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Mala ia diagnosis among child en a ending some p ima y heal h ca e cen e s in
Ke i, Nige ia: A c oss-sec ional s udy
Uchechukwu Scholas ica Chukwu-Eze 1, *, Folake Saida Bello 1, 2, Vic o Ochapa Aboh 1, Adamu Ishaku Akyala 1 and Da id
Ishaleku 1
1 Global Heal h and In ec ious Diseases Con ol Ins i u e (GHIDI), PMB 1022, Ke i, Nasa awa S a e Uni e si y, Ke i,
Nasa awa S a e Nige ia.
2 Depa men o Medical Labo a o y Se ices, Haema ology BGS Uni , Fede al Medical Cen e , Ke i, PMB 1004, Ke i,
Nasa awa S a e, Nige ia.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 4049-4058
Publica ion his o y: Recei ed on 18 Ma ch 2025; e ised on 26 Ap il 2025; accep ed on 29 Ap il 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.1.1486
Abs ac
Mala ia is a eb ile illness caused by he bi e o an in ec ed emale Anopheles mosqui o ansmi ing he Plasmodium
species. I is s ill an endemic public heal h disease especially in Sub-Saha an A ica, Sou h-Eas Asia and Sou h Ame ica.
Nige ia, was epo ed o ha e he highes bu den o he disease wi h 27% o he global mala ia bu den. 2ml o blood
samples we e collec ed om 220 child en aged 0-17 yea s a ending i e P ima y Heal h Cen e s (PHCs Angwan Wuje,
Ko a -Pada, Gua a, Angwan- Kaswa and Yelwa) in Ke i Local Go e nmen A ea (LGA) o de ec mala ia pa asi es. Fi s
esponse Rapid Diagnos ic Tes (RDT) ki s we e used o he ini ial sc eening while hin and hick blood ilms we e
made and s ained wi h Geimsa s ain o mic oscopy. The p e alence o mala ia using apid diagnos ic es ki s (RDT)
was 34.5% (76/220) while ha o mic oscopy was 70% (154/220). The age ange mos a ec ed o RDT and
mic oscopy was 13-17 yea s (27.6% s 29.9%) ollowed closely by 4-6yea s (25% s 20.8%) and 7-12yea s (25% s
19.5%), 1-3 yea s we e (13.2% s 15.6%) and < 1yea (9.2%. s 14.2%). Females we e mo e in ec ed han males a
(57.9% s 42.1%), bu age and sex we e no s a is ically signi ican (p>0.05). The age ange mos in ec ed we e hose
be ween 13-17yea s using bo h me hods. The younge child en 0-3 yea s whe e mos ly p o ec ed wi h physical ba ie s
like insec icide ea ed ne s (ITNs) and i s use was signi ican a p<0.05; 4-6yea s we e he nex wi h a high pe cen age
o being in ec ed as kids become mo e ac i e and p obably he uncom o ableness o ITNs make hem es i e. We
ad oca e o mo e heal h p omo ion campaigns, enligh enmen and p e en i e ips o be made as jingles, augh o
pa en s and he g owing child en a schools, ma ke s, heal h cen e s e c. so hey don’ se e as ese oi s. Mo e policies
e.g. en i onmen al sani a ion and seasonal mala ia es ing, ea men and p e en ion p ac ices should be made and
sus ained by go e nmen o enhance he igh agains mala ia as global aid is dwindling.
Keywo ds: Rapid diagnos ic es ki s; Mala ia mic oscopy; P e alence; Physical ba ie s
1. In oduc ion
Mala ia caused by he bi e o he emale Anopheles mosqui o is s ill a global h ea a ec ing Sub-Saha an A ican, Sou h-
Eas Asia and Sou h Ame ican egions he mo e. O he majo Plasmodia species (Plasmodium alcipa um, Plasmodium
mala iae, Plasmodium o ale Plasmodium knowlesi and Plasmodium i ax), Plasmodium alcipa um is he mos dange ous
and endemic in he Sub-Saha an A ican egion [1].
The Wo ld Heal h O ganiza ion (WHO) es ima ed ha he e we e 263 million cases o mala ia globally in 2023, wi h
global dea h bu den o 597,000 [1]. A ican egion had a signi ican sha e o he cases; Nige ia is said o ha e abou 27%
o he global sha e o he dea hs [1,2].
