A cross-sectional study of the availability and price of anti-malarial medicines and malaria rapid diagnostic tests in private sector retail drug outlets in rural Western Kenya, 2013

Background In Ethiopia, anti-malaria treatment is initiated after parasitological confirmation using blood film microscopy at health centers and hospitals, or serological rapid diagnostic tests at health posts. At health posts, the diagnosis is performed by health extension workers using rapid diagnostic tests after little training. However, there is paucity of data about the health extension workers’ performance on rapid diagnostic tests. Hence, periodic monitoring of the performances of health extension workers on malaria rapid diagnostic tests and predicted factors plays a pivotal role for the control of malaria. Methods A cross sectional study was conducted in May 2020, among 75 health extension workers working at health posts in Bahir Dar Zuria district, Northwest Ethiopia. Their performance on malaria rapid diagnostic tests was assessed by distributing known positive and negative samples as confirmed by investigators using both rapid diagnostic test and blood film microscopy. Test results from health extension workers were then compared with that of investigators. Procedural errors committed while performing the tests were assessed using observational checklist. Data were analyzed using SPSS software version 20. Results The overall sensitivity and specificity of health extension workers in detecting Plasmodium species were 96.8% and 98.7%, respectively with 97.3% result agreement between the health extension workers and investigators (kappa value = 0.949). The most common procedural errors committed by health extension workers was ‘not checking expiry date of the test kits’ followed by ‘not adhering to the appropriate time of reading results’ that 70.7% and 64% of the participants committed these errors, respectively. Total number of procedural errors committed by those who have got in-service training was decreased by 47.3% as compared to those without in-service training. Conclusions Health extension workers had high performance on malaria rapid diagnostic tests. However, in-service training and periodic supervision should be given in order to maximize performance on these tests.

Download Full-text

Prevalence and Epidemiological Characteristics of Asymptomatic Malaria Based on Ultrasensitive Diagnostics: A Cross-sectional Study

Clinical Infectious Diseases ◽

10.1093/cid/ciy1005 ◽

2018 ◽

Vol 69 (6) ◽

pp. 1003-1010 ◽

Cited By ~ 20

Author(s):

Seble Girma ◽

James Cheaveau ◽

Abu Naser Mohon ◽

Dewdunee Marasinghe ◽

Ruth Legese ◽

...

Keyword(s):

Diagnostic Tests ◽

Cross Sectional Study ◽

Rapid Diagnostic Tests ◽

World Health ◽

Asymptomatic Malaria ◽

Global Public Health ◽

Sectional Study ◽

Cross Sectional ◽

Qrt Pcr ◽

Epidemiological Characteristics

Abstract Background As the global public-health objectives for malaria evolve from malaria control towards malaria elimination, there is increasing interest in the significance of asymptomatic infections and the optimal diagnostic test to identify them. Method We conducted a cross-sectional study of asymptomatic individuals (N = 562) to determine the epidemiological characteristics associated with asymptomatic malaria. Participants were tested by rapid diagnostic tests (CareStart, Standard Diagnostics [SD] Bioline, and Alere ultrasensitive RDT [uRDT]), loop-mediated isothermal amplification (LAMP), and quantitative reverse transcription polymerase chain reaction (qRT-PCR) to determine malaria positivity. Hemoglobin values were recorded, and anemia was defined as a binary variable, according to World Health Organization guidelines. Results Compared to reference qRT-PCR, LAMP had the highest sensitivity (92.6%, 95% confidence interval [CI] 86.4–96.5), followed by uRDT Alere Malaria (33.9%, 95% CI 25.5–43.1), CareStart Malaria (14.1%, 95% CI 8.4–21.5), microscopy (5.0%, 95% CI 1.8–10.5), and SD Bioline (5.0%, 95% CI 1.8–10.5). For Plasmodium falciparum specimens only, the sensitivity for uRDT Alere Malaria was 50.0% (95% CI 38.8–61.3) and SD Bioline was 7.3% (95% CI 2.7–15.3). Based on multivariate regression analysis with qRT-PCR as the gold standard, for every 3.2% increase in the prevalence of asymptomatic malaria, hemoglobin decreased by 1 gram per deciliter (prevalence ratio 0.968, 95% CI 0.940–0.997; P = .032). Deletions (4.8%) in hrp2 were noted. Conclusions While uRDT Alere Malaria has superior sensitivity to rapid diagnostic tests and microscopy in detecting asymptomatic malaria, LAMP is superior still. Ultrasensitive diagnostics provide the accurate prevalence estimates of asymptomatic malaria required for elimination.

