Ten Years of Universal Testing: How the Rapid Diagnostic Test Became a Game Changer for Malaria Case Management and Improved Disease Reporting

Abstract

In 2010, the World Health Organization changed its guidance on malaria case management, recommending parasitological confirmation of all suspected cases before treatment with an antimalarial. This recommendation was in large part as a result of the availability of quality assured malaria rapid diagnostic tests (RDTs) that made it possible for malaria diagnosis to be performed by laboratory staff in all health facilities irrespective of the facility’s place in the tiered health system. Community health workers and other non-laboratory health workers who traditionally did not perform malaria testing due to the technical and logistic demands of smear microscopy were now able to test for malaria. The use of RDTs has led to substantial increases in testing rates, improved quality of case management, as well as more accurate reporting of malaria cases. Although current RDTs have limitations, they remain one of the most important tools in contemporary malaria control. Further improvements to existing products, such as increased sensitivity for non-falciparum tests, diversification of Plasmodium falciparum antigen targets, along with strengthened health system support for current RDTs will further enhance their utility in malaria control and prevention.

Challenges in Diagnosing and Treating Acutely Febrile Children with Suspected Malaria at Health Care Facilities in the Lake Mwanza Region of Tanzania

“…The rate of mRDT testing for suspected malaria cases in SSA rose from 36% in 2010 to 84% in 2018. 34 However, an increasing number of mRDT manufacturers has resulted in variability in testing performance. Meta-analysis conducted in 2022 concluded that conventional mRDTs might be only 42% sensitive.…”

Sensitive Detection of Asymptomatic and Symptomatic Malaria with Seven Novel Parasite-Specific LAMP Assays and Translation for Use at Point-of-Care

“…In another study from Yeung et al ( 42 ), this ultrasensitive RDT had a SEN of between 53.8% and 60% compared to qPCR in a low-transmission setting targeting asymptomatic P. falciparum infections. Although deletions in Pf HRP2/3 have been widely reported, their prevalence in sub-Saharan Africa remains low ( 43 ). We also performed a Pf HRP2 ELISA because it is an indicator of total parasite biomass, and its performance reflects the current diagnostic tools available in this region.…”

Malaria Diagnostics

“…With the inclusion of the WHO Methods Manual for product testing of malaria rapid diagnostic tests [51], the quality and trust in RDTs improved. Aidoo et al [52] reported an increase in the RDT testing rate for malaria from 36 (2010) to 84% (2018) in sub-Saharan Africa, with an increase from 100 million supplied malaria RDTs in 2010 to 348 million in 2019. RDTs have also allowed for increased availability of testing for malaria in remote and rural areas [52].…”