Molecular Diagnostics and Treatment Failures in Pediatric Malaria: a prospective observational study from Omdurman, Sudan

Introduction Recurrent malaria is a new significant health challenge in Sudan, particularly among pediatric populations. Despite the dominance of P. falciparum , increasing cases of P. vivax and mixed infections complicate the diagnosis and management. This study aimed to analyze the demographic, clinical, diagnostic and treatment characteristics of recurrent malaria in children, highlighting diagnostic challenges and treatment outcomes. Methods We conducted a prospective observational study from October 2021 to April 2023, at the Tropical Diseases Teaching Hospital in Omdurman, Sudan among all consecutive pediatric patients with recurrent malaria (n=81). Data on demographics, clinical history, diagnostic and treatment were collected. Species identification was performed using Blood Film for Malaria (BFFM), and PCR. Treatment adherence to Sudan’s national malaria/WHO protocol was assessed, and outcomes were tracked over 28-day follow-up periods. Results Patients had a mean age of 6.78±4.7 years, with 53.1% male. Most cases originated from Khartoum (60.5%), with a malaria recurrence duration of 9.7±8.8 months. PCR detected P. falciparum (55.6%), P. vivax (6.2%), and mixed infections (38.2%), whereas BFFM primarily identified P. falciparum (93.8%). Recrudescence was seen in 55.6% of cases and relapses in 44.4%. When the BFFM is compared to PCR, it has a sensitivity of 11.1% for diagnosing relapsing recurrent malaria. Conclusion This study highlights the diagnostic limitations of traditional methods compared to PCR and underscores the need for protocol adherence and tailored therapies. Enhanced diagnostic tools and management strategies are crucial for addressing recurrent and resistant malaria in pediatric populations in Sudan.