A focus on improving molecular diagnostic approaches to malaria control and elimination in low transmission settings: Review

The malaria elimination goal is back to the global agenda. Understanding its epidemiology in low transmission settings is crucial to design reliable strategies to detect a large reservoir of individuals infected with sub-microscopic (and often asymptomatic) infections characterized by low-parasite densities and gametocyte carriage. Traditional diagnostic methods such a light microscopy is widely used mainly in developing countries and as a result, the true picture of malaria epidemiology is misrepresented. In the last few decades, the advancement of molecular diagnostic tools significantly improved our understanding of the epidemiology of the diseases. However, the detection capacity of different molecular assays is determined by different factors such as the sensitivity of the assay and the transmission and infection dynamics of the disease particularly when there is low parasitic density in reservoir hosts. Hence, in this review, the epidemiology of malaria in low transmission settings and the priority in addressing the malaria control and elimination goals are highlighted.