Jul 09, 2025
To What Extent Do People in Malaria-Endemic Countries Know Asymptomatic Malaria Infections? A Systematic Review
- Taofic Bouwe1,
- Noudehouenou Credo A. A.1,
- Kimiyo Kikuchi2,3,
- Moritoshi Iwagami4,5,
- Daisuke Nonaka1
- 1Department of Global Health, Graduate School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan;
- 2Institute for Asian and Oceanian Studies, Kyushu University, Japan;
- 3Department of Global Health and Population, Harvard T.H. Chan School of Public Health, USA;
- 4Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine (NCGM), Japan;
- 5Institut Pasteur du Lao, Vientiane-Lao PDR
External link: https://doi.org/10.1371/journal.pone.0340636
Protocol Citation: Taofic Bouwe, Noudehouenou Credo A. A., Kimiyo Kikuchi, Moritoshi Iwagami, Daisuke Nonaka 2025. To What Extent Do People in Malaria-Endemic Countries Know Asymptomatic Malaria Infections? A Systematic Review. protocols.io https://dx.doi.org/10.17504/protocols.io.6qpvrwemplmk/v1
Manuscript citation:
Bouwe T, Ahissou NCA, Kikuchi K, Iwagami M, Nonaka D (2026) To what extent do people in malaria-endemic countries know asymptomatic malaria infections? A systematic review. PLOS One 21(1). doi: 10.1371/journal.pone.0340636
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: July 09, 2025
Last Modified: July 09, 2025
Protocol Integer ID: 222034
Keywords: awareness on asymptomatic malaria, community knowledge of asymptomatic malaria, knowledge of asymptomatic malaria, awareness of this asymptomatic plasmodium infection, asymptomatic malaria infection, asymptomatic malaria, knowledge of malaria, asymptomatic plasmodium infection, malaria infection, malaria infection with plasmodium parasite, malaria, having malaria symptom, malaria symptom, beliefs about malaria control, malaria control, people in malaria, malaria relapse, malaria control intervention, plasmodium parasite, malaria elimination, challenges to malaria elimination, awareness of the disease, mosquito bite, symptomatic infection, transmission through mosquito bite, disease, symptomatic infections with available diagnostic tool, endemic country, asymptomatic individual, disease reservoir, symptom, infection
Funders Acknowledgements:
Japan International Cooperation & Japan Agency for Medical Research and Development (AMED) Agency (JICA)
Grant ID: JP24jm0110028: 2022–2028
Abstract
In the fight against malaria, control measures mainly focus on symptomatic infections with available diagnostic tools such as rapid diagnostic tests and microscopy in urban and remote areas. Individuals having malaria symptoms are likely to be aware of their condition and seek treatment at healthcare facilities. Furthermore, many studies have assessed community’s knowledge of malaria. These studies often focus on people’s awareness of the disease’s symptoms, their attitude in seeking treatment and protective measures they use. On the other hand, asymptomatic malaria, which is defined as malaria infection with Plasmodium parasites of any density without symptoms related to the disease, constitutes one of the challenges to malaria elimination, and awareness of this asymptomatic Plasmodium infection remains relatively understudied among the affected communities. Moreover, not only asymptomatic individuals do not necessarily seek treatment, but they also constitute the disease reservoir that contributes to malaria relapses and transmission through mosquito bites. To present, few studies reported community knowledge of asymptomatic malaria. Hence, it is crucial to explore and raise awareness on asymptomatic malaria as this knowledge may determine community level of engagement in malaria control interventions. Therefore, this systematic review aims to determine the proportion of people who have knowledge of asymptomatic malaria in endemic countries and describe their perceptions and beliefs about malaria control.
