Rapid diagnostic tests for bacterial meningitis applicable in sub-Saharan Africa

Clinical infection with malaria, caused by parasites of the genus Plasmodium, is considered a serious medical condition with the potential to become a life-threatening emergency. This is especially relevant to low-income countries in tropical and subtropical regions of the world where high rates of malaria-related morbidity and mortality are recorded. As a means to combat this major global public health threat, rapid and effective diagnosis remains the frontline action to initiate a timely and appropriate medical intervention. From all the approaches to parasite detection, rapid diagnostic tests, so-called RDTs, are the easiest to use and most cost-effective. However, some of the limitations inherent in this methodology could hinder effective patient treatment. A primary drawback is that the vast majority of commercially available RDTs detect only one of the five species of human malaria, P. falciparum. While this is the main cause of infection in many areas, it excludes the possibility of infection with another parasite (P. vivax, P. ovale, P. malariae, and P. knowlesi) or of mixed infections containing different species. Hence, a diagnosis of non-P. falciparum malaria is missed. In turn, in resource-constrained settings where optimal microscopy is not available, a misdiagnosis of bacterial infection based on signs and symptoms alone often results in an inappropriate prescription of antibiotics. Here, we discuss how effective diagnosis of malaria and indiscriminate use of antibiotics in sub-Saharan Africa, a hot spot for P. falciparum transmission, may both be addressed by the development of innovative multiplexing RDTs that detect two or more species of Plasmodium.

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Effect of Supportive Supervision on Performance of Malaria Rapid Diagnostic Tests in Sub-Saharan Africa

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.18-0364 ◽

2019 ◽

Vol 100 (4) ◽

pp. 876-881 ◽

Cited By ~ 3

Author(s):

M. James Eliades ◽

Jolene Wun ◽

Sarah M. Burnett ◽

Fozo Alombah ◽

Felicia Amoo-Sakyi ◽

...

Keyword(s):

Diagnostic Tests ◽

Rapid Diagnostic Tests ◽

Sub Saharan Africa ◽

Supportive Supervision ◽

Malaria Rapid Diagnostic Tests ◽

Sub Saharan

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Scale-up of Malaria Rapid Diagnostic Tests and Artemisinin-Based Combination Therapy: Challenges and Perspectives in Sub-Saharan Africa

PLoS Medicine ◽

10.1371/journal.pmed.1001590 ◽

2014 ◽

Vol 11 (1) ◽

pp. e1001590 ◽

Cited By ~ 53

Author(s):

Guido J. H. Bastiaens ◽

Teun Bousema ◽

Toby Leslie

Keyword(s):

Combination Therapy ◽

Diagnostic Tests ◽

Scale Up ◽

Rapid Diagnostic Tests ◽

Sub Saharan Africa ◽

Malaria Rapid Diagnostic Tests ◽

Sub Saharan

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Modelling the cost-effectiveness of introducing subsidised malaria rapid diagnostic tests in the private retail sector in sub-Saharan Africa

BMJ Global Health ◽

10.1136/bmjgh-2019-002138 ◽

2020 ◽

Vol 5 (5) ◽

pp. e002138

Author(s):

David Bath ◽

Catherine Goodman ◽

Shunmay Yeung

Keyword(s):

Cost Effectiveness ◽

Diagnostic Tests ◽

Cost Effective ◽

Rapid Diagnostic Tests ◽

Sub Saharan Africa ◽

Small Scale ◽

Retail Sector ◽

First Line ◽

Sub Saharan ◽

The Cost

BackgroundOver the last 10 years, there has been a huge shift in malaria diagnosis in public health facilities, due to widespread deployment of rapid diagnostic tests (RDTs), which are accurate, quick and easy to use and inexpensive. There are calls for RDTs to be made available at-scale in the private retail sector where many people with suspected malaria seek care. Retail sector RDT use in sub-Saharan Africa (SSA) is limited to small-scale studies, and robust evidence on value-for-money is not yet available. We modelled the cost-effectiveness of introducing subsidised RDTs and supporting interventions in the SSA retail sector, in a context of a subsidy programme for first-line antimalarials.MethodsWe developed a decision tree following febrile patients through presentation, diagnosis, treatment, disease progression and further care, to final health outcomes. We modelled results for three ‘treatment scenarios’, based on parameters from three small-scale studies in Nigeria (TS-N), Tanzania (TS-T) and Uganda (TS-U), under low and medium/high transmission (5% and 50% Plasmodium falciparum (parasite) positivity rates (PfPR), respectively).ResultsCost-effectiveness varied considerably between treatment scenarios. Cost per disability-adjusted life year averted at 5% PfPR was US$482 (TS-N) and US$115 (TS-T) and at 50% PfPR US$44 (TS-N) and US$45 (TS-T), from a health service perspective. TS-U was dominated in both transmission settings.ConclusionThe cost-effectiveness of subsidised RDTs is strongly influenced by treatment practices, for which further evidence is required from larger-scale operational settings. However, subsidised RDTs could promote increased use of first-line antimalarials in patients with malaria. RDTs may, therefore, be more cost-effective in higher transmission settings, where a greater proportion of patients have malaria and benefit from increased antimalarial use. This is contrary to previous public sector models, where RDTs were most cost-effective in lower transmission settings as they reduced unnecessary antimalarial use in patients without malaria.

