Keating Joseph, Miller John M, Bennett Adam, Moonga Hawela B, Eisele Thomas P
Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, United States of America.
Acta Trop. 2009 Dec;112(3):277-82. doi: 10.1016/j.actatropica.2009.08.011. Epub 2009 Aug 13.
This paper presents estimates of P. falciparum infection prevalence in children under 5 years old in the context of a population-based household survey in Luangwa District (Lusaka Province), Zambia, an area where greater than 75% of households possess at least one insecticide-treated mosquito net (ITN). The sensitivity and specificity of an HRP-2 rapid diagnostic test (RDT) (ICT Malaria Pf((R))) compared to microscopy, as well as factors associated with discordant diagnostic results are also presented. P. falciparum infection prevalence was estimated at 7.0% (95% CI 4.9-9.0%) using microscopy. Using microscopy as the gold standard, the sensitivity of the HRP-2 RDT was 100% and specificity was 91.5%; positive predictive value was estimated to be 46.7% (95% CI 36.3-57.4%). RDT discordance, or HRP-2 false positivity, was highest among older children, those in the northern part of Luangwa District, and those with a reported history of antimalarial treatment. These data suggest microscopy should remain the gold standard for estimating malaria parasite point prevalence from household surveys for monitoring and evaluation purposes.
本文介绍了在赞比亚卢安瓜区（卢萨卡省）开展的一项基于人群的家庭调查中，5岁以下儿童恶性疟原虫感染率的估计情况。该地区超过75%的家庭拥有至少一顶经杀虫剂处理的蚊帐（ITN）。文中还介绍了HRP-2快速诊断检测（RDT）（ICT Malaria Pf((R))）与显微镜检测相比的敏感性和特异性，以及与诊断结果不一致相关的因素。使用显微镜检测，恶性疟原虫感染率估计为7.0%（95%可信区间4.9 - 9.0%）。以显微镜检测作为金标准，HRP-2 RDT的敏感性为100%，特异性为91.5%；阳性预测值估计为46.7%（95%可信区间36.3 - 57.4%）。RDT结果不一致，即HRP-2假阳性，在年龄较大的儿童、卢安瓜区北部的儿童以及有抗疟治疗史报告的儿童中最为常见。这些数据表明，为了监测和评估目的，在家庭调查中估计疟原虫现患率时，显微镜检测应仍然作为金标准。
