Performance of self-diagnosis and standby treatment of malaria in international oilfield service employees in the field

Roukens, Anna H.E.; Berg, Johannes; Barbey, Alexander; Visser, Leo G.

doi:10.1186/1475-2875-7-128

Cited by 29 publications

(25 citation statements)

References 13 publications

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“…Travellers and expatriates staying for longer periods in malaria‐endemic settings are generally more prone to acquiring malaria infection due to poor adherence to malaria prophylaxis regimens . Besides, they are facing particular problems of malaria diagnosis, such as the absence of qualified medical services in remote settings or the tendency to over‐diagnose malaria in local laboratories .…”

Section: Use Of Rdts For Self‐diagnosis By Travellersmentioning

confidence: 99%

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Malaria rapid diagnostic tests in travel medicine

Maltha

Gillet

Jacobs

2013

Clinical Microbiology and Infection

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Malaria is a serious condition in the non-immune traveller, and prognosis depends on timely diagnosis. Although microscopy remains the cornerstone of diagnosis, malaria rapid diagnostic tests (RDTs) are increasingly used in non-endemic settings. They are easy to use, provide results rapidly and require no specific training and equipment. Reported sensitivities vary between different RDT products but are generally good for Plasmodium falciparum, with RDTs detecting the P. falciparum antigen histidine-rich protein-2 (PfHRP2) scoring slightly better than P. falciparum-lactate dehydrogenase (Pf-pLDH)-detecting RDTs. Sensitivity is lower for Plasmodium vivax (66.0 - 88.0%) and poor for Plasmodium ovale (5.5 - 86.7%) and Plasmodium malariae (21.4 - 45.2%). Rapid diagnostic tests have several other limitations, including persistence of the PfHRP2 antigen, cross-reactions of P. falciparum with the non-falciparum test line and vice versa and (rare) false-positive reactions due to other infectious agents or immunological factors. False-negative results occur in the case of low parasite densities, prozone effect or pfhrp2 gene deletions. In addition, errors in interpretation occur, partly due to inadequacies in the instructions for use. Finally, RDTs do not give information about parasite density. In the diagnostic laboratory, RDTs are a valuable adjunct to (but not a replacement for) microscopy for the diagnosis of malaria in the returned traveller.In malaria endemic settings, special groups of travellers (those travelling for long periods, expatriates and short-stay frequent travellers) who are remote from qualified medical services may benefit from self-diagnosis by RDTs, provided they use correctly stored RDT products of proven accuracy, with comprehensive instructions for use and appropriate hands-on training.

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Section: Use Of Rdts For Self‐diagnosis By Travellersmentioning

confidence: 99%

“…long‐term stay, expats, rural areas) after appropriate instructions and training . A more recent evaluation of self‐testing among oilfield service employees showed that RDTs can be useful for expatriates when appropriate instructions are received .…”

Section: Use Of Rdts For Self‐diagnosis By Travellersmentioning

confidence: 99%

Malaria rapid diagnostic tests in travel medicine

Maltha

Gillet

Jacobs

2013

Clinical Microbiology and Infection

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“…The failure to explain/depict the use of the blood lancet is a major shortcoming as one of the major difficulties in RDT performance by travelers observed in previous studies was the finger prick [2], [29]. Test interpretation was another frequently observed difficulty [2], [3] and therefore all possible test results should preferably be depicted.…”

Section: Discussionmentioning

confidence: 99%

“…Important, fulfillment of all these requirements does not preclude the need for training and counseling of the end-user of these tests. Although not presently studied, previous reports have demonstrated the needs for training and the benefits of a comprehensive training program [29]. For expatriates and travelers performing RDTs abroad who ask for advice, we currently ask them to send a photograph of the RDT.…”

