Background The global decline of malaria incidence over the past decade has led to the thought that elimination could be achieved. This has resulted in an increased interest to design strategies to target the hidden reservoir of asymptomatic infections among populations and interrupt on-going residual local malaria transmission. This study explored the reservoir of asymptomatic Plasmodium infections and its relationship with subsequent clinical malaria infections in low-transmission areas in Senegal.

Methods Cross-sectional surveys were carried out in 2013, 2014, 2015, and 2016 and combined with longitudinal follow-up to determine and geolocalise both asymptomatic and clinical malaria episodes in Dielmo and Ndiop, Senegal. The prevalence of asymptomatic Plasmodium carriage in the community was investigated by real-time PCR while clinical malaria attacks were identified at health facilities during the transmission season. All households were georeferenced to spatially map asymptomatic and clinical infections.

Results The study revealed substantial asymptomatic infections with average parasite carriage of 8.11% and 7% in Dielmo and Ndiop, respectively. P. falciparum accounted for most asymptomatic infections (more than 90%). In Dielmo, 95% of asymptomatic infections clustered within the same geographical areas while infections were disparate in Ndiop. Preliminary fine-scale mapping of asymptomatic and clinical malaria infections identified clusters of higher malaria incidence interpreted as foci of transmission across the four-year study period with 95%–98% of clinical infections occurring in households where an asymptomatic malaria infection existed.

Conclusion This study revealed substantial asymptomatic Plasmodium infections in both settings throughout the four-year study period and spatial clusters of malaria infections at the microepidemiological level. Together, these findings could offer a feasible approach for a rational targeting of malaria control interventions to achieve elimination.