ArticlePloS one2020
Limitations of rapid diagnostic tests in malaria surveys in areas with varied transmission intensity in Uganda 2017-2019: Implications for selection and use of HRP2 RDTs.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 29 papers, 2 of them syntheses that pooled it.
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Who cites it
29 citing papers in PubMed, 2 syntheses or guidelines pooled it, 56 citations in OpenAlex.
- Performance and challenges of malaria rapid diagnostic tests in endemic regions of Africa.Scientific reports · 2025Pooled it
- Plasmodium falciparum histidine-rich protein 2 and 3 genes deletion in global settings (2010-2021): a systematic review and meta-analysis.Malaria journal · 2022Pooled it
- Trial
- Low practical knowledge but high willingness to use malaria rapid diagnostic tests among healthcare workers in the Republic of Congo.BMC public health · 2026Article
- The Potential of Bioinformatics in Revolutionizing Disease Diagnosis in Sub-Saharan Africa: A Narrative Review.Health science reports · 2026Article
- Field and laboratory evaluation of Abbott-Bioline™ Malaria Ag Pf/Pv RDT performance in a high-transmission setting: contrasting results with a low-endemic area.Malaria journal · 2026Article
- Pediatric MixedChildren (Basel, Switzerland) · 2026Article
- False-positive and false-negative malaria rapid diagnostic test results: evidence from a nationally representative survey of children in Ghana.Malaria journal · 2026Article
- FedMal-XAI: an explainable federated vision transformer leveraging knowledge distillation for privacy-preserving malaria detection.Frontiers in public health · 2026Article
- Article
- First report of pfhrp2 and pfhrp3 gene deletions compromising HRP2-based malaria rapid diagnostic tests in Malawi.Infectious diseases of poverty · 2025Article
- Malaria epidemics and its drivers in Uganda in 2022.Malaria journal · 2025Article
- Field evaluation of the Bioline Malaria Ag P.f/Pan rapid diagnostic test: causes of microscopy discordance and performance in Uganda.Malaria journal · 2025Article
- Point-of-Care Evaluation of Malaria Rapid Diagnostic Test (mRDT) for Detection ofJournal of parasitology research · 2025Article
- Diagnostic accuracy ofExperimental biology and medicine (Maywood, N.J.) · 2025Article
- Enhancing the Interpretability of Malaria and Typhoid Diagnosis with Explainable AI and Large Language Models.Tropical medicine and infectious disease · 2024Article
- Receipt of antimalarials among children aged 6-59 months in Nigeria from 2010 to 2021.Malaria journal · 2024Article
- Sub-microscopic Plasmodium falciparum infections and multiple drug resistant single nucleotide polymorphic alleles in pregnant women from southwestern Nigeria.BMC research notes · 2024Article
- Limited threat of Plasmodium falciparum pfhrp2 and pfhrp3 gene deletion to the utility of HRP2-based malaria RDTs in Northern Uganda.Malaria journal · 2024Article
- Article
Corrections and comments
- Erratum issued
Authors and funding
21 authors at 7 institutions in 2 countries.
Funding
Abstract
backgroundPlasmodium falciparum histidine-rich protein 2 (HRP2)-based rapid diagnostic tests (RDTs) are exclusively recommended for malaria diagnosis in Uganda; however, their functionality can be affected by parasite-related factors that have not been investigated in field settings.
methodsUsing a cross-sectional design, we analysed 219 RDT-/microscopy+ and 140 RDT+/microscopy+ dried blood spots obtained from symptomatic children aged 2-10 years from 48 districts in Uganda between 2017 and 2019. We aimed to investigate parasite-related factors contributing to false RDT results by molecular characterization of parasite isolates. ArcGIS software was used to map the geographical distribution of parasites. Statistical analysis was performed using chi-square or Fisher's exact tests, with P ≤ 0.05 indicating significance. Odds ratios (ORs) were used to assess associations, while logistic regression was performed to explore possible factors associated with false RDT results.
resultsThe presence of parasite DNA was confirmed in 92.5% (332/359) of the blood samples. The levels of agreement between the HRP2 RDT and PCR assay results in the (RDT+/microscopy+) and (RDT-/microscopy+) sample subsets were 97.8% (137/140) and 10.9% (24/219), respectively. Factors associated with false-negative RDT results in the (RDT-/microscopy+) samples were parasite density (<1,000/μl), pfhrp2/3 gene deletion and non-P. falciparum species (aOR 2.65, 95% CI: 1.62-4.38, P = 0.001; aOR 4.4, 95% CI 1.72-13.66, P = 0.004; and aOR 18.65, 95% CI: 5.3-38.7, P = 0.001, respectively). Overall, gene deletion and non-P. falciparum species contributed to 12.3% (24/195) and 19.0% (37/195) of false-negative RDT results, respectively. Of the false-negative RDTs results, 80.0% (156/195) were from subjects with low-density infections (< 25 parasites per 200 WBCs or <1,000/μl).
conclusionThis is the first evaluation and report of the contributions of pfhrp2/3 gene deletion, non-P. falciparum species, and low-density infections to false-negative RDT results under field conditions in Uganda. In view of these findings, the use of HRP2 RDTs should be reconsidered; possibly, switching to combination RDTs that target alternative antigens, particularly in affected areas, may be beneficial. Future evaluations should consider larger and more representative surveys covering other regions of Uganda.
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