The reliability of diagnostic techniques in the diagnosis and management of malaria in the absence of a gold standard

Ochola, Lucy; Vounatsou, Penelope; Smith, T.; Mabaso, Musawenkosi; Newton, Charles R.

doi:10.1016/s1473-3099(06)70579-5

Cited by 192 publications

(171 citation statements)

References 47 publications

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“…RDT sensitivity becomes low when parasite densities are below the level of 200 parasites/ μL or less than 0.002% of the red blood cells infected (WHO, 2010). Low parasite density of malaria observed in this study is likely to have contributed to the low sensitivity of the rapid test (Ochola et al, 2006). A few individuals were who were RDT positive were blood smear negative.…”

Section: Discussionmentioning

confidence: 86%

Defining malaria burden from morbidity and mortality records, self treatment practices and serological data in Magugu, Babati District, northern Tanzania

Mwanziva

Manjurano

Mbugi

et al. 2011

Tanzania J Hlth Res

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Malaria morbidity and mortality data from clinical records provide essential information towards defining disease burden in the area and for planning control strategies, but should be augmented with data on transmission intensity and serological data as measures for exposure to malaria. The objective of this study was to estimate the malaria burden based on serological data and prevalence of malaria, and compare it with existing self-treatment practices in Magugu in Babati District of northern Tanzania. Prospectively, 470 individuals were selected for the study. Both microscopy and Rapid Diagnostic Test (RDT) were used for malaria diagnosis. Seroprevalence of antibodies to merozoite surface proteins (MSP-119) and apical membrane antigen (AMA-1) was performed and the entomological inoculation rate (EIR) was estimated. To complement this information, retrospective data on treatment history, prescriptions by physicians and use of bed nets were collected. Malaria prevalence in the area was 6.8% (32/470). Of 130 individuals treated with artemisinin combination therapy (ACT), 22.3 % (29/130) were slide confirmed while 75.3% (98/130) of them were blood smear negative. Three of the slides confirmed individuals were not treated with ACT. Fever was reported in 38.2% of individuals, of whom 48.8 % (88/180) were given ACT. Forty-two (32.3%) of those who received ACT had no history of fever. About half (51.1%) of those treated with ACT were children <10 years old. Immunoglobulin against MSP-119 was positive in 16.9% (74/437) while against AMA-1 was positive in 29.8 % (130/436). Transmission intensity was estimated at <0.2 infectious bites per person per year. The RDT was highly specific (96.3%) but with low sensitivity (15.6%). In conclusion, Magugu is a low endemic area. There is substantial over diagnosis, over treatment and self treatment in the community. The burden of malaria based on medical records is over estimated as was mostly presumptive. The low sensitivity of RDT reflects the low number of immune individuals as well as the low parasite density. ________________________________________________________________________________

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Section: Discussionmentioning

confidence: 86%

Defining malaria burden from morbidity and mortality records, self treatment practices and serological data in Magugu, Babati District, northern Tanzania

Mwanziva

Manjurano

Mbugi

et al. 2011

Tanzania J Hlth Res

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“…Originally developed to inform clinical treatment, RDTs are increasingly important for epidemiological characterization 7 because of their low cost and field applicability. However, most only have reported detection limits in the range of 100 to 200 parasites per microlitre 8,9 in comparison with around 50 parasites per microlitre by expert microscopy 10 .…”

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confidence: 99%

“…1). A limited number of studies have reviewed the detection capability of RDTs in asymptomatic individuals 8,21 , but key research questions still remain. A recent analysis of Demographic and Health Surveys (DHS) across Africa showed a higher prevalence of malaria when measured by RDTs compared with detection by microscopy in 19 out of 22 surveys.…”

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confidence: 99%

Comparison of diagnostics for the detection of asymptomatic Plasmodium falciparum infections to inform control and elimination strategies

Hoogen

Slater

et al. 2015

Nature

194

206

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The global burden of malaria has been substantially reduced over the past two decades. Future efforts to reduce malaria further will require moving beyond the treatment of clinical infections to targeting malaria transmission more broadly in the community. As such, the accurate identification of asymptomatic human infections, which can sustain a large proportion of transmission, is becoming a vital component of control and elimination programmes. We determined the relationship across common diagnostics used to measure malaria prevalence -polymerase chain reaction (PCR), rapid diagnostic test and microscopy -for the detection of Plasmodium falciparum infections in endemic populations based on a pooled analysis of cross-sectional data. We included data from more than 170,000 individuals comparing the detection by rapid diagnostic test and microscopy, and 30,000 for detection by rapid diagnostic test and PCR. The analysis showed that, on average, rapid diagnostic tests detected 41% (95% confidence interval = 26-66%) of PCR-positive infections. Data for the comparison of rapid diagnostic test to PCR detection at high transmission intensity and in adults were sparse. Prevalence measured by rapid diagnostic test and microscopy was comparable, although rapid diagnostic test detected slightly more infections than microscopy. On average, microscopy captured 87% (95% confidence interval = 74-102%) of rapid diagnostic test-positive infections. The extent to which higher rapid diagnostic test detection reflects increased sensitivity, lack of specificity or both, is unclear. Once the contribution of asymptomatic individuals to the infectious reservoir is better defined, future analyses should ideally establish optimal detection limits of new diagnostics for use in control and elimination strategies.

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“…Diggle et al also recorded that respondents preferred RDT due to its perceived ease and swiftness of use, portability and non-reliance on electricity. The authors also reported that the fact that RDTs can't quantify parasitaemia, while some only detect P. falciparum and are not always reliable were some of the reasons for nonacceptance of malaria RDTs [12,13].…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Malaria Test Preference among Households in Rubavu District, Rwanda: A Cross-sectional Study

Misbah¹,

Habtu²,

Monica³

et al. 2017

J Med Diagn Meth

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Background: If people are not diagnosed and treated promptly for malaria, they may develop severe complications and death. Globally, an estimated 3.3 billion people are at risk of being infected with malaria and 1.2 billion are at high risk. The World Health Organization recommends using malaria rapid diagnostic tests (RDTs) or microscopy followed by prescribing antimalarial only to patients who have a positive test result. In Rwanda, malaria RDT was introduced in 2008 to be used by community health workers (CHWs) before offering treatment. This study assessed malaria test preference and associated factors among community members in Rubavu district, Rwanda.

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The reliability of diagnostic techniques in the diagnosis and management of malaria in the absence of a gold standard

Cited by 192 publications

References 47 publications

Defining malaria burden from morbidity and mortality records, self treatment practices and serological data in Magugu, Babati District, northern Tanzania

Defining malaria burden from morbidity and mortality records, self treatment practices and serological data in Magugu, Babati District, northern Tanzania

Comparison of diagnostics for the detection of asymptomatic Plasmodium falciparum infections to inform control and elimination strategies

Factors Associated with Malaria Test Preference among Households in Rubavu District, Rwanda: A Cross-sectional Study

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