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ORIGINAL RESEARCH article

Front. Malar.
Sec. Case Management
Volume 3 - 2025 | doi: 10.3389/fmala.2025.1545825
This article is part of the Research Topic Women in Malaria Research View all 13 articles

High rate of false positive malaria rapid diagnostic tests in a district hospital in Uganda

Provisionally accepted
Susanne E Mortazavi Susanne E Mortazavi 1,2*Allan Lugaajju Allan Lugaajju 3Anna-Clara Ivarsson Anna-Clara Ivarsson 4Sara Karlsson Söbirk Sara Karlsson Söbirk 4,5Hans Norrgren Hans Norrgren 5Kristina E M Persson Kristina E M Persson 2,6
  • 1 Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden
  • 2 Department of Laboratory Medicine, Lund University, Lund, Sweden
  • 3 College of Health Sciences, Makerere University, Kampala, Uganda
  • 4 Clinical Microbiology, Infection Prevention and Control, Office for Medical Services, Region Skåne, Lund, Sweden
  • 5 Division of Infection Medicine, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Skane County, Sweden
  • 6 Clinical Chemistry and Pharmacology, Laboratory Medicine, Office for Medical Services, Region Skåne, Lund, Sweden

The final, formatted version of the article will be published soon.

    Background: Malaria remains a significant health burden, particularly in Uganda, which has one of the highest incidence rates globally. Rapid diagnostic tests (RDTs) are widely used for malaria diagnosis due to their ease of use and affordability in resource-limited settings. However, false-positive RDT results may lead to unnecessary antimalarial treatments and missed diagnoses of other febrile conditions. This study aimed to evaluate the diagnostic accuracy of RDT compared to microscopy and loop-mediated isothermal amplification (LAMP) in a malaria-endemic region of Uganda.Methods: A prospective study was conducted with 225 febrile individuals diagnosed with malaria using RightSign Malaria Ag HRPII/Pan Plasmodium Aldolase RDT (Hangzhou Biotest Biotech Co., Ltd., China) at Iganga General Hospital, Uganda. Blood samples were analyzed using microscopy and LAMP. Demographic information, malaria history, and parasitemia levels were also recorded.Results: Among the RDT-positive participants, 48% tested negative by microscopy, and 45% of these were also negative by LAMP, indicating that 20% of all RDT-positive individuals were likely false positives. Overall, 66% (149/225) of RDT-positive cases were confirmed as true positives. Conclusions: This study identified a high rate of false positives with the tested RDT, risking inappropriate treatment and missed diagnoses of other illnesses. It is essential that healthcare facilities use RDTs validated and recommended by the World Health Organization (WHO) to ensure high specificity and accuracy, particularly in resource-limited settings where alternative diagnostic methods may not be available.

    Keywords: Malaria, Plasmodium, False positive, Rapid diagnostic test, Microscopy, LAMP, RDT

    Received: 15 Dec 2024; Accepted: 17 Jan 2025.

    Copyright: © 2025 Mortazavi, Lugaajju, Ivarsson, Karlsson Söbirk, Norrgren and Persson. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Susanne E Mortazavi, Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.