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sub-Saha an A ica accoun s o he majo i y o mala ia cases and dea hs, wi h coun ies like Nige ia, he Democ a ic
Republic o Congo and Mozambique being signi ican ly a ec ed [1,2]. Plasmodium alcipa um is he mos p e alen and
i ulen specie, mos ly ound in sub-Saha an A ica. I causes uncomplica ed mala ia bu is also esponsible o he
majo i y o se e e mala ia cases and dea hs globally [3,4]. I accoun s o 99.7% o he es ima ed mala ia cases in he
WHO A ican egion, 50% o he cases in he WHO Sou h-Eas Asia egion, 71% o he WHO Eas e n Medi e anean
egion and 65% o he WHO Wes e n Paci ic Region [4]. The o he mala ia species a e no as li e h ea ening as P.
alcipa um [3,1].
Plasmodium alcipa um assumes di e en o ms du ing i s li e cycle. The human in ec i e s age is he spo ozoi e om
he sali a y gland o he mosqui o. The spo ozoi es g ow and mul iply in he li e o o m me ozoi es. These me ozoi es
in ade he ed blood cells (e y h ocy es) o o m ophozoi es, schizon s and game ocy es du ing which he symp oms
o mala ia a e p oduced. In he mosqui o, he game ocy es unde go sexual ep oduc ion o o m a zygo e om which
ookine es a e o med. Ookine es p oduce oocys s which in u n o m spo ozoi es ha emain in he sali a y gland o
he mosqui o eady o ake a blood meal so as o be eleased in he blood s eam o he hos and he cycle con inues [5,
6].
The pa asi e is known o be ansmi ed by in ec ed emale Anopheles mosqui oes, Anopheles gambiae and Anopheles
unes us a e he p ima y ec o s in A ica [7]. A la es h ea known as Anopheles s ephensi ha e been epo ed by he
CDC; “ his mosqui o can h i e in bo h u ban and u al a eas and is esis an o mos insec icides commonly used in
mala ia con ol” [5]. An addi ional 126 million people is es ima ed o be a isk o mala ia i his ec o con inues o
expand in A ica [5]. T ansmission o mala ia o en peaks du ing and a e he ainy season when mosqui o popula ions
a e highes and he en i onmen being humid enhances he g ow h o he mosqui oes. Human ac i i ies, such as
ag icul u e and u baniza ion, can in luence he b eeding habi a s o mosqui oes, impac ing ansmission dynamics [8].
Child en a e mos ly a ec ed due o hei de eloping immune sys em; complica ions can be se e e leading o acu e enal
ailu e, coma and dea h i no ea ed app op ia ely. The objec i es o his s udy a e o iden i y he p e alence o mala ia
among child en a ending P ima y Heal h Cen e s (PHC) in Ke i, Nasa awa S a e Nige ia, diagnos ic accu acy o apid
diagnos ic es ki s (RDTs) compa ed o mic oscopy in diagnosis o mala ia and use o physical ba ie s like long las ing
insec icide ea ed ne s o p e en i e pu poses. RDT and mic oscopy me hods ha e hei me i s and deme i s ha can
be ha nessed di e en ly o a o wo k on ield analysis (RDT o i s simplici y and ease o use) while o esea ch,
clinical bases (mic oscopy wi h ained and e ained pe sonnels) a e ad oca ed. P ima y heal h cen e s we e used o
his wo k as hey a e he i s poin o call o pa en s and gua dians o child en in a semi- u ban a ea like Ke i. PHCs in
Nige ia co e a ange o essen ial se ices like ma e nal and child heal h, immuniza ions, heal h educa ion, managemen
o common illnesses e.g. mala ia [9]. I is accessible and a o dable o he locals compa ed o he seconda y and e ia y
heal h ins i u ions which a e o e e als.
2. Ma e ials and me hods
2.1. S udy a ea
The s udy a ea used o his esea ch wo k was Ke i Local Go e nmen A ea (L.G.A.). Ke i L.G.A. is a subu ban
comme cial own loca ed in Nasa awa S a e, No h cen al Nige ia. Ke i is 50 kilome e s om Abuja, he Fede al Capi al
Te i o y o Nige ia. Ins i u ions like he Nasa awa S a e Uni e si y, Fede al Medical Cen e a e loca ed he e and his
a ac s people om di e en wo ks o li e a ound his ancien ci y. Apa om he ci il se an s, occupa ions like
a me s and ade s abound he e oo.
