The dilemma of malaria diagnosis: How accurate are the diagnostic tools?

Wadie  Elmadhoun; Omyma  Elnoor Hassan; Sufian  KM Noor; Mohamed  H Ahmed

doi:10.52981/sjms.v10i1.1045

Wadie Elmadhoun Nile Valley University
Omyma Elnoor Hassan Nile Valley University
Sufian KM Noor Nile Valley University Sudan
Mohamed H Ahmed Department of Medicine, Milton Keynes Hospital

DOI: https://doi.org/10.52981/sjms.v10i1.1045

الملخص

Background: Malaria represents a major health problem for the public as well as clinicians and
diagnosticians, because many diseases have similar symptoms to the symptoms of malaria. This study
aimed to determine the accuracy of malaria diagnosis both clinically and using various laboratory tests
compared to the gold standard microscopy.
Materials and Methods: This is a descriptive, cross-sectional hospital-based study, conducted at the
casualty of Atbara Hospital, in January 2011. Any patient clinically suspected to have malaria in this
month was included. Demographic and clinical data was collected using a standardized pre-tested
questionnaire. Each patient was diagnosed primarily by the clinician, mainly medical officers and
houseofficers, investigated by a thick blood film stained by Giemsa stain in the hospital laboratory. We,
thereafter, obtained blood samples from the same patient, made thick and thin films stained by Giemsa
and Field stains in addition to rapid tests for malaria antigens and antibodies. For quality assurance, tests
were reviewed by expert technicians in the State Reference Laboratory for Malaria. Giemsa thick blood
film was taken as the gold standard. Results of the various diagnostic methods were compared.
Results: Two hundred patients volunteered to participate in this study. Females were 121(60.5%). The
age range was from 7 months to 70 years, mean 25.85(+20.5). Only 5(2.5%) cases were confirmed
positive for malaria. When compared to the gold standard test, giemsa thin film and Field stain showed
100% sensitivity and 100% specificity. The sensitivity and specificity of the blood film done by hospital
laboratory was 80% and 99.5% respectively. While Rapid Antibody scored 60% and 89.7%, and for
Rapid Antigen scored 80% and 96.9% for the sensitivity and specificity respectively. The clinical
diagnosis was the least accurate method 80% sensitivity and 38.5% specificity.
Conclusion: The prevalence of malaria among symptomatic patients in Atbara hospital is low. The ICT
antigen and antibody tests, as well as clinicians over diagnose malaria when compared to the blood film.
A combination of Rapid Diagnostic Test (RDT) with thick blood film for suspected malaria cases is
recommended.

