Bwire et al. Malar J (2019) 18:354 https://doi.org/10.1186/s12936-019-2990-9 RESEARCH Diagnostic performance of CareStart ™ malaria HRP2/pLDH test in comparison with standard microscopy for detection of uncomplicated malaria infection among symptomatic patients, Eastern Coast of Tanzania George M. Bwire 1* , Billy Ngasala 2 , Manase Kilonzi 3 , Wigilya P. Mikomangwa 3 , Fatuma F. Felician 1 and Appolinary A. R. Kamuhabwa 3 Abstract Background: CareStart ™ malaria HRP2/pLDH (Pf/pan) combo test is one of the several rapid diagnostic tests (RDT) approved for diagnosis of malaria at the point of care in Tanzania. However, there are limited studies on the diagnostic performance of RDT after wide scale use in primary health care facilities in Tanzania. Therefore, this study was carried out to determine the diagnostic performance of RDT when compared with blood smear (BS) microscopy as a refer- ence standard. Methods: A cross-sectional study was conducted between March and August 2019 at Kibiti Health Centre, Pwani region, Tanzania. Blood samples for malaria tests were collected from patients with malaria symptoms. Diagnostic performance parameters of RDT, i.e. sensitivity, specificity, positive and negative likelihood ratios (LR+/−), diagnostic accuracy and predictive values were determined using contingency table. An agreement between RDT and micros- copy was statistically determined by Cohen’s kappa test. Results: Of 980 patients screened, 567 (57.9%) were found to be malaria positive by RDT, whereas 510 patients (52%) were positive by microscopy. Of the 510 microscopy-positive patients, 487 (95.5%) were infected with Plasmodium falciparum. The geometric mean parasite density was 2921parasites/µl, whereas majority (68.6%) of patients had para- site density greater than 10,000/µl. The sensitivity, specificity, positive and negative predictive values of CareStart ™ were 99.8%, 87.6%, 89.8%, and 99.8%, respectively. The LR+ and LR− were 8.0 and 0.002, respectively. The diagnostic accuracy was 0.5. There was a strong agreement between the results obtained using CareStart ™ and BS microscopy (kappa = 0.863, P < 0.0001). Conclusion: CareStart ™ malaria HRP2/pLDH (Pf/pan) had high sensitivity and strong agreement with microscopy results. However, moderate specificity of RDT resulted in a substantial number of patients with false positive malaria test. Wherever available, microscopy should be used to confirm RDT test results. Keywords: CareStart ™ malaria, Microscopy, Diagnostic performance, Kibiti, Tanzania © The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Open Access Malaria Journal *Correspondence: georgebwire@gmail.com 1 Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania Full list of author information is available at the end of the article