I co e s a o al land mass o abou 28,735km2 bounded by Kaduna S a e o he no h, Abuja and Kogi S a es o he wes ,
Benue o he sou h, Pla eau and Ta aba S a e o he eas [10]. The d y and we seasons a e he wo main seasons in he
a ea and he a e age humidi y is 42%. I has a popula ion o abou 1,983,910 (2006 census) p ojec ed a 3.2% annual
g ow h a e gi ing i an es ima ed popula ion o 2,523,395 (2016) [11].
We used a c oss-sec ional design o he s udy and was conduc ed in i e di e en p ima y heal h ca e cen e s (PHC),
44 pa icipan s pe PHC, o ally 220. (PHC Angwan-Wuje, PHC Ko a -Pada, PHC Gua a, PHC Angwan Kaswa and PHC
Yelwa) in Ke i Local Go e nmen A ea (L.G.A.), Nasa awa S a e, Nige ia om June- Augus , 2024 which alls du ing he
ainy season.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 4049-4058
4051
Figu e 1 Map o Nasa awa S a e showing Ke i own [12]
PHCs a e suppo ed by he ede al, s a e go e nmen s and dono agencies which makes i a o dable o he locals. They
ha e days s ipula ed o in an immuniza ions, heal h enligh enmen and p omo ions on di e en diseases a e augh
he e. So we keyed in o i and spoke o hem on Mala ia- ea ly de ec ion, p e en ion and ea men , he impo ance o
iden i ying i ea ly especially in young child en.
2.2. E hical Conside a ion
E hical app o al o he s udy we e ob ained om Fede al Medical Cen e Ke i, Nasa awa S a e Heal h Resea ch E hics
Commi ee FMC/KF/HREC/02643/24, and he S a e Sec e a ia o P ima y Heal h Ca e De elopmen Agency
DHS/07/24. Consen o he pa en s o legal gua dians o he child en we e also go en in w i ing be o e he s udy
s a ed.
2.3. Sample Size
A o al o 220 blood samples we e collec ed om child en less han 17yea s a ending he i e selec ed p ima y heal h
cen e s wi h complain s o headache, e e , malaise and omi ing. Selec ion o PHC was done andomly o elimina e
bias.
Sample size was de e mined using Fishe ’s o mula o es ima ing he minimum numbe o pa icipan s needed o
ob ain eliable esul s in s udies o disease p e alence [13]. The sample size was calcula ed based on expec ed
p e alence o mala ia and he desi ed con idence le el. The o mula used o es ima e he equi ed sample size is as
ollows:
𝑛 = 𝑍2. 𝑃. (1 − 𝑃)
𝑑2
Z ep esen s he desi ed con idence le el which is 1.96 o a 95% con idence in e al, P ep esen s he es ima ed
p e alence a e o mala ia in he popula ion assumed o be (50%) 0.5 o accoun o maximum a iabili y when he
p e alence a e is unknown he eby ensu ing a conse a i e es ima e [14], d is he ma gin o e o se a 7%, e lec ing
he desi ed le el o p ecision in he es ima e.
2.3.1. Calcula ion
Subs i u ing he alues in o he o mula:
n = (1.96)2 .0.5 (1 -0.5) / (0.07)2
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 4049-4058
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= 3.84 (0.25) / 0.0049
= 194
A i ion ac o = 7 % o 194 = 13.58 + 194
= 207.58
The numbe was ound up o he nea es en, gi ing i a calcula ed alue o 210. Addi ional 10 pa icipan s we e added
o his numbe o gi e i a mo e ep esen a i e igu e 44 pe PHC making i 220. This ensu es he sample has enough
s a is ical powe o make compa ison be ween RDTs and mic oscopy in child en a ending hese PHCs.
2.3.2. Sample Collec ion and P ocessing
2ml o blood sample was collec ed by enipunc u e om each pa icipan . The si e was i s s e ilized wi h 95% e hanol
and allowed o d y, hen sample collec ed. E hylene diamine e a-ace ic acid (EDTA) was labelled wi h unique
iden i ie s o each child while a isk ac o assessmen ques ionnai e adminis e ed o he pa en o gua dian o he
younge child en.
