Sub microscopic infections (SMI) are one of the major hurdles in achieving the goal of malaria elimination. SMI remains undetected through standard diagnostic tools and contribute to sustenance of malaria transmission. Deora and colleagues in The Lancet Regional Health-Southeast Asia review SMI and highlight the issue of SMI in context of India where burden of SMI ranged from 0.4 to 38.4%.1 The sensitivity of micros copy is lower for Plasmodium falciparum (Pf) malaria than Plasmodium vivax (Pv) and extremely compromised for mixed Pf-Pv infections. Importantly, the prevalence of Pf (63.8%) is » 1.8 times higher than Pv (36.2%) in India which means that a significant proportion is missed by microscopy.2 The review advocated theimportance of mapping hotspots of sub-microscopicinfections using molecular techniques. But, molecular technique like polymerase chain reaction (PCR) requires skilled technician with sophisticated instrument and well equipped laboratory infrastructure.
