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Use of an HRP2‐based rapid diagnostic test to guide treatment of children admitted to hospital in a malaria‐endemic area of north‐east Tanzania
Author(s) -
Mtove George,
Nadjm Behzad,
Amos Ben,
Hendriksen Ilse C. E.,
Muro Florida,
Reyburn Hugh
Publication year - 2011
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2011.02737.x
Subject(s) - tanzania , malaria , medicine , tropical medicine , diagnosis of malaria , protozoal disease , geography , pediatrics , plasmodium falciparum , immunology , pathology , environmental planning
Summary Objective To compare the performance of the Paracheck™ rapid diagnostic test (RDT) with microscopy for diagnosing malaria in hospitalised children. Methods Children aged between 2 months and 13 years with fever were enrolled in the study over 1 year. A standard clinical history and examination were recorded and blood drawn for culture, complete blood count, Paracheck™ RDT and double‐read blood slide. Results Of 3639 children enrolled, 2195 (60.3%) were slide positive. The sensitivity and specificity of Paracheck were 97.5% (95% CI 96.9–98.0) and 65.3% (95% CI 63.8–66.9), respectively. There was an inverse relationship between age‐specific prevalence of parasitaemia and Paracheck specificity. In logistic regression model, false‐positive Paracheck results were significantly associated with pre‐admission use of antimalarial drug (OR 1.44, 95% CI 1.16–1.78), absence of current fever (OR 0.64, 95% CI 0.52–0.79) and non‐typhi Salmonella bacteraemia (OR 3.89. 95% CI 2.27–6.63). In spite of high sensitivity, 56/2195 (2.6%) of true infections were Paracheck negative and 8/56 (14.3%) were in patients with >50 000 parasites/μl. Conclusions Paracheck had poor specificity in diagnosing malaria in severely ill children; this was likely to be due to HRP2 persistence following recent parasite clearance. The combination of positive Paracheck and negative blood slide results identified a group of children at high risk of non‐typhi Salmonella infection. While Paracheck was highly sensitive, some high‐density infections were missed. For children with severe febrile illness, at least two reliable negative parasitological test results should be available to justify withholding antimalarial treatment; the optimal choice of these has yet to be identified.