Download Full-text

Situation of Asymptomatic Malaria among Iranian Native and Af-ghan and Pakistani Immigrants in a Malarious Area under the Na-tional Malaria Elimination Program of Iran

Iranian Journal of Parasitology ◽

10.18502/ijpa.v15i4.4858 ◽

2020 ◽

Author(s):

Setareh ASKARI ◽

Mehdi NATEGHPOUR ◽

Afsaneh MOTEVALLI HAGHI ◽

Leila FARIVAR ◽

Ahmad RAEISI ◽

...

Keyword(s):

Malaria Elimination ◽

Diagnostic Tests ◽

Cross Sectional Study ◽

Rapid Diagnostic Tests ◽

Asymptomatic Malaria ◽

Sectional Study ◽

Cross Sectional ◽

Microscopical Method ◽

Pakistani Immigrants ◽

Pcr Techniques

Background: This study was designed to detect, if there are asymptomatic malaria infections amongst native and immigrant population from Afghanistan and Pakistan countries in Sistan & Baluchistan Province of Iran, where is under the national malaria elimination program. Methods: This cross-sectional study was performed among native individuals and resident immigrants in the southeastern province of Sistan & Baluchistan from May 2016 to Jul 2017. A total of 271 individuals were considered in this cross- sectional study based on microscopical method, Rapid Diagnostic Tests (RDTs) and PCR techniques. Out of 271 native and immigrant participants 140 (52%) and 131 (48%) were male and female, respectively. Results: None of the prepared samples was diagnosed as malaria positive case when was considered via above mentioned three techniques. Conclusion: Neither native nor immigrant individuals had asymptomatic malaria, hinting that national malaria elimination program is performed according to planned schedule in the studied areas

Download Full-text

Performance of four HRP-2/pLDH combination rapid diagnostic tests and field microscopy as screening tests for malaria in pregnancy in Indonesia: a cross-sectional study

Malaria Journal ◽

10.1186/s12936-015-0943-5 ◽

2015 ◽

Vol 14 (1) ◽

Cited By ~ 16

Author(s):

Rukhsana Ahmed ◽

Elvira I. Levy ◽

Sylvia S. Maratina ◽

Judith J. de Jong ◽

Puji B. S. Asih ◽

...

Keyword(s):

Diagnostic Tests ◽

Cross Sectional Study ◽

Rapid Diagnostic Tests ◽

Malaria In Pregnancy ◽

Screening Tests ◽

Sectional Study ◽

Cross Sectional ◽

In Pregnancy

Download Full-text

Integration of symptomatic, demographical and diet-related comorbidities data with SARS-CoV-2 antibody rapid diagnostic tests during epidemiological surveillance: a cross-sectional study in Jakarta, Indonesia

BMJ Open ◽

10.1136/bmjopen-2020-047763 ◽

2021 ◽

Vol 11 (8) ◽

pp. e047763

Author(s):

Rina Agustina ◽

Ari Fahrial Syam ◽

Fadila Wirawan ◽

Indah S Widyahening ◽

Ahmad Jabir Rahyussalim ◽

...

Keyword(s):

Predictive Value ◽

Diagnostic Tests ◽

Cross Sectional Study ◽

Rapid Diagnostic Tests ◽

Epidemiological Surveillance ◽

Sectional Study ◽

Rt Pcr ◽

Cross Sectional ◽

Predictive Values ◽

Current Infection

ObjectivesAffordable options for COVID-19 epidemiological surveillance are needed. Virus detection by reverse transcription-PCR (RT-PCR) is sensitive but costly, and antigen-based rapid diagnostic tests (RDTs) are cheap but with reduced sensitivity; both detect current infection but not exposure. RDT-IgM/IgG antibodies to SARS-CoV-2 detect exposure but have poor sensitivity for current infection. We investigated if the integration of symptomatic, demographical and diet-related comorbidities data with antibody RDTs improves their potential to assess infection rates in addition to exposure, thereby broadening their utility for surveillance.DesignWe conducted a cross-sectional study using data from community surveillance for SARS-CoV-2. Health workers collected nasopharyngeal swabs for RT-PCR and RDT antigen assessments and venous blood for RDT-IgM/IgG from symptomatic and asymptomatic persons. Data on age, gender, contact history, symptoms (ie, fever, cough, runny nose, sore throat, headache, dyspnoea and diarrhoea), diet-related comorbidities (ie, diabetes and hypertension) and chest radiology were collected.SettingHigh-risk communities in Jakarta, Indonesia, in May 2020.Participants343 community members’ data were included.Outcome measuresRDT-IgM/IgG sensitivity, specificity and predictive values and area under receiver operating characteristic curve for RT-PCR positivity using RDT results alone and in combination with other predictors, including symptom components derived from principal component analysis.ResultsThere were 24 PCR-confirmed infections. RDT-IgM/IgG-positive tests were associated with infection (OR 10.8, 95% CI 4.43 to 26.4, p<0.001) with an area under the curve (AUC) of 0.708% and 50% sensitivity, 91.5% specificity, 30.8% positive predictive value (PPV) and 96.1% negative predictive value (NPV). RDT results combined with age, gender, contact history, symptoms and comorbidities increased the AUC to 0.787 and yielded 62.5% sensitivity, 87.0% specificity, 26.6% PPV and 96.9% NPV.ConclusionsSARS-CoV-2 RDT-IgM/IgG results integrated with other predictors may be an affordable tool for epidemiological surveillance for population-based COVID-19 exposure and current infection, especially in groups with outbreaks or high transmission.

