Evaluation of the utility value of three diagnostic methods in the detection of malaria parasites in endemic area View Full Text


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Article Info

DATE

2017-05-06

AUTHORS

Uchenna Iyioku Ugah, Moses Nnaemeka Alo, Jacob Oluwabusuyi Owolabi, Oluchi DivineGift Okata-Nwali, Ifeoma Mercy Ekejindu, Nancy Ibeh, Michael Okpara Elom

ABSTRACT

BackgroundMalaria is a debilitating disease with high morbidity and mortality in Africa, commonly caused by different species of the genus Plasmodium in humans. Misdiagnosis is a major challenge in endemic areas because of other disease complications and technical expertise of the medical laboratory staff. Microscopic method using Giemsa-stained blood film has been the mainstay of diagnosis of malaria. However, since 1993 when rapid diagnostic test (RDT) kits were introduced, they have proved to be effective in the diagnosis of malaria. This study was aimed at comparing the accuracy of microscopy and RDTs in the diagnosis of malaria using nested PCR as the reference standard. Four hundred and twenty (420) venous blood specimens were collected from patients attending different General Hospitals in Ebonyi State with clinical symptoms of malaria. The samples were tested with Giemsa-stained microscopy and three RDTs. Fifty specimens were randomly selected for molecular analysis.ResultsUsing different diagnostic methods, the prevalence of malaria among the subjects studied was 25.95% as detected by microscopy, prevalence found among the RDTs was 22.90, 15.20 and 54.80% for Carestart, SD Bioline PF and SD Bioline PF/PV, respectively. Molecular assay yielded a prevalence of 32%. The major specie identified was Plasmodium falciparum; there was co-infection of P. falciparum with Plasmodium malariae and Plasmodium ovale. The sensitivity and specificity of microscopy was 50.00 and 70.59% while that of the RDTs were (25.00 and 85.29%), (25.00 and 94.12%) and (68.75 and 52.94%) for Carestart, SD Bioline PF and SD Bioline PF/PV, respectively. Cohen’s kappa coefficient was used to measure the level of agreement of the methods with nested PCR. Microscopy showed a moderate measure of agreement (k = 0.491), Carestart showed a good measure of agreement (k = 0.611), SD Bioline PF showed a fair measure of agreement (k = 0.226) while SD Bioline PF/PV showed a poor measure of agreement (k = 0.172).ConclusionsThis study recommends that the policy of malaria diagnosis be changed such that the routine diagnosis of malaria is done by a combination of both microscopy and a RDT kit of high sensitivity and specificity so as to complement the errors associated with either of the methods. The finding of P. ovale in the study area necessitates an expanded molecular epidemiology of malaria within the study area. More... »

PAGES

189

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12936-017-1838-4

DOI

http://dx.doi.org/10.1186/s12936-017-1838-4

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1085189621

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28477621


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36 schema:description BackgroundMalaria is a debilitating disease with high morbidity and mortality in Africa, commonly caused by different species of the genus Plasmodium in humans. Misdiagnosis is a major challenge in endemic areas because of other disease complications and technical expertise of the medical laboratory staff. Microscopic method using Giemsa-stained blood film has been the mainstay of diagnosis of malaria. However, since 1993 when rapid diagnostic test (RDT) kits were introduced, they have proved to be effective in the diagnosis of malaria. This study was aimed at comparing the accuracy of microscopy and RDTs in the diagnosis of malaria using nested PCR as the reference standard. Four hundred and twenty (420) venous blood specimens were collected from patients attending different General Hospitals in Ebonyi State with clinical symptoms of malaria. The samples were tested with Giemsa-stained microscopy and three RDTs. Fifty specimens were randomly selected for molecular analysis.ResultsUsing different diagnostic methods, the prevalence of malaria among the subjects studied was 25.95% as detected by microscopy, prevalence found among the RDTs was 22.90, 15.20 and 54.80% for Carestart, SD Bioline PF and SD Bioline PF/PV, respectively. Molecular assay yielded a prevalence of 32%. The major specie identified was Plasmodium falciparum; there was co-infection of P. falciparum with Plasmodium malariae and Plasmodium ovale. The sensitivity and specificity of microscopy was 50.00 and 70.59% while that of the RDTs were (25.00 and 85.29%), (25.00 and 94.12%) and (68.75 and 52.94%) for Carestart, SD Bioline PF and SD Bioline PF/PV, respectively. Cohen’s kappa coefficient was used to measure the level of agreement of the methods with nested PCR. Microscopy showed a moderate measure of agreement (k = 0.491), Carestart showed a good measure of agreement (k = 0.611), SD Bioline PF showed a fair measure of agreement (k = 0.226) while SD Bioline PF/PV showed a poor measure of agreement (k = 0.172).ConclusionsThis study recommends that the policy of malaria diagnosis be changed such that the routine diagnosis of malaria is done by a combination of both microscopy and a RDT kit of high sensitivity and specificity so as to complement the errors associated with either of the methods. The finding of P. ovale in the study area necessitates an expanded molecular epidemiology of malaria within the study area.
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43 BackgroundMalaria
44 CareStart
45 Cohen's kappa coefficient
46 ConclusionsThis study
47 Ebonyi State
48 General Hospital
49 Giemsa
50 P. falciparum
51 P. ovale
52 PCR
53 PF
54 PV
55 Plasmodium
56 Plasmodium falciparum
57 Plasmodium malariae
58 Plasmodium ovale
59 RDT
60 RDT kits
61 accuracy
62 accuracy of microscopy
63 agreement
64 analysis
65 area
66 blood films
67 blood specimens
68 challenges
69 clinical symptoms
70 coefficient
71 combination
72 complications
73 detection
74 diagnosis
75 diagnosis of malaria
76 diagnostic methods
77 diagnostic test kits
78 different diagnostic methods
79 different general hospitals
80 different species
81 disease
82 disease complications
83 endemic areas
84 epidemiology
85 error
86 evaluation
87 expertise
88 fair measure
89 falciparum
90 films
91 findings
92 genus Plasmodium
93 good measure
94 high morbidity
95 high sensitivity
96 hospital
97 humans
98 kappa coefficient
99 kit
100 laboratory staff
101 level of agreement
102 levels
103 mainstay
104 mainstay of diagnosis
105 major challenge
106 major species
107 malaria
108 malaria diagnosis
109 malaria parasites
110 malariae
111 measures
112 medical laboratory staff
113 method
114 microscopic methods
115 microscopy
116 misdiagnosis
117 moderate measures
118 molecular analysis
119 molecular epidemiology
120 morbidity
121 mortality
122 ovale
123 parasites
124 patients
125 policy
126 poor measure
127 prevalence
128 prevalence of malaria
129 rapid diagnostic test kits
130 reference standard
131 routine diagnosis
132 samples
133 sensitivity
134 species
135 specificity
136 specificity of microscopy
137 specimens
138 staff
139 standards
140 state
141 study
142 study area
143 subjects
144 symptoms
145 technical expertise
146 test kit
147 utility values
148 values
149 venous blood specimens
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