A multicentre study conducted by researchers from West Africa and the UK evaluated a portable molecular malaria test that can detect asymptomatic and submicroscopic infections in under 45 minutes, with a sensitivity exceeding 95%.

Despite major progress in malaria control, Africa still accounts for 94% of global cases and 95% of malaria deaths, according to the latest World Health Organization report. In countries such as Burkina Faso and The Gambia, transmission continues largely because many asymptomatic individuals — though infected — never seek care and remain undetected by standard surveillance.

These low parasite-density infections, known as submicroscopic malaria, escape rapid diagnostic tests and often even conventional microscopy, yet they continue to drive transmission. Detecting these hidden cases is considered a crucial step towards malaria elimination.

To address this gap, an international consortium of institutions from West Africa and the UK developed a point-of-care molecular diagnostic tool. Published in Nature Communications, the study is a collaboration among the Medical Research Council Unit The Gambia, the London School of Hygiene and Tropical Medicine, and the Institut de Recherche en Sciences de la Santé in Burkina Faso.

The team aimed to design a high-sensitivity, low-cost method suitable for resource-limited regions without advanced laboratory infrastructure.

New Test Simplifies Malaria Diagnosis

The study analysed 672 finger-prick blood samples from residents of rural communities in The Gambia and Burkina Faso. Of these, 146 samples tested positive for Plasmodium falciparum using quantitative polymerase chain reaction (qPCR).

The new test, called Dragonfly, combines a magnetic DNA extraction system known as SmartLid with a colorimetric isothermal amplification platform based on loop-mediated isothermal amplification (LAMP). Its performance was compared with three reference methods: qPCR (the gold standard), expert optical microscopy, and rapid antigen tests detecting the histidine-rich protein 2.

The device achieved a detection limit of 0.6 parasite per microlitre, and the full process — from sample collection to result — took less than 45 minutes.

Dragonfly integrates two key innovations. The SmartLid uses silica-coated magnetic beads to capture DNA directly from small blood samples without centrifugation, completing extraction in about 10 minutes. The Dragonfly platform then uses temperature-stable lyophilised reagents to amplify DNA at 63.5 °C. Results are visually read — a colour change from pink to yellow indicates a positive result — eliminating the need for optical or digital readers.

The system demonstrated a sensitivity of 95.2% (95% CI, 90.4%-98.1%) and specificity of 96.8% (95% CI, 94.9%-98.0%) compared with qPCR. Among asymptomatic individuals, sensitivity was 94.9%, and for submicroscopic infections (fewer than 16 parasites per microlitre), it was 95.3%. These rates far surpassed rapid tests (49.6%) and microscopy (70.1%), even when performed by experienced technicians.

Beyond its diagnostic accuracy, Dragonfly offers practical advantages. Commercial LAMP platforms such as Loopamp (Eiken Chemical, Japan) and Alethia Malaria (Meridian Bioscience, the US) perform well but require costly equipment (around $20,000) and have limited throughput. In contrast, Dragonfly operates with a 20-W portable heat block, powered by battery or solar energy, making it far more suitable for field deployment in remote areas.

Disease Surveillance

The authors emphasise that the new system meets the Malaria Eradication Research Agenda criteria for field diagnostics — high sensitivity, speed, affordability, ease of use, and portability. Mathematical models suggest that lowering the detection threshold below two parasites per microlitre could triple the effectiveness of mass testing and treatment strategies.

Still under development, the technology will undergo additional field studies to assess thermal stability and usability by community health workers. The lyophilised reagents remain stable for at least 6 months at 30 °C, while the SmartLid extraction kits can be stored for up to 1 year without losing efficacy.

The research team also plans to transfer the technology to African production centres, a move that could reduce costs and support regional manufacturing of molecular diagnostics. The Dragonfly platform has already been adapted for rapid detection of mpox and emerging respiratory infections, showing its flexibility for use beyond malaria.

The next phase involves integrating digital connectivity and cloud-based data storage to allow real-time reporting and epidemiologic surveillance, aligned with the Africa Centers for Disease Control and Prevention’s digital health transformation strategy.

Possible Applications in the Amazon

The diagnostic approach tested in Africa could inspire similar efforts in the Brazilian Amazon, where logistical challenges and limited healthcare access remain major barriers to malaria elimination.

According to Brazil’s Ministry of Health, 140,263 locally acquired malaria cases were recorded in 2023 — 15.3% caused by P. falciparum and 82.7% by Plasmodium vivax. More than 99% of cases occurred in the Amazon region, where geographic isolation makes laboratory testing difficult.

By March 2025, Brazil had reported 25,473 cases, a 26.8% decrease compared with the same period in 2024. In the state of Amazonas, 12,527 cases were recorded between January and March 2025, down from 14,340 during the same period a year earlier.

In remote riverine and Indigenous communities, dependence on central laboratories or microscopy is often impractical. Portable molecular technologies such as Dragonfly could enable rapid on-site diagnosis in floating clinics, mobile health boats, or Indigenous health centres, ensuring faster detection and treatment.

Similar innovations are already emerging. In Amazonas, researchers funded by the Amazonas Research Foundation have developed antibody-based prototypes and rapid tests tailored to local conditions. The Oswaldo Cruz Foundation, Brazil’s leading biomedical research institute, has also created a portable isothermal amplification device for diagnosing neglected infectious diseases, including malaria and arboviral infections such as dengue and Zika.

In 2025, the Brazilian Ministry of Health launched the Malariômetro, a digital surveillance tool designed to improve real-time monitoring of malaria trends and strengthen epidemiologic oversight nationwide.

The combination of high-sensitivity molecular diagnostics and digital data systems may represent a new frontier in malaria control. As demonstrated in Africa, technological decentralisation and regional production are essential to expanding access, reducing health disparities, and strengthening genomic and epidemiologic surveillance in hard-to-reach regions like the Amazon.

This story was translated from Medscape’s Portuguese edition.