Field performance of the SD Bioline Malaria Ag P.f. rapid diagnostic test among children under five in Nigeria: insights from the 2021 Malaria Indicator Survey

SD Bioline Malaria Ag P.f. shows high sensitivity and negative predictive value, confirming its reliability for ruling out malaria in children aged 6-59 months in Nigeria. However, moderate specificity and low positive predictive value with a large microscopy-RDT estimated prevalence gap indicate a risk of overestimating malaria prevalence. False negatives may occur, potentially due to PfHRP2/3 deletions, test handling, or non-falciparum infections. These findings underscore the need for confirmatory testing where feasible, with the consideration of complementary diagnostic strategies to optimize surveillance and case management, and ongoing postmarketing evaluation of RDT performance.