Reducing the burden of childhood malaria in Africa: the role of improved

Rafael, Maria E.; Taylor, Terrie E.; Magill, Alan J.; Lim, Yee Wei; Girosi, Federico; Allan, Richard

doi:10.1038/nature05445

Cited by 102 publications

(92 citation statements)

References 27 publications

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“…The results of a recently published analysis are in contrast to this WHO position on testing of young children, though. Using a decision tree model to evaluate the impact of introducing MRDTs for the diagnosis of febrile children under the age of 5 years in sub-Saharan Africa, this analysis demonstrated that an MRDT with 95% sensitivity for parasitemia of Ն500/l and 95% specificity could avert over 100,000 malariarelated deaths and about 400 million unnecessary treatments (75). The key to gaining this improvement in outcomes was the much wider availability of an MRDT leading to a marked increase in access to the population.…”

Section: Diagnosis Of Symptomatic Persons In Health Care Settingsmentioning

confidence: 99%

Update on Rapid Diagnostic Testing for Malaria

et al. 2008

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SUMMARY To help mitigate the expanding global impact of malaria, with its associated increasing drug resistance, implementation of prompt and accurate diagnosis is needed. Malaria is diagnosed predominantly by using clinical criteria, with microscopy as the current gold standard for detecting parasitemia, even though it is clearly inadequate in many health care settings. Rapid diagnostic tests (RDTs) have been recognized as an ideal method for diagnosing infectious diseases, including malaria, in recent years. There have been a number of RDTs developed and evaluated widely for malaria diagnosis, but a number of issues related to these products have arisen. This review highlights RDTs, including challenges in assessing their performance, internationally available RDTs, their effectiveness in various health care settings, and the selection of RDTs for different health care systems.

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Section: Diagnosis Of Symptomatic Persons In Health Care Settingsmentioning

confidence: 99%

Update on Rapid Diagnostic Testing for Malaria

et al. 2008

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“…Coupled with malaria, the situation is worsened further by the upsurge of HIV/AIDS and related opportunistic infections, especially in the adult population (Korenromp et al, 2005;Suri et al, 2006). For various reasons including local beliefs, poor access to health facilities and self-medication practices, many deaths in Africa occur outside the health care systems (Lopez, 1990;de Savigny et al, 2004;Rafael et al, 2006). Most of the information on mortality estimate therefore, emanates from data collected from health facilities which is always an underestimate.…”

Section: Introductionmentioning

confidence: 99%

Malaria specific mortality in lowlands and highlands of Muheza district, north-eastern Tanzania

Kamugisha

Gesase²,

Mlwilo³

et al. 2007

Tanzania J Hlth Res

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Vital registration of causes of death in Tanzania is incomplete and many deaths occur outside health care settings. Verbal autopsies (VA) are used to determine the underlying cause of death, and the probable diagnosis helps to estimate reasonably cause-specific mortality. In this paper, we report findings of a verbal autopsy survey which involved eight villages in both low and highlands of Muheza district, north-eastern Tanzania. The survey was conducted following a rapid census, which was done to identify households that had lost one or more members within a period of two years from the date of census. Trained research assistants administered VA questionnaires to parents/close relatives. Two physicians reviewed each report independently and a third opinion was sought where there was discordant report between the two. A total of 9,872 households were surveyed and 134 deaths were recorded. A total of 96 (71.6%) deaths were from lowland villages representing high malaria transmission. Majority (72.4%) of the reported deaths occurred at home whilst 32.1% occurred at heath facility settings. Overall, severe malaria was the leading cause accounting for 34.3% of all deaths. Infants were most affected and accounted for 43.5% of the total deaths. Pulmonary tuberculosis ranked second (8.2%) cause of deaths and was exclusively confined to individuals ≥15 years. Probable cause of death could not be determined in 13.4% of deaths. In conclusion, majority of deaths in rural north-eastern Tanzania occur at home and the immediate causes are usually unknown or not documented. These findings indicate that the verbal autopsy is a useful tool for detecting leading causes of death at community level in the absence of health facility-based data.

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“…Moreover, when the influence of individual variables was ranked in a model of the public health impact of new theoretical malaria diagnostics, diagnostic accessibility was found to be a more influential parameter on total lives saved than diagnostic sensitivity or specificity (22). For example, a field-based POC malaria diagnostic with 90% sensitivity and specificity was estimated to save over 2.2 million adjusted lives and prevent 450 million unnecessary treatments annually, but a test with 95% sensitivity and specificity that required even minimal laboratory infrastructure would save only 1.8 million adjusted lives and prevent only 400 million unnecessary treatments (22). Accordingly, LFIAs that detect various Plasmodium sp.…”

Section: Presentmentioning

confidence: 99%

Point-of-Care Testing for Infectious Diseases: Past, Present, and Future

2017

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Point-of-care (POC) diagnostics provide rapid actionable information for patient care at the time and site of an encounter with the health care system. The usual platform has been the lateral flow immunoassay. Recently, emerging molecular diagnostics have met requirements for speed, low cost, and ease of use for POC applications. A major driver for POC development is the ability to diagnose infectious diseases at sites with a limited infrastructure. The potential use in both wealthy and resource-limited settings has fueled an intense effort to build on existing technologies and to generate new technologies for the diagnosis of a broad spectrum of infectious diseases.KEYWORDS infectious disease, lateral flow immunoassay, molecular diagnostic, point-of-care, rapid tests A point-of-care (POC) test is performed at or near the site where a patient initially encounters the health care system, has a rapid turnaround time (approximately 15 min), and provides actionable information that can lead to a change in patient management. Rapid results reduce the need for multiple patient visits, enable timely treatment, and facilitate the containment of infectious disease outbreaks. POC diagnostics also reduce the reliance on presumptive treatment and thereby facilitate antibiotic stewardship. Rapid diagnostic tests work by detecting analytes that are found in or extracted from clinical samples. There are two primary types of analytes: microbial antigens and patient antibodies that are specific for microbial antigens. However, there are emerging molecular technologies that enable nucleic acid-based approaches at the POC. In this minireview, we describe the origins and evolution of rapid POC tests, highlight several recent developments, and identify future directions that will move the field forward. PASTPerhaps the first large-scale use of the immunoassay for the diagnosis of infectious disease was in a report in 1917 by Dochez and Avery that pneumococcal polysaccharide can be detected by immunoassay of serum and urine from patients with lobar pneumonia (1). In a prescient comment, the authors suggested that antigen detection could enable a rapid diagnosis of infection. Interest in the immunoassay for an antigen or antibody for the diagnosis of disease was accelerated with the high sensitivity provided by the radioimmunoassay (RIA) in 1960 (2) and the enzyme-linked immunoassay (ELISA) in 1971 (3, 4). Indeed, the ELISA remains the dominant immunoassay platform technology in the non-POC central laboratory setting. Moreover, with automation, the ELISA technology also enables high-throughput sample processing. However, the ELISA and RIA platforms are also time consuming, have moderate or high complexity that requires trained laboratory personnel, and are typically equipment intensive. As a consequence, these technologies are not suited for POC use.The promise of immunoassays such as ELISA and RIA for the diagnosis of disease prompted numerous individuals and biotechnology companies to find the means to

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Reducing the burden of childhood malaria in Africa: the role of improved

Cited by 102 publications

References 27 publications

Update on Rapid Diagnostic Testing for Malaria

Update on Rapid Diagnostic Testing for Malaria

Malaria specific mortality in lowlands and highlands of Muheza district, north-eastern Tanzania

Point-of-Care Testing for Infectious Diseases: Past, Present, and Future

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