Abstract
BackgroundEarly diagnosis, as well as prompt and effective treatment of uncomplicated malaria, are essential components of the anti-malaria strategy in Madagascar to prevent severe malaria, reduce mortality and limit malaria transmission. The purpose of this study was to assess the performance of the malaria rapid diagnostic tests (RDTs) used by community health workers (CHWs) by comparing RDT results with two reference methods (microscopy and Polymerase Chain Reaction, PCR).MethodsEight CHWs in two districts, each with a different level of endemic malaria transmission, were trained to use RDTs in the management of febrile children under five years of age. RDTs were performed by CHWs in all febrile children who consulted for fever. In parallel, retrospective parasitological diagnoses were made by microscopy and PCR. The results of these different diagnostic methods were analysed to evaluate the diagnostic performance of the RDTs administered by the CHWs. The stability of the RDTs stored by CHWs was also evaluated.ResultsAmong 190 febrile children with suspected malaria who visited CHWs between February 2009 and February 2010, 89.5% were found to be positive for malaria parasites by PCR, 51.6% were positive by microscopy and 55.8% were positive by RDT. The performance accuracy of the RDTs used by CHWs in terms of sensitivity, specificity, positive and negative predictive values was greater than 85%. Concordance between microscopy and RDT, estimated by the Kappa value was 0.83 (95% CI: 0.75-0.91). RDTs stored by CHWs for 24 months were capable of detecting Plasmodium falciparum in blood at a level of 200 parasites/μl.ConclusionIntroduction of easy-to-use diagnostic tools, such as RDTs, at the community level appears to be an effective strategy for improving febrile patient management and for reducing excessive use of anti-malarial drugs.
Highlights
Diagnosis, as well as prompt and effective treatment of uncomplicated malaria, are essential components of the anti-malaria strategy in Madagascar to prevent severe malaria, reduce mortality and limit malaria transmission
Rapid diagnostic tests (RDTs) for malaria appear to be a good strategy for meeting these World Health Organization (WHO) recommendations in areas lacking either microscopy equipment or sufficiently skilled technicians
rapid diagnostic tests (RDTs) were distributed to eight community health workers (CHWs) and the performance of the RDTs administered by the CHWs was assessed
Summary
As well as prompt and effective treatment of uncomplicated malaria, are essential components of the anti-malaria strategy in Madagascar to prevent severe malaria, reduce mortality and limit malaria transmission. In most countries with endemic malaria, the World Health Organization (WHO) recommends using rapid and reliable diagnostic tests as an essential means of reducing the morbidity and mortality due to malaria, continue to be relevant today despite significant decreases in malaria in endemic areas due to the implementation of effective strategies such as long-lasting bed nets (LLNs) and artemisinin-combination therapy (ACT) [5,6]. Rapid diagnostic tests (RDTs) for malaria appear to be a good strategy for meeting these WHO recommendations in areas lacking either microscopy equipment or sufficiently skilled technicians. Several immuno-chromatographic tests for detecting specific Plasmodium antigens are currently available. Some of these tests are specific for Plasmodium falciparum and detect histidine-rich protein 2 (HRP2). Combo RDTs can diagnose infections by P. falciparum or by non-P. falciparum malaria parasites (Plasmodium vivax, Plasmodium ovale and Plasmodium malariae)
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