Section: Discussionmentioning

confidence: 99%

Self-Diagnosis of Malaria by Travelers and Expatriates: Assessment of Malaria Rapid Diagnostic Tests Available on the Internet

et al. 2013

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IntroductionIn the past malaria rapid diagnostic tests (RDTs) for self-diagnosis by travelers were considered suboptimal due to poor performance. Nowadays RDTs for self-diagnosis are marketed and available through the internet. The present study assessed RDT products marketed for self-diagnosis for diagnostic accuracy and quality of labeling, content and instructions for use (IFU).MethodsDiagnostic accuracy of eight RDT products was assessed with a panel of stored whole blood samples comprising the four Plasmodium species (n = 90) as well as Plasmodium negative samples (n = 10). IFUs were assessed for quality of description of procedure and interpretation and for lay-out and readability level. Errors in packaging and content were recorded.ResultsTwo products gave false-positive test lines in 70% and 80% of Plasmodium negative samples, precluding their use. Of the remaining products, 4/6 had good to excellent sensitivity for the diagnosis of Plasmodium falciparum (98.2%–100.0%) and Plasmodium vivax (93.3%–100.0%). Sensitivity for Plasmodium ovale and Plasmodium malariae diagnosis was poor (6.7%–80.0%). All but one product yielded false-positive test lines after reading beyond the recommended reading time. Problems with labeling (not specifying target antigens (n = 3), and content (desiccant with no humidity indicator (n = 6)) were observed. IFUs had major shortcomings in description of test procedure and interpretation, poor readability and lay-out and user-unfriendly typography. Strategic issues (e.g. the need for repeat testing and reasons for false-negative tests) were not addressed in any of the IFUs.ConclusionDiagnostic accuracy of RDTs for self-diagnosis was variable, with only 4/8 RDT products being reliable for the diagnosis of P. falciparum and P. vivax, and none for P. ovale and P. malariae. RDTs for self-diagnosis need improvements in IFUs (content and user-friendliness), labeling and content before they can be considered for self-diagnosis by the traveler.

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“…Une chimioprophylaxie lors des séjours en zone hyperendémique (littoral et forêt) pourrait être recommandée en association avec les mesures préventives habituelles et une information adaptée (6). Dans les zones forestières du sud Cameroun, au climat équatorial où séjournent des expatriés travaillant dans la coopération ou sur des sites d'exploitations minières éloignés des centres de soins, la stratégie pourrait être la prévention mécanique (moustiquaires impré-gnées, répulsifs anti-moustique), associée à l'utilisation de test rapide d'orientation diagnostique (TROD) et d'un traitement d'urgence disponible (7,16,19). A Yaoundé où l'accès à un centre de soin est facile, un traitement présomptif ne se justifie pas.…”

Section: Discussionunclassified

Descriptive analysis of Plasmodium falciparum malaria in an expatriate community in Yaounde-Cameroon

Vanhecke

Nguimfack

Berry

et al. 2014

Bull. Soc. Pathol. Exot.

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Malaria is an endemic disease in Cameroon. Expatriate population is also affected by malaria risk. Many studies are published on malaria, but few are focused on the expatriate population. The objective was to describe epidemiological characteristics andmanagement ofmalaria at Plasmodium falciparum in Yaounde expatriate population. This is a retrospective analysis of all patients treated at health center of the French Embassy in Yaounde in 2013 with a diagnosis of malaria. 103 cases were recruited. Out of them, 32.7% came from the outskirts of Yaounde, 25.2% from the coastal area of Cameroon, and 20.4% from the center of Yaounde. 22 patients were hospitalized, including 6 in Emergency department. 3 deaths were reported during this period. Severe malaria cases are regularly detected in expatriate population inYaounde and preferentially patients, who are over 50 years old, long stay residents in Cameroon and they paid less attention on prevention and vector control. This study confirms the presence of urban malaria in Yaounde and the need to adopt measures including prophylaxis. To the ignorance of risk and the poor adherence to prophylactic measures, it appears important that the various embassies in northern countries have specific information to their expatriates living in endemic areas.

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Performance of self-diagnosis and standby treatment of malaria in international oilfield service employees in the field

Cited by 29 publications

References 13 publications

Malaria rapid diagnostic tests in travel medicine

Malaria rapid diagnostic tests in travel medicine

Self-Diagnosis of Malaria by Travelers and Expatriates: Assessment of Malaria Rapid Diagnostic Tests Available on the Internet

Descriptive analysis of Plasmodium falciparum malaria in an expatriate community in Yaounde-Cameroon

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