Abstract
BACKGROUND: Asymptomatic Plasmodium infection is a protozoan disease transmitted by vectors, in which the parasite remains inside the host without causing signs and/or symptoms. It poses a significant challenge to malaria control and elimination efforts due to its role in sustaining silent transmission within communities. Despite ongoing progress toward the 2030 malaria elimination targets, the disease remains a significant public health issue in Ethiopia. Schoolchildren in endemic areas are common carriers of the parasite and deserve special attention, as they represent a highly vulnerable population. As a result, this study determined the prevalence and identified predictors of asymptomatic Plasmodium infection among schoolchildren in the Bahir Dar Zuria District, Northwest Ethiopia. METHODS: A school-based cross-sectional study was conducted from March to May 2024. It involved 416 schoolchildren selected through systematic random sampling. Data on socio-demographic characteristics and potential predictors were collected using a pre-tested, semi-structured questionnaire administered through face-to-face interviews. To detect Plasmodium parasites, blood samples were analysed using Rapid Diagnostic Tests, capillary Buffy Coat, and blood film. Multilevel, mixed-effect logistic regression analysis was performed to identify predictors associated with the asymptomatic Plasmodium infection. A p-value ≤ 0.05 was considered statistically significant. RESULTS: The composite prevalence of asymptomatic Plasmodium infection in this study was 3.4% (95% CI: 1.7-6.3). Plasmodium falciparum accounted for 64.3% of cases. Age (Adjusted Odd Ratio, AOR = 3.53; 95% CI: 1.65-6.20; p = 0.001), gender (AOR = 2.87; 95% CI: 1.93-4.28; p = 0.021), presence of stagnant water near the household (AOR = 3.76; 95% CI: 1.48-6.82; p = 0.031), never used long-lasting insecticidal nets (AOR = 2.90, 95% CI: 1.72-3.48; p = 0.007), and a history of malaria infection in the last year (AOR = 2.23 95% CI: 1.420-5.22; p = 0.047) were statistically significantly predictors of asymptomatic Plasmodium infection. CONCLUSION: This study revealed that asymptomatic schoolchildren serve as significant reservoirs for malaria, challenging elimination efforts. The findings emphasize the need for integrated interventions such as active case detection and treatment, improved long-lasting insecticidal net coverage, and environmental management. Importantly, comprehensive surveillance and seasonal malaria chemoprevention are also recommended to reduce silent transmission and support targeted control strategies.