High value of rapid diagnostic tests to diagnose malaria within children: A systematic review and meta-analysis

Zhu, Wenjun; Ling, Xiaoxiao; Shang, Wenru; Du, Yanqiu; Liu, Jinyu; Cao, Yuanyuan; Mu, Yang; Zhu, Guoding; Cao, Jun; Huang, Jiayan

doi:10.7189/jogh.10.010411

Cited by 10 publications

(11 citation statements)

References 84 publications

(60 reference statements)

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“…At the same time, with the increase of age, the diagnostic competency of microscopy technicians will decrease. In contrast, Rapid Diagnostic Test (RDT) is more convenient and faster than plasmodium microscopy in the areas lacking equipment, technicians, and technologies, and has lower requirements on the technicians' competence (33,39), so is more suitable to be widely used in primary health institutions in Chongqing.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, the number of imported cases of P. ovale malaria cases has increased year on year ( 20 , 29 , 30 ), which is related to the establishment of malaria reference laboratories nationwide to carry out PCR reviews for each reported case since the implementation of the malaria elimination action plan. Compared with other detection methods, PCR detection can more accurately distinguish various types of plasmodium species ( 25 , 27 , 31 – 33 ). In 2012, the malaria reference laboratory was established in Chongqing CDC.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of Malaria Microscopy Competency at Primary Health Institutions in the Chongqing Municipality

Luo¹,

Zhou²,

Yi³

et al. 2021

Front. Med.

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Background: In April 2019, Chongqing passed the national malaria elimination assessment. However, around 30 imported malaria cases are still being reported every year, and Anopheles sinensis was widely distributed in Chongqing, meaning the risk of malaria resurgence still exists. Early diagnosis and treatment for malaria cases are effective measures to prevent malaria resurgence. The primary health institutions are the first station where potential malaria cases may seek treatment. The competency with which primary health institutions diagnose malaria will directly affect the timeliness of malaria diagnosis. Nowadays, most primary health institutions in Chongqing use microscopy to confirm malaria cases. This study assessed the microscopy competence of primary health institutions, studied and analyzed the results, and provided a scientific basis for malaria prevention and control after malaria elimination in Chongqing.Methods: According to the stratified sampling principle, four plasmodium microscopy technicians (156 in total) were selected from each of the 39 districts/counties of Chongqing to test the plasmodium microscopy competence. Descriptive statistical analysis, correlation analysis, spatial self-correlation analysis, and ROC curve analysis were carried out on the test results.Result: The average of the technicians' test scores was 4.33 ± 0.47 (min: 3, mid: 4.5, max: 5); The spatial clustering of the scores was significant (MoranI = 0.338, Z = 3.618, P < 0.01). The test scores were positively correlated with the “level of work institutions” (R = 0.21, P < 0.01) but were negatively correlated with “age” (R = −0.31, P < 0.01). The highest Sensitivity of the technicians' microscopy was in qualitative diagnosis (98.92%, CI: 98.00–99.69%). The Delong's test showed that the diagnostic efficiency of the technicians' microscopy to P. falciparum was the best (P < 0.01), however to P. ovale was the worst (P < 0.01).Conclusion: The microscopy technicians in primary health institutions in Chongqing have good microscopy competency in qualitative diagnosis, but there were deficiencies in the identification of plasmodium species. Township level health institutions in Central China have weaker microscopy than those in other areas.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessment of Malaria Microscopy Competency at Primary Health Institutions in the Chongqing Municipality

Luo¹,

Zhou²,

Yi³

et al. 2021

Front. Med.

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show abstract

“…Therefore, RDT is suitable for primary health care institutions with limited facilities and unskilled staff. However, they may also fail to accurately diagnose for cases with low parasitaemia, and false positives are possible due to cross reactions [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of malaria rapid diagnostic test in the elimination setting

