Abstract
BackgroundRapid diagnostic tests (RDTs) are the current complement to microscopy for ensuring prompt malaria treatment. We determined the performance of three candidate RDTs (Paracheck™-Pf, SD Bioline malaria Ag-Pf and SD Bioline malaria Ag-Pf/pan) for rapid diagnosis of malaria in the Central African Republic.MethodsBlood samples from consecutive febrile patients who attended for laboratory analysis of malaria at the three main health centres of Bangui were screened by microscopy and the RDTs. Two reference standards were used to assess the performance of the RDTs: microscopy and, a combination of microscopy plus nested PCR for slides reported as negative, on the assumption that negative results by microscopy were due to sub-patent parasitaemia.ResultsWe analysed 436 samples. Using the combined reference standard of microscopy + PCR, the sensitivity of Paracheck™-Pf was 85.7% (95% CI, 80.8–89.8%), that of SD Bioline Ag-Pf was 85.4% (95% CI, 80.5–90.7%), and that of SD Bioline Ag-Pf/pan was 88.2% (95% CI, 83.2–92.0%). The tests performed less well in cases of low parasitaemia; however, the sensitivity was > 95% at > 500 parasites/μl.ConclusionsOverall, SD Bioline malaria Ag-Pf and SD Bioline malaria Ag-Pf/pan performed slightly better than Paracheck™-Pf. Use of RDTs with reinforced microscopy practice and laboratory quality assurance should improve malaria treatment in the Central African Republic.
Highlights
Rapid diagnostic tests (RDTs) are the current complement to microscopy for ensuring prompt malaria treatment
The main malaria parasite is Plasmodium falciparum, and malaria transmission occurs throughout the year, with peaks at the beginning and the end of the rainy season, no data are available on the intensity of transmission
Microscopic analysis showed that 53.8% (235/437) of the blood slides were positive for P. falciparum
Summary
Rapid diagnostic tests (RDTs) are the current complement to microscopy for ensuring prompt malaria treatment. Effective but more expensive artemisinin combination treatments were introduced for first-line treatment [6] These new therapies should be targeted in order to avoid overuse of antimalarial drugs, which can lead to the selection of drug-resistant parasites [7]. The World Health Organization (WHO) recommends parasitological confirmation for all patients suspected of having malaria before starting treatment This recommendation includes high-quality microscopy or, when that is not available, use of easy-to-use rapid diagnostic tests (RDTs) [8]. Local data are required to select suitable RDTs before they are used [16,26,27,28]
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