False-positive and false-negative malaria rapid diagnostic test results: evidence from a nationally representative survey of children in Ghana

HRP2-based RDTs are highly sensitive and reliable for ruling out malaria in children under five in Ghana. However, their lower PPV may lead to overestimation of malaria prevalence, particularly in high-transmission rural areas and IRS-targeted districts. Programmatic use of RDT-based prevalence data should account for this limitation, and confirmatory microscopy or molecular data should be incorporated where feasible. Continued surveillance of pfhrp2/3 deletions and post-treatment HRP2 persistence is warranted to sustain diagnostic accuracy.