Assessment of malaria diagnostic methods and treatments at a Ghanaian health facility

Prah, James Kojo; Amoah, Samuel Kofi; Yartey, Andrews Nicholas; Ampofo-Asiama, Adelaide; Ameyaw, Elvis Ofori

doi:10.11604/pamj.2021.39.251.28996

Cited by 4 publications

(6 citation statements)

References 21 publications

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“…This phenomenon of lower sensitivity relative to higher specificity rates for mRDTs was also reported in previous multicenter studies in same region and other regions in Ghana as well as studies in other African countries [20,[22][23][24]. Similar to pfhrp2-based CareStart, a relatively lower mean rates of sensitivity (72.7%) and specificity (62.7%) rates for using pfhrp2-based Paracheck were also previously reported in Ghana and West-African countries as well as other African countries [18,25,26].…”

Section: Discussionsupporting

confidence: 83%

“…Similar to pfhrp2-based CareStart, a relatively lower mean rates of sensitivity (72.7%) and specificity (62.7%) rates for using pfhrp2-based Paracheck were also previously reported in Ghana and West-African countries as well as other African countries [18,25,26]. The most cited reasons for this phenomenon included, but were not limited to, variations in geo-demographics of the clinical population and impact of experience microscopy [18][19][20]23].…”

Section: Discussionsupporting

confidence: 52%

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Clinical Utility of Mono-Biomarker based Malaria Rapid Diagnostic Test Kits at a Military Medical Centre in Ghana: A Prospective Pilot Study

2023

IJHPP

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Introduction: The proliferation of non-falciparum species of plasmodium into a predominant falciparum population compromises the utility of monobiomarker-based Malaria Rapid Diagnostic Test (mRDT). This study evaluated the clinical utility of a monobiomarker-based Carestart and Paracheck mRDTs, which were in routine use at a Military Medical Centre in Ghana at the time of the study. Methods: The study was designed to assess the validity of candidate mRDTs among population risk of exposure to nonfalciparum species of plasmodium in Ghana. Blood samples collected from a consecutive series of 207 febrile patients in the months of June and July 2020, were tested for malaria parasites, using the mRDTs and microscopy as the gold standard. Prevalence, validity, and reliability metrics were determined using Frequentist, Receiver Operating Characteristics (ROC), and Kappa statistics, respectively. Results: The prevalence was 23.2% and 12.3% using microscopy and candidate mRDT, respectively. Sensitivities and specificities were 53.2% and 98.1% (Carestart) 45.8% and 99.4% (Paracheck), respectively. Neither ROC analysis showed a significant disparity between mRDTs (Carestart: AUROC=0.75 vs Paracheck: AUROC=0.73), nor the reliability index showed disagreement between both mRDTs (Cronbach’s α = 0.92). However, there was significant disagreement between microscopy and mRDTs (Carestart: Kappa=0.58 vs Paracheck: Kappa=0.55). Conclusion: The use of a monobiomaker mRDTs in this study led to a significant variation between the ‘internal’ and ‘ecological’ validity metrics. Averagely, 84% of mRDT false negatives were confirmed by microscopy as non-falciparum species of plasmodium. The observed trends have and research policy implications. It is therefore, critical to accelerate the implementation of WHO’s recommendation to switch from mono to multiple biomarker (s) based mRDTs for detecting both falciparum and non-falciparum species. Extended research is needed to consolidate our understanding on the dynamics of malaria among our military personnel exposed to non-falciparum plasmodium.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 52%

Clinical Utility of Mono-Biomarker based Malaria Rapid Diagnostic Test Kits at a Military Medical Centre in Ghana: A Prospective Pilot Study