Download Full-text

Assessing Village Health Workers’ Ability to Perform and Interpret Rapid Diagnostic Tests for Malaria 4 Years after Initial Training: A Cross-Sectional Study

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.20-0747 ◽

2021 ◽

Vol 104 (1) ◽

pp. 294-297

Author(s):

James S. Miller ◽

Rapheal Kisolhu Mbusa ◽

Stephen Baguma ◽

Palka Patel ◽

Michael Matte ◽

...

Keyword(s):

Diagnostic Tests ◽

Health Workers ◽

Cross Sectional Study ◽

Rapid Diagnostic Tests ◽

Initial Training ◽

Sectional Study ◽

Cross Sectional ◽

Village Health Workers ◽

Village Health

Download Full-text

Trends in access to anti‐malarial treatment in the formal private sector in Uganda: an assessment of availability and affordability of first‐line anti‐malarials and diagnostics between 2007 and 2018

Malaria Journal ◽

10.1186/s12936-021-03680-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Denis Kibira ◽

Anthony Ssebagereka ◽

Hendrika A. van den Ham ◽

Jimmy Opigo ◽

Henry Katamba ◽

...

Keyword(s):

Private Sector ◽

Diagnostic Tests ◽

Malaria Treatment ◽

World Health ◽

First Line ◽

Cross Sectional ◽

Malaria Rapid Diagnostic Tests ◽

Retail Outlets ◽

Health Action ◽

Health Organization

Abstract Background Malaria is the single largest cause of illness in Uganda. Since the year 2008, the Global Fund has rolled out several funding streams for malaria control in Uganda. Among these are mechanisms aimed at increasing the availability and affordability of artemisinin-based combination therapy (ACT). This paper examines the availability and affordability of first-line malaria treatment and diagnostics in the private sector, which is the preferred first point of contact for 61% of households in Uganda between 2007 and 2018. Methods Cross-sectional surveys were conducted between 2007 and 2018, based on a standardized World Health Organization/Health Action International (WHO/HAI) methodology adapted to assess availability, patient prices, and affordability of ACT medicines in private retail outlets. A minimum of 30 outlets were surveyed per year as prescribed by the standardized methodology co-developed by the WHO and Health Action International. Availability, patient prices, and affordability of malaria rapid diagnostic tests (RDTs) was also tracked from 2012 following the rollout of the test and treat policy in 2010. The median patient prices for the artemisinin-based combinations and RDTs was calculated in US dollars (USD). Affordability was assessed by computing the number of days’ wages the lowest-paid government worker (LPGW) had to pay to purchase a treatment course for acute malaria. Results Availability of artemether/lumefantrine (A/L), the first-line ACT medicine, increased from 85 to100% in the private sector facilities during the study period. However, there was low availability of diagnostic tests in private sector facilities ranging between 13% (2012) and 37% (2018). There was a large reduction in patient prices for an adult treatment course of A/L from USD 8.8 in 2007 to USD 1.1 in 2018, while the price of diagnostics remained mostly stagnant at USD 0.5. The affordability of ACT medicines and RDTs was below one day’s wages for LPGW. Conclusions Availability of ACT medicines in the private sector medicines retail outlets increased to 100% while the availability of diagnostics remained low. Although malaria treatment was affordable, the price of diagnostics remained stagnant and increased the cumulative cost of malaria management. Malaria stakeholders should consolidate the gains made and consider the inclusion of diagnostic kits in the subsidy programme.

Download Full-text