{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T01:11:49Z","timestamp":1778116309035,"version":"3.51.4"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:00:00Z","timestamp":1774656000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":40,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-043942."],"award-info":[{"award-number":["INV-043942."]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["No.7200AA20CA0003"],"award-info":[{"award-number":["No.7200AA20CA0003"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Malar J"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Accurate interpretation and recording of malaria rapid diagnostic tests (RDTs) are critical for case management and surveillance in malaria-endemic settings. In Benin, where over 90% of malaria diagnoses rely on RDTs, concerns remain about the accuracy of the reporting and recording of RDT results. This study assessed the fidelity of RDT recording by healthcare workers (HCWs) in public health facilities and explored associated factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A six-month mixed-methods, prospective observational study was conducted in 16 public health facilities across two departments in Benin. For each RDT performed, an image was captured using a digital RDT reader (HealthPulse, Audere, Seattle, WA USA) and independently interpreted by an external trained panel. HCW-recorded results were compared to panel interpretations. A knowledge, attitudes, practices, and beliefs (KAPB) survey and structured observations of RDT performance were conducted, alongside in-depth interviews with selected HCWs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 35,720 RDTs assessed, overall agreement between HCW and reference panel interpretations was 94.3% (Cohen\u2019s kappa\u2009=\u20090.88). Results misrecorded as positive (5.0%) were more frequent than results misrecorded as negative (0.7%). Agreement varied by patient age, HCW experience, and facility characteristics. Accuracy was highest with children under 5 years (96.7%) and lowest with patients over 15 years (91.6%). HCWs with\u2009\u2265\u200910 years of experience, and access to electricity and internet performed better. From 226 HCWs surveyed, 89.4% believed a patient with malaria could have a negative RDT, though only 19.5% supported treating such cases with antimalarials. While most HCWs were proficient in performing RDTs, only 40.5% waited the recommended time before reading results, and glove use was low (15.6%) highlighting safety gaps. RDT use was primarily motivated by adherence to guidelines (60.2%), rather than patient or supervisor expectations. Qualitative interviews highlighted contextual challenges including workload, lighting conditions in health facilities, and resource constraints.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HCWs in Benin showed high accuracy in interpreting and reporting malaria RDT results, likely supported by recent nationwide RDT cassette validations. Performance was strongest among those with more experience, training, and adequate infrastructure. However, negative results misrecorded as positive, especially in adult patients, remains a concern. Targeted training and supportive supervision may help strengthen confidence in negative results and improve overall diagnostic accuracy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12936-026-05871-7","type":"journal-article","created":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T04:56:13Z","timestamp":1774673773000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The accuracy of recording malaria rapid diagnostic test (RDT) results in public health facilities in Benin; results from the MaCRA project"],"prefix":"10.1186","volume":"25","author":[{"given":"Idelphonse","family":"Ahogni","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hospice","family":"Avanon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corneille","family":"Hueha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Augustin","family":"Kpemasse","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julien","family":"Aissan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cyriaque","family":"Affoukou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manfred","family":"Accrombessi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John J.","family":"Aponte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Hilton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shawna","family":"Cooper","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Griffith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Humes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kim A.","family":"Lindblade","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corine","family":"Ngufor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,28]]},"reference":[{"key":"5871_CR1","volume-title":"World malaria report","author":"WHO","year":"2023","unstructured":"WHO. World malaria report. Geneva: World Health Organisation; 2023."},{"key":"5871_CR2","volume-title":"Guidelines for malaria vector control","author":"WHO","year":"2025","unstructured":"WHO. Guidelines for malaria vector control. Geneva, Switzerland: World Health Organization; 2025."},{"key":"5871_CR3","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-017-1808-x","volume":"16","author":"C Zinsou","year":"2017","unstructured":"Zinsou C, Cherifath AB. The malaria testing and treatment landscape in Benin. Malar J. 2017;16:174.","journal-title":"Malar J"},{"key":"5871_CR4","unstructured":"PMI: President\u2019s malaria initiative Benin malaria operational plan. 2024. PMI website. https:\/\/www.pmi.gov\/where-we-work\/benin. Accessed 4 January 2025."