Background Global efforts to scale-up malaria control interventions are gaining steam. These include the use of LLINs, IRS, Intermittent Preventive Treatment and Test, Treat and Track. Despite these, the drive for malaria elimination is far from being realistic in endemic communities in Africa. This is partly because asymptomatic parasite carriage, not specifically targeted by most interventions fuel transmission. There is a need to use alternative strategies that target asymptomatic parasitaemia. We report the impact of malaria mass testing, treatment and tracking (MTTT) on prevalence of asymptomatic parasitaemia over a two-year period in Ghana.

Methods 5800 individuals in 7 communities in the Pakro sub-district of Ghana participated in this study. Community-based health volunteers moved from house-to-house testing participants using RDTs and treating positive cases with ACTs quarterly.

Results In the intervention arm, the prevalence of asymptomatic parasitaemia significantly decreased from 22.9% (95% CI: 19.8, 26.1) in March 2020 to 6.5% (95% CI 5.9, 7.0) in March 2022 among all the participants. Also, a significant reduction in parasitaemia was observed during the July season 2020 to 2021 (P<0.001). Interestingly, there was no significant decline in asymptomatic malaria during the season of November between 2020 and 2022. In the control arm, the parasitaemia increased from 30.3% (95% CI: 24.1, 36.5) in March 2020 to 41.4% (95% CI: 32.8, 50.0) in March 2022. Similar trends were observed for participants ≤15 years and ≥15 years. In the intervention arm the prevalence of moderate anaemia reduced from 4.2% in March 2020 to 1.2% in March 2022.

Conclusion This study suggests that implementing MTTT could reduce the prevalence of asymptomatic parasitaemia in children under 15 years of age over time. However, care should be taken when planning MTTT as the asymptomatic parasitaemia prevalence varies across season. There is a need to reduce the times interval between interventions.