{
  "abstract": "We sought to identify groups in which performance of point-of-care malaria rapid diagnostic tests (MRDTs) was decreased to improve the accuracy of MRDT-based diagnosis. We evaluated the performance of Plasmodium falciparum MRDTs compared to quantitative polymerase chain reaction (PCR) in population subgroups based on 1108 patient visits to rural health centers in Malawi from 2019 to 2021. Approximately 48% of malaria PCRs and 37% of MRDTs were positive. Overall, the fraction of positive MRDTs among participants with positive PCR (sensitivity) was 67% and the fraction of negative MRDTs among participants with negative PCR (specificity) was 91%. Sensitivity varied with age, lowest among subjects aged 25–40 years (38%) and < 1 year (33%) and highest among those 5–8 years (86%). Nearly all cases of MRDT-negative/PCR-positive discordance (false negative MRDTs) had < 200 parasites/µl of blood. In regression models, male sex, younger age, and presence of fever, headache, chills, and vomiting reduced the likelihood of a false negative result. Presence of fever, headache, chills, and vomiting were more likely to result in a false positive result. Using classification tree analysis, combinations of clinical and demographic characteristics predicted true positive and true negative MRDT results with 79% and 84% overall accuracy, respectively. Age and parasite density were negatively correlated; age was included in regression models and classification trees rather than parasite density because it would be information readily available to clinicians. Though there are several possible explanations for discordance between PCR and MRDT (including incidental malaria infections), MRDTs performed less well in certain subgroups, which may inform deployment and development of these important tools in clinical settings and for malaria surveillance.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, United States of America",
    "Margaret C. Ryan Global Health Program, Boston Children’s Hospital, Boston, Massachusetts, United States of America",
    "Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America",
    "Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America",
    "MAC Communicable Diseases Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi",
    "Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi",
    "Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, Indiana, United States of America",
    "Department of Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, United States of America",
    "Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi",
    "Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America",
    "Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom",
    "Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Geoffrey Guenther",
      "orcid": "0009-0000-4094-9681"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Alick Sixpence"
    },
    {
      "affs": [
        5
      ],
      "name": "Charles Mangani"
    },
    {
      "affs": [
        4
      ],
      "name": "Alfred Matengeni"
    },
    {
      "affs": [
        6
      ],
      "name": "Jaroslaw Harezlak"
    },
    {
      "affs": [
        4
      ],
      "name": "Don P. Mathanga"
    },
    {
      "affs": [
        7,
        8
      ],
      "name": "Terrie E. Taylor",
      "orcid": "0000-0001-7416-3986"
    },
    {
      "affs": [
        9
      ],
      "name": "Miriam K. Laufer"
    },
    {
      "affs": [
        7,
        8
      ],
      "name": "Karl B. Seydel"
    },
    {
      "affs": [
        9,
        10
      ],
      "name": "Lauren M. Cohee"
    },
    {
      "affs": [
        11
      ],
      "name": "Clarissa Valim"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c4ky3danj7yr6.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pgph.0007366",
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  "id": "c4ky3danj7yr6",
  "issns": [
    "2767-3375"
  ],
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  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
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  "native_subjects": [
    [
      "heading",
      "Artificial Gene Amplification and Extension"
    ],
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      "heading",
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    ],
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      "heading",
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    ],
    [
      "heading",
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    ],
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      "heading",
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    ],
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  "pmcid": "PMC13730336",
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  "published": "2026-11-03",
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  "title": "Identifying subgroups with decreased performance on malaria rapid diagnostic tests in Malawi",
  "title_text": "Identifying subgroups with decreased performance on malaria rapid diagnostic tests in Malawi",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:22:55Z",
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