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Implementing COVID-19 (SARS-CoV-2) Rapid Diagnostic Tests in Sub-Saharan Africa: A Review

Frontiers in Medicine ◽

10.3389/fmed.2020.557797 ◽

2020 ◽

Vol 7 ◽

Author(s):

Jan Jacobs ◽

Vera Kühne ◽

Octavie Lunguya ◽

Dissou Affolabi ◽

Liselotte Hardy ◽

...

Keyword(s):

Diagnostic Tests ◽

Rapid Diagnostic Tests ◽

Sub Saharan Africa ◽

Sub Saharan

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Malaria

10.1093/med/9780198816805.003.0073 ◽

2021 ◽

pp. 227-248

Author(s):

Frank Baiden ◽

Keziah L. Malm ◽

Fred Binka

Keyword(s):

Plasmodium Falciparum ◽

Pregnant Women ◽

Neurological Deficit ◽

Diagnostic Tests ◽

Point Of Care ◽

Rapid Diagnostic Tests ◽

Sub Saharan Africa ◽

Protozoan Infection ◽

Life Threatening ◽

Sub Saharan

Malaria is a subtropical and tropical protozoan infection that accounts for nearly half a million deaths each year. Most deaths occur in sub-Saharan Africa and are caused by Plasmodium falciparum. The least studied of the five Plasmodia species that cause malaria, P. knowlesi, along with P. vivax cause life-threatening disease, mostly in Southeast Asia. Children, pregnant women, and non-immune travellers to endemic countries are most vulnerable to severe malaria. Cerebral malaria and anaemia are complications that results in neurological deficit and death if treatment is delayed or inappropriately administered. Rapid diagnostic tests have emerged as accurate and reliable means to diagnosing malaria at point-of-care.

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Access to affordable medicines and diagnostic tests for asthma and COPD in sub Saharan Africa: the Ugandan perspective

BMC Pulmonary Medicine ◽

10.1186/s12890-017-0527-y ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 9

Author(s):

Davis Kibirige ◽

Leaticia Kampiire ◽

David Atuhe ◽

Raymond Mwebaze ◽

Winceslaus Katagira ◽

...

Keyword(s):

Diagnostic Tests ◽

Sub Saharan Africa ◽

Sub Saharan

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Clinical overlap between malaria and pneumonia: can malaria rapid diagnostic test play a role?

The Journal of Infection in Developing Countries ◽

10.3855/jidc.945 ◽

2011 ◽

Vol 5 (03) ◽

pp. 199-203 ◽

Cited By ~ 10

Author(s):

Kingsley Nnanna Ukwaja ◽

Olufemi B Aina ◽

Ademola A Talabi

Keyword(s):

Diagnostic Test ◽

Rapid Diagnostic Test ◽

Diagnostic Tests ◽

Health Centre ◽

Rapid Diagnostic Tests ◽

Case Definition ◽

Sub Saharan Africa ◽

Malaria Rapid Diagnostic Test ◽

Chi Square ◽

Symptom Overlap

Introduction: Malaria and pneumonia account for 40% of mortality among children under five years of age in sub-Saharan Africa. Due to lack of diagnostic facilities, their management is based on the integrated management of childhood illnesses (IMCI) strategy. Symptoms of malaria and pneumonia overlap in African children, necessitating dual IMCI classifications at health centres and treatment with both antibiotics and antimalarials. This study determined the prevalence of malaria-pneumonia symptom overlap and confirmed the diagnosis of malaria in these cases using a rapid diagnostic test. Methodology: Consecutive consultations of 1,216 children (two months to five years old) were documented over a three-month period in a comprehensive health centre. Malaria rapid diagnostic tests were conducted only for children who had symptom overlap. Results: Of the 1,216 children enrolled, 1,090 (90%) reported cough or fever. Among the children fulfilling the malaria case definition, 284 (30%) also met the pneumonia case definition. Twenty-three percent (284) of all children enrolled met the criteria for both malaria and pneumonia. However, only 130 (46%) of them had a positive result for malaria using a malaria rapid diagnostic test. During a malaria-pneumonia overlap, female children (chi-square 5.9, P = 0.01) and children ≥ one year (chi-square 4.8, P = 0.003) were more likely to seek care within two days of fever. Conclusion: Dual treatment with antimalarials and antibiotics in children with malaria-pneumonia overlap may result in unnecessary over-prescription of antimalarial medications. Use of rapid diagnostic tests in their management can potentially avoid over-prescribing of malaria medications.

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