{
  "abstract": "Background\n\nSaudi Arabia has reported no indigenous malaria since 2021 and is in the prevention-of-reintroduction phase, with residual and imported infections concentrated in Jazan and Aseer. At this stage, each reported case triggers programmatic action, yet the operational accuracy of routine facility diagnostics has not been measured in this setting.Objective\n\nTo evaluate the operational accuracy of facility-performed routine light microscopy (RLM) and two Pf/PAN rapid diagnostic tests (RDTs) against species-specific nested PCR.Methods\n\nRetrospective diagnostic accuracy study on consecutively archived specimens. Of 118 archived EDTA samples from febrile patients tested for suspected malaria at hospitals in nine governorates of southwestern Saudi Arabia during January-December 2023, 106 were eligible (12 were excluded). Index tests were performed by facility staff during routine care; nested PCR was later performed blinded. Accuracy was assessed against nested PCR and, in a sensitivity analysis, a composite reference (RLM or PCR positive).Results\n\nNested PCR detected Plasmodium in 81/106 samples (76.4%; 95% CI 67.2-84.0), all single-species (P. falciparum 56/81; P. vivax 25/81). RLM was positive in 98/106 (92.5%), CareStart in 106/106 (100%), QuickProfile in 100/106 (94.3%). RLM called 29/98 positives mixed (29.6%) versus 0/81 by PCR (Fisher's exact, p < 0.001). Against PCR, RLM sensitivity was 97.5% (91.3-99.6) and specificity 24.0% (10.2-45.5); CareStart specificity 0% (0-13.9), QuickProfile 20.0% (8.1-39.8). PCR confirmation increased with reported parasitemia, from 12/23 (52.2%) at 10-90 parasites/μL to 22/24 (91.7%) at 1000-10,000 parasites/μL (Cochran-Armitage, p < 0.001).Conclusion\n\nIn the selected clinically suspected cases, routine diagnostics returned more positives, and far more mixed infections, than nested PCR; both routine false positives and reduced PCR sensitivity in archived material plausibly contribute. Findings should not be extrapolated beyond this population. Strengthened microscopy training, RDT quality assurance, and evaluation of molecular confirmation may support case classification during the prevention-of-reintroduction phase.",
  "abstract_shown": true,
  "affiliations": [
    "Main Laboratory and Blood Bank Medical and Molecular Microbiology Laboratory Jazan Health Cluster Jazan Saudi Arabia.",
    "Main Laboratory and Blood Bank Medical and Molecular Microbiology Laboratory King Faisal Medical City for Southern Region Abha Saudi Arabia.",
    "Department of Medical Laboratory Sciences Faculty of Applied Medical Sciences King Abdulaziz University Jeddah 21589 Saudi Arabia kau.edu.sa.",
    "Special Infectious Agents Unit King Fahd Medical Research Center King Abdulaziz University Jeddah 21589 Saudi Arabia kau.edu.sa.",
    "Vaccines and Immunotherapy Unit King Fahd Medical Research Center King Abdulaziz Aziz University Jeddah Saudi Arabia kau.edu.sa.",
    "Molecular Biology Department Jazan Health Cluster Jazan Saudi Arabia.",
    "Biotechnology Department Jazan Health Cluster Jazan Saudi Arabia.",
    "Main Laboratory and Blood Bank Medical Microbiology Laboratory Jazan 86735 Saudi Arabia.",
    "Main Laboratory and Blood Bank Medical Microbiology Laboratory Jazan Health Cluster Jazan Saudi Arabia."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Musa A Ayashi",
      "orcid": "0009-0003-5515-8251"
    },
    {
      "affs": [
        1
      ],
      "name": "Ahmed A Muyidi",
      "orcid": "0009-0000-5681-0510"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Majed H Wakid",
      "orcid": "0000-0003-4941-5373"
    },
    {
      "affs": [
        2
      ],
      "name": "Fadi M Baakdah",
      "orcid": "0000-0001-9603-5328"
    },
    {
      "affs": [
        2,
        4
      ],
      "name": "Maimonah S Alghanmi",
      "orcid": "0000-0003-1628-4696"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Hattan S Gattan",
      "orcid": "0000-0003-3514-4912"
    },
    {
      "affs": [
        5
      ],
      "name": "Amro A Zalah",
      "orcid": "0009-0006-1353-2243"
    },
    {
      "affs": [
        6
      ],
      "name": "Emad E A Wasili",
      "orcid": "0009-0009-3783-4221"
    },
    {
      "affs": [
        7
      ],
      "name": "Abdulaziz Y Bajawi",
      "orcid": "0009-0000-3446-1858"
    },
    {
      "affs": [
        8
      ],
      "name": "Thamer M Brek",
      "orcid": "0000-0003-4014-2276"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0rgbp2mg2ecma.bib",
  "cited_by": 0,
  "doi": "10.1155/jotm/8453252",
  "fulltext_url": "https://europepmc.org/articles/PMC13686394",
  "id": "0rgbp2mg2ecma",
  "issns": [
    "1687-9686",
    "1687-9694"
  ],
  "landing_url": "https://europepmc.org/article/MED/42910361",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2739|Malaria Research and Control"
    ]
  ],
  "openalex": "W7223134248",
  "pdf_url": "https://europepmc.org/articles/PMC13686394?pdf=render",
  "pmcid": "PMC13686394",
  "pmid": "42910361",
  "published": "2026-10-21",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/0rgbp2mg2ecma.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:10Z",
      "native_id": "MED:42910361",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42910361"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Malaria Research and Control",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "When Diagnosis Meets Reality: Operational Performance of Routine Malaria Diagnostics Against Molecular Evidence in Southwestern Saudi Arabia.",
  "title_text": "When Diagnosis Meets Reality: Operational Performance of Routine Malaria Diagnostics Against Molecular Evidence in Southwestern Saudi Arabia.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:10Z",
  "url": "https://research.draconitic.com/paper/0rgbp2mg2ecma",
  "venue": "Journal of tropical medicine",
  "versions": []
}