RDT performance through high-throughput bead-based antigen detection during malaria school survey in Senegal.

Area of Science:

• Malariology
• Infectious Disease Diagnostics
• Public Health Surveillance

Background:

• Rapid Diagnostic Tests (RDTs) are crucial for malaria diagnosis but struggle with low-density infections.
• Population-level performance of RDTs in detecting subtle infections is not well understood.

Purpose of the Study:

• To assess the diagnostic accuracy of HRP2-based RDTs.
• To integrate high-throughput HRP2 quantification into school-based malaria surveys for enhanced diagnostic evaluation.

Main Methods:

• A cross-sectional study involved 3,748 school children in Senegal.
• RDTs and a multiplex bead-based HRP2 assay on dried blood spots were used.
• Statistical models analyzed HRP2 concentration and RDT positivity.

Main Results:

• Overall RDT positivity was 7.2%, with significant district-level variation.
• HRP2 concentration strongly predicted RDT results (aOR 14.55).
• RDTs exhibited varying limits of detection, from 3.9 ng/mL to 204.3 ng/mL across districts.

Conclusions:

• RDTs are valuable for malaria surveillance in higher transmission areas.
• Complementary high-sensitivity assays are vital for malaria elimination strategies in low-transmission settings.
• Further research should investigate these integrated methods in areas without malaria prevention interventions.