Pathogens · Published 2026-07-23 · DOI 10.3390/pathogens15080779
Irene Molina-de la Fuente, Akeem Abiodun Akindele, Thuy-Huong Ta-Tang, Alexandra Martin-Ramírez, Vicenta Gonzalez, Ibukun Temitope Sossou, Samuel Adeyinka Adedokun, Raquel Capote-Morales, Agustín Benito, Sulaiman Adebayo Nassar, Pedro Berzosa
Background: Nigeria has a high prevalence of malaria, with asymptomatic patients being one of the possible reservoirs. In this context, accurate diagnosis is essential for malaria control. The efficacy of rapid diagnostic tests (RDTs) is being threatened by false negatives due to <i>pfhrp2</i> and <i>pfhrp3</i> deletions. This study aims to describe malaria in asymptomatic schoolchildren in Osun State, Southwestern Nigeria and to assess the performance of malaria diagnosis, including the characterisation of <i>pfhrp2</i> and <i>pfhrp3</i> deletions. Methods: A total of 350 dried blood spot (DBS) samples from schoolchildren were used for malaria diagnosis using microscopy, RDTs, and polymerase chain reaction (PCR). Sensitivity and specificity were calculated for microscopy and RDTs, using PCR as the gold standard. <i>Pfhrp2</i> and <i>pfhrp3</i> deletions were analysed for all <i>P. falciparum</i>-positive samples using multiplex qPCR. Results: The <i>P. falciparum</i> infection frequency among asymptomatic schoolchildren in Osun State was 89%. Considering PCR as the gold standard, microscopy presented better sensitivity at 100% (86% for RDTs), but RDTs had better specificity at 76% (60% for microscopy). The deletion frequency of the <i>pfhrp2</i> gene among positive samples was 16.6%, while it was 1.3% for <i>pfhrp3</i> and 0.9% for double deletion. However, considering all positive samples, only 3% of samples yielded false negatives by RDT with deletion in <i>pfhrp2</i>. Conclusions: <i>P. falciparum</i> infection has a high frequency in asymptomatic schoolchildren, being a potential hotspot for malaria. The combination of RDTs and microscopy could increase the accuracy of malaria diagnosis. Deletions in <i>pfhrp2</i> and <i>pfhrp3</i> are highly common in Osun State, but their impact on RDT results is still limited. More surveillance studies are recommended to assess the contribution of asymptomatic children to malaria transmission and the impact of deletions.
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Fuente, I., Akindele, A., Ta-Tang, T., et al. (2026). High Burden of Asymptomatic Malaria Among Schoolchildren in Nigeria: Diagnosis Challenges and pfhrp2 Deletions. Pathogens. https://doi.org/10.3390/pathogens15080779