Woyessa A., Deressa W., Ali A., Lindtjørn B.
Ethiopian Health and Nutrition Research Institute, P. O. Box 1242, Addis Ababa, Ethiopia; School of Public Health, College of Health Sciences, Addis Ababa University, P. O. Box 9086, Addis Ababa, Ethiopia; Centre for International Health, University of Bergen, Bergen, Norway
Woyessa, A., Ethiopian Health and Nutrition Research Institute, P. O. Box 1242, Addis Ababa, Ethiopia; Deressa, W., School of Public Health, College of Health Sciences, Addis Ababa University, P. O. Box 9086, Addis Ababa, Ethiopia; Ali, A., School of Public Health, College of Health Sciences, Addis Ababa University, P. O. Box 9086, Addis Ababa, Ethiopia; Lindtjørn, B., Centre for International Health, University of Bergen, Bergen, Norway
Malaria is a major public health problem in Ethiopia. Plasmodium falciparum and Plasmodium vivax co-exist and malaria rapid diagnostic test (RDTs) is vital in rendering parasite-confirmed treatment especially in areas where microscopy from 2008 to 2010 is not available. CareStartTM Malaria Pf/Pv combo test was evaluated compared to microscopy in Butajira area, south-central Ethiopia. This RDT detects histidine-rich protein-2 (HRP2) found in P. falciparum, and Plasmodium enzyme lactate dehydrogenase (pLDH) for diagnosis of P. vivax. The standard for the reporting of diagnostic accuracy studies was complied. Among 2,394 participants enrolled, 10.9% (n=87) were Plasmodium infected (household survey) and 24.5% (n=392) health facility-based using microscopy. In the household surveys, the highest positivity was caused by P. vivax (83.9%, n=73), P. falciparum (15.0%, n=13), and the rest due to mixed infections of both (1.1%, n=1). In health facility, P. vivax caused 78.6% (n=308), P. falciparum caused 20.4% (n=80), and the rest caused by mixed infections 1.0% (n=4). RDT missed 9.1% (n=8) in household and 4.3% (n=17) in health facility-based surveys among Plasmodium positive confirmed by microscopy while 3.3% (n=24) in household and 17.2% (n=208) in health facility-based surveys were detected false positive. RDT showed agreement with microscopy in detecting 79 positives in household surveys (n=796) and 375 positives in health centre survey (n=1,598).RDT performance varied in both survey settings, lowest PPV (64.3%) for Plasmodium and P. falciparum (77.2%) in health centres; and Plasmodium (76.7%) and P. falciparum (87.5%) in household surveys. NPV was low in P. vivax in health centres (77.2%) and household (87.5%) surveys. Seasonally varying RDT precision of as low as 14.3% PPV (Dec. 2009), and 38.5% NPV (Nov. 2008) in health centre surveys; and 40-63.6% PPV was observed in household surveys. But the influence of age and parasite density on RDT performance was not ascertained. Establishing quality control of malaria RDT in the health system in areas with low endemic and where P. falciparum and P. vivax co-exist is recommendable. CareStartTM RDT might be employed for epidemiological studies that require interpreting the results cautiously. Future RDT field evaluation against microscopy should be PCR corrected. © 2013 Woyessa et al.; licensee BioMed Central Ltd.
histidine; histidine rich protein 2; lactate dehydrogenase; unclassified drug; adolescent; adult; aged; article; child; controlled study; density; diagnostic accuracy; diagnostic test accuracy study; Ethiopia; female; health care facility; health center; health survey; household; human; infant; major clinical study; malaria falciparum; malaria rapid test; male; microscopy; mixed infection; nonhuman; Plasmodium falciparum; Plasmodium vivax; Plasmodium vivax malaria; predictive value; preschool child; quality control; school child; Adolescent; Adult; Aged; Aged, 80 and over; Antigens, Protozoan; Child; Child, Preschool; Clinical Laboratory Techniques; Coinfection; Cross-Sectional Studies; Ethiopia; Female; Humans; Infant; Malaria, Falciparum; Malaria, Vivax; Male; Middle Aged; Parasitology; Plasmodium falciparum; Plasmodium vivax; Point-of-Care Systems; Prospective Studies; Young Adult