Diagnostic performance of urine-based rapid diagnostic malaria tests in Pakistan

Urine-based rapid diagnostic tests offer a non-invasive alternative for malaria diagnosis; however, their use has not been evaluated in Faisalabad, Pakistan.

To assess the diagnostic accuracy of a urine-based rapid diagnostic test for detecting Plasmodium vivax and Plasmodium falciparum infections in Faisalabad, Pakistan.

From January 2023 to December 2024, we collected and analysed laboratory samples from 360 febrile patients aged ≥5 years, with clinical symptoms suggestive of malaria, at a district headquarters hospital in Faisalabad, Punjab, Pakistan. We analysed the data using SPSS version 25 and used Cohen's kappa coefficient to assess the inter-test reliability agreement between blood- and urine-based rapid diagnostic tests.

Of the 360 participants, microscopy identified Plasmodium vivax in 216 (60.0%) cases, Plasmodium falciparum in 108 (30.0%), and mixed infections in 36 (10.0%). Blood-based rapid diagnostic tests showed higher positive predictive value than urine-based tests (94.3% vs 85.2%) and higher sensitivity. Overall agreement between tests was 91.1% (Cohen's kappa = 0.83).

Urine-based rapid diagnostic tests showed good agreement with blood-based tests, providing a practical non-invasive option for malaria screening in this setting. Further multicentre studies are recommended.