Performance of Two Malaria Rapid Diagnostic Tests in Febrile Adult Patients with and without Human Immunodeficiency Virus-1 Infection in Blantyre, Malawi

Chinkhumba, Jobiba; Nyanda, Monica; Skarbinski, Jacek; Mathanga, Don P.

doi:10.4269/ajtmh.2012.11-0350

Cited by 4 publications

(6 citation statements)

References 20 publications

(23 reference statements)

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“…19 Generally, at lower parasitaemia, variability in sensitivity is more common. 20,38,39 Similar observation of false negative MRDT results at parasite counts even higher than 1000 cells/µL have been reported in other studies 19,25,40,41 and may be attributed to prozone effect observed with immunochromatographic tests such as MRDT. 42 All the same, many MRDTs today can achieve excellent sensitivity and specificity for P. falciparum at parasite density lower than 500 cells/µL.…”

Section: Discussionsupporting

confidence: 84%

“…19 Contrary to our results, a 100% sensitivity and similar specificity of about 95.4% was documented in a Burkina Faso study among HIV-positive participants. 21 Other studies on MRDT performance among HIV-positive population in Malawi, 25 and two different studies in Uganda 10,20 have shown higher sensitivity of over 94%. In these studies, the specificities averaged over 97% like in ours except for the Malawi study that reported about 51% specificity.…”

Section: Discussionmentioning

confidence: 97%

“…21 It is worth noting that in this study, participants were recruited at routine follow-up visits, regardless of suspicion of malaria unlike the other studies comparing performance of BSM and MRDT in HIV-positive patients suspected of suffering from or having symptoms of malaria. For example, the Tanzania 24 and Burkina Faso 21 studies looked at HIV-positive children suspected of malaria, while those from Lagos, 19 Uganda, 10,20 and Malawi 25 looked at adults with HIV attending outpatient clinics suspected of having malaria. Thus, the direct comparison of proportions positive for malaria in our studies with the others must be considered with caution.…”

Section: Discussionmentioning

confidence: 99%

“…In these studies, the specificities averaged over 97% like in ours except for the Malawi study that reported about 51% specificity. 25…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of standard diagnostic rapid test kits for malaria diagnosis among HIV patients in Kano, Nigeria

Mbah¹,

Jegede

Abdulrahman

et al. 2018

African Journal of Laboratory Medicine

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BackgroundMalaria diagnosis among HIV-positive patients is uncommon in Nigeria despite the high burden of both diseases.ObjectivesWe evaluated the performance of a malaria rapid diagnostic test (MRDT) against blood smear microscopy (BSM) among HIV-positive patients in relation to anti-retroviral treatment (ART) status, CD4+ count, fever, cotrimoxazole prophylaxis and malaria density count.MethodA cross-sectional study involving 1521 consenting randomly selected HIV-positive adults attending two ART clinics in Kano, Nigeria, between June 2015 and May 2016. Venous blood samples were collected for testing with MRDT, BSM, and CD4+ T cells count by cytometry. Biodata and other clinical details were extracted from patient folders into an Excel file, cleaned, validated, and exported for analysis into SPSS version 23.0. Sensitivity, specificity, predictive values of MRDT were compared with BSM with a 95% confidence interval.ResultsMalaria parasites were detected in 25.4% of enrollees by BSM and 16.4% by MRDT. Overall sensitivity of MRDT was 58% and specificity was 97%. Cotrimoxazole prophylaxis and fever status did not affect MRDT sensitivity and specificity. Unexpectedly, the sensitivity was highest at parasite density count of less than 500 cells/µL. At CD4+ T cells count over 500 cells/µL the sensitivity was higher (62.4%) compared to 56% at less than 500 cells/µL. In the non-ART group sensitivity was higher (65%) compared to those on ART (56%) but the specificity was similar. All differences were significant for all variables (p < 0.05).ConclusionAlthough the MRDT specificity was good, the sensitivity was poor, requiring further evaluation for use in malaria diagnosis among HIV-malaria co-infected persons in these settings.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

“…In these studies, the specificities averaged over 97% like in ours except for the Malawi study that reported about 51% specificity. 25…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of standard diagnostic rapid test kits for malaria diagnosis among HIV patients in Kano, Nigeria

Mbah¹,

Jegede

Abdulrahman

et al. 2018

African Journal of Laboratory Medicine

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“…RDTs have been shown to be a cost-effective measure to ensure malaria treatment is directed to those who are infected [22,23]. In Mutasa District, the use of RDT increased to approximately 80% of suspected cases and up to 75% of RDT were positive.…”

Section: Discussionmentioning

confidence: 99%

Changes in the burden of malaria following scale up of malaria control interventions in Mutasa District, Zimbabwe

