{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:38:57Z","timestamp":1792604337888,"version":"4.5.0"},"reference-count":59,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":293,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Tropical Medicine"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Saudi Arabia has reported no indigenous malaria since 2021 and is in the prevention\u2010of\u2010reintroduction phase, with residual and imported infections concentrated in Jazan and Aseer. At this stage, each reported case triggers programmatic action, yet the operational accuracy of routine facility diagnostics has not been measured in this setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the operational accuracy of facility\u2010performed routine light microscopy (RLM) and two Pf\/PAN rapid diagnostic tests (RDTs) against species\u2010specific nested PCR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective diagnostic accuracy study on consecutively archived specimens. Of 118 archived EDTA samples from febrile patients tested for suspected malaria at hospitals in nine governorates of southwestern Saudi Arabia during January\u2013December 2023, 106 were eligible (12 were excluded). Index tests were performed by facility staff during routine care; nested PCR was later performed blinded. Accuracy was assessed against nested PCR and, in a sensitivity analysis, a composite reference (RLM or PCR positive).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nested PCR detected\n                      <jats:italic>Plasmodium<\/jats:italic>\n                      in 81\/106 samples (76.4%; 95% CI 67.2\u201384.0), all single\u2010species (\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      56\/81;\n                      <jats:italic>P. vivax<\/jats:italic>\n                      25\/81). RLM was positive in 98\/106 (92.5%), CareStart in 106\/106 (100%), QuickProfile in 100\/106 (94.3%). RLM called 29\/98 positives mixed (29.6%) versus 0\/81 by PCR (Fisher\u2019s exact,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). Against PCR, RLM sensitivity was 97.5% (91.3\u201399.6) and specificity 24.0% (10.2\u201345.5); CareStart specificity 0% (0\u201313.9), QuickProfile 20.0% (8.1\u201339.8). PCR confirmation increased with reported parasitemia, from 12\/23 (52.2%) at 10\u201390 parasites\/\u03bcL to 22\/24 (91.7%) at 1000\u201310,000 parasites\/\u03bcL (Cochran\u2013Armitage,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In the selected clinically suspected cases, routine diagnostics returned more positives, and far more mixed infections, than nested PCR; both routine false positives and reduced PCR sensitivity in archived material plausibly contribute. Findings should not be extrapolated beyond this population. Strengthened microscopy training, RDT quality assurance, and evaluation of molecular confirmation may support case classification during the prevention\u2010of\u2010reintroduction phase.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/jotm\/8453252","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:50:08Z","timestamp":1792601408000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["When Diagnosis Meets Reality: Operational Performance of Routine Malaria Diagnostics Against Molecular Evidence in Southwestern Saudi Arabia"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5515-8251","authenticated-orcid":false,"given":"Musa A.","family":"Ayashi","sequence":"first","affiliation":[{"name":"Main Laboratory and Blood Bank Medical and Molecular Microbiology Laboratory Jazan Health Cluster  Jazan Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5681-0510","authenticated-orcid":false,"given":"Ahmed A.","family":"Muyidi","sequence":"additional","affiliation":[{"name":"Main Laboratory and Blood Bank Medical and Molecular Microbiology Laboratory King Faisal Medical City for Southern Region  Abha Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4941-5373","authenticated-orcid":false,"given":"Majed H.","family":"Wakid","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory Sciences Faculty of Applied Medical Sciences King Abdulaziz University  Jeddah 21589 Saudi Arabia  kau.edu.sa"},{"name":"Special Infectious Agents Unit King Fahd Medical Research Center King Abdulaziz University  Jeddah 21589 Saudi Arabia  kau.edu.sa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9603-5328","authenticated-orcid":false,"given":"Fadi M.","family":"Baakdah","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory Sciences Faculty of Applied