# Unmasking Malaria: Microscopy and nPCR Reveal the Hidden Misdiagnosis of Plasmodium Infections Among Febrile Pediatric in Northwest Ethiopia

## TL;DR

This study in Ethiopia finds that many malaria cases in children are misdiagnosed, highlighting the need for better diagnostic methods and training.

## Contribution

The study reveals hidden misdiagnosis rates using microscopy and nPCR in pediatric malaria cases in Northwest Ethiopia.

## Key findings

- Microscopy detected 22.2% malaria cases, while nPCR found 18.2%, showing discrepancies in diagnosis.
- Age, lack of bed net use, and awareness of symptoms were significantly linked to Plasmodium infections.
- The highest prevalence was observed in children aged ≥ 5 years, with 25.6% diagnosed by nPCR.

## Abstract

Pediatric populations in Sub‐Saharan Africa (SSA) are particularly susceptible to malaria, contributing significantly to malaria‐related mortality. Accurate diagnosis of Plasmodium infections is crucial for early detection and prompt treatment. Malaria diagnosis relies on the use of microscopic and malaria rapid diagnostic test (mRDT) for the detection and identification of Plasmodium species. However, the performances of diagnostic methods are affected by epidemiology, study population, level of parasitemia, Plasmodium spp., and practical skills. This study aimed to assess the prevalence of Plasmodium infections. A diagnostic approach of microscopic and nested PCR reveals misdiagnosis of Plasmodium infections among febrile pediatric in Northwest Ethiopia.

An institution‐based cross‐sectional study was conducted among 302 malaria‐suspected participants from March to October 2015 in Northwest Ethiopia. Capillary blood samples were collected from each study participant to detect Plasmodium infections, and a structured questionnaire was administered to gather data on associated risk factors. Data were analyzed using SPSS Version 23. Chi‐square test and binary logistic regression analyses were used to compare categorical variables and assess risk factors. A p value < 0.05 was considered statistically significant.

The prevalence of malaria was found to be 22.2% and 18.2% by microscopy and nPCR, respectively. Among those diagnosed by nPCR, 19.2% were males and 17.3% were females, with the highest prevalence (25.6%) observed in pediatric aged ≥ 5 years. Age, not using bed nets, and awareness of signs and symptoms of malaria were significantly associated with Plasmodium infections (p < 0.05).

This study emphasizes the complex challenges of malaria infections in pediatric populations, worsened by restricted access to universal health coverage, which impedes efforts to reduce new infections. Furthermore, immediate actions should prioritize enhancing routine microscopic practical skills, regular quality control, and strict adherence to standardized operating procedures (SOPs) for slide preparation and examination.