Adebisi Nurudeen Ayobami, Dada-Adegbola Hannah Odunola, Dairo Magbagbeola David, Ajayi IkeOluwapo Oyeneye, Ajumobi Olufemi Olamide
Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria.
Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan, Nigeria.
Pan Afr Med J. 2018 Aug 1;30:242. doi: 10.11604/pamj.2018.30.242.13268. eCollection 2018.
The World Health Organization (WHO) recommends testing of suspected malaria cases before treatment. Malaria rapid diagnostic test (mRDT) has been recommended for this purpose in endemic countries where microscopy is not accessible. However, its diagnostic performance remains a concern in clinical settings. We assessed diagnostic performance of RDT among febrile under-five children (U5) presenting at Oni Memorial Children's Hospital, Ibadan (OMCH).
A cross-sectional study was conducted among 370 febrile U5 attending OMCH February to May, 2016. We examined their finger prick blood samples for malaria parasitaemia using CareStart histidine rich protein II (HRP-2) RDT and microscopy. The sensitivity, specificity, positive and negative predictive values (PPV, NPV), false positive (FP), invalid rates (IR), likelihood ratio of positive and negative tests (LRP and LRN), were calculated.
Mean age of the children was 28.17 ± 15.59 months. Malaria prevalence was 21.6% and 15.1% by mRDT and microscopy, respectively. Sensitivity of CareStart HRP-2 RDT was 94.6% (95% confidence interval (CI): 84.2-98.6), specificity: 91.4% (CI: 87.6-94.2), PPV: 66.3% (CI: 54.7-76.2), NPV: 98.9% (CI: 96.8-99.7), FPR 6.5%, IR 8.1%, LRP:10.6 and LRN:0.1.
Diagnostic performance of CareStart used in the study met the ≥ 95% sensitivity at 100 parasites/µL recommended by WHO. This finding provides clinical evidence that testing before anti-malarial treatment as recommended by WHO will identify cases of malaria infection and reduce unnecessary use of drugs. Healthcare workers should be educated on diagnostic accuracy of mRDT and adhere to the WHO's test-treat strategy for anti-malaria therapy.
世界卫生组织（WHO）建议在治疗前对疑似疟疾病例进行检测。在无法进行显微镜检查的疟疾流行国家，推荐使用疟疾快速诊断检测（mRDT）来实现这一目的。然而，在临床环境中，其诊断性能仍然令人担忧。我们评估了在伊巴丹奥尼纪念儿童医院（OMCH）就诊的五岁以下发热儿童（U5）中RDT的诊断性能。
于2016年2月至5月对370名到OMCH就诊的发热U5儿童进行了一项横断面研究。我们使用CareStart富含组氨酸蛋白II（HRP-2）RDT和显微镜检查他们的手指刺血样本中的疟原虫血症。计算了敏感性、特异性、阳性和阴性预测值（PPV、NPV）、假阳性（FP）、无效率（IR）、阳性和阴性检测的似然比（LRP和LRN）。
儿童的平均年龄为28.17±15.59个月。通过mRDT和显微镜检查得出的疟疾患病率分别为21.6%和15.1%。CareStart HRP-2 RDT的敏感性为94.6%（95%置信区间（CI）：84.2 - 98.6），特异性为91.4%（CI：87.6 - 94.2），PPV为66.3%（CI：54.7 - 76.2），NPV为98.9%（CI：96.8 - 99.7），FPR为6.5%，IR为8.1%，LRP为10.6，LRN为0.1。
本研究中使用的CareStart的诊断性能达到了WHO推荐的每微升100个寄生虫时≥95%的敏感性。这一发现提供了临床证据，即按照WHO的建议在抗疟治疗前进行检测将能够识别疟疾感染病例并减少不必要的药物使用。应教育医护人员关于mRDT的诊断准确性，并坚持WHO的抗疟疾治疗检测 - 治疗策略。