Medical Sciences King Abdulaziz University  Jeddah 21589 Saudi Arabia  kau.edu.sa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1628-4696","authenticated-orcid":false,"given":"Maimonah S.","family":"Alghanmi","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory Sciences Faculty of Applied Medical Sciences King Abdulaziz University  Jeddah 21589 Saudi Arabia  kau.edu.sa"},{"name":"Vaccines and Immunotherapy Unit King Fahd Medical Research Center King Abdulaziz Aziz University  Jeddah Saudi Arabia  kau.edu.sa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3514-4912","authenticated-orcid":false,"given":"Hattan S.","family":"Gattan","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory Sciences Faculty of Applied Medical Sciences King Abdulaziz University  Jeddah 21589 Saudi Arabia  kau.edu.sa"},{"name":"Special Infectious Agents Unit King Fahd Medical Research Center King Abdulaziz University  Jeddah 21589 Saudi Arabia  kau.edu.sa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1353-2243","authenticated-orcid":false,"given":"Amro A.","family":"Zalah","sequence":"additional","affiliation":[{"name":"Molecular Biology Department Jazan Health Cluster  Jazan Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3783-4221","authenticated-orcid":false,"given":"Emad E. A.","family":"Wasili","sequence":"additional","affiliation":[{"name":"Biotechnology Department Jazan Health Cluster  Jazan Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3446-1858","authenticated-orcid":false,"given":"Abdulaziz Y.","family":"Bajawi","sequence":"additional","affiliation":[{"name":"Main Laboratory and Blood Bank Medical Microbiology Laboratory  Jazan 86735 Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4014-2276","authenticated-orcid":false,"given":"Thamer M.","family":"Brek","sequence":"additional","affiliation":[{"name":"Main Laboratory and Blood Bank Medical Microbiology Laboratory Jazan Health Cluster  Jazan Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"key":"e_1_2_15_1_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-023-044700"},{"key":"e_1_2_15_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-015-0858-1"},{"key":"e_1_2_15_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-021-03846-4"},{"key":"e_1_2_15_4_2","doi-asserted-by":"crossref","DOI":"10.30875\/9789287076717","volume-title":"World Malaria Report 2024: Addressing Inequity in the Global Malaria Response","author":"World Health Organization","year":"2024"},{"key":"e_1_2_15_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-018-2438-7"},{"key":"e_1_2_15_6_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1476951"},{"key":"e_1_2_15_7_2","doi-asserted-by":"publisher","DOI":"10.3347\/kjp.2019.57.3.233"},{"key":"e_1_2_15_8_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics12061485"},{"key":"e_1_2_15_9_2","first-page":"655","article-title":"Evaluation of Malaria Rapid Diagnostic Tests in Madinah, Saudi Arabia","volume":"51","author":"Wakid M. H.","year":"2020","journal-title":"Southeast Asian Journal of Tropical Medicine and Public Health"},{"key":"e_1_2_15_10_2","doi-asserted-by":"publisher","DOI":"10.15537\/smj.2015.2.10874"},{"key":"e_1_2_15_11_2","unstructured":"World Health Organization Malaria Surveillance Monitoring & Evaluation: a Reference Manual 2025 https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/4290c98b-553a-4da7-b618-e91bc0651f36\/content."},{"key":"e_1_2_15_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-015-0597-3"},{"key":"e_1_2_15_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-023-04506-5"},{"key":"e_1_2_15_14_2","doi-asserted-by":"publisher","DOI":"10.1080\/20477724.2021.1893484"},{"key":"e_1_2_15_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-025-05680-4"},{"key":"e_1_2_15_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-019-3028-z"},{"key":"e_1_2_15_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-020-03460-w"},{"key":"e_1_2_15_18_2","volume-title":"Malaria Rapid Diagnostic Test Performance: Results of WHO Product Testing of Malaria Rdts: Round 8 (2016\u20132018)","author":"World Health Organization","year":"2019"},{"key":"e_1_2_15_19_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0008091"},{"key":"e_1_2_15_20_2","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2012.10-0665"},{"key":"e_1_2_15_21_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-017-1768-1"},{"key":"e_1_2_15_22_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-021-03812-0"},{"key":"e_1_2_15_23_2","volume-title":"Response Plan to pfhrp2 Gene Deletions","author":"World Health Organization","year":"2024"},{"key":"e_1_2_15_24_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-024-04904-3"},{"key":"e_1_2_15_25_2","doi-asserted-by":"publisher","DOI":"10.1385\/1-59259-271-6:189"},{"key":"e_1_2_15_26_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001788"},{"key":"e_1_2_15_27_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h5527"},{"key":"e_1_2_15_28_2","unstructured":"General Authority for Statistics (GASTAT) Saudi Arabia 2025 https:\/\/www.stats.gov.sa\/en\/statistics."