Abstract
Background: Malaria remains a significant public health challenge in Pakistan, with evolving epidemiological patterns requiring continuous monitoring of diagnostic approaches. This study aimed to evaluate the current diagnostic accuracy of Rapid Diagnostic Tests (RDTs) in District Dir Lower, Khyber Pakhtunkhwa.
Methods: A cross-sectional hospital-based study was conducted from March to August 2025 across seven tehsils. A total of 2,551 microscopy-confirmed malaria cases were enrolled from 2,831 suspected cases. Diagnostic performance of HRP-2 based RDTs was assessed against microscopy as gold standard using standard statistical measures including sensitivity, specificity, predictive values, and overall accuracy.
Results: The RDT demonstrated high diagnostic accuracy with 90.7% sensitivity, 98.2% specificity, 99.8% positive predictive value, and 91.5% overall accuracy. The negative predictive value was 53.7%, reflecting the high prevalence setting. The false positive and false negative rates were 1.8% and 9.3% respectively.
Conclusion: HRP-2 based RDTs remain highly reliable for malaria diagnosis in this endemic region, demonstrating excellent positive predictive value and specificity. However, the modest negative predictive value suggests that negative results in symptomatic patients should be interpreted with caution and confirmed by microscopy when clinical suspicion persists.