9 packs o Fi s Response Mala ia An igen P. alcipa um (HRP2) apid diagnos ic ki s (P emie Medical Co po a ion
P i a e Limi ed, India) we e used in es ing all he pa icipan s. The ki s we e used acco ding o manu ac u e ’s
ins uc ions. Then blood d opped on a new mic oscope slide; hick and hin ilms we e made and Geimsa s ained. Thin
ilm was me hanol ixed only and bo h allowed o ai d y. I was examined using x40 and hen, a 100x/hp oil imme sion
o pa asi e and specie iden i ica ion [15]. The slides we e ead by ained medical labo a o y pe sonnels o ensu e
accu acy and p ecision in diagnosis.
2.3.3. Mic oscopic Analysis
Mic oscopic examina ion was used as he gold s anda d o examina ion o slides o he diagnosis o mala ia. Fo each
sample, 2ul and 6ul we e d opped on same slide o a hin and hick ilm and labelled app op ia ely wi h a unique
numbe co esponding o hei ques ionnai e and consen o m. Thin ilm was me hanol ixed and hick ilm allowed o
ai d y; hey we e hen Geimsa s ained ollowing es ablished p o ocols [7]. Ini ial mic oscopic examina ion ocused on
he hick ilms which a e used o de ec he mala ia pa asi es hen specie iden i ied wi h he hin ilm p epa a ion on
u he examina ion. Reexamina ion o 10% o he slides by an independen quali y con ol mic oscopis was done o
ensu e diagnos ic p ecision and accu acy [4,7]. This se ed o emo e e o s and imp o e he s udy’s eliabili y.
2.3.4. Rapid Diagnos ic Tes (RDT) Analysis
Fi s Response Mala ia An igen P. alcipa um (HRP2) apid diagnos ic ki s (P emie Medical Co po a ion P i a e
Limi ed, India) known o i s obus ness and has unde gone WHO p equali ica ion es s, we e used immedia ely
ollowing he manu ac u e ’s ins uc ions o main ain accu acy and consis ency. The RDT is highly sensi i e o
Plasmodium alcipa um wi h a epo ed p oduc speci ica ions o : 100% sensi i i y, 100% speci ici y and esul s can be
ead in 20-30 minu es ime [16]. So, i s sui able o ield and clinical analysis.
2.4. S a is ical Analysis
S a is ical analysis o he da a was conduc ed o e alua e he signi icance o a iables, wi h he Chi-squa e es employed
o assess ela ionships be ween ca ego ical a iables. Desc ip i e s a is ics, like pe cen ages we e used o summa ize
he collec ed da a e ec i ely.
S a is ical Package o he Social Sciences e sion 22.0 we e used o analyze he da a. A p- alue o ≤ 0.05 was conside ed
s a is ically signi ican , gi ing a h eshold o iden i ying meaning ul di e ences o associa ions while a p- alue o ≥ was
seen as no s a is ically signi ican associa ion. Also, sensi i i y, speci ici y, posi i e p edic i e alue and nega i e
p edic i e alue we e calcula ed using s anda d o mulae o e alua e he diagnos ic pe o mance o he me hods used.
3. Resul s
These esul s show he mala ia p opensi y acco ding o loca ions, age g oups and he wo ypes o es ing used. F om
able 1, he di e en PHC loca ions and he posi i e esul s a e shown; PHC Angwan Kaswa is seen o ha e he highes
RDT p e alence a 40% and mic oscopy a 74%, his shows he sco es a e ela ably high. Child en li ing a ound his
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 4049-4058
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a ea close o a ma ke migh be pa o he eason o his high mala ia p e alence as clus e s o di s, muddy pools o
wa e can be ound a ound because i was a ainy pe iod. PHC Angwan Wuje and Yelwa had same p e alence o 64%
using mic oscopy while RDT was 28% and 34% espec i ely. PHC Gua a, had he leas RDT alue o 24% bu he
mic oscopy was highe a 58% highligh ing mic oscopy o being able o pick he mala ia pa asi es a e y low olumes
unlike RDT. Ko a -Pada was close o Gua a a RDT o 26% and mic oscopy alue o 29%.
