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Performance of HRP2-based rapid test in children attending the health centre compared to asymptomatic children in the community.

Ilombe G, Maketa V, Mavoko HM, da Luz RI, Lutumba P, Van geertruyden JP - Malar. J. (2014)

Bottom Line: RDTs and microscopy were concordant in 84.3% and 83.4% children in the health centre and at the community level, respectively.The sensitivity was high (>95%), but the specificity was too low and lower in the community (66.9%; 95%CI: 58.5-75.2) compared to the HC (79.4%; 95%CI: 75.7-83.2).The estimated parasitic threshold of 5,414 parasites/μl was with a sensitivity of 63.3% and a specificity of 71.8% not very discriminative, and thus not a threshold.

View Article: PubMed Central - PubMed

Affiliation: Clinical Pharmacology Unit, University of Kinshasa, Kinshasa, Democratic Republic of Congo. gillonilombe@yahoo.fr.

ABSTRACT

Background: The Democratic Republic of the Congo (DRC) is one of the five countries carrying half of global malaria burden with children 0-5 years old being most at risk. Rapid diagnostic tests (RDTs) are currently routinely used for the detection of Plasmodium infection in health centres and may be a useful tool for population-based survey.

Methods: This study assessed, in a stable transmission zone of Kinshasa, whether a HRP2-based RDT matches the selection criteria of the National Malaria Control Programme (NMCP), DRC and assessed the most relevant fever threshold in this context.

Results: RDTs and microscopy were concordant in 84.3% and 83.4% children in the health centre and at the community level, respectively. The sensitivity was high (>95%), but the specificity was too low and lower in the community (66.9%; 95%CI: 58.5-75.2) compared to the HC (79.4%; 95%CI: 75.7-83.2). The estimated parasitic threshold of 5,414 parasites/μl was with a sensitivity of 63.3% and a specificity of 71.8% not very discriminative, and thus not a threshold.

Conclusion: HRP-based RDT gives a satisfactory proxy to estimate and monitor malaria endemicity, but the low specificity, far below the selection criteria of the NMCP, DRC is problematic for use in a clinical setting.

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ROC curve to assess the fever parasitaemia threshold in children in Kinshasa, RDC, 2012–3.
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Fig4: ROC curve to assess the fever parasitaemia threshold in children in Kinshasa, RDC, 2012–3.

Mentions: The children were categorized as symptomatic when attending the HC and at the community level they were categorized as asymptomatic. ROC analysis estimated 5,218 parasites/μl to be the discriminating cut-off. This cut off point had a sensitivity and specificity of 64% and 70% respectively, and the area under the curve was 0.70 (Figure 3). Some children in the community presented fever although medical assistance was not sought. History of fever was consequently included into a model to enhance the discriminatory power of the cut-off value. The cut-off to distinguish children with history of fever from those without was 5414 parasites/μl. This cut-off point was similar to the previous one with a sensitivity and specificity of 63% and 70% respectively with the area under the curve being 0.70 (Figure 4).Figure 2


Performance of HRP2-based rapid test in children attending the health centre compared to asymptomatic children in the community.

Ilombe G, Maketa V, Mavoko HM, da Luz RI, Lutumba P, Van geertruyden JP - Malar. J. (2014)

ROC curve to assess the fever parasitaemia threshold in children in Kinshasa, RDC, 2012–3.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4248466&req=5

Fig4: ROC curve to assess the fever parasitaemia threshold in children in Kinshasa, RDC, 2012–3.
Mentions: The children were categorized as symptomatic when attending the HC and at the community level they were categorized as asymptomatic. ROC analysis estimated 5,218 parasites/μl to be the discriminating cut-off. This cut off point had a sensitivity and specificity of 64% and 70% respectively, and the area under the curve was 0.70 (Figure 3). Some children in the community presented fever although medical assistance was not sought. History of fever was consequently included into a model to enhance the discriminatory power of the cut-off value. The cut-off to distinguish children with history of fever from those without was 5414 parasites/μl. This cut-off point was similar to the previous one with a sensitivity and specificity of 63% and 70% respectively with the area under the curve being 0.70 (Figure 4).Figure 2

Bottom Line: RDTs and microscopy were concordant in 84.3% and 83.4% children in the health centre and at the community level, respectively.The sensitivity was high (>95%), but the specificity was too low and lower in the community (66.9%; 95%CI: 58.5-75.2) compared to the HC (79.4%; 95%CI: 75.7-83.2).The estimated parasitic threshold of 5,414 parasites/μl was with a sensitivity of 63.3% and a specificity of 71.8% not very discriminative, and thus not a threshold.

View Article: PubMed Central - PubMed

Affiliation: Clinical Pharmacology Unit, University of Kinshasa, Kinshasa, Democratic Republic of Congo. gillonilombe@yahoo.fr.

ABSTRACT

Background: The Democratic Republic of the Congo (DRC) is one of the five countries carrying half of global malaria burden with children 0-5 years old being most at risk. Rapid diagnostic tests (RDTs) are currently routinely used for the detection of Plasmodium infection in health centres and may be a useful tool for population-based survey.

Methods: This study assessed, in a stable transmission zone of Kinshasa, whether a HRP2-based RDT matches the selection criteria of the National Malaria Control Programme (NMCP), DRC and assessed the most relevant fever threshold in this context.

Results: RDTs and microscopy were concordant in 84.3% and 83.4% children in the health centre and at the community level, respectively. The sensitivity was high (>95%), but the specificity was too low and lower in the community (66.9%; 95%CI: 58.5-75.2) compared to the HC (79.4%; 95%CI: 75.7-83.2). The estimated parasitic threshold of 5,414 parasites/μl was with a sensitivity of 63.3% and a specificity of 71.8% not very discriminative, and thus not a threshold.

Conclusion: HRP-based RDT gives a satisfactory proxy to estimate and monitor malaria endemicity, but the low specificity, far below the selection criteria of the NMCP, DRC is problematic for use in a clinical setting.

Show MeSH
Related in: MedlinePlus