Malaria Rapid Diagnostic Test Versus Microscopy for Diagnosis Among Febrile Children Under Five Years in Cross River State, South South Nigeria

Accurate and timely diagnosis of malaria in under-five children is essential for effective case management and prevention of severe disease progression. This study compared the diagnostic performance of malaria rapid diagnostic tests with conventional microscopy among febrile children under five years attending selected primary health centres in Cross River State, South South Nigeria. A cross-sectional comparative study was conducted involving 250 febrile children aged one month to 59 months. Thick and thin blood films stained with Giemsa and malaria RDT using the HRP-2 antigen detection format were performed simultaneously on each child's fingerprick blood sample. Sensitivity, specificity, positive predictive value, and negative predictive value of RDT were calculated using microscopy as the reference standard. Microscopy detected malaria parasitaemia in 44.4% of children, while RDT was positive in 47.6%. RDT demonstrated sensitivity of 93.7%, specificity of 89.2%, positive predictive value of 87.4%, and negative predictive value of 94.6%. Discordant results were most common in children with low parasite densities. RDT performed comparably to microscopy in high-transmission settings. The study concludes that malaria RDTs are reliable diagnostic tools for use in peripheral health facilities in South South Nigeria where microscopy capacity is limited. Proper training of health workers in RDT interpretation and adherence to test-and-treat protocols are recommended. Keywords: malaria, rapid diagnostic test, microscopy, febrile children, Cross River State