Diagnostic Performance of Malaria Rapid Diagnostic Test and Microscopy Compared with PCR for Detection of Plasmodium falciparum Infections among Primary Schoolchildren in Kibiti District, Eastern Tanzania: An Area with Moderate Malaria Transmission

A substantial decline of malaria transmission intensity has been observed in sub-Saharan Africa over the past two decades and may affect the