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Rising malaria in UK kids post-pandemic: Dr Chris Bird highlights research on the potential of Rapid Diagnostic Tests for quicker malaria detection, reducing painful blood tests and hospital wait times.

A graphics comparing the pros and cons of two ways to diagnose malaria.
Current “gold standard” test for malaria. Carried out in a laboratory by
examining a drop of the patient's blood under a microscope to look for the
presence of the malaria parasites.
Rapid Diagnostic Test (RDT)
A type of diagnostic tool (similar to at home Covid tests many will be familiar
with). For malaria, these tests typically involve a nger-prick
blood sample.
• Highly accurate when performed by trained personnel.
• Can identify the specic species of malaria parasite, which
is important for treatment decisions.
• Allows for the quantication of parasites in the blood,
which can help assess disease severity.
• Can be time-consuming, delaying diagnosis and
• Can put added costs and pressure on busy
frontline settings.
• Quick results, often within 15–30 minutes.
• Simple to use.
• Does not require specialised training or equipment.
• Can be used in a wide range of settings, including remote
areas with limited laboratory facilities.
• May not be as accurate as microscopy, particularly for
detecting non-falciparum species of malaria.
• Cannot quantify the number of parasites in the blood.
• Some strains of Plasmodium falciparum with certain
gene deletions may not be detected by certain types of RDTs.

Malaria is a parasitic disease spread from mosquitoes to humans in tropical regions and remains a major cause of death in children worldwide . Increasing numbers of children and young people (CYP) are travelling and imported malaria cases in the UK are once again on the rise post pandemic .

The symptoms of malaria – fever, lethargy, cough, tummy and muscle pain among others – are non-specific so while only around 3 in 100 children who present to UK emergency departments likely have malaria, any child who has fever and who has returned from a malaria endemic area needs an urgent test to screen for the disease.

Click to expandClick to expandThe traditional, “gold standard” test for malaria has for decades been microscopy, where a lab technician looks at a blood sample under a microscope to look for malaria parasites. It takes time to get a result and current guidance recommends up to three tests at close intervals to ensure a child does not have malaria. This means children can wait several hours in the emergency department for a result and may need to return to hospital for further, painful blood tests.

A newer rapid diagnostic test for malaria (RDT) is now used alongside microscopy in UK labs to screen for malaria and is a mainstay for malaria diagnosis in resource-limited settings. We looked at the data for over 1,400 children tested for malaria across 15 UK hospitals during 2016-17. Our study aimed to see whether an RDT alone, which is a quick and simple finger-prick test, can rule out malaria in children presenting to UK emergency departments.

We found that RDT alone was very good at ruling out the Plasmodium falciparum type of malaria (the type that is the main cause of death from malaria and which is found in over three quarters of cases imported to the UK) but not quite so good for other species, so we still need to use microscopy until more accurate tests are developed.

However, we believe the study’s results, the first to evaluate the accuracy of RDTs to rule out imported malaria in children, can still improve the patient journey:

  • We found that malaria was accurately diagnosed in all but one case (1 out of 47) with an RDT and one microscopy test alone. We think that in a well-looking child, most children will not need to come back for repeat tests (which is what we found was happening with over four fifths of children tested anyway)
  • We plan to trial taking the RDT out of the lab and use it in children’s emergency departments, aiming to make an earlier diagnosis and cut the time families spend in the emergency department (we will still need to send a sample for microscopy but most well-appearing children will not need to wait for the result)

You can read the full paper here:

Click here to download a .pdf of the infographic.

The views expressed here are those of the authors and not necessarily those of the NIHR, the NHS or the Department of Health and Social Care. Readers' comments will be moderated - see our guidelines for further information.