Malaria Diagnostic Positivity and Testing Patterns in Liberia: An Ecological
Analysis of Routine Surveillance Data, 2021–2025

Germue M. Gbawoquiya; Allen S. Kpehe

doi:10.46609/IJSSER.2026.v11i10.001

Title: Malaria Diagnostic Positivity and Testing Patterns in Liberia: An Ecological Analysis of Routine Surveillance Data, 2021–2025
Authors: Germue M. Gbawoquiya and Allen S. Kpehe
Journal: International Journal of Social Science and Economic Research (IJSSER) ISSN: 2455-8834 Volume: 11 Issue: 10 Publication Date: October 2026 DOI: 10.46609/IJSSER.2026.v11i10.001
\|\| \|\|
Germue M. Gbawoquiya1 and Allen S. Kpehe2 1,2. Department of Epidemiology, Cuttington University School of Graduate and Professional Studies, Liberia
MLA 8 Gbawoquiya, Germue M., and Allen S. Kpehe. "Malaria Diagnostic Positivity and Testing Patterns in Liberia: An Ecological Analysis of Routine Surveillance Data, 2021–2025." Int. j. of Social Science and Economic Research, vol. 11, no. 10, Oct. 2026, pp. 5375-5392, doi.org/10.46609/IJSSER.2026.v11i10.001. Accessed Oct. 2026. APA 6 Gbawoquiya, G., & Kpehe, A. (2026, October). Malaria Diagnostic Positivity and Testing Patterns in Liberia: An Ecological Analysis of Routine Surveillance Data, 2021–2025. Int. j. of Social Science and Economic Research, 11(10), 5375-5392. Retrieved from https://doi.org/10.46609/IJSSER.2026.v11i10.001 Chicago Gbawoquiya, Germue M., and Allen S. Kpehe. "Malaria Diagnostic Positivity and Testing Patterns in Liberia: An Ecological Analysis of Routine Surveillance Data, 2021–2025." Int. j. of Social Science and Economic Research 11, no. 10 (October 2026), 5375-5392. Accessed October, 2026. https://doi.org/10.46609/IJSSER.2026.v11i10.001.
References [1] . World Health Organization. (2024a). World malaria report 2024. Geneva: World Health Organization. https://www.who.int/publications/i/item/9789240104440 [2] . World Health Organization. (2024b). Malaria 2024 Liberia country profile. Geneva: World Health Organization. https://cdn.who.int/media/docs/default-source/country-profiles/malaria/malaria-2024-lbr.pdf [3] . World Health Organization. (2025a). Liberia country profile: WHO results report 2024–2025. Geneva: World Health Organization. https://www.who.int/about/accountability/results/who-results-report-2024-2025/country-profile/2024/liberia [4] . World Health Organization. (2023). WHO guidelines for malaria. Geneva: World Health Organization. https://www.who.int/publications/i/item/guidelines-for-malaria [5] . World Health Organization. (2025b). Diagnostic testing for malaria. Geneva: World Health Organization. https://www.who.int/activities/treating-malaria/diagnostic-testing-for-malaria [6] . World Health Organization. (2018). Malaria surveillance, monitoring & evaluation: A reference manual. Geneva: World Health Organization. https://www.who.int/docs/default-source/documents/publications/gmp/malaria-surveillance-monitoring-and-evaluation---a-reference-manual.pdf [7] . Ministry of Health, Republic of Liberia. (2022a). Liberia health sector strategic plan 2022–2026. Monrovia: Ministry of Health. https://www.moh.gov.lr/wp-content/uploads/Liberia-Health-Sector-Strategic-Plan.2022-2026.pdf [8] . Ministry of Health, Republic of Liberia. (2022b). Liberia malaria indicator survey 2022. Monrovia: Ministry of Health. https://moh.gov.lr/documents/malaria-indicator-survey/ [9] . von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., Vandenbroucke, J. P., & STROBE Initiative. (2007). The Strengthening of the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. PLoS Medicine, 4(10), e296. https://doi.org/10.1371/journal.pmed.0040296 [10] . Liberia Ministry of Health, National Malaria Control Program. (2021–2025). Aggregated malaria routine surveillance dataset [Unpublished dataset].
ABSTRACT: Malaria remains an important public health problem in Liberia, and routine diagnostic data can show differences in testing patterns across counties and facility types that are not captured in national summaries. We conducted a retrospective longitudinal ecological analysis of aggregated routine malaria surveillance data for 2021–2025. The dataset comprised 300 countyby-facility-type-year observations covering all 15 counties and four facility types. Diagnostic testing was defined from recorded microscopy and rapid diagnostic test (RDT) positive and negative results, and diagnostic positivity as positive tests divided by all recorded tests. Across the study period, 7,097,294 diagnostic tests were recorded, including 3,914,734 positive results (55.2% overall positivity). RDTs accounted for 59.0% of testing and microscopy for 41.0%. Annual positivity declined from 59.1% in 2021 to 51.2% in 2025, while recorded testing increased by 11.0%. County-level positivity ranged from 46.9% in Rivercess to 63.4% in Bomi. Public facilities contributed 64.7% of recorded testing, whereas Private facilities had the highest aggregate positivity (62.9%). Eighty observations had all diagnostic variables missing, with missingness concentrated in non-public facility categories. The data show geographic and health-system variation in routine malaria diagnostic activity and indicate that test positivity should be interpreted with testing volume, diagnostic method, and reporting completeness rather than as a direct estimate of population prevalence.

IJSSER is Member of