Submicroscopic malaria parasite carriage and hemoglobin levels among outpatients attending the laboratories of the Korle Bu Teaching Hospital

Malaria remains a major public health challenge in sub-Saharan Africa, where asymptomatic infections continue to hinder elimination efforts. Although the effects of microscopic infections are well documented, the health implications of submicroscopic Plasmodium falciparum infections remain poorly understood, particularly in Ghana. Beyond serving as reservoirs for sustained transmission, emerging evidence suggests these infections may contribute to adverse health outcomes. This study assessed the burden of submicroscopic P. falciparum infections and their association with anemia among outpatients attending Korle Bu Teaching Hospital. A cross-sectional study involving 345 participants was conducted. Malaria infection was assessed using mRDT, blood smear microscopy, and LAMP-PCR for parasite detection and species identification. Hemoglobin levels and red blood cell indices (MCV, RDW, RBC count, MCHC, and HCT) were measured using a hematology analyzer. Statistical analysis was performed using STATA version 14, applying Pearson’s chi-square test and logistic regression. The overall prevalence of asymptomatic P. falciparum infection was 35.0% (117/334), with 18.9% microscopic and 16.1% submicroscopic infections. Both infection types were significantly associated with lower hemoglobin levels after adjusting for age and anemia severity ( p = 0.024). Low MCHC emerged as the strongest predictor of submicroscopic infection ( p = 0.04). Asymptomatic P. falciparum infections are common in this population, with a substantial proportion occurring at submicroscopic levels. Their association with reduced hemoglobin suggests a potential contribution to anemia despite the absence of symptoms. The findings underscore the need for sensitive diagnostics and targeted interventions to support malaria elimination efforts in Ghana.