Mharakurwa

Mutambu²,

Mberikunashe

et al. 2013

Malar J

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BackgroundTo better understand trends in the burden of malaria and their temporal relationship to control activities, a survey was conducted to assess reported cases of malaria and malaria control activities in Mutasa District, Zimbabwe.MethodsData on reported malaria cases were abstracted from available records at all three district hospitals, three rural hospitals and 25 rural health clinics in Mutasa District from 2003 to 2011.ResultsMalaria control interventions were scaled up through the support of the Roll Back Malaria Partnership, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and The President’s Malaria Initiative. The recommended first-line treatment regimen changed from chloroquine or a combination of chloroquine plus sulphadoxine/pyrimethamine to artemisinin-based combination therapy, the latter adopted by 70%, 95% and 100% of health clinics by 2008, 2009 and 2010, respectively. Diagnostic capacity improved, with rapid diagnostic tests (RDTs) available in all health clinics by 2008. Vector control consisted of indoor residual spraying and distribution of long-lasting insecticidal nets. The number of reported malaria cases initially increased from levels in 2003 to a peak in 2008 but then declined 39% from 2008 to 2010. The proportion of suspected cases of malaria in older children and adults remained high, ranging from 75% to 80%. From 2008 to 2010, the number of RDT positive cases of malaria decreased 35% but the decrease was greater for children younger than five years of age (60%) compared to older children and adults (26%).ConclusionsThe burden of malaria in Mutasa District decreased following the scale up of malaria control interventions. However, the persistent high number of cases in older children and adults highlights the need for strategies to identify locally effective control measures that target all age groups.

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Rapid diagnostic tests for diagnosing uncomplicated non-falciparum or Plasmodium vivax malaria in endemic countries

Abba

Kirkham

Olliaro

et al. 2014

Cochrane Database of Systematic Reviews

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BackgroundIn settings where both Plasmodium vivax and Plasmodium falciparum infection cause malaria, rapid diagnostic tests (RDTs) need to distinguish which species is causing the patients' symptoms, as different treatments are required. Older RDTs incorporated two test lines to distinguish malaria due to P. falciparum, from malaria due to any other Plasmodium species (non-falciparum). These RDTs can be classified according to which antibodies they use: Type 2 RDTs use HRP-2 (for P. falciparum) and aldolase (all species); Type 3 RDTs use HRP-2 (for P. falciparum) and pLDH (all species); Type 4 use pLDH (fromP. falciparum) and pLDH (all species).More recently, RDTs have been developed to distinguish P. vivax parasitaemia by utilizing a pLDH antibody specific to P. vivax.ObjectivesTo assess the diagnostic accuracy of RDTs for detecting non-falciparum or P. vivax parasitaemia in people living in malaria-endemic areas who present to ambulatory healthcare facilities with symptoms suggestive of malaria, and to identify which types and brands of commercial test best detect non-falciparum and P. vivax malaria.Search methodsWe undertook a comprehensive search of the following databases up to 31 December 2013: Cochrane Infectious Diseases Group Specialized Register; MEDLINE; EMBASE; MEDION; Science Citation Index; Web of Knowledge; African Index Medicus; LILACS; and IndMED.Selection criteriaStudies comparing RDTs with a reference standard (microscopy or polymerase chain reaction) in blood samples from a random or consecutive series of patients attending ambulatory health facilities with symptoms suggestive of malaria in non-falciparum endemic areas.Data collection and analysisFor each study, two review authors independently extracted a standard set of data using a tailored data extraction form. We grouped comparisons by type of RDT (defined by the combinations of antibodies used), and combined in meta-analysis where appropriate. Average sensitivities and specificities are presented alongside 95% confidence intervals (95% CI).Main resultsWe included 47 studies enrolling 22,862 participants. Patient characteristics, sampling methods and reference standard methods were poorly reported in most studies.RDTs detecting 'non-falciparum' parasitaemiaEleven studies evaluated Type 2 tests compared with microscopy, 25 evaluated Type 3 tests, and 11 evaluated Type 4 tests. In meta-analyses, average sensitivities and specificities were 78% (95% CI 73% to 82%) and 99% (95% CI 97% to 99%) for Type 2 tests, 78% (95% CI 69% to 84%) and 99% (95% CI 98% to 99%) for Type 3 tests, and 89% (95% CI 79% to 95%) and 98% (95% CI 97% to 99%) for Type 4 tests, respectively. Type 4 tests were more sensitive than both Type 2 (P = 0.01) and Type 3 tests (P = 0.03).Five studies compared Type 3 tests with PCR; in meta-analysis, the average sensitivity and specificity were 81% (95% CI 72% to 88%) and 99% (95% CI 97% to 99%) respectively.RDTs detecting P.vivax parasitaemiaEight studies compared pLDH tests to microscopy; the average sensitivity and specificit...

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Performance of Two Malaria Rapid Diagnostic Tests in Febrile Adult Patients with and without Human Immunodeficiency Virus-1 Infection in Blantyre, Malawi

Cited by 4 publications

References 20 publications

Evaluation of standard diagnostic rapid test kits for malaria diagnosis among HIV patients in Kano, Nigeria

Evaluation of standard diagnostic rapid test kits for malaria diagnosis among HIV patients in Kano, Nigeria

Changes in the burden of malaria following scale up of malaria control interventions in Mutasa District, Zimbabwe

Rapid diagnostic tests for diagnosing uncomplicated non-falciparum or Plasmodium vivax malaria in endemic countries

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