Troubleshooting
Review Start Date
March 2024
Anticipated Completion Date
December 2024
Contact Details
BOUWE Taofic; E-mail: [email protected]; [email protected]
Organization and Affiliation of the Review
Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Okinawa, Japan. Website: Faculty of Medicine, University of the Ryukyus (u-ryukyu.ac.jp)
Review Team Members and Their Affiliation
Taofic Bouwe: Department of Global Health, Graduate School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
Noudehouenou Credo A. A.: Department of Global Health, Graduate School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
Kimiyo Kikuchi: Institute for Asian and Oceanian Studies, Kyushu University, Japan / Department of Global Health and Population, Harvard T.H. Chan School of Public Health, USA
Moritoshi Iwagami: Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine (NCGM), Japan / Institut Pasteur du Laos, Vientiane, Lao PDR
Daisuke Nonaka: Department of Global Health, Graduate School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
Review Question
To what extent do people in malaria-endemic countries know asymptomatic malaria infections?
Searches
The search will be in English language with a strategy that includes both subject headings and text words relating to or describing the topic (community, knowledge, asymptomatic malaria).
Search terms: "community" and "awareness" or "knowledge" or perception or "attitude" and "asymptomatic” or “symptomless” or “afebrile” and “malaria".
Databases: PubMed (MEDLINE), Google Scholar and Web of Science.
References and citations for the articles included in the review will be searched for additional relevant studies.
Inclusion and Exclusion Criteria
Inclusion criteria:
Peer-reviewed and Published articles on knowledge, perceptions, or awareness of asymptomatic malaria
Date of publication: January 1st, 2010 to May 2024
Quantitative studies: Cross-sectional, cohort, case-control and intervention studies
Qualitative studies: In-depth interviews, focus group interviews, focus group discussions.
Exclusion criteria:
Articles on simian malaria other than P. knowlesi
Case reports, opinion papers, editorials
The Condition or Domain Being Studied
Asymptomatic malaria and community knowledge and awareness
Participants/Population
Individuals or communities residing in malaria-endemic countries.
Intervention/Exposure
N/A
Comparator/Control
N/A
Context
Asymptomatic malaria in malaria-endemic countries
Main Outcome
Proportion of the Population who know about asymptomatic malaria.
Additional Outcome
Awareness, perceptions, or beliefs about asymptomatic malaria
Data Extraction (Selection and Coding)
To identify studies that potentially meet the inclusion criteria, two authors will independently screen titles and abstracts of studies retrieved using the search strategy as well as those from additional sources. The full text of these eligible studies will be retrieved and independently assessed by two review team members. Disagreements between them regarding the eligibility of particular studies will be resolved through discussion with a third author.
A standard form will be used to extract the following information: the year when the study was conducted, year of study publication, study sites, study population and age groups, and baseline characteristics, study design, outcomes, information for risk of bias assessment. Data will be extracted independently by two authors. When necessary, a third author will be consulted to resolve discrepancies.
Quality Assessment
For the quality assessment of included studies, the Joanna Briggs Institute (JBI) critical appraisal tool will be used. For cross-sectional studies, a critical appraisal tool checklist with 8 criteria will be applied (Example: 1. Were the criteria for inclusion in the sample clearly defined? 2. Were confounding factors identified? 3. Were the outcomes measured in a valid and reliable way? 4. Was appropriate statistical analysis used?), while for cohort studies, a checklist tool with 11 criteria will be applied (Example: 1. Were the two groups similar and recruited from the same population? 2. Were the groups/participants free of the outcome at the start of the study?), and for qualitative studies, a checklist with 10 criteria will be used (Example: 1. Is there congruity between the research methodology and the research question or objectives? 2. Is there congruity between the research methodology and the interpretation of results? 3. Do the conclusions drawn in the research report flow from the analysis, or interpretation, of the data?).
Strategy for Data Synthesis
For quantitative studies, the proportions of participants aware of asymptomatic malaria and confidence intervals from the included studies will be pooled. Due to heterogeneity among included studies (i.e. various study designs, and geographical areas), the summary of the effect size will be conducted using a meta-analysis random-effects model. Statistical heterogeneity will be assessed using I2 Statistic and if necessary, a sub-group analysis will be conducted to explore heterogeneity among and between studies for a better explanation of the observed differences. For qualitative studies, we will descriptively summarize findings on Awareness, perceptions or beliefs about asymptomatic malaria and provide a narrative synthesis.
Conflicts of Interest
No conflict of interest to declare.