Evaluating the Diagnostic Accuracy of Rapid Malaria Tests in Pediatric Patients: A Retrospective Cohort Study

Background Malaria remains one of the most significant public health challenges, particularly in pediatric populations in developing countries. Rapid diagnostic tests (RDTs) have been widely adopted due to their ease of use and quick results, but their diagnostic accuracy, compared to microscopy, the gold standard, remains a topic of interest. Early and accurate detection of malaria is crucial in reducing complications and mortality in children, who are especially vulnerable to delayed or inaccurate diagnoses. Objective This study aims to evaluate the diagnostic accuracy of RDTs for diagnosing Plasmodium falciparum malaria in children, using microscopy as the gold standard for comparison. Methods A retrospective cohort study was conducted in the Pediatric Department of Lady Reading Hospital Medical Teaching Institution (MTI), Peshawar, from January 1, 2023, to December 31, 2023. A total of 140 pediatric patients (aged 12 years or below) who were clinically suspected of malaria were included. Patients were excluded if they had a prior confirmed diagnosis of malaria before admission, were already receiving anti-malarial treatment, or if their guardians did not provide consent for participation. Blood samples were collected from each patient and subjected to both RDT and microscopic examination. Statistical analyses, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy, were calculated using SPSS version 24.0. Multivariate logistic regression was conducted to adjust for potential confounders such as age, gender, and parasitic load. Results Out of 140 children, 83 (58.57%) tested positive for malaria by RDT, while microscopy confirmed 80 (57.14%) positive cases. The sensitivity of RDT was 96.25% (95% CI: 89.43%-99.22%), and the specificity was 90.00% (95% CI: 79.49%-96.24%). The PPV was 92.77%, and the NPV was 94.74%, with a diagnostic accuracy of 93.57%. Multivariate logistic regression analysis indicated that parasitic load was a significant predictor of RDT accuracy, while age and gender were not. Conclusion RDT is a highly accurate diagnostic tool for detecting Plasmodium falciparum malaria in children, demonstrating high sensitivity and specificity compared to microscopy. RDTs can be effectively used in resource-limited settings, but attention should be given to parasitemia levels to ensure accurate diagnosis.