Key Lab of Health Technology Assessment, National Health Commission; School of Public Health, Fudan University, Shanghai, China.
Department of Statistical Science, University College London, London, UK.
J Glob Health. 2020 Jun;10(1):010411. doi: 10.7189/jogh.10.010411.
Children aged under five years accounted for 61% of all malaria deaths worldwide in 2017, and quicker differential diagnosis of malaria fever is vital for them. Rapid diagnostic tests (RDTs) are strips to detect.
specific antigens promptly and are helpful in resource-limited areas. Thus, our aim is to assess the diagnostic accuracy of RDTs for malaria in children against the gold standard.
MEDLINE, Web of Science, EMBASE, Cochrane Library, the China National Knowledge Infrastructure, Wanfang, and Sinomed databases were systematically searched on August 23, 2019. Studies that compared RDTs with microscopy or polymerase chain reaction in malaria diagnoses for children were eligible. Relevant data were extracted. The quality of studies was evaluated using the revised Quality Assessment of Diagnostic Accuracy Studies instrument. Meta-analyses were carried out to calculate the pooled estimates and 95% confidence intervals of sensitivity and specificity.
51 articles were included. For diagnostic accuracy, the pooled estimates of the sensitivity and specificity of RDTs were 0.93 (95% confidence interval (CI) = 0.90, 0.95) and 0.93 (95% CI = 0.90, 0.96) respectively. Studies were highly heterogeneous, and subgroup analyses showed that the application of RDTs in high malaria transmission areas had higher sensitivity but lower specificity than those in low-to-moderate areas.
RDTs have high accuracy for malaria diagnosis in children, and this characteristic is more prominent in high transmission areas. As they also have the advantages of rapid-detection, are easy-to-use, and can be cost-effective, it is recommended that the wider usage of RDTs should be promoted, especially in resource-limited areas. Further research is required to assess their performance in WHO South-East Asia and Americas Region.
2017 年，全球五岁以下儿童占所有疟疾死亡人数的 61%，因此更快地区分疟疾发热对他们来说至关重要。快速诊断检测（RDT）是一种即时检测疟原虫特异性抗原的条带，在资源有限的地区很有帮助。因此，我们的目的是评估 RDT 对儿童疟疾的诊断准确性，以金标准为准。
2019 年 8 月 23 日，我们系统地检索了 MEDLINE、Web of Science、EMBASE、Cochrane 图书馆、中国知识基础设施、万方和中国生物医学文献数据库。纳入比较 RDT 与显微镜或聚合酶链反应在儿童疟疾诊断中的研究。提取相关数据。使用修改后的诊断准确性研究质量评估工具评估研究质量。进行荟萃分析以计算敏感性和特异性的合并估计值和 95%置信区间。
共纳入 51 篇文章。在诊断准确性方面，RDT 的敏感性和特异性的合并估计值分别为 0.93（95%置信区间[CI] = 0.90，0.95）和 0.93（95%CI = 0.90，0.96）。研究存在高度异质性，亚组分析表明，在高疟疾传播地区应用 RDT 的敏感性较高，但特异性较低。
RDT 对儿童疟疾诊断具有较高的准确性，在高传播地区更为显著。由于它们还具有快速检测、易于使用和具有成本效益的优点，因此建议在资源有限的地区推广更广泛地使用 RDT。需要进一步研究来评估它们在世界卫生组织东南亚和美洲地区的性能。