2023

IJHPP

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 83%

Untitled

2023

IJHPP

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Introduction:The proliferation of non-falciparum species of plasmodium into a predominant falciparum population compromises the utility of monobiomarker-based Malaria Rapid Diagnostic Test (mRDT). This study evaluated the clinical utility of a monobiomarker-based Carestart and Paracheck mRDTs, which were in routine use at a Military Medical Centre in Ghana at the time of the study. Methods:The study was designed to assess the validity of candidate mRDTs among population risk of exposure to nonfalciparum species of plasmodium in Ghana. Blood samples collected from a consecutive series of 207 febrile patients in the months of June and July 2020, were tested for malaria parasites, using the mRDTs and microscopy as the gold standard. Prevalence, validity, and reliability metrics were determined using Frequentist, Receiver Operating Characteristics (ROC), and Kappa statistics, respectively. Results:The prevalence was 23.2% and 12.3% using microscopy and candidate mRDT, respectively. Sensitivities and specificities were 53.2% and 98.1% (Carestart) 45.8% and 99.4% (Paracheck), respectively. Neither ROC analysis showed a significant disparity between mRDTs (Carestart: AUROC=0.75 vs Paracheck: AUROC=0.73), nor the reliability index showed disagreement between both mRDTs (Cronbach's α = 0.92). However, there was significant disagreement between microscopy and mRDTs (Carestart: Kappa=0.58 vs Paracheck: Kappa=0.55). Conclusion:The use of a monobiomaker mRDTs in this study led to a significant variation between the 'internal' and 'ecological' validity metrics. Averagely, 84% of mRDT false negatives were confirmed by microscopy as non-falciparum species of plasmodium. The observed trends have and research policy implications. It is therefore, critical to accelerate the implementation of WHO's recommendation to switch from mono to multiple biomarker (s) based mRDTs for detecting both falciparum and non-falciparum species. Extended research is needed to consolidate our understanding on the dynamics of malaria among our military personnel exposed to non-falciparum plasmodium.

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“…Furthermore, a positive parasitological test result from either microscopy or a rapid diagnostic test (RDT) is required before treatment can begin, according to WHO criteria for malaria diagnosis and treatment [ 157 ]. According to a review [ 90 ], 69.5 percent of all P. vivax blood-stage infections are submicroscopic, and asymptomatic P. vivax causes 89–100 percent of submicroscopic infections.…”

Section: Control Challengesmentioning

confidence: 99%

Plasmodium vivax: the potential obstacles it presents to malaria elimination and eradication

Habtamu

Petros

Yan

2022

Trop Dis Travel Med Vaccines

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Initiatives to eradicate malaria have a good impact on P. falciparum malaria worldwide. P. vivax, however, still presents significant difficulties. This is due to its unique biological traits, which, in comparison to P. falciparum, pose serious challenges for malaria elimination approaches. P. vivax's numerous distinctive characteristics and its ability to live for weeks to years in liver cells in its hypnozoite form, which may elude the human immune system and blood-stage therapy and offer protection during mosquito-free seasons. Many malaria patients are not fully treated because of contraindications to primaquine use in pregnant and nursing women and are still vulnerable to P. vivax relapses, although there are medications that could radical cure P. vivax. Additionally, due to CYP2D6's highly variable genetic polymorphism, the pharmacokinetics of primaquine may be impacted. Due to their inability to metabolize PQ, some CYP2D6 polymorphism alleles can cause patients to not respond to treatment. Tafenoquine offers a radical treatment in a single dose that overcomes the potentially serious problem of poor adherence to daily primaquine. Despite this benefit, hemolysis of the early erythrocytes continues in individuals with G6PD deficiency until all susceptible cells have been eliminated. Field techniques such as microscopy or rapid diagnostic tests (RDTs) miss the large number of submicroscopic and/or asymptomatic infections brought on by reticulocyte tropism and the low parasitemia levels that accompany it. Moreover, P. vivax gametocytes grow more quickly and are much more prevalent in the bloodstream. P. vivax populations also have a great deal of genetic variation throughout their genome, which ensures evolutionary fitness and boosts adaptation potential. Furthermore, P. vivax fully develops in the mosquito faster than P. falciparum. These characteristics contribute to parasite reservoirs in the human population and facilitate faster transmission. Overall, no genuine chance of eradication is predicted in the next few years unless new tools for lowering malaria transmission are developed (i.e., malaria elimination and eradication). The challenging characteristics of P. vivax that impede the elimination and eradication of malaria are thus discussed in this article.

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Assessment of malaria diagnostic methods and treatments at a Ghanaian health facility

Cited by 4 publications

References 21 publications

Clinical Utility of Mono-Biomarker based Malaria Rapid Diagnostic Test Kits at a Military Medical Centre in Ghana: A Prospective Pilot Study

Clinical Utility of Mono-Biomarker based Malaria Rapid Diagnostic Test Kits at a Military Medical Centre in Ghana: A Prospective Pilot Study

Untitled

Plasmodium vivax: the potential obstacles it presents to malaria elimination and eradication

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