Background: One of the main challenges in controlling morbidity and mortality caused byrnmalaria is limited access to effective diagnosis in areas where malaria is endemic. This studyrnwas designed to compare the performance of CarestartTMpf/pan RDT, Giemsa microscopy andrn18S nested PCR for the diagnosis of malaria.rnMethods: Health facility and community based cross-sectional study was conducted fromrnDecember ,2016 to February, 2017 in villages of Batodegama kebele and at Adama malariarncontrol center located in Adama woreda, East Shoa Zone of Oromia Regional State. A total ofrn330 residents (202 suspected malaria cases and 128 healthy individuals without any symptom)rnwere enrolled in this study. Finger prick blood samples were taken from each participant, forrnCarestartTM pf/pan RDTtest, Giemsa microscopy and Dry Blood Spot (DBS) for 18S nestedrnPCR assay.rnResult: From 128 asymptomatic, participants, 20.3 %, 6.3 % and 3.9 % were positive withrnnested 18S PCR, Giemsa microscopy and RDT respectively. Similarlly from 202 symptomaticrnparticipants malaria parasite were detected in 27.2 %, 13.9 % and 12.9 % by 18S nested PCR,rnGiemsa microscope and RDT respectively.rnAs compaired to Giemsa microscopy; CarestartTMpf/pan RDT perform equivalent 100.0 % forrnall parameters (sensitivity, specificity, positive predictive value (PPV) and a negativernpredictive value (NPV)) for the diagnosis of symptomatic malaria infections, where as inrndetecting asymptomatic cases, it had a lower sensitivity (62.5 %). While comparing Giemsarnmicroscopy and CarestartTMpf/pan RDT with 18S nested PCR to diagnose symptomaticrnmalaria infections both presented an equivalent sensitivity of 50.0 %, specificity of 100.0 %,rnpositive predictive value (PPV) of 100.0 % and negative predictive(NPV) value of 84.6 % andrnin detecting asymptomatic malaria infections, the CarestartTMpf /pan RDT presented arnsensitivity of 15.4 %, a specificity of 98.0 %, a positive predictive value (PPV) of 66.7 % andrna negative predictive value (NPV) of 82.0 %. Giemsa microscopy presented a sensitivity ofrn19.2 %, a specificity of 97.1 %, a positive predictive value (PPV) of 62.5 % and a negativernpredictive value (NPV) of 82.5 %.rnConclusion: The performance of CareStart TM pf/pan RDT and Giemsa microscopy wasrncomparable and both of them had significantly lower sensitivity compaired to 18S nestedrnPCR.