess predicting factors among adults residing in an endemic area from the Democratic Republic of Congo (DRC). A community-based cross-sectional survey in subjects aged 18 years and above was therefore carried out. Study participants were interviewed using a standard questionnaire and tested for Plasmodium spp. using a rapid diagnostic test and a nested polymerase chain reaction assay. Logistic regression models were fitted to assess the effect of potential predictive factors for infections with different Plasmodium spp. Overall, 420 adults with an estimated prevalence of Plasmodium spp. infections of 60.2% [95% CI 55.5; 64.8] were included. Non-falciparum species infected 26.2% [95% CI 22.2; 30.5] of the study population. Among infected participants, three parasite species were identified, including Plasmodium falciparum (88.5%), Plasmodium malariae (39.9%), and Plasmodium ovale (7.5%) but no Plasmodium vivax. Mixed species accounted for 42.3% of infections while single-species infections predominated with P. falciparum (56.5%) among infected participants. All infected participants were asymptomatic at the time of the survey. Adults belonging to the “most economically disadvantaged” households had increased risks of infections with any Plasmodium spp. (adjusted odds ratio, aOR = 2.87 [95% CI 1.66, 20.07]; p < 0.001), compared to those from the "less economically disadvantaged” households. Conversely, each 1 year increase in age reduced the risk of infections with any Plasmodium spp. (aOR = 0.99 [95% CI 0.97, 0.99]; p = 0.048). Specifically for non-falciparum spp., males had increased risks of infection than females (aOR = 1.83 [95% CI 1.13, 2.96]; p = 0.014). Adults infected with malaria constitute a potentially important latent reservoir for the transmission of the disease in the study setting. They should specifically be taken into account in public health measures and translational research.

中文翻译：

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居住在刚果民主共和国高流行地区的成年人的疟疾感染情况

感染疟原虫属的成人。需要根据全球消除疟疾目标重新评估流行地区的情况。它们可能会破坏疟疾干预措施，但仍然是公共卫生战略中被忽视的一个方面。本研究旨在估计疟原虫属的患病率。感染，以确定潜在的寄生虫种类，并评估居住在刚果民主共和国（DRC）流行地区的成年人的预测因素。因此，对 18 岁及以上的受试者进行了一项以社区为基础的横断面调查。研究参与者使用标准问卷进行访谈，并进行疟原虫检测。使用快速诊断测试和巢式聚合酶链反应测定。拟合逻辑回归模型来评估潜在预测因素对不同疟原虫属感染的影响。总体而言，估计有 420 名成年人患有疟原虫属。感染率为 60.2% [95% CI 55.5；64.8] 被包括在内。非恶性疟原虫感染率为 26.2% [95% CI 22.2；30.5]研究人群。在受感染的参与者中，发现了三种寄生虫，包括恶性疟原虫（88.5%）、三日疟原虫（39.9%）和卵形疟原虫（7.5%），但没有间日疟原虫。混合物种感染占感染者的 42.3%，而单一物种感染在感染者中以恶性疟原虫（56.5%）为主。所有受感染的参与者在调查时都没有症状。属于“经济上最弱势”家庭的成年人感染任何疟原虫属的风险增加。（调整后的比值比，aOR = 2.87 [95% CI 1.66, 20.07]；p < 0.001），与来自“经济条件较差”家庭的家庭相比。相反，年龄每增加 1 岁，感染任何疟原虫的风险就会降低(aOR = 0.99 [95% CI 0.97, 0.99]; p = 0.048)。特别是对于非恶性疟原虫属，男性感染风险高于女性 (aOR = 1.83 [95% CI 1.13, 2.96]; p = 0.014）。感染疟疾的成年人是研究环境中疾病传播的潜在重要潜在宿主。在公共卫生措施和转化研究中应特别考虑到他们。