Diagnostic Accuracy of Histidine-Rich Protein 2 Based Rapid Diagnostic Test and Microscopy in the Diagnosis of Plasmodium falciparum Malaria in Akpabuyo, South-Eastern Nigeria.
E.N.U. EZENDINACHI1,2*, F.A. ODEY1,3, O.A. ODUWOLE1,4, E.B. ESU1,5, A.A. OYO-ITA1,6, R. EJEMOT-NWADIARO1,5, E.E. UDOH1,3, V.ASIEGBU1,4, N.S. NWACHUKU1,5, A.A. ALARIBE1,4 AND M.M. MEREMIKWU1,3
1Calabar Institute of Tropical Diseases Research and Prevention, UCTH, Calabar
2Department of Medicine, University of Calabar;
3Department of Paediatrics, University of Calabar;
4Department of Medicine Laboratory Sciences, University of Calabar;
5Department of Public Health, University of Calabar;
6Department of Community Medicine, University of Calabar, Calabar, Nigeria.
Abstract: Malaria is the most significant public health problem in Nigeria accounting for 25% of under-5 mortality and 11% maternal mortality and a major cause of poor child development. Poor access to reliable diagnostic tools and widespread use of symptom-based algorithms lead to over-diagnosis of malaria. The aim of the study was to evaluate the programmatic effectiveness and diagnostic accuracy of histidine-rich protein 2 (HRP-2) rapid diagnostic test (RDT) with a view to generating relevant evidence that could inform policy guideline, and encourage community acceptability and use of RDT. This was a prospective diagnostic accuracy study that compared HRP-2 based RDT with microscopy for diagnosis of malaria in children aged six months and above. Children with fever (e”37.5oC) or history of fever within the last 48 hours that has not been treated with an artemisinin combination therapy in the preceding two weeks were included. Using microscopy as “gold standard”, we determined the HRP-2 sensitively, specificity, positive predictive value and negative predictive value at 95% confidence interval (CI) and then adjusted for age groups. Eight hundred and sixty patients were enrolled from March to May 2011. The mean age of study participants was 47 months (6months-14years). Overall, the HRP-2 based RDT test demonstrated a sensitivity of 81% [95% CI 75.8 -85.9], a specificity of 97% [95% CI 76.1-82.3%], a positive predictive value of 59% [95% CI 53.3 – 63-9%] and a negative predictive value of 92% [95% CI 89.7 – 94.2%] using microscopy as the gold standard. Forty-five (16.5%) of 272 children positive for P. falciparum by microscopy were negative by RDT though geometric mean parasitaemia in these children was 205 parasites/µl. The overall specifically was 79.3% which is below the WHO recommendation of e” 90% but similar or better than some similar studies.
Keywords: Rapid diagnostic test; Histidine Rich Protein 2; malaria diagnosis; resource-limited setting.
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