Table 2 demons a es he di e en age g oups, gende and hei associa ion wi h he wo diagnos ic echniques in
mala ia de ec ion. Age ange 13-17yea s is he highes a ec ed (27.6% RDT), while mic oscopy is also high a 29.9%,
hough he ange is a bi wide han he o he s o gi e he s udy mo e s a is ical powe in compa ing wi h o he age
g oups. This is ollowed by age g oup 4-6 and 7-12 a 25% each o RDT while o mic oscopy, 4-6yea s g oup ha ing
sligh ly highe ale a 20.8% and 19.5%. This shows he e ol ing na u e o child en, mo emen om one place o
ano he migh inc ease hei chances o coming in con ac wi h mosqui o bi es. In e es ing o no e is he age g oup <1
yea ha ing he lowes posi i i y a e o RDT 9.2% and mic oscopy alue a 14.2%. This shows ha mo he s ha e mo e
ca e o he younge child en, using physical ba ie s as p e en i e measu es especially when hey a e younge and
don’ ha e he willpowe o mo e a ound much. Gende showed ha emales (57.9%), we e mo e in ec ed han males
(42.1%) o RDT, and mic oscopy alues show ha emales 60.4% we e also mo e in ec ed han males 39.6%. This
shows ha bo h me hods used also showed gende di e ence a ec ing mo e emales han males. Females we e mo e
in numbe in his s udy (60.9%), han males, so he highe in ec ion a e migh be jus i ied he e as s a is ically i was
no signi ican , bo h sexes ha ing equal chances o be in ec ed. The use o physical ba ie s e.g., long las ing insec icide
ea ed ne s, needs pa ience especially in his opical, wa m en i onmen o p o ec om mosqui o bi es. This shows
he impo ance o mo e enligh enmen and heal h educa ion o pa en s and he child en in ea ly de ec ion, p e en ion
and ea men o educe mo bidi y and mo ali y om un ea ed o se e e cases.
Table 3 compa es he diagnos ic pe o mance o he wo echniques u ilized in his s udy by analyzing hei sensi i i y,
speci ici y, Posi i e P edic i e Value (PPV) and Nega i e P edic i e Value (NPV). This compa ison shows he
e ec i eness o sc eening p og ams he eby ha ing a comp ehensible assessmen o he accu acy and use ulness in
mala ia diagnosis. In his s udy, RDT shows a sensi i i y o 57.5% and speci ici y o 62%, his e lec s i s abili y o
iden i y mode a e posi i e cases and also iden i y nega i e cases as non-mala ial cases. The Posi i e P edic i e Value
(PPV) was 46% and Nega i e P edic i e Value 72%, indica ing he p obabili y ha a posi i e esul was ai ly posi i e
and a highe p obabili y ha a nega i e RDT mala ia es was nega i e. The mic oscopy esul s show a ema kably sha p
di e ence om he RDT ha ing a sensi i i y o 93.9% and speci ici y o 50%. This demons a es he abili y o
mic oscopy o iden i y mos posi i e mala ia cases as ue posi i es, his shows i s abili y as he gold s anda d o mala ia
pa asi e iden i ica ion while ha ing a lowe abili y o iden i y nega i e cases. The PPV was 70% while he NPV was
86.8%, his e lec s a good likelihood ha posi i e mala ia esul s we e accu a e and also showed a ela i ely highe
chance ha a nega i e mala ia es esul was ac ually nega i e using mic oscopy. While mic oscopy had a highe
sensi i i y han RDT, bo h ha e ela i ely close speci ici y, PPV and NPV which may imply ha bo h me hods can be
u ilized compa a i ely depending on he en i onmen o es ing whe he ield, esea ch o clinical se ing, (bu o
clinical, mic oscopy is encou aged) o enhance diagnosis and make in o med decisions on ea men .
