Abstract / Summary
Malaria remains a major public health challenge in Sub-Saharan Africa (SSA), where accurate diagnosis is essential for effective treatment and control. Conventional blood-based diagnostic methods, although widely used, are invasive and may limit acceptability among certain populations. Urine-based malaria diagnostic tests have emerged as promising non-invasive alternatives; however, evidence regarding their diagnostic performance and implementation remains fragmented. This scoping review mapped available diagnostic test accuracy research on urine-based malaria diagnostics in SSA with emphasis on design characteristics, diagnostic accuracy, acceptability, and other contextual factors. A scoping review was conducted following the Arksey and O’Malley framework and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Electronic databases including PubMed, Google Scholar, and African Journals Online were searched for studies published in English. Eligible studies included primary research conducted in SSA evaluating the diagnostic performance of urine-based malaria diagnostic platforms such as urine malaria tests (UMTs), urine-based rapid diagnostic tests (RDTs), PCR, and ELISA methods. Data extracted included study characteristics, diagnostic performance indicators, acceptability findings, and implementation-related factors. Fourteen studies met the inclusion criteria. Most were conducted in Nigeria (7), followed by Cameroon (3), Ghana (2), and one study each from Sudan and Zambia (1each). Cross-sectional diagnostic studies predominated 12 (85.7%) and were conducted in hospital or health facility settings 13 (92.9%), while only one study was community-based. Urine malaria tests (UMTs) and urine-based rapid diagnostic tests (RDTs) were the most frequently evaluated platforms 12 (85.7%), with urine PCR and urine ELISA each assessed in one study. Microscopy was the predominant reference standard 12 (85.7%). While all studies assessed diagnostic performance, only two examined patient acceptability, and none evaluated cost-effectiveness, implementation, or health system integration. Children, pregnant women, and community populations were underrepresented. Current evidence on urine-based malaria diagnostics is limited and largely confined to diagnostic accuracy studies conducted in health facilities. Future research should prioritize implementation, cost-effectiveness, acceptability, and community-based evaluations to support evidence-informed policy and practice.