DOI: https://doi.org/10.36347/sasjm.2026.v12i05.032

Pages: 545-553

Introduction: Malaria remains one of the leading causes of pediatric morbidity and mortality in sub-Saharan Africa. The diagnostic performance of rapid diagnostic tests (RDTs) and microscopy remains limited in high-endemic settings because of submicroscopic infections and low parasite densities. This study aimed to evaluate the diagnostic performance of RDTs and microscopy using PCR as the reference method among children under five years of age in Kisangani. Methods: This was a multicenter cross-sectional study with prospective data collection conducted from June 15 to December 30, 2025, in several healthcare facilities in Kisangani. Children aged 0–59 months presenting with fever or a recent history of fever were included. Each child underwent an RDT, microscopy, and PCR. Diagnostic performance was assessed through calculation of sensitivity, specificity, predictive values, and the Kappa coefficient. Results: A total of 417 children were included. The overall prevalence of malaria according to PCR was 64.5%. The proportion of submicroscopic infections was estimated at 27.8%. RDT sensitivity was low compared with PCR, whereas specificity was high. PCR also identified several mixed infections not detected by microscopy. Conclusion: PCR proved significantly more effective than conventional methods for malaria diagnosis among children under five years of age in Kisangani. Submicroscopic infections appear frequent and may contribute to the persistence of malaria transmission.