Comparative Assessment of Microscopy, Malaria Rapid Diagnostic Test and Polymerase Chain Reaction as Diagnostic Test Tools in Adama Woreda, East Shoa Zone of Ethiopia

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Addis Ababa University


Background: One of the main challenges in controlling morbidity and mortality caused by malaria is limited access to effective diagnosis in areas where malaria is endemic. This study was designed to compare the performance of CarestartTMpf/pan RDT, Giemsa microscopy and 18S nested PCR for the diagnosis of malaria. Methods: Health facility and community based cross-sectional study was conducted from December ,2016 to February, 2017 in villages of Batodegama kebele and at Adama malaria control center located in Adama woreda, East Shoa Zone of Oromia Regional State. A total of 330 residents (202 suspected malaria cases and 128 healthy individuals without any symptom) were enrolled in this study. Finger prick blood samples were taken from each participant, for CarestartTM pf/pan RDTtest, Giemsa microscopy and Dry Blood Spot (DBS) for 18S nested PCR assay. Result: From 128 asymptomatic, participants, 20.3 %, 6.3 % and 3.9 % were positive with nested 18S PCR, Giemsa microscopy and RDT respectively. Similarlly from 202 symptomatic participants malaria parasite were detected in 27.2 %, 13.9 % and 12.9 % by 18S nested PCR, Giemsa microscope and RDT respectively. As compaired to Giemsa microscopy; CarestartTMpf/pan RDT perform equivalent 100.0 % for all parameters (sensitivity, specificity, positive predictive value (PPV) and a negative predictive value (NPV)) for the diagnosis of symptomatic malaria infections, where as in detecting asymptomatic cases, it had a lower sensitivity (62.5 %). While comparing Giemsa microscopy and CarestartTMpf/pan RDT with 18S nested PCR to diagnose symptomatic malaria infections both presented an equivalent sensitivity of 50.0 %, specificity of 100.0 %, positive predictive value (PPV) of 100.0 % and negative predictive(NPV) value of 84.6 % and in detecting asymptomatic malaria infections, the CarestartTMpf /pan RDT presented a sensitivity of 15.4 %, a specificity of 98.0 %, a positive predictive value (PPV) of 66.7 % and a negative predictive value (NPV) of 82.0 %. Giemsa microscopy presented a sensitivity of 19.2 %, a specificity of 97.1 %, a positive predictive value (PPV) of 62.5 % and a negative predictive value (NPV) of 82.5 %. Conclusion: The performance of CareStart TM pf/pan RDT and Giemsa microscopy was comparable and both of them had significantly lower sensitivity compaired to 18S nested PCR.



Malaria; Diagnostic Test