Undetected and infections in HRP2 RDT-positive children with uncomplicated malaria in Nanoro, Burkina Faso.

BACKGROUND

The widespread use of histidine-rich protein 2 (HPR2)-based rapid diagnostic tests (RDTs), specific to in endemic areas may underestimate the weight of minor species such as and in malaria transmission. This study aimed to determine the extent of undetected and infections in children with positive diagnosis of uncomplicated malaria based on HRP2 RDT in the Nanoro health district, Burkina Faso.

MATERIALS AND METHODS

Children <5 yrs with uncomplicated malaria confirmed by HRP2 RDT were recruited from July 2021 to June 2022 in five peripheral health facilities of the Nanoro health district. Blood samples were collected from finger prick for malaria species identification by microscopy and nested PCR. The prevalence of , , and mixed infections was estimated as the ratio of positive cases over the total samples analysed. Binomial generalised linear models were used to assess the effect of age and sex on the positivity rate of mixed infections.

RESULTS

Over the study period, 207 children with uncomplicated malaria who tested positive for the HRP2 antigen were included. Microscopy detected 4 non- cases: 3 and 1 . In addition to these patent cases, sub-patent infection with and were detected in 6 and 5 cases, respectively. Mixed infections with non- species exhibited lower parasite densities than mono-infections with alone. There was no effect of gender or age on the mixed infection positivity rate (X=0.16, p=0.683).

CONCLUSION

The widespread use of HPR2-based RDTs underestimate the burden of non- species. In the context of eliminating malaria, new diagnostic tools allowing the detection of species other than must be deployed.