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Background  The literature data on malaria in Western Kasai, DRC, are limited and inadequate. A recent molecular survey there has detected  Plasmodium ovale  and  Plasmodium malariae  as mixed infections with  Plasmodium falciparum . In Tshimbulu, Western Kasai, during a humanitarian initiative designed to provide children with free preventive screening and to reduce the local high malaria death rate, accurate species identification was performed, in order to collect unambiguous epidemiological data and to evaluate the reliability of locally applied diagnostics.    Methods  Finger pricks provided fresh blood for microscopic analysis (MA), for rapid diagnostic test (RDT) and for molecular diagnostics (MD). MA and RDT were first performed by the local team and then a re-interpretation of the results (on the same slides and on RDT’s taken pictures) was conducted in Italy, where MD were performed.    Results  The analysis was conducted on 306 children; RDT found 80.9 % as  P. falciparum -positive (37.4 % as two-band positive,  P. falciparum  single infection). MA identified a further four children as positive to  P. falciparum  and six co-infections with  P. ovale.  The second RDT evaluation confirmed a similar infection rate (78.2 %) but interpreted as two-band positive a significantly higher share of tests (56.8 %). MA confirmed 80.0 % of the children as malaria positive and, in addition to  P. falciparum , identified  P. malariae  (13.8 %),  P. vivax  (3.4 %) and  P. ovale  (2.4 %), and detected  Babesia microti  in 19 smears. MD confirmed all of the species found ( Babesia microti  included), classified as mono-infection with  P. falciparum  a rate of spots comparable to MA revision, and identified all  P. ovale  as  Plasmodium ovale wallikeri . The RDT used locally proved 93.1 % sensitive and 92.1 % specific for  P. falciparum .    Conclusions  The malaria prevalence among the children and the presence of four  Plasmodium  species, highlighted in this study, identified a sanitary issue which proved to be more alarming than expected, as it was worsened by the unpredictable presence of  P. vivax  and  Babesia microti  (never before reported in DRC). Each diagnostic tool showed its point of weakness. Therefore, the most correct approach is by the combined use of different, locally available, diagnostic tools.

malaria journal

Malaria in children of Tshimbulu (Western Kasai, Democratic Republic of the Congo): epidemiological data and accuracy of diagnostic assays applied in a limited resource setting