scholarly journals Evaluating Field Performance of Highly Sensitive Malaria RDT: Detection of Infection Among Febrile Patients, Asymptomatic Pregnant Women and Household Contacts in Mpigi, Uganda

2021 ◽  
Author(s):  
Daniel Kyabayinze ◽  
Dan Kajungu ◽  
Proscovia M. Nambuya ◽  
Christopher Okiira ◽  
Bbaale Ndawula ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Pregnant Women ◽  
Diagnostic Tests ◽  
Health Workers ◽  
Training Session ◽  
Rapid Diagnostic Tests ◽  
Community Settings ◽  
Targeted Interventions ◽  
Training Requirements ◽  
Highly Sensitive

Abstract BackgroundWorld Health Organisation recommends that malaria case management be based on parasite-based diagnosis in all cases, but currently available tools for clinical use have limitations, including the inability to detect low-level infections. Currently, next-generation highly sensitive rapid diagnostic tests (hsRDT) for Plasmodium falciparum (Pf) are commercially available, but require field-based validation. This study evaluated the performance of the highly sensitive NxTek™ Eliminate Malaria Pf (NxTek) diagnostic test in health facilities and community settings in Mpigi district, Uganda in comparison to the conventional rapid diagnostic tests (cRDTs).MethodsBetween April and December 2019, symptomatic and asymptomatic participants were randomly enrolled from the Outpatient Department (OPD), Antenatal Care (ANC), and community settings. The participants were tested with both cRDTs and an hsRDT to detect Plasmodium falciparum HRP2 antigen and quality assured results with PCR as a reference. Geo-coded real time data were transmitted by health facility and community-based providers using a smartphone with custom designed software.ResultsAt the OPD, the parasite positivity rate was 13.3% for HS-RDT, compared to 6.4% with cRDT. The HS-RDT detected twice the number of positives compared to cRDT. At ANC, 11% (384/3,490) of the pregnant women were malaria parasite positive. HS-RDT detected more positive cases (10.4%) than cRDT (7.0%). At the community setting, 79.7% (2,397/3,009) of the under-five age group were positive for malaria parasites. Index clients in households resulted in a detection of 21.1% (1,877) asymptomatic positive especially among school going children. Health workers were able to learn how to effectively perform the HS-RDT, from a one-day training session. The additional support supervision was provided for VHTs to enable all to transmit results through the android phones. ConclusionUse of HS-RDTs increased case findings of low parasite density infections compared to cRDTs in study populations and provides the opportunity to eliminate malaria reservoirs through treatments. There were minimal additional training requirements when the HS-RDT kits were introduced. The observed increased positivity rates among school-age children call for integrating targeted interventions into school health programs.

Malaria

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.

scholarly journals Potential for community based surveillance of febrile diseases: Feasibility of self-administered rapid diagnostic tests in Iquitos, Peru and Phnom Penh, Cambodia

2021 ◽  
Vol 15 (4) ◽  
pp. e0009307
Author(s):  
Amy C. Morrison ◽  
Julia Schwarz ◽  
Jennie L. Mckenney ◽  
Jhonny Cordova ◽  
Jennifer E. Rios ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Disease Transmission ◽  
Diagnostic Tests ◽  
Large Scale ◽  
Health Workers ◽  
Rapid Diagnostic Tests ◽  
Community Members ◽  
Phnom Penh ◽  
Local Public Health ◽  
At Home

Rapid diagnostic tests (RDTs) have the potential to identify infectious diseases quickly, minimize disease transmission, and could complement and improve surveillance and control of infectious and vector-borne diseases during outbreaks. The U.S. Defense Threat Reduction Agency’s Joint Science and Technology Office (DTRA-JSTO) program set out to develop novel point-of-need RDTs for infectious diseases and deploy them for home use with no training. The aim of this formative study was to address two questions: 1) could community members in Iquitos, Peru and Phnom Penh, Cambodia competently use RDTs of different levels of complexity at home with visually based instructions provided, and 2) if an RDT were provided at no cost, would it be used at home if family members displayed febrile symptoms? Test kits with written and video (Peru only) instructions were provided to community members (Peru [n = 202]; Cambodia [n = 50]) or community health workers (Cambodia [n = 45]), and trained observers evaluated the competency level for each of the several steps required to successfully operate one of two multiplex RDTs on themselves or other consenting participant (i.e., family member). In Iquitos, >80% of residents were able to perform 11/12 steps and 7/15 steps for the two- and five-pathogen test, respectively. Competency in Phnom Penh never reached 80% for any of the 12 or 15 steps for either test; the percentage of participants able to perform a step ranged from 26–76% and 23–72%, for the two- and five-pathogen tests, respectively. Commercially available NS1 dengue rapid tests were distributed, at no cost, to households with confirmed exposure to dengue or Zika virus; of 14 febrile cases reported, six used the provided RDT. Our findings support the need for further implementation research on the appropriate level of instructions or training needed for diverse devices in different settings, as well as how to best integrate RDTs into existing local public health and disease surveillance programs at a large scale.