المراجع

1. Khalid A Elmardi, Abdisalan M Noor, SophieGithinji, Tareg M Abdelgadir, ElFatih M Malik,and Robert W Snow. Self-reported fever, treatmentactions and malaria infection prevalence in thenorthern states of Sudan. Malar J. 2011; 10: 128.
2. Hay SI, Guerra CA, Gething PW, Patil AP, TatemAJ, Noor AM, Kabaria CW, Manh BH, ElyazarIRF, Brooker S, Smith DL, Moyeed RA, SnowRW. A world malaria map: Plasmodiumfalciparum endemicity in 2007. PLoS Med.2009;6:e1000048.
3. Guerra CA, Howes RE, Patil AP, Gething PW,Van Boeckel TP, Temperley WH, Kabaria CW,Tatem AJ, Manh BH, Elyazar IRF, Baird JK,Snow RW, Hay SI. The international limits andpopulation at risk of Plasmodium vivaxtransmission in 2009 PLoS NTD. 2010. p. e774.
4. WHO. Sudan : malaria control and elimination.Available at:http://www.emro.who.int/sdn/programmes/malaria-sudan.html) Accessed 13/12/2015
5. Kahama-Maro J, D’Acremont V, Mtasiwa D,Genton B, Lengeler C: Low quality of routinemicroscopy for malaria at different levels of thehealth system in Dares Salaam. Malar J. 2011;10:332
6. Michael L. Wilson, MD. Laboratory Diagnosis ofMalaria; Conventional and Rapid DiagnosticMethods. Arch Pathol Lab Med.2013; 137.
7. A. Moody. Rapid diagnostic tests for malariaparasites. Clinical Microbiology Reviews.2002; 15(1):66–78.
8. C. K. Murray, R. A. Gasser Jr., A. J. Magill, andR. S. Miller. Update on rapid diagnostic testing formalaria, Clinical Microbiology Reviews.2008;21(1):97–110.
9. I. Bates, V. Bekoe, and A. Asamoa-Adu.Improving the accuracy of malaria-relatedlaboratory tests in Ghana. Malaria Journal.2004;3: 38.
10. Premji Z, et al. Laboratory diagnosis of malaria byvillage health workers using the rapid manualParaSight-F test. Transactions of the RoyalSociety of Tropical Medicine and Hygiene. 1994;88:418.
11. Lema OE, et al. Comparison of five methods ofmalaria detection in the outpatient setting.American Journal of Tropical Medicine andHygiene.1999; 60:177–182.
12. Grobusch MP, et al. False-positive rapid testsfor malaria in patients with rheumatoid factor.Lancet. 1999; 353:297.
13. World Health Organization. The use of malariarapid diagnostic tests. 2nd ed. Geneva: WHO,2006. (WHO-TDR/WHO-WPRO 2006.)
14. Bell D, Wongsrichanalai C, Barnwell JW.Ensuring quality and access for malariadiagnosis: how can it be achieved? Nat RevMicrobiol.2006;4:682-695.
15. Marx A, Pewsner D, Egger M, Nuesch R,Bucher HC, Genton B, Hatz C, Juni P. Metaanalysis:accuracy of rapid tests for malaria intravelers returning from endemic areas. AnnIntern Med.2005;142: 836–846.
16. Endeshaw T, Gebre T, Ngondi J, Graves PM,Shargie EB, Ejigsemahu Y, AyeleB, YohannesG, Teferi T, Messele A, Zerihun M, Genet A,Mosher AW,Emerson PM, Richards FO.Evaluation of light microscopy and rapiddiagnostic test for the detection of malariaunder operational field conditions: a householdsurvey in Ethiopia. Malar J. 2008, 7:118.
17. Mishra B, Samantaray JC, Kumar A, MirdhaBR. Study of false positivity of two rapidantigen detection tests for diagnosis ofPlasmodium falciparum malaria. JClinMicrobiol.1999; 37:1233.
18. Koita OA, Doumbo OK, Ouattara A, Tall LK,Konare A, Diakite M, DialloM,Sagara I,Masinde GL, Doumbo SN, Dolo A, TounkaraA, Traore I, Krogstad DJ. False-negative rapiddiagnostic tests for malaria and deletion of thehistidine-rich repeat region of the hrp2 gene.Am J Trop Med Hyg. 2012;86:194–198.
19. Guinovart C, Bassat Q, Sigauque B, Aide P,Sacarlal J, Nhampossa T, et al. Malaria in ruralMozambique. Part I: children attending theoutpatient clinic. Malar J. 2008;7:36.
20. Tarimo DS, Minjas JN, Bygbjerg IC. Malariadiagnosis and treatment under the strategy ofthe integrated management of childhood illness(IMCI): relevance of laboratory support fromthe rapid immunochromatographic tests of ICTMalaria P.f/P.v and OptiMal. Ann Trop MedParasitol. 2001;95(5):437–444.
21. World Health Organisation, author.Parasitological confirmation of malariadiagnosis: WHO technical consultation,Geneva, 6–8 October 2009. Geneva: WorldHealth Organisation; 2009.
22. Wongsrichanalai C, Barcus MJ, Muth S,Sutamihardja A, Wernsdorfer WH. A review ofmalaria diagnostic tools: microscopy and rapiddiagnostic test (RDT). Am J Trop Med Hyg2007, 77 :119-127
23. McMorrow ML, Masanja MI, Kahigwa E,Abdulla SM, Kachur SP. Quality assurance ofrapid diagnostic tests for malaria in routinepatient care in rural Tanzania. Am J Trop MedHyg 82:151-155.
24. Proux S, Hkirijareon L, Ngamngonkiri C,McConnell S, Nosten F. Paracheck- Pf: a new,inexpensive and reliable rapid test for P.falciparum malaria. Trop Med Int Health2001, 6:99-101
25. Swarthout TD, Counihan H, Senga RK, vanden Broek I. Paracheck-Pf accuracy andrecently treated Plasmodium falciparuminfections: is there a risk of over-diagnosis?Malar J 2007, 6:58
26. Hamer DH, Ndhlovu M, Zurovac D, Fox M,Yeboah-Antwi K, Chanda P, Sipilinyambe N,Simon JL, Snow RW. Improved diagnostictesting and malaria treatment practices inZambia. JAMA 2007, 297:2227-2231.