Abstract
BackgroundRapid accurate diagnosis followed by effective treatment is very important for malaria control. Light microscopy remains the “golden standard” method for malaria diagnosis. Diagnostic test method must have sufficient level of accuracy for detecting malaria parasites. Therefore, this study aimed to investigate the diagnostic accuracy of rapid diagnostic tests (RDTs), microscopy, loop-mediated isothermal amplification (LAMP) and/or polymerase chain reaction (PCR) for the malaria diagnosis in Ethiopia.MethodsData bases such as PubMed, PubMed central, Science direct databases, Google scholar, and Scopus were searched from September to October, 2020 for studies assessing the diagnostic accuracy of RDTs, microscopy, LAMP and PCR methods for malaria diagnosis.ResultsA total of 29 studies published between 2001 and 2020 were analysed using review manager, Midas (Stata) and Meta-disc. The sensitivity and specificity of studies comparing RDT with microscopy varies from 79%–100% to 80%–100%, respectively. The sensitivity of LAMP (731 tests) was 100% and its specificity was varies from 85 to 99% when compared with microscopy and PCR. Considerable heterogeneity was observed between studies included in this meta-analysis. Meta-regression showed that blinding status and target antigens were the major sources of heterogeneity (P < 0.05). RDT had an excellent diagnostic accuracy (Area under the ROC Curve = 0.99) when compared with microscopy. Its specificity was quite good (93%–100%) except for one outlier (28%), but lower “sensitivity” was observed when PCR is a reference test. This indicates RDT had a good diagnostic accuracy (AUC = 0.83). Microscopy showed a very good diagnostic accuracy when compared with PCR.ConclusionsThe present study showed that microscopy and RDTs had high efficiency for diagnosing febrile malaria patients. The diagnostic accuracy of RDT was excellent when compared with microscopy. This indicates RDTs have acceptable sensitivities and specificities to be used in resource poor settings as an alternative for microscopy. In this study, LAMP showed an excellent sensitivities and specificities. Furthermore, the need of minimum equipment and relatively short time for obtaining results can made LAMP one of the best alternatives especially for accurate diagnosis of asymptomatic malaria.
Highlights
Rapid accurate diagnosis followed by effective treatment is very important for malaria control
Studies that assessed the diagnostic accuracy of rapid diagnostic tests (RDTs), microscopy, loop-mediated isothermal amplification (LAMP) and polymerase chain reaction (PCR) for the detection of malaria parasites were eligible for this review
The search was performed from September to October, 2020 using key words including “malaria”, “P. falciparum”, “P. vivax”, “P. ovale”, “P. malariae”,“diagnosis”, “RDT”, “Histidine rich protein 2 (HRP-2)”, “Plasmodium lactate dehydrogenase (pLDH)” “PCR”, “microscopy” “diagnostic test accuracy”, “systematic review”, “meta-analysis” and “Ethiopia”
Summary
Rapid accurate diagnosis followed by effective treatment is very important for malaria control. Light microscopy remains the “golden standard” method for malaria diagnosis. Diagnostic test method must have sufficient level of accuracy for detecting malaria parasites. This study aimed to investigate the diagnostic accuracy of rapid diagnostic tests (RDTs), microscopy, loop-mediated isothermal amplification (LAMP) and/or polymerase chain reaction (PCR) for the malaria diagnosis in Ethiopia. Most malaria cases were in the World Health Organization (WHO) African region (213 million or 93%) [3]. An estimated 90% of all global malaria mortality is in sub-Saharan Africa, mainly in children aged under 5 years [4]. In Ethiopia, approximately 75% of the land mass is estimated to be malarious with about 52 million people being at risk of malaria. Malaria transmission in Ethiopia is seasonal and unstable with the peak transmission season from September to December, following the main rainy season from June/July to September [5, 6]
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