Randomized trial measures changes in Plasmodium falciparum population size in northern Ghana, indicating resilience to interventions.
Key Points
This research aims to introduce a new endpoint for evaluating the control of Plasmodium falciparum infections based on the census population size of the parasite.
Utilized a Bayesian approach to estimate multiplicity of infection (MOIvar) from sequencing var genes.
Tracked changes in census population size through indoor residual spraying (IRS) and seasonal malaria chemoprevention (SMC) in northern Ghana from 2012 to 2017.
Measured var gene diversity, MOIvar, and population size in approximately 2000 humans across all ages.
Following IRS, transmission intensity was reduced by over 90%, and parasite prevalence decreased by approximately 40–50%.
Observed significant reductions in var diversity, MOIvar, and population size, which were short-lived, rebounding within 32 months of intervention cessation.
Despite major interventions, the parasite population remained large, retaining high var diversity and genetic characteristics of a high-transmission system.