Martha Betson, Sarah Clifford, Michelle Stanton, Narcis B Kabatereine, J Russell Stothard

As part of a longitudinal cohort investigation of intestinal schistosomiasis and malaria in Ugandan children and their mothers on the shorelines of Lakes Victoria and Albert, we documented risk factors and morbidity associated with non-falciparum Plasmodium infections and the longitudinal dynamics of Plasmodium species in children. Host age, household location and P. falciparum infection were strongly associated with non-falciparum Plasmodium infections, and P. malariae infection was associated with splenomegaly. Despite regular artemisinin combination therapy treatment, there was a threefold rise in P. malariae prevalence, which was not accountable for by increasing age of the child. Worryingly, our findings reveal the consistent emergence of non-falciparum infections in children, highlighting the complex dynamics underlying multi-species infections here. Given the growing body of evidence that non-falciparum malaria infections cause significant morbidity, we encourage better surveillance for non-falciparum Plasmodium infections, particularly in children, with more sensitive DNA detection methods and improved field-based diagnostics.