scholarly journals Emergence and evolution of Plasmodium falciparum histidine-rich protein 2 and 3 deletion mutant parasites in Ethiopia

2021 ◽  
Author(s):  
Sindew M. Feleke ◽  
Emily N. Reichert ◽  
Hussein Mohammed ◽  
Bokretsion G. Brhane ◽  
Kalkidan Mekete ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Falciparum Malaria ◽  
Diagnostic Tests ◽  
Deletion Mutant ◽  
Diagnostic Testing ◽  
Rapid Diagnostic Tests ◽  
Horn Of Africa ◽  
Diagnostic Strategies ◽  
Genomic Tools ◽  
Subtelomeric Deletion

AbstractMalaria diagnostic testing in Africa is threatened by Plasmodium falciparum parasites lacking histidine-rich protein 2 (pfhrp2) and 3 (pfhrp3) genes. Among 12,572 subjects enrolled along Ethiopia’s borders with Eritrea, Sudan, and South Sudan and using multiple assays, we estimate HRP2-based rapid diagnostic tests would miss 9.7% (95% CI 8.5-11.1) of falciparum malaria cases due to pfhrp2 deletion. Established and novel genomic tools reveal distinct subtelomeric deletion patterns, well-established pfhrp3 deletions, and recent expansion of pfhrp2 deletion. Current diagnostic strategies need to be urgently reconsidered in Ethiopia, and expanded surveillance is needed throughout the Horn of Africa.

scholarly journals PO 8271 PFHRP2 GENE DELETIONS IN PLASMODIUM FALCIPARUM AND SCHISTOSOMA MANSONI CO-INFECTIONS: AN EMERGING CHALLENGE FOR MALARIA RAPID DIAGNOSTIC TESTS

2019 ◽  
Vol 4 (Suppl 3) ◽  
pp. A25.2-A25
Author(s):  
Hilda Echelibe ◽  
Masumbe Netongo Palmer ◽  
Nji Akindeh ◽  
Wilfred Mbacham
Keyword(s):  
Plasmodium Falciparum ◽  
Schistosoma Mansoni ◽  
Diagnostic Tests ◽  
False Negative ◽  
Rapid Diagnostic Tests ◽  
Sub Saharan Africa ◽  
P Value ◽  
Gene Deletions ◽  
Malaria Rdts ◽  
Malaria Rapid Diagnostic Tests

BackgroundMalaria and schistosomiasis are infections that have a great impact in sub-Saharan Africa based on their high morbidity and mortality rates. We suggest the possibility that the microenvironment created from interactions between the parasites involved generates a pressure on the malaria parasite which could in turn favour the parasite’s adaptation or escape through Pfhrp2 gene deletions. Thus, this study aimed at determining the association between the co-infection with both parasites and false-negative PfHRP2-based malaria rapid diagnostic tests which occur because of these deletions.MethodsThis pilot study was conducted in a total of 149 children aged 7–17 years living in Yorro, located in the Mbam-Inoubou division of the Center region of Cameroon. We collected fresh stool samples from each participant to identify Schistosoma mansoni (Sm) eggs by Kato Katz method and blood samples to identify the ring stages of Plasmodium falciparum (Pf) by thick smear. Malaria rapid diagnostic test and Pfhrp2 gene polymerase chain reaction were performed. The association between the co-infection with Sm/Pf and the false-negative malaria RDTs was determined by the Fisher’s exact test. A p value<0.05 was considered statistically significant.ResultsOur results showed that samples were singly infected with Sm, Pf, co-infected (Sm/Pf) and negative for both infections at frequencies of 12%, 43%, 30.2% and 14.8% respectively. False-negative PfHRP2-based RDTs were observed in 4.7% of the participants. A higher frequency (5/7) of the cases with false-negative malaria RDTs were co-infected with Sm/Pf. A p value of 0.027 showed statistical significance in the association of Sm/Pf co-infection and false-negative PfHRP2-based RDTs.ConclusionA significant association of Plasmodium falciparum and Schistosoma mansoni co-infection with false-negative PfHRP2-based RDTs supports the case for a plausible implication of Pfhrp2 gene deletions, with consequences for malaria rapid diagnostic testing.

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