Malaria prevalence and diagnostic performance of rapid diagnostic test versus microscopy among febrile patients at Kigorobya Hospital, Hoima District, Uganda

Abstract

This study investigated the prevalence of malaria and the diagnostic performance of Abbott rapid diagnostic tests (RDTs) compared to microscopy among adolescent and adult febrile patients attending Kigorobya Community Hospital. Malaria remains a major public health challenge in Uganda, particularly in rural endemic settings where accurate and timely diagnosis is essential for effective case management. The study aimed to determine malaria prevalence among patients with acute undifferentiated fever aged 12 years and above and assess the concordance between Abbott malaria RDTs and microscopy. A descriptive cross-sectional study nested within the SPIRIT study was conducted from April to December 2024. Secondary data were extracted from the RED Cap database for 213 eligible participants. Malaria diagnosis was performed using both Abbott malaria RDTs and microscopy blood smear tests. Data were analyzed using SPSS version 26, and diagnostic performance measures including sensitivity, specificity, positive predictive value, negative predictive value, and Cohen’s kappa were computed. The overall malaria prevalence was 34.7% by microscopy and 34.3% by RDT. The highest malaria prevalence was observed among participants aged 19–34 years. The Abbott malaria RDT demonstrated excellent diagnostic performance, with sensitivity of 98.65%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 99.29%. There was nearly perfect agreement between RDT and microscopy results (κ = 0.990, p < 0.001). The findings demonstrate a high burden of malaria among adolescent and adult febrile patients in this setting and confirm that Abbott malaria RDTs are highly reliable compared to microscopy. The study recommends continued use of Abbott malaria RDTs in resource-limited settings and strengthening malaria control interventions targeting high-risk populations.