Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

<ns4:p><ns4:bold>Background:</ns4:bold> Central to the successful elimination of <ns4:italic>Plasmodium falciparum</ns4:italic> malaria, are tests with superior capability of diagnosing low-density parasitaemias. Empirical evidence on the performance of the commonly available diagnostics (light microscopy (LM), rapid diagnostic tests (RDT) and polymerase chain reaction (PCR)) is needed to better inform case management and surveillance activities within primary health care settings where elimination of <ns4:italic>falciparum</ns4:italic> malaria is targeted. The objective of this study was to estimate the sensitivity (Se) and specificity (Sp) and predictive values of LM, RDT and PCR tests for <ns4:italic>P. falciparum</ns4:italic> infection in children, while evaluating the effect of specific covariates on the accuracy of the tests.</ns4:p><ns4:p> <ns4:bold>Methods:</ns4:bold> The study enrolled 1,563 children presenting with fever (axillary temperature ≥ 37.50C) to the Ngerenya dispensary, Kilifi County between March and December 2014. A Bayesian latent class model (BLCM) was fitted to the participants’ diagnostic data obtained from blood samples that were screened for the presence of <ns4:italic>P. falciparum</ns4:italic> using the three tests.</ns4:p><ns4:p> <ns4:bold>Results:</ns4:bold> The PCR assay registered a higher Se (97.6% [92.0; 99.7]) than LM (84.0% [74.8; 91.0]) but similar to RDT (92.2% [84.4; 97.0]). However, the assay showed a similar Sp (98.9% [98.2; 99.4]) to both RDT (99.4% [98.9; 99.7]) and LM (99.5% [99.0; 99.8]). Regarding predictive values, the tests yielded statistically similar estimates of positive and negative predictive values (PPV and NPV). A serial interpretation of the results of RDT and LM raised the PPVs and NPVs to &gt;98%.</ns4:p><ns4:p> <ns4:bold>Conclusions:</ns4:bold> LM and RDT afford high Se and Sp in a low <ns4:italic>P. falciparum</ns4:italic> prevalence setting. A serial combination of the tests assures high PPV and NPV estimates. These elements, coupled with the wide deployment and affordability of the tests, lend the tests useful for guiding clinical care and surveillance activities for <ns4:italic>P. falciparum</ns4:italic> within elimination settings.</ns4:p>

Original publication

DOI

10.12688/wellcomeopenres.15204.2

Type

Journal article

Journal

Wellcome Open Research

Publisher

F1000 Research Ltd

Publication Date

14/08/2019

Volume

4

Pages

67 - 67