Published in PLOS One on 2026-06-23, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Diane Yirgnur Some, Francois Kiemde, Berenger Kabore, Daniel Valia, Toussaint Rouamba, Seydou Sawadogo, Athanase M. Some, Hermann Sorgho, Macaire Nana, Yacouba Nombre, Nadine A. Kone, Adelaide Compaore, Fadima Yaya Bocoum, Massa dit Achille Bonko, Georges Some, Gautier Tougri, Sylvie Yeri Youl, Konseibo Noellie, Yeri Esther Hien, Aly Savadogo, Fla Koueta, Henk D. F. H. Schallig, Halidou Tinto
Source: PLOS One • DOI 10.1371/journal.pone.0351990
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
To evaluate the field accuracy of a malaria diagnostic algorithm combining sequential interpretation of two-step malaria RDT detecting PfHRP2 and pLDH with information on previous antimalarial treatments within the past four weeks for the diagnosis of malaria in febrile children under 5 years compared to standard diagnosis using a PfHRP2 only based RDT.
Febrile children aged 6–59 months attending outpatient clinics were randomized to either the control group, which received the standard RDT (PfHRP2 only), or the intervention groups (an e-algorithm or a decisional algorithm), which was subjected to the diagnostic algorithm combining an RDT detecting PfHRP2 and pLDH with information on previous antimalarial treatment. Malaria diagnosis with PfHRP2-based RDT was reported as positive or negative. The sequential interpretation was reported as (i) positive when the pLDH line appeared, regardless of the PfHRP2 results, (ii) negative when both lines did not appear and (iii) undetermined when only the PfHRP2 line appeared, and information on previous antimalarial treatment within the past 4 weeks was used as a decision-support tool to classify active malaria from past infection. Blood samples were also collected for expert microscopy as the gold standard, and for qPCR to further evaluate undeterminate results and potential false-positive RDT outcomes.
In total 1176 children were included, with 66.7% (784/1176) assigned to the intervention arms and 33.3% (392/1176) to the control arm. In patients assigned to the sequential algorithm, the number of undetermined cases was 12.7% (100/784). Considering microscopy as the gold standard, PfHRP2-based RDT reported a sensitivity of 96.5% and a of specificity 79.1%, with positive and negative predictive values of 78.3% and 96.7%, respectively. For the sequential algorithm, the sensitivity, specificity, positive and negative predictive values of the conclusive-only results (i.e., PfHRP2±/pLDH+ and PfHRP2-/pLDH-) were 97.4%, 98.4%, 98.0% and 97.9%. However, when undetermined result were combined with conclusive results, the sensitivity, specificity, positive and negative predictive values were 89.7%, 96.8%, 95.6% and 92.4% respectively. Among recently antimalarial treated participants in sequential algorithm arm, 59.5% (50/84) were qPCR-positive, compared to 68.7% (11/16) qPCR-positivity in those without recent treatment.
The sequential diagnostic approach improves the diagnosis of malaria in a real world setting, compared to the use of PfHRP2-(only) based RDT. However, relying only on history of antimalarial treatment in undetermined cases may decrease algorithm’s sensitivity, which could result in missing active or recurrent malaria infections.
Introduction
Malaria rapid diagnostic tests (RDT) are essential tools in the management of febrile diseases in resource-limited settings without routine microscopy [1]. Malaria RDTs are simple, affordable, rapid and easy to perform by non-technicians and do not require sophisticated laboratory infrastructure, making them widely available to front-line healthcare workers at the point-of-care and allowing for timely treatment decisions [2]. However, the effective use of malaria RDTs in routine health systems is hindered due to their limitations, such as the persistence of Plasmodium falciparum histidine rich protein-2 (PfHRR2) antigen up to four weeks after successful treatment and the low sensitivity of Plasmodium Lactate Dehydrogenase (pLDH) -based tests [3]. These limitations can result in misdiagnosis of the real cause of fever [4].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider technology & industry desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Diane Yirgnur Some, Francois Kiemde, Berenger Kabore, Daniel Valia, Toussaint Rouamba, Seydou Sawadogo, Athanase M. Some, Hermann Sorgho, Macaire Nana, Yacouba Nombre, Nadine A. Kone, Adelaide Compaore, Fadima Yaya Bocoum, Massa dit Achille Bonko, Georges Some, Gautier Tougri, Sylvie Yeri Youl, Konseibo Noellie, Yeri Esther Hien, Aly Savadogo, Fla Koueta, Henk D. F. H. Schallig, Halidou Tinto. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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