Determinants of the accuracy of rapid diagnostic tests in malaria case management: evidence from low and moderate transmission settings in the East African highlands

Abeku, Tarekegn A.; Kristan, Mojca; Jones, Caroline; Beard, James; Mueller, Dirk H; Okia, Michael; Rapuoda, B.; Greenwood, Brian; Cox, Jonathan

doi:10.1186/1475-2875-7-202

Cited by 105 publications

(129 citation statements)

References 17 publications

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“…It was comparable to the sensitivity found in a mesoendemic area in Uganda (91% for HRP-2 RDT). 23 The sensitivity recorded in this study could be explained by the consistently high parasite density of 100 parasites/μL. 24 The overall specificity of the RDT was consistent with the WHO recommendations and higher than reported by the studies in areas with a moderate malaria transmission in Nigeria (62.9%) and Uganda (65%).…”

Section: Discussionsupporting

confidence: 84%

Performance of an HRP-2 Rapid Diagnostic Test in Nigerian Children Less Than 5 Years of Age

Ajumobi

Sabitu

Nguku

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. The diagnostic performance of histidine-rich protein 2 (HRP-2)-based malaria rapid diagnostic test (RDT) was evaluated in a mesoendemic area for malaria, Kaduna, Nigeria. We compared RDT results with expert microscopy results of blood samples from 295 febrile children under 5 years. Overall, 11.9% (35/295) tested positive with RDT compared with 10.5% (31/295) by microscopy: sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 100%, 98.5%, 88.6%, and 100%, respectively. The RDT sensitivity was not affected by transmission season, parasite density, and age. Specificity and positive PV decreased slightly during the high-transmission season (97.5% and 83.3%). The RDT test positivity rates in the low-and high-transmission seasons were 9.4% and 13.5%, respectively. Overall, the test performance of this RDT was satisfactory. The findings of a low proportion of RDT false positives, no invalid and no false-negative results should validate the performance of RDTs in this context.

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Section: Discussionsupporting

confidence: 84%

Performance of an HRP-2 Rapid Diagnostic Test in Nigerian Children Less Than 5 Years of Age

Ajumobi

Sabitu

Nguku

et al. 2015

The American Society of Tropical Medicine and Hygiene

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“…In addition, in a large surveillance project that included patients of all ages, patient age was also found to affect false-positive HRP2 results. Abeku and others 22 found false-positive rates of HRP2-based RDT to decline in older age groups; the authors suggest this may be a result of acquired immunity in clearing parasite antigens. In a clinical setting, persistent antigenemia detectable by HRP2-based RDTs limits their use in monitoring treatment of malaria.…”

Section: Discussionmentioning

confidence: 93%

Accuracy of Two Malaria Rapid Diagnostic Tests (RDTS) for Initial Diagnosis and Treatment Monitoring in a High Transmission Setting in Uganda

Mbabazi

Hopkins

Osilo

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. Malaria rapid diagnostic tests (RDTs) may improve fever management in areas without microscopy. We compared the accuracy of histidine-rich protein 2 (HRP2) and Plasmodium lactate dehydrogenase (pLDH)-based RDTs, using expert microscopy as a gold standard, for initial diagnosis, treatment monitoring, and diagnosis of recurrent malaria in a cohort of children followed longitudinally in a high-transmission area in Uganda. For 305 initial fever episodes, sensitivity was 98% for HRP2 and 87% for pLDH, whereas specificity was 55% and 96%, respectively. The HRP2 gave 51% false-positive results on Day 28, whereas pLDH gave no false positives after Day 7. For 59 recurrent fever episodes during follow-up, sensitivity was 100% for HRP2 and 91% for pLDH, whereas specificity was 33% and 100%, respectively. The HRP2-based RDTs are useful for initial diagnosis of malaria caused by superior sensitivity; however, as a result of superior specificity, pLDH-based RDTs are more appropriate to monitor treatment and diagnose recurrent malaria.

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“…individuals with clinical symptoms, found an association between parasite density and RDT positivity 60 . This study also stressed the issue of false positives and how RDT specificity, in addition to being influenced by parasite density, may be correlated with age and transmission intensity.…”

Section: S91mentioning

confidence: 95%

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

Hoogen

Slater

et al. 2015

Nature

202

210

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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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Determinants of the accuracy of rapid diagnostic tests in malaria case management: evidence from low and moderate transmission settings in the East African highlands

Cited by 105 publications

References 17 publications

Performance of an HRP-2 Rapid Diagnostic Test in Nigerian Children Less Than 5 Years of Age

Performance of an HRP-2 Rapid Diagnostic Test in Nigerian Children Less Than 5 Years of Age

Accuracy of Two Malaria Rapid Diagnostic Tests (RDTS) for Initial Diagnosis and Treatment Monitoring in a High Transmission Setting in Uganda

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

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