Table 1 P e alence o Mala ia among Child en acco ding o loca ion o s udies using Rapid Diagnos ic Tes s and
Mic oscopy
Va iables
G oups (PHCs)
To al
RDT + e (%)
Mic oscopy + e (%)
Loca ion
Angwa Wuje
44
14 (28.0)
32 (64.0)
Yelwa
44
17 (34.0)
32 (64.0)
Ko a Pada
44
13 (26.0)
24(48.0)
Gua a
44
12 (24.0)
29 (58.0)
Angwa Kaswa
44
20 (40.0)
37 (74.0)
To al
220
Chi-squa e
76
4.63
154
5.56
p- alue
0.33
0.23
Angwan Kaswa had highes p e alence showing en i onmen and i s ole in mala ia in ec ion hough p >0.05
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 4049-4058
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Table 2 Associa ion be ween Rapid Diagnos ic Tes s and Mic oscopic posi i i y wi h demog aphic cha ac e is ics o
pa icipan s (Age and Sex)
Va iables
G oups(y s)
No
examined
(%)
RDT posi i e
(%)
χ2
P-
alue
Mic oscopy posi i e
(%)
χ2
P-
alue
Age g oups
< 1
33 (15)
7 (9.2)
6.32
0.18
22(14.2)
6.5
0.17
1-3
37 (16.8)
10(13.2)
24 (15.6)
4-6
41 (18.6)
19 (25)
32 (20.8)
7-12
50 (22.7)
19 (25)
30 (19.5)
13-17
59 (26.8)
21(27.6)
46 (29.9)
To al
220 (100)
76 (100)
154 (100)
Sex
Female
134(60.9)
44(57.9)
0.55
0.46
93 (60.4)
0.03
0.86
Male
86 (39.1)
32(42.1)
61 (39.6)
P alue was > 0.05 in his s udy so associa ion be ween RDT, mic oscopy and demog aphic pa ame e s we e no s a is ically signi ican
Table 3 Sensi i i y, Speci ici y, Posi i e P edic i e Value (PPV), Nega i e P edic i e Value (NPV) o bo h diagnos ic
me hods used
Cha ac e is ics
RDT
Mic oscopy
Sensi i i y
57.5%
93.9%
Speci ici y
62%
50%
PPV
46.3%
70%
NPV
72%
86.8%
Mic oscopy was mo e sensi i e bu RDT was a li le mo e speci ic o diagnosis o Plasmodium alcipa um.
Table 4 Use o Insec icide T ea ed Ne s (ITN)
Use o ITNs
Response (Y) %
No. examined
RDT + e (%)
Mic oscopy + e
< 1yea
30 (22.4)
33
7 (9.2)
22 (14.2)
1-3
34 (25.4)
37
10 (13.2)
24 (15.6)
4-6
20 (14.9)
41
19 (25.0)
32 (20.8)
7-12
23 (17.2)
50
19 (25.0)
30 (19.5)
13-17
27 (20.1)
59
21 (27.6)
46 (29.9)
To al
134 (100)
220
76 (100)
154 (100)
Y- Yes; Responden s use o ITNs was s a is ically signi ican a p < 0.05
4. Discussion
Mala ia has con inued o be a public heal h h ea especially in he sub-Saha an A ica egion. Nige ia has a
disp opo iona e sha e o he in ec ion (27%) [1], ou clima ic condi ions and en i onmen being a signi ican cons an
ac o acing his challenge. This s udy seeks o ca y ou mala ia diagnosis using he mos common and a o dable
me hods in ou egion: (RDT and mic oscopy); a compa a i e analysis o P. alcipa um mala ia apid diagnos ic es s
and mic oscopy o child en a ending selec ed p ima y heal h cen e s in Ke i, Local Go e nmen A ea, Nasa awa S a e,
Nige ia we e ca ied ou . The indings depic mala ia p e alence, associa ion be ween mala ia posi i i y be ween he
di e en es me hods and diagnos ic e iciency. The o e all p e alence o mala ia in his s udy was 52.3%. This is in
opposi ion o a s udy ca ied ou in ano he acili y which had a p e alence o below 15% and he s udy was ca ied ou
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 4049-4058
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in Ke i bu in ano he loca ion and using di e en RDTs [14]. This dispa i y migh be due o loca ion, en i onmen al
condi ions, s o age o ba ch o RDT used [6, 8, 17]. Ano he s udy ca ied ou in he Sou h-Eas e n egion o Nige ia
showed an o e all mala ia p e alence o 26.7% bu child en in low socio-economic class had a signi ican ly highe
p e alence a e o 32.7% which is also simila o wha is seen in his s udy [18]. Acco ding o he di e en P ima y
Heal h Cen e s (PHC), he di e en p e alences we e seen o be a ec ed by loca ions as he ones close o he ma ke
(PHC Angwan Kaswa RDT 40%, Mic oscopy 74%) highe alues as opposed o he ones in a cleane and d ie
en i onmen . This is in line wi h ano he s udy, which p oposes h ough gene alized addic i e modelling ha su icien
p ecipi a ion p o ides com o able mosqui o habi a s o ec o species, which ensu es adequa e humidi y ha
p opaga es he su i al o mosqui oes [19]. Also, i is seen ha inc eased ain all, looding, inc eased empe a u e,
p ecipi a ion e c. which a e all clima e change condi ions inc ease ec o - bo ne diseases like mala ia, dengue e e ,
Lyme disease and Wes Nile i us which can lead o epidemics so s onge con ol s a egies a e ad oca ed [17, 19].
