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Besides PfHRP2, the PfHRP3 antigen contributes to the detection of\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      infections in PfHRP2 RDTs. However, the performance HRP2-based RDT is affected by\n                      <jats:italic>pfhrp2\/3<\/jats:italic>\n                      gene deletions resulting in false-negative test results. The objective of this study was to determine the presence and prevalence of\n                      <jats:italic>pfhrp2\/3<\/jats:italic>\n                      gene deletions including the respective flanking regions among symptomatic patients in Assosa zone, Northwest Ethiopia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A health-facility based cross-sectional study was conducted in febrile patients seeking a malaria diagnosis in 2018. Blood samples were collected by finger-prick for microscopic examination of blood smears, malaria RDT, and molecular analysis using dried blood spots (DBS) prepared on Whatman filter paper. A total of 218\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      positive samples confirmed by quantitative PCR were included for molecular assay of\n                      <jats:italic>pfhrp2\/3<\/jats:italic>\n                      target gene.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 218\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      positive samples, exon 2 deletions were observed in 17.9% of\n                      <jats:italic>pfhrp<\/jats:italic>\n                      2 gene and in 9.2% of\n                      <jats:italic>pfhrp<\/jats:italic>\n                      3 gene. A high proportion of deletions in short segments of\n                      <jats:italic>pfhrp2<\/jats:italic>\n                      exon1-2 (50%) was also detected while the deletions of the\n                      <jats:italic>pfhrp3<\/jats:italic>\n                      exon1-2 gene were 4.1%. The deletions were extended to the downstream and upstream of the flanking regions in\n                      <jats:italic>pfhrp2\/3<\/jats:italic>\n                      gene (above 30%). Of eighty-six PfHRP2 RDT negative samples, thirty-six lacked\n                      <jats:italic>pfhrp2 exon 2<\/jats:italic>\n                      . Five PfHRP2 RDT negative samples had double deletions in\n                      <jats:italic>pfhrp2 exon 2<\/jats:italic>\n                      and\n                      <jats:italic>pfhrp3 exon2<\/jats:italic>\n                      . Of these double deletions, only two of the samples with a parasite density above 2000 parasite\/\u00b5l were positive by the microscopy. Three samples with intact\n                      <jats:italic>pfhrp3 exon2<\/jats:italic>\n                      in the\n                      <jats:italic>pfhrp2 exon2<\/jats:italic>\n                      deleted parasite isolates were found to be positive by PfHRP2 RDT and microscopy with a parasite density above 10,000\/\u00b5l.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This study confirms the presence of deletions of\n                      <jats:italic>pfhrp2\/3<\/jats:italic>\n                      gene including the flanking regions.\n                      <jats:italic>Pfhrp2\/3<\/jats:italic>\n                      gene deletions results in false-negative results undoubtedly affect the current malaria control and elimination effort in the country. However, further countrywide investigations are required to determine the magnitude of\n                      <jats:italic>pfhrp2\/3<\/jats:italic>\n                      gene deletions and its consequences on routine malaria diagnosis.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12936-021-03629-x","type":"journal-article","created":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T03:03:05Z","timestamp":1614049385000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["Detection of high prevalence of Plasmodium falciparum histidine-rich protein 2\/3 gene deletions in Assosa zone, Ethiopia: implication for malaria diagnosis"],"prefix":"10.1186","volume":"20","author":[{"given":"Gezahegn Solomon","family":"Alemayehu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayla","family":"Blackburn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Lopez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheikh","family":"Cambel Dieng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenia","family":"Lo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Janies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lemu","family":"Golassa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,2,23]]},"reference":[{"key":"3629_CR1","unstructured":"WHO: World malaria report 2019. 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The project was also reviewed and approved by the Institutional Review Board of the University of North Carolina at Charlotte (IRB number 18\u20130451). Permission was obtained from Benishangul-Gumuz regional Health Bureau. Information about the study, the objective of the study, the possible risks and benefits of the study were explained to the participants or their guardians using the local language. Figure prink blood samples were taken after obtaining written informed consent and assent from parents or guardian\u2019s in case of children. Malaria positives were treated by health workers based on national treatment guideline. Confidentiality was maintained throughout the study.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"This study reports no individual person\u2019s data. There is no opposition to its presentation and\/or publication. All authors have read and approved the manuscript for publication.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no conflict of interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"109"}}