Improving Accuracy of Malaria Diagnosis in Underserved Rural and Remote Endemic Areas of Sub-Saharan Africa: A Call to Develop Multiplexing Rapid Diagnostic Tests

Abstract

Clinical infection with malaria, caused by parasites of the genus Plasmodium, is considered a serious medical condition with the potential to become a life-threatening emergency. This is especially relevant to low-income countries in tropical and subtropical regions of the world where high rates of malaria-related morbidity and mortality are recorded. As a means to combat this major global public health threat, rapid and effective diagnosis remains the frontline action to initiate a timely and appropriate medical intervention. From all the approaches to parasite detection, rapid diagnostic tests, so-called RDTs, are the easiest to use and most cost-effective. However, some of the limitations inherent in this methodology could hinder effective patient treatment. A primary drawback is that the vast majority of commercially available RDTs detect only one of the five species of human malaria, P. falciparum. While this is the main cause of infection in many areas, it excludes the possibility of infection with another parasite (P. vivax, P. ovale, P. malariae, and P. knowlesi) or of mixed infections containing different species. Hence, a diagnosis of non-P. falciparum malaria is missed. In turn, in resource-constrained settings where optimal microscopy is not available, a misdiagnosis of bacterial infection based on signs and symptoms alone often results in an inappropriate prescription of antibiotics. Here, we discuss how effective diagnosis of malaria and indiscriminate use of antibiotics in sub-Saharan Africa, a hot spot for P. falciparum transmission, may both be addressed by the development of innovative multiplexing RDTs that detect two or more species of Plasmodium.

Convolutional neural networks to automate the screening of malaria in low-resource countries

“…Malaria is an infectious disease caused by Plasmodium parasites, which are transmitted through female mosquito bites. P. falciparum is the most common and the deadliest human malaria parasite in Africa, accounting for nearly all fatal cases in Sub-Saharan Africa (WHO, 2019;McKenzie et al, 2008;Makanjuola & Taylor-Robinson, 2020). Typical symptoms include fever, malaise, headaches, and vomiting, and in severe cases, seizures and coma.…”

COVID-19 and malaria in sub-saharan Africa: Holistic diagnostic approaches may promote effective clinical case management

“…When performed by a trained technician it provides both qualitative and quantitative information in terms of infecting Plasmodium spp. In addition to its proven sensitivity and reliability, sample preparation is easier when compared to the procedure for nucleic acid-based diagnosis, it can be undertaken in the field using rudimentary facilities and easily transported consumables [29,30].…”

“…Despite the high level of sensitivity and specificity of RT-PCR and other molecular-based diagnostic approaches for COVID-19 and malaria, these sophisticated testing strategies require expensive equipment and consumables, highly trained expertise and are time-consuming to perform [30,31]. As a result, they are available only in accredited reference laboratories and a very few health care centres throughout sub-Saharan Africa.…”

“…Rapid diagnostic tests (RDTs) are pointof-care immunochromatographic tests that are tailored towards the specific detection of antigens or antibodies peculiar to a particular infectious disease. In malaria-endemic regions, the use of RDTs has gained significant momentum, especially in primary health care centres, for the detection of Plasmodium-specific antigens in blood samples [30]. This is due to the fact that most of the commercially available malaria RDTs satisfy the guidelines for the WHO's ASSURED (Affordable, Sensitive, Specific, User-friendly, Rapid and Robust, Equipment-free, and Deliverable to endusers) criteria for appropriate diagnostic assays [32,33].…”

Peer Review #1 of "Convolutional neural networks to automate the screening of malaria in low-resource countries (v0.1)"

“…Malaria is an infectious disease caused by Plasmodium parasites, which are transmitted through female mosquito bites. P. falciparum is the most common and the deadliest human malaria parasite in Africa, accounting for nearly all fatal cases in Sub-Saharan Africa (WHO, 2019), (McKenzie et al, 2008), (Makanjuola and Taylor-Robinson, 2020). Typical symptoms include fever, malaise, headaches, and vomiting, and in severe cases, seizures and coma.…”