Editorial commentary on: Malaria parasitaemia among long distance truck drivers in the Niger delta of Nigeria.

Erhabor et al1 describe the prevalence of asymptomatic malaria in a unique study population of truck drivers, who have otherwise featured in medical literature for risky sexual behaviour and associated high HIV prevalence rates2. Their findings suggest that limited access to adequate health care facilities and preventative strategies exposes truck drivers to infection with plasmodium facliparum, the most virulent species of the genus plasmodium that causes malaria, accounting for millions of deaths in Africa3. Curtailing vectorial-transmission of p. falciparum is one of the key strategies towards control, eradication and ultimate elimination of this disease in Africa. Indeed, increased coverage of preventative measures such as insecticide treated nets and Indoor residual spraying, has resulted in malaria control and eradication in some parts of Africa3. A secondary consequence of success in malaria control in children < 5 years of age is a shift in disease burden to older population’s highlighting the elusiveness of this parasite and intricacies required in eliminating this deadly parasite from the face of the world4. Thought interesting, their findings of higher point prevalence of asymptomatic malaria among truck drivers with low CD4 counts would have been more informative if the HIV status of the truck drivers had been studied. HIV disease impairs acquired immunity to malaria seen in older children and adults in endemic areas and has been associated with increased frequency of both parasitemia and clinical malaria in HIV-infected adults5-6. Increase prevalence of HIV in this population could as well explain their findings. Despite limitations, the key finding of high rates of asymptomatic malaria coverage in an otherwise ‘unsuspected’ population of truck driver is telling of the need to cast the net wide to eradicate the parasite in hosts that efficiently harbour the parasite, propagating spread of malaria to vulnerable populations by aiding the parasite vectors ‘mosquitoes’ in transmitting the parasite from place to place.