Which malaria rapid test for Madagascar? Field and laboratory evaluation of three tests and expert microscopy of samples from suspected malaria patients in Madagascar.

Field and laboratory studies were carried out in October and November 2005 to provide a comparative evaluation of the performance of three rapid malaria detection tests, two of which were recently introduced (the CareStart Malaria test and the SD Malaria Antigen Bioline test) and the well-known OptiMAL-IT test. Compared with microscopy, the sensitivity of the three tests to detect Plasmodium falciparum malaria was 97% for the CareStart Malaria test, 89.4% for the SD Malaria Antigen Bioline test, and 92.6% for the OptiMAL-IT test. The three tests were less sensitive in detecting non-P. falciparum infections, and the sensitivity decreased at levels of parasitemia<or=500 parasites/microL for P. falciparum and<or=5,000 parasites/microL for other Plasmodium spp. On the basis of World Health Organization recommendations, only the CareStart Malaria test and the OptiMAL-IT test had sensitivities greater than 95% for samples with parasitemias>or=100 parasites/microL.