Ling

Jin

et al. 2020

Infect Dis Poverty

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Background As more and more countries approaching the goal of malaria elimination, malaria rapid diagnostic tests (RDT) was recomendated to be a diagnostic strategy to achieve and maintain the statute of malaria free, as it’s less requirments on equipment and experitise than microscopic examination. But there are very few economic evaluations to confirm whether RDT was cost-effective in the setting of malaria elimination. This research aimed to offer evidence for helping decision making on malaria diagnosis strategy. Methods A cost-effectiveness analysis was conducted to compare RDT with microscopy examination for malaria diagnosis, by using a decision tree model. There were three strategies of malaria diagnostic testing evaluated in the model, 1) microscopy, 2) RDT, 3) RDT followed by microscopy. The effect indicator was defined as the number of malaria cases treated appropriately. Based on the joint perspective of health sector and patient, costs data were collected from hospital information systems, key informant interviews, and patient surveys. Data collection was conducted in Jiangsu from September 2018 to January 2019. Epidemiological data were obtained from local malaria surveillance reports. A hypothetical cohort of 300 000 febrile patients were simulated to calculate the total cost and effect of each strategy. One-way, two-way, and probabilistic sensitivity analysis were performed to test the robustness of the result. Results The results showed that RDT strategy was the most effective (245 cases) but also the most costly (United States Dollar [USD] 4.47 million) compared to using microscopy alone (238 cases, USD 3.63 million), and RDT followed by microscopy (221 cases, USD 2.75 million). There was no strategy dominated. One-way sensitivity analysis reflected that the result was sensitive to the change in labor cost and two-way sensitivity analysis indicated that the result was not sensitive to the proportion of falciparum malaria. The result of Monte Carlo simulation showed that RDT strategy had higher effects and higher cost than other strategies with a high probability. Conclusions Compared to microscopy and RDT followed by microscopy, RDT strategy had higher effects and higher cost in the setting of malaria elimination.

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“…RDTs can detect only one species ( Plasmodium falciparum [ P. f. ]) or multiple species ( P. vivax , P. malariae and P. ovale ) [ 9 – 11 ]. RDTs have much shorter testing time, user-friendly testing procedure, and similar accuracy compared to microscopy [ 10 , 12 – 15 ]. Thus, RDT is particularly appropriate in improving the accessibility and efficiency of malaria testing for febrile patients at the grassroot level [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluating the implementation of rapid diagnostic tests in a malaria elimination setting

et al. 2020

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Background It was recommended that malaria rapid diagnostic tests (RDTs) should be available in all epidemiological situations. But evidence was limited on the implementation of RDTs and its effectiveness in malaria elimination settings. This study examined the implementation of RDTs and how it affected the diagnosis of imported malaria patients in Jiangsu Province, China. Methods To scale up RDTs, this study developed an intervention package with four major elements covering the supply of RDT test, the training on RDTs, the monitoring and management of RDT use, and the advocacy of RDTs. By using a pretest-posttest control group design, we implemented the interventions in 4 cities in Jiangsu Province with the rest nine cities as controlled areas, from January 2017 to January 2018. Difference-in-Difference approach was used to evaluate the impact of the scale-up of RDTs on the identification of malaria cases. Three binary outcome measures were included to indicate delayed malaria diagnosis, malaria cases with confirmed malaria diagnosis at township-level institutions, and severe malaria cases, respectively. Linear probability regression was performed with time and group fixed effects and the interaction term between time and group. Results Intervention areas received sufficient RDT test supply, regular professional training programs, monthly tracking and management of RDT supply and use, and health education to targeted population. The implementation of interventions was associated with 10.8% ( P = 0.021) fewer patients with delayed diagnosis. But intervention areas did not see a higher likelihood of having confirmed diagnosis from township-level institutions (coefficient = -0.038, P = 0.185) or reduced severe malaria cases (coef. = 0.040, P = 0.592). Conclusions The comprehensive package of RDT implementation in this study is promising in scaling up RDT use and improving access to care among malaria patients, especially in malaria elimination settings.

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High value of rapid diagnostic tests to diagnose malaria within children: A systematic review and meta-analysis

Cited by 10 publications

References 84 publications

Assessment of Malaria Microscopy Competency at Primary Health Institutions in the Chongqing Municipality

Assessment of Malaria Microscopy Competency at Primary Health Institutions in the Chongqing Municipality

Cost-effectiveness analysis of malaria rapid diagnostic test in the elimination setting

Evaluating the implementation of rapid diagnostic tests in a malaria elimination setting

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