},{"key":"5871_CR5","doi-asserted-by":"publisher","first-page":"29","DOI":"10.4269\/ajtmh.21-0643","volume":"106","author":"M Aidoo","year":"2022","unstructured":"Aidoo M, Incardona S. Ten years of universal testing: how the rapid diagnostic test became a game changer for malaria case management and improved disease reporting. Am J Trop Med Hyg. 2022;106:29\u201332.","journal-title":"Am J Trop Med Hyg"},{"key":"5871_CR6","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-017-4398-1","volume":"17","author":"MR Boyce","year":"2017","unstructured":"Boyce MR, O\u2019Meara WP. Use of malaria RDTs in various health contexts across sub-Saharan Africa: a systematic review. BMC Public Health. 2017;17:470.","journal-title":"BMC Public Health"},{"key":"5871_CR7","unstructured":"Benin P. Rapport de la mission d\u2019echange avec les structures departementales du PNLP et des EEZ des zones sanitaires; Etape Oueme\/Plateau et Mono\/Couffo. 2019."},{"key":"5871_CR8","unstructured":"Ngufor C, Ahogni I. Documentation of the monthly validation of malaria rapid diagnostic test (RDTs) results in Benin. Cotonou, Benin. 2025."},{"key":"5871_CR9","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-13-502","volume":"13","author":"E Diggle","year":"2014","unstructured":"Diggle E, Asgary R, Gore-Langton G, Nahashon E, Mungai J, Harrison R, et al. Perceptions of malaria and acceptance of rapid diagnostic tests and related treatment practises among community members and health care providers in Greater Garissa, North Eastern Province, Kenya. Malar J. 2014;13:502.","journal-title":"Malar J"},{"key":"5871_CR10","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s12936-015-1020-9","volume":"15","author":"R Altaras","year":"2016","unstructured":"Altaras R, Nuwa A, Agaba B, Streat E, Tibenderana JK, Strachan CE. Why do health workers give anti-malarials to patients with negative rapid test results? A qualitative study at rural health facilities in western Uganda. Malar J. 2016;15:23.","journal-title":"Malar J"},{"key":"5871_CR11","doi-asserted-by":"publisher","first-page":"159","DOI":"10.4269\/ajtmh.14-0595","volume":"93","author":"C Faust","year":"2015","unstructured":"Faust C, Zelner J, Brasseur P, Vaillant M, Badiane M, Cisse M, et al. Assessing drivers of full adoption of test and treat policy for malaria in Senegal. Am J Trop Med Hyg. 2015;93:159\u201367.","journal-title":"Am J Trop Med Hyg"},{"key":"5871_CR12","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-025-05459-7","volume":"24","author":"KA Lindblade","year":"2025","unstructured":"Lindblade KA, Mpimbaza A, Ngufor C, Yavo W, Atobatele S, Akpiroroh E, et al. Assessing the accuracy of the recording and reporting of malaria rapid diagnostic test results in four African countries: methods and key results. Malar J. 2025;24:206.","journal-title":"Malar J"},{"key":"5871_CR13","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-018-2500-5","volume":"17","author":"DA Pfeffer","year":"2018","unstructured":"Pfeffer DA, Lucas TCD, May D, Harris J, Rozier J, Twohig KA, et al. MalariaAtlas: an R interface to global malariometric data hosted by the Malaria Atlas Project. Malar J. 2018;17:352.","journal-title":"Malar J"},{"key":"5871_CR14","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-025-05595-0","volume":"24","author":"C Ngufor","year":"2025","unstructured":"Ngufor C, Lindblade KA, Atobatele S, Mpimbaza A, Ahogni I, Ssewante N, et al. Are malaria rapid diagnostic test results stable over time to support verification of surveillance data? Malar J. 2025;24:356.","journal-title":"Malar J"},{"key":"5871_CR15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0129545","volume":"10","author":"AK Mbonye","year":"2015","unstructured":"Mbonye AK, Magnussen P, Lal S, Hansen KS, Cundill B, Chandler C, et al. A cluster randomised trial introducing rapid diagnostic tests into registered drug shops in Uganda: impact on appropriate treatment of malaria. PLoS ONE. 2015;10:e0129545.","journal-title":"PLoS ONE"},{"key":"5871_CR16","first-page":"11","volume":"15","author":"IC Ezenyi","year":"2024","unstructured":"Ezenyi IC, Picozzi K, Amaka JI, Adigwe OP. Factors influencing health workers\u2019 adherence to malaria treatment guidelines in under-five children in Nigeria: A scoping review. 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Malar J. 2016;15:126.","journal-title":"Malar J"}],"container-title":["Malaria Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12936-026-05871-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-026-05871-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-026-05871-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:23:33Z","timestamp":1778113413000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12936-026-05871-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,28]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["5871"],"URL":"https:\/\/doi.org\/10.1186\/s12936-026-05871-7","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-7002558\/v1","asserted-by":"object"}]},"ISSN":["1475-2875"],"issn-type":[{"value":"1475-2875","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,28]]},"assertion":[{"value":"29 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study received ethical approval from the Comit\u00e9 National d\u2019\u00c9thique pour la Recherche en Sant\u00e9 (CNERS) under the Ministry of Health in Benin (Approval No. CNERS019\/2023), as well as from the Western Institutional Review Board (WCG IRB). Written informed consent was obtained from HWCs participating in the study. Patient consent was not required, as RDT images were anonymized and data extracted from health facility registers constituted secondary, non-identifiable information. Permission to conduct the study in the selected health facilities was obtained from the Ministry of Health.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"199"}}