{"doi":"10.1093/infdis/jiaf604","title":"False-positive Malaria Rapid Diagnostic Tests are Prevalent Among Children Under 5 Years of Age in Uganda","abstract":"BACKGROUND: Malaria rapid diagnostic tests (mRDTs) are a cornerstone of malaria testing and treatment efforts globally. However, positive mRDT results can occur after treatment due to antigen persistence, even in the absence of malaria parasites. False-negative mRDTs are well-described, but less is known about the prevalence and consequences of such false-positive results. METHODS: We estimated the prevalence of false-positive mRDTs, defined as mRDT(+)/microscopy(-), using data from the 2018-2019 Uganda Malaria Indicator Survey (MIS). Children aged <5 years (under-5s) with paired mRDT and microscopy results were included. We estimated the prevalence of false-positive mRDTs among microscopy(-) children using survey weights. We fit bivariate generalized linear models to estimate the prevalence difference (PD) of false-positive mRDTs for pre-specified covariates. We constructed cross-validated weighted lasso regression models to determine which variables best predict false-positive mRDTs among children with recent fever. RESULTS: The prevalence of false-positive mRDTs was 10.7% (849/6786) and was strongly correlated with region-level transmission intensity. Prevalence was higher among children with recent fever (PD: 17.2%; 95% CI: 13.7%, 20.6%), recent antimalarial use (14.7%; 7.1%, 22.3%), and comorbid anemia (8.1%; 5.9%, 10.3%). Prevalence was lower among those with recent antibiotic use (-17.6%; -22.5%, -12.7%). A model with clinical, environmental, and household variables better predicted false-positive mRDTs (weighted AUC = 0.79) than individual models. CONCLUSIONS: False-positive mRDTs are prevalent among under-5s in the 2018-19 Uganda MIS and lead to overestimates of community-level malaria prevalence. These results suggest that false-positive mRDTs may also contribute to misdiagnosis and unnecessary antimalarial use in clinical settings.","journal":"The Journal of Infectious Diseases","year":2025,"id":583630,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9635,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":334760,"name":"Bonnie E. Shook‐Sa","orcid":"0000-0001-9506-4047","position":1,"is_corresponding":false},{"id":428586,"name":"Ross M. Boyce","orcid":"0000-0002-9489-6324","position":2,"is_corresponding":false},{"id":578286,"name":"Emily J. Ciccone","orcid":"0000-0003-2445-8473","position":3,"is_corresponding":false},{"id":420429,"name":"Emily W. Gower","orcid":"0000-0003-1016-9910","position":4,"is_corresponding":false},{"id":1157356,"name":"Amber Young","orcid":"0000-0001-7042-6961","position":5,"is_corresponding":false},{"id":352751,"name":"Jessie K. Edwards","orcid":"0000-0002-1741-335X","position":6,"is_corresponding":false},{"id":1011579,"name":"Caitlin A. Cassidy","orcid":"0000-0002-8796-4990","position":0,"is_corresponding":true}],"reference_count":29,"raw_metadata":null,"created_at":"2026-07-19T02:59:07.970345Z","pmid":"41313736","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}