ArticleNature microbiology2021
Plasmodium falciparum is evolving to escape malaria rapid diagnostic tests in Ethiopia.
Article in Nature microbiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 113 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
113 citing papers in PubMed, 1 synthesis or guideline pooled it, 185 citations in OpenAlex.
- Malaria and Helminthic Co-Infection during Pregnancy in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.International journal of environmental research and public health · 2022Pooled it
- Peptide-Enabled Nanoplatforms for Malaria and Leishmaniasis: From Intracellular Targeting to Translational Diagnostic Perspectives.ChemMedChem · 2026Review
- Resurgence of Malaria in Ethiopia.JAMA · 2026Article
- First TES in Djibouti: A Critical Milestone Amid Rising Regional Threats.Open forum infectious diseases · 2026Article
- Continental-scale genomic surveillance of Plasmodium falciparum malaria across sub-Saharan Africa with rapid nanopore sequencing.Nature communications · 2026Article
- Global-scale population genetic analysis of Plasmodium falciparum identifies region-specific patterns of malaria parasite adaptation.Nature communications · 2026Article
- Cellular Immune Response and T Cell Epitope Mapping ofVaccines · 2026Article
- Unite against Malaria: challenges and achievements in malaria control around the globe.Nature communications · 2026Article
- Parasite population dynamics shaped P. falciparum pfhrp2 and pfhrp3 deletion expansion in the Peruvian Amazon.Scientific reports · 2026Article
- Prevalence of Plasmodium falciparum histidine rich protein 2/3 gene deletions affecting rapid diagnostic test performance in travellers.Journal of travel medicine · 2026Article
- Are HRP2/3 deletions silently crippling malaria rapid diagnostic tests?The Indian journal of medical research · 2026Review
- Malaria control and the unexpected spread of diagnostic-resistantbioRxiv : the preprint server for biology · 2026Article
- CRISPR-Cas-associated SCCmec Variants in Methicillin-resistant Staphylococcus aureus Evade Rapid Diagnostic Detection.The Journal of infectious diseases · 2026Article
- SIMPLseq: a high-sensitivity Plasmodium falciparum genotyping and PCR contamination tracking tool.Malaria journal · 2026Article
- Molecular, Transcriptomic, and Proteomic Characterization ofmedRxiv : the preprint server for health sciences · 2026Article
- Low prevalence ofFrontiers in epidemiology · 2026Article
- Spatial and genetic dynamics of Plasmodium falciparum histidine-rich protein2 in sub-Saharan Africa.PloS one · 2026Article
- Local variability inMalariaWorld journal · 2026Article
- Performance evaluation of the automated haematology analyzer XN-31 for malaria diagnosis in Plasmodium vivax-dominant regions of Thailand.Malaria journal · 2025Article
- Evaluation ofiScience · 2025Article
53 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
19 authors at 7 institutions in 3 countries.
Funding
Abstract
In Africa, most rapid diagnostic tests (RDTs) for falciparum malaria recognize histidine-rich protein 2 antigen. Plasmodium falciparum parasites lacking histidine-rich protein 2 (pfhrp2) and 3 (pfhrp3) genes escape detection by these RDTs, but it is not known whether these deletions confer sufficient selective advantage to drive rapid population expansion. By studying blood samples from a cohort of 12,572 participants enroled in a prospective, cross-sectional survey along Ethiopia's borders with Eritrea, Sudan and South Sudan using RDTs, PCR, an ultrasensitive bead-based immunoassay for antigen detection and next-generation sequencing, we estimate that histidine-rich protein 2-based RDTs would miss 9.7% (95% confidence interval 8.5-11.1) of P. falciparum malaria cases owing to pfhrp2 deletion. We applied a molecular inversion probe-targeted deep sequencing approach to identify distinct subtelomeric deletion patterns and well-established pfhrp3 deletions and to uncover recent expansion of a singular pfhrp2 deletion in all regions sampled. We propose a model in which pfhrp3 deletions have arisen independently multiple times, followed by strong positive selection for pfhrp2 deletion owing to RDT-based test-and-treatment. Existing diagnostic strategies need to be urgently reconsidered in Ethiopia, and improved surveillance for pfhrp2 deletion is needed throughout the Horn of Africa.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.