The p e alence o mala ia using apid diagnos ic es s was 34.5% while using mic oscopy he p e alence was 70%, his
shows he dispa i y in diagnosis and limi a ion o RDT no being able o iden i y lowe pa asi e densi y. In di e en
pa s o Nige ia, he e a e a ious epo s o mala ia p e alence like Com o e al., epo ed 14% o mic oscopy and
4.7% o RDTs in Ke i [14]. Ano he s udy in Soko o, epo ed 60.4% [20], Nwaneli e al., epo ed o al p e alence o
46.2% in Nnewi [18], Onyishi e al., in Nsukka epo ed 72.8% [21]; hese show ha iming and loca ion can also a ec
mala ia ansmission. These alues indica e ha we should no elax on p e ious gains o mala ia educ ion bu should
wo k ha de wi h con ol s a egies (especially seasonal mala ia in e en ions) ea ly de ec ions, p omp ea men o
cases o achie e e en i i ’s a p e-elimina ion mode in Nige ia.
Mala ia posi i i y ac oss he di e en age anges <1, 1-3, 4-6, 7-12 and 13-17 yea s we e 9.2%, 13.2%, 25%, 25%, 21%
(RDT) while o mic oscopy i was 14.2%, 15.6%, 20.8%, 19.5% and 29.9%. This is in ag eemen wi h he wo k o
Nwaneli e al., ha showed ha mala ia posi i i y was inc eased as he age o he child en inc eased [18]. Bu om his
age ange, age 13-17yea s, had a cons an inc ease in bo h RDT and mic oscopy ollowed by 4-6 yea s, his showed ha
child en 6yea s and below migh be mo e in ec ed i app op ia e ca e is no gi en o hem, and he olde child en 13-
17 yea s hough assuming acqui ed immuni y a his age migh lose i and can expose hem o d ug esis an species i
no de ec ed and ea ed on ime [22]. Females we e mo e in ec ed han males 57.9% s 60.4% o RDT and mic oscopy,
while males we e 42.1% s 39.6%, emales we e signi ican ly mo e in numbe bu sex was no a s a is ically signi ican
associa ion wi h mala ia (p> 0.05). This is also seen in a s udy ca ied ou in Ghana whe e emales we e mo e in numbe
and mo e in ec ed bu no s a is ically signi ican [23]. The Fi s Response RDT used in his s udy ga e a ai ly good
ep esen a ion almos hal he mic oscopy alues, which makes i s ease and simplici y good o ield wo k bu wi h
con i ma ion o mos nega i e cases should be done by ained mala ia mic oscopis s. This is as opposed o o he RDTs
used in o he s udies by [14, 24]. They had lowe posi i e a es using di e en RDTs, bu mic oscopy esul s we e highe
as seen in his s udy. This means ha some posi i e samples migh be missed using some ba ches o RDTs. Some
pa icipan s on medica ions o submic oscopic a ios migh also be missed [22]. This migh also be as a esul o s o age
o empe a u e e ec s on he RDT ki s which migh lead o mo e alse nega i e esul s [24].