},{"key":"e_1_2_15_29_2","volume-title":"Giemsa Staining of Malaria Blood Films (SOP 07a)","author":"World Health Organization","year":"2016"},{"key":"e_1_2_15_30_2","doi-asserted-by":"publisher","DOI":"10.1155\/japr\/4950793"},{"key":"e_1_2_15_31_2","unstructured":"Access Bio Inc Carestart\u2122 Malaria Pf\/PAN HRP2\/pLDH Combo Test https:\/\/accessbio.net\/products\/rapid-diagnostic-tests\/carestart-malaria-rdt."},{"key":"e_1_2_15_32_2","unstructured":"Lumiquick Diagnostics Inc Quickprofile\u2122 Malaria Pf\/PAN Antigen Test https:\/\/lumiquick.co\/infectious-diseases."},{"key":"e_1_2_15_33_2","unstructured":"QIAGEN QIAamp DNA Blood Mini Kit Handbook https:\/\/www.qiagen.com\/en-US\/resources\/download\/KitHandbook\/hb-0329-007-hb-qiaamp-dna-mini-blood-mini-0725-ww."},{"key":"e_1_2_15_34_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02316-06"},{"key":"e_1_2_15_35_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid2403.171723"},{"key":"e_1_2_15_36_2","doi-asserted-by":"publisher","DOI":"10.1179\/136485911X12987676649421"},{"key":"e_1_2_15_37_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0103905"},{"key":"e_1_2_15_38_2","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2003.69.42"},{"key":"e_1_2_15_39_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-018-2371-9"},{"key":"e_1_2_15_40_2","doi-asserted-by":"publisher","DOI":"10.1080\/03630269.2022.2034644"},{"key":"e_1_2_15_41_2","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.16-0141"},{"key":"e_1_2_15_42_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmala.2025.1460491"},{"key":"e_1_2_15_43_2","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-12-321"},{"key":"e_1_2_15_44_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00074-12"},{"key":"e_1_2_15_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.trstmh.2006.09.007"},{"key":"e_1_2_15_46_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.15.1.66-78.2002"},{"key":"e_1_2_15_47_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002455"},{"key":"e_1_2_15_48_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002456"},{"key":"e_1_2_15_49_2","doi-asserted-by":"publisher","DOI":"10.1179\/136485907X156997"},{"key":"e_1_2_15_50_2","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2007.76.481"},{"key":"e_1_2_15_51_2","doi-asserted-by":"publisher","DOI":"10.1111\/1469-0691.12151"},{"key":"e_1_2_15_52_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-016-1103-2"},{"key":"e_1_2_15_53_2","doi-asserted-by":"publisher","DOI":"10.1086\/644781"},{"key":"e_1_2_15_54_2","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.59872"},{"key":"e_1_2_15_55_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jit610"},{"key":"e_1_2_15_56_2","doi-asserted-by":"publisher","DOI":"10.3347\/PHD.22165"},{"key":"e_1_2_15_57_2","volume-title":"Global Technical Strategy for Malaria 2016-2030, 2021 Update","author":"World Health Organization","year":"2021"},{"key":"e_1_2_15_58_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.trsl.2017.12.004"},{"key":"e_1_2_15_59_2","doi-asserted-by":"publisher","DOI":"10.3390\/s18020513"}],"container-title":["Journal of Tropical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/jotm\/8453252","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/jotm\/8453252","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/jotm\/8453252","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:50:11Z","timestamp":1792601411000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/jotm\/8453252"}},"subtitle":[],"editor":[{"given":"Priya","family":"Gusain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":59,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/jotm\/8453252"],"URL":"https:\/\/doi.org\/10.1155\/jotm\/8453252","archive":["Portico"],"relation":{},"ISSN":["1687-9686","1687-9694"],"issn-type":[{"value":"1687-9686","type":"print"},{"value":"1687-9694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-06-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"8453252"}}