加纳部分医疗机构中有症状个体的疟疾寄生虫血症和快速诊断试验（mRDT）的诊断性能
Malaria parasitaemia and mRDT diagnostic performances among symptomatic individuals in selected health care facilities across Ghana.
作者信息
Abuaku Benjamin, Amoah Linda Eva, Peprah Nana Yaw, Asamoah Alexander, Amoako Eunice Obeng, Donu Dickson, Adu George Asumah, Malm Keziah Laurencia
机构信息
Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Ghana.
Immunology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Ghana.
出版信息
BMC Public Health. 2021 Jan 28;21(1):239. doi: 10.1186/s12889-021-10290-1.
BACKGROUND
Parasitological diagnosis generates data to assist malaria-endemic countries determine their status within the malaria elimination continuum and also inform the deployment of proven interventions to yield maximum impact. This study determined prevalence of malaria parasitaemia and mRDT performances among febrile patients in selected health care facilities across Ghana.
METHODS
This study was a cross-sectional survey conducted in the previously 10 regions of Ghana from May to August 2018. Each patient suspected to have uncomplicated malaria was tested using microscopy and two malaria rapid diagnostic tests (mRDTs): routinely used CareStart™ Malaria HRP2 (Pf) and SD Bioline Malaria Ag Pf (HRP2/pLDH). Main outcome variables were malaria slide and CareStart™ Malaria HRP2 (Pf) positivity rates; and diagnostic accuracy of CareStart™ Malaria HRP2 (Pf) and SD Bioline Malaria Ag Pf (HRP2/pLDH) using microscopy as "gold standard".
RESULTS
Overall parasite positivity rates were 32.3% (6266/19402) by mRDT and 16.0% (2984/18616) by microscopy, with Plasmodium falciparum mono-infection accounting for 98.0% of all infections. The odds of parasitaemia by microscopy was significantly lower among female patients compared with males (OR = 0.78; 95% CI: 0.66-0.91), and among patients with history of previous antimalarial intake compared with those with no such history (OR = 0.72; 95% CI: 0.54-0.95). Overall sensitivity of CareStart™ Malaria HRP2 (Pf) was statistically similar to that of the HRP2 band of SD Bioline Malaria Ag Pf (HRP2/pLDH) combo kit (95.4%; 95% CI: 94.6-96.1 vs 94.3%; 95% CI: 93.4-95.1; p = 0.065) but significantly higher than the pLDH band (89.3%; 95% CI: 88.1-90.4; p < 0.001). The same pattern was observed for negative predictive value.
CONCLUSIONS
Malaria control interventions should be targeted at the general population, and history of antimalarial intake considered a key predictor of malaria slide negativity. Furthermore, HRP2-based mRDTs remain effective diagnostic tool in the management of suspected uncomplicated malaria in the country.
背景
寄生虫学诊断可生成数据，以协助疟疾流行国家确定其在疟疾消除连续过程中的状况，并为部署经证实的干预措施提供信息，以产生最大影响。本研究确定了加纳选定医疗机构中发热患者的疟疾寄生虫血症患病率和疟疾快速诊断检测（mRDT）的性能。
方法
本研究是一项横断面调查，于2018年5月至8月在加纳之前的10个地区进行。对每名疑似患有非复杂性疟疾的患者进行显微镜检查和两种疟疾快速诊断检测（mRDT）：常规使用的CareStart™疟疾HRP2（恶性疟原虫）和SD Bioline疟疾抗原恶性疟原虫（HRP2/pLDH）。主要结局变量为疟疾血涂片和CareStart™疟疾HRP2（恶性疟原虫）阳性率；以及以显微镜检查为“金标准”的CareStart™疟疾HRP2（恶性疟原虫）和SD Bioline疟疾抗原恶性疟原虫（HRP2/pLDH）的诊断准确性。
结果
通过mRDT检测的总体寄生虫阳性率为32.3%（6266/19402），通过显微镜检查为16.0%（2984/18616），恶性疟原虫单一感染占所有感染的98.0%。与男性患者相比，女性患者通过显微镜检查发现寄生虫血症的几率显著更低（比值比=0.78；95%置信区间：0.66 - 0.91），与无抗疟药服用史的患者相比有抗疟药服用史的患者通过显微镜检查发现寄生虫血症的几率也显著更低（比值比=0.72；95%置信区间：0.54 - 0.95）。CareStart™疟疾HRP2（恶性疟原虫）的总体敏感性与SD Bioline疟疾抗原恶性疟原虫（HRP2/pLDH）组合试剂盒的HRP2条带的总体敏感性在统计学上相似（95.4%；95%置信区间：94.6 - 96.1对94.3%；95%置信区间：93.4 - 95.1；p = 0.065），但显著高于pLDH条带（89.3%；95%置信区间：88.1 - 90.4；p < 0.001）。阴性预测值也观察到相同模式。
结论
疟疾控制干预措施应针对普通人群，抗疟药服用史被视为疟疾血涂片阴性的关键预测因素。此外，基于HRP2的mRDT仍然是该国疑似非复杂性疟疾管理中的有效诊断工具。
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