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Background Microscopy is the gold standard for malaria diagnosis but is dependent on trained personnel. Rapid diagnostic tests (RDTs) form the mainstay of diagnosis in endemic areas without access to high-quality microscopy. We aimed to evaluate whether RDT alone could rule out imported malaria in children presenting to UK emergency departments (EDs). Methods UK-based, multi-center, retrospective, diagnostic accuracy study. Included : any child <16 years presenting to ED with history of fever and travel to a malaria-endemic country, between 01/01/2016 and 31/12/2017. Diagnosis: microscopy for malarial parasites (clinical reference standard) and RDT (index test). UK Health Research Authority approval: 20/HRA/1341. Results There were 47 cases of malaria out of 1,414 eligible cases (prevalence 3.3%) in a cohort of children whose median age was 4 years (IQR 2–9), of whom 43% were female. Cases of Plasmodium falciparum totaled 36 (77%, prevalence 2.5%). The sensitivity of RDT alone to detect malaria infection due to any Plasmodium species was 93.6% (95% CI 82.5–98.7%), specificity 99.4% (95% CI 98.9–99.7%), positive predictive value 84.6% (95% CI 71.9–93.1%) and negative predictive value 99.8% (95% CI 99.4–100.0%). Sensitivity of RDT to detect P. falciparum infection was 100% (90.3–100%), specificity 98.8% (98.1–99.3%), positive predictive value 69.2% (54.9–81.2%, n = 46/52) and negative predictive value 100% (99.7–100%, n = 1,362/1,362). Conclusions RDTs were 100% sensitive in detecting P. falciparum malaria. However, lower sensitivity for other malaria species and the rise of pfhrp2 and pfhrp3 (pfhrp2/3) gene deletions in the P. falciparum parasite mandate the continued use of microscopy for diagnosing malaria. [ABSTRACT FROM AUTHOR]

Background: Development of verbal skills during early childhood and school age years is consequential for children's educational achievement and adult outcomes. We examine ethnic differences in longitudinal latent verbal profiles and assess the contribution of family process and family resource factors to observed differences. Methods: Using data from the UK Millennium Cohort Study and the latent profile analysis, we estimate longitudinal latent verbal profiles using verbal skills measured 4 times from age 3-11 years. We investigate the odds of verbal profiles by ethnicity (reported in infancy), and the extent observed differences are mediated by the home learning environment, family routines, and psychosocial environment (measured at age 3). Results: Indian children were twice as likely (OR = 2.14, CI: 1.37-3.33) to be in the high achieving profile, compared to White children. Socioeconomic markers attenuated this advantage to nonsignificance. Pakistani and Bangladeshi children were significantly more likely to be in the low performing group (OR = 2.23, CI: 1.61- 3.11; OR = 3.37, CI: 2.20-5.17, respectively). Socioeconomic and psychosocial factors had the strongest mediating influence on the association between lower achieving profiles and Pakistani children, whereas for Bangladeshi children, there was mediation by the home learning environment, family routines, and psychosocial factors. Conclusion: Family process and resource factors explain ethnic differences in longitudinal latent verbal profiles. Family resources explain verbal advantages for Indian children, whereas a range of home environment and socioeconomic factors explain disparities for Pakistani and Bangladeshi children. Future policy initiatives focused on reducing ethnic disparities in children's development should consider supporting and enhancing family resources and processes. [ABSTRACT FROM AUTHOR]