How did a malaria rapid test compare with microscopy?

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Background: Rapid diagnostic tests offer an alternative to microscopy for diagnosing malaria in rural settings, but their performance has been inconsistent. Manufacturing, transport and storage, the level of parasites in the blood, and the skills of the person performing the test might affect performance. The researchers said periodic evaluation of local field performance is necessary so that declines can be corrected early.

Methods: This facility-based cross-sectional study was conducted from January to May 2020 among 257 patients with suspected malaria attending selected health centers in Bahir Dar Zuria district. Capillary blood from each participant was tested for Plasmodium infection using a CareStart™ rapid diagnostic test kit and thin and thick blood film microscopy. The data were analyzed using Statistical Software for Social Sciences version 20 and MedCalc version 19.3. Sensitivity, specificity, positive and negative predictive values, and kappa were calculated to assess the rapid test against microscopy.

Results: Of the 257 participants, 47 (18.3%) tested positive for Plasmodium infection by at least one method. The rapid test produced 3 false-positive and 3 false-negative results. The CareStart Malaria Pf/Pv Combo test had a sensitivity of 93.2% and a specificity of 98.6%, with a kappa value of 0.918.

Conclusion: The researchers concluded that the CareStart™ rapid diagnostic test had comparable performance to microscopy for diagnosing malaria. They recommended continued use of the CareStart Malaria Pf/Pv Combo test at health posts in Ethiopia where microscopy is unavailable.