Abstract
BackgroundAchieving malaria elimination requires the targeting of the human reservoir of infection, including those patients with asymptomatic infection. The objective was to synthesise evidence on the accuracy of the rapid-onsite diagnostic tests (RDTs) and microscopy for the detection of asymptomatic malaria as part of the surveillance activities in Asian countries.MethodsThis was a meta-analysis of diagnostic test accuracy. Relevant studies that evaluated the diagnostic performance of RDTs and microscopy for detection of asymptomatic malaria were searched in health-related electronic databases. The methodological quality of the studies included was assessed using the QUADAS-2 tool.ResultsTen studies assessing RDT and/or microscopy were identified. The diagnostic accuracies in all these studies were verified by PCR. Overall, the pooled sensitivities of RDT, as well as microscopy for detection of any malaria parasites in asymptomatic participants, were low, while their pooled specificities were almost ideal. For the detection of Plasmodium falciparum, pooled sensitivity by RDT (59%, 95%CI:16–91%) or microscopy (55%, 95%CI: 25–82%) were almost comparable. For detection of Plasmodium vivax, pooled sensitivity of RDT (51%, 95% CI:7–94%) had also the comparable accuracy of microscopy (54%, 95%CI,11–92%). Of note are the wide range of sensitivity and specificity.ConclusionThe findings of this meta-analysis suggest that RDTs and microscopy have limited sensitivity and are inappropriate for the detection of asymptomatic Plasmodium infections. Other methods including a combination of PCR-based strategies, Loop-Mediated Isothermal Amplification (LAMP) technique must be considered to target these infections, in order to achieve malaria elimination. However, more data is needed for the wide acceptance and feasibility of these approaches. Studies to explore the role of asymptomatic and sub-patent infections in the transmission of malaria are of critical importance and are recommended.
Highlights
Achieving malaria elimination requires the targeting of the human reservoir of infection, including those patients with asymptomatic infection
One study was done under an reactive case detection (RCD) approach [23], while three studies were under an active case detection (ACD) approach [18, 19, 22] and six studies used a survey approach [17, 20, 21, 24,25,26]
The major observations are as follows. (i) This review consists of ten individual studies, in which blood samples were collected from 10,945 participants across six malaria-endemic countries in Asia. (ii) The true positive rate of Rapid-onsite diagnostic test (RDT), as well as microscopy, was relatively low in the detection of asymptomatic malaria cases, while the true negative rates were close to an ideal situation
Summary
Achieving malaria elimination requires the targeting of the human reservoir of infection, including those patients with asymptomatic infection. The objective was to synthesise evidence on the accuracy of the rapidonsite diagnostic tests (RDTs) and microscopy for the detection of asymptomatic malaria as part of the surveillance activities in Asian countries. Naing et al Malaria Journal (2022) 21:50 treat all malaria infections early so that they do not generate secondary cases [4, 5], more targeted surveillance is required in the elimination phase [4,5,6]. The objective of the meta-analysis was to synthesize evidence on the accuracy of the currently and routinely used field-based diagnostic tests (microscopy, RDTs) for detection of asymptomatic malaria as part of the surveillance activities in countries entering the pre-/elimination phase
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