Background
Point‐of‐care (POC) tests for diagnosing schistosomiasis include tests based on circulating antigen detection and urine reagent strip tests. If they had sufficient diagnostic accuracy they could replace conventional microscopy as they provide a quicker answer and are easier to use.
Objectives
To summarise the diagnostic accuracy of: a) urine reagent strip tests in detecting active
Schistosoma haematobium
infection, with microscopy as the reference standard; and b) circulating antigen tests for detecting active
Schistosoma
infection in geographical regions endemic for
Schistosoma mansoni
or
S. haematobium
or both
,
with microscopy as the reference standard.
Search methods
We searched the electronic databases MEDLINE, EMBASE, BIOSIS, MEDION, and Health Technology Assessment (HTA) without language restriction up to 30 June 2014.
Selection criteria
We included studies that used microscopy as the reference standard: for
S. haematobium
, microscopy of urine prepared by filtration, centrifugation, or sedimentation methods; and for
S. mansoni
, microscopy of stool by Kato‐Katz thick smear. We included studies on participants residing in endemic areas only.
Data collection and analysis
Two review authors independently extracted data, assessed quality of the data using QUADAS‐2, and performed meta‐analysis where appropriate. Using the variability of test thresholds, we used the hierarchical summary receiver operating characteristic (HSROC) model for all eligible tests (except the circulating cathodic antigen (CCA) POC for
S. mansoni
, where the bivariate random‐effects model was more appropriate). We investigated heterogeneity, and carried out indirect comparisons where data were sufficient. Results for sensitivity and specificity are presented as percentages with 95% confidence intervals (CI).
Main results
We included 90 studies; 88 from field settings in Africa. The median
S. haematobium
infection prevalence was 41% (range 1% to 89%) and 36% for
S. mansoni
(range 8% to 95%). Study design and conduct were poorly reported against current standards.
Tests for
S. haematobium
Urine reagent test strips versus microscopy
Compared to microscopy, the detection of microhaematuria on test strips had the highest sensitivity and specificity (sensitivity 75%, 95% CI 71% to 79%; specificity 87%, 95% CI 84% to 90%; 74 studies, 102,447 participants). For proteinuria, sensitivity was 61% and specificity was 82% (82,113 participants); and for leukocyturia, sensitivity was 58% and specificity 61% (1532 participants). Howeve...
