Meta-analytic review on the impact of factors that affect performance of malaria rapid diagnostic test in Africa

Abstract

Timely, accurate diagnosis and treatment has improved malaria case management. Malaria Rapid Diagnostic Test (mRDT) kits are largely used in malaria diagnosis. Their performance is compromised by factors related to gene deletions, parasite density, quality of the kit, poor storage conditions and end-user inefficiencies hence diagnosis gives either positive, negative, false negative (FN) or false positive (FP) which defines consequent management strategies. This review assessed reports on prevalence of the Plasmodium falciparum histidine rich protein 2/3 (Pfhrp2/3) gene deletions in malaria infected populations in Africa and the risk of mRDT failure to identify malaria positive cases. Preferred Reporting Items for Systematic Meta-Analysis (PRISMA) statement was used for data collection. Literature search was done using Google and Mendel search for data published in a malaria journal, Journal of infectious diseases, scientific reports, Annals of Ibadan postgraduate medicine, and BMC journals published between 2019 and 2023. Fifty eight reports were identified were screened and tested for eligibility. 
 Majority of studies described the consistent use of Pfhrp2/3 mRDT for malaria diagnosis in rural health facilities in Africa and nine reports met inclusion criteria for review. Five of them certified the world health organization’s sample criteria of ‘more than 350 sample’ to estimate the prevalence of Pfhrp2/3 gene deletions leading to declaration of false negative results of which one study posted FN outcome resulting from these deletions. Four out of nine studies did not meet this WHO criterion. This review affirmed presence of Pfhrp2/3 gene deletions challenges in Africa though other countries recorded the converse. Data was pooled using random effect models with Odds ratio and 95% confidence limit. The prevalence of the gene deletions was heterogeneous, ranging from 0% to 78.1%. The review found that an average prevalence of Pfhrp2/3 deletion as 26.2%. This was above the WHO standard recommended declaration value of 5%.; a factor that demonstrated setback to the use of mRDT in malaria endemic regions. Therefore alternative methods should be used where aspersions are cast on outcome of mRDT for 
 it will help improve malaria treatment, tracking and management.