The sensi i i y, speci ici y Posi i e P edic i e Value (PPV) and Nega i e P edic i e Value (NPV) o he es s we e used
o e alua e he diagnos ic e iciency o he wo echniques used. The sensi i i y o RDT was 57.5% while mic oscopy
was 93.9%, Speci ici y was 62% and 50%, PPV 46.3% and 70% and NPV 72% and 86.8%. This is in line wi h he s udies
o Runmokun e al., ha had sensi i i y o 97.08% in a s udy o wo p ima y heal h and mala ia in child en in Po -
Ha cou , Nige ia. Also, Com o e al., had high sensi i i y o he mic oscopy wo ks as opposed o he Ghana s udy ha
had sensi i i y o mic oscopy as 39.3% and RDT 55.7% bu bo h es s had compa able speci ici y o 98.2% and 98.3%,
simila PPV 95.7% s 94.5% bu highe NPV (75.3% s 69.0%) [23]. The NPV alue o Opoku e al., was simila o he
esul we go in his s udy as abo e depic ing ha nega i e esul s we e ac ually nega i e simila o RDT and mic oscopy.
Plasmodium an igens p oduce special p o eins called his idine ich p o eins ha a e used in a ge ing o de ec ion in
apid diagnos ic ki s [25, 26]. The p esence o hese p o eins has been ound o be dele ed in some s ains o Plasmodium
due o b eakage and ejoining a he uns able sub- elome ic egions o ch omosome 8 and 13 o p h p2 and p h p3
genes so ha he pa asi e can’ be de ec ed ea ly enough ( alse-nega i e esul ) hence encou aging i s ansmission and
esis ance pa e ns [26]. The iden i ica ion o mo e mic oscopy samples may be a ibu ed o his. HRP2 and HRP3 a e
mos ly common wi h Plasmodium alcipa um and a e bo h simila in s uc u e. The s uc u al simila i y be ween hem
is esponsible o he c oss- eac i i y o monoclonal an ibodies agains P HRP2 wi h hose o P HRP3. Unlike P HRP1
and P HRP3, P HRP2 is p oduced in la ge concen a ions h oughou he pa asi e li e cycle [26].
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5. Conclusion
Se e al epo s ha e a ibu ed mic oscopy as he gold s anda d me hod o mala ia iden i ica ion hough mo e mode n
echnologies like polyme ase chain eac ion, a i icial in elligence is gaining g ound (bu he expensi e na u e is a
d awback and can’ be used as ou ine in es iga ion). The compa ison o apid diagnos ic es s ips and mic oscopy is
seen in his s udy as a o ing mic oscopy as he accep able gold s anda d iden i ying mala ia pa asi es ea lie and e en
in low pa asi emia. This hough equi es aining and e aining by ce i ied labo a o y pe sonnels. In low- and middle-
income coun ies whe e mala ia is s ill endemic, s eng hening manpowe by ainings, in as uc u e a ailabili y like
elec ici y is necessa y o mic oscopy o be e icien ly ca ied ou . Rapid diagnos ic ki s a e a o dable, accessible and
can be easily used on he ield bu de ec ing low pa asi emia coupled wi h he h p 2/3 dele ions can be an issue so
nega i e esul s should be con i med by mic oscopy. Clima ic change which we a e no icing now can inc ease
empe a u e, ain all and humidi y leading o p oli e a ion o mala ia-ca ying mosqui oes hen mala ia ansmission
inc eases mo e. We ad oca e o mo e physical ba ie s using mosqui o ne s and window ne sc eens a homes,
en i onmen ally sa e indoo insec icide sp ays, imp o ed dip s ick es ing de ices and subsidies o new mala ia
combina ion he apies a e es ing. Thus, ea ly de ec ion, ea men and p e en ion is pe inen in he igh agains his
ancien scou ge. This will enable as e iden i ica ion, ea men ime and inc ease communi y, amily wellbeing and he
globe a la ge.
Compliance wi h e hical s anda ds
Acknowledgmen s
The au ho s hank all s udy pa icipan s, heal h pe sonnels and s a o he a ious P ima y Heal h Ca e Cen e s used.
Au ho con ibu ions
US and DI concei ed he wo k, US and FS conduc ed sample collec ion and RDT. FS and VO ca ied ou mic oscopy, US
w o e he i s d a o he manusc ip , DI and AI edi ed he d a manusc ip . All au ho s ead and ag eed wi h he inal
e sion o he manusc ip
Disclosu e o con lic o in e es
The au ho s decla e no con lic o in e es in ca ying ou his esea ch.
S a emen o e hical app o al
The s udy was app o ed by he Fede al Medical Cen e Resea ch and E hics Commi ee FMC/ P io o sample collec ion.
S a emen o in o med consen
In o med consen was go en om each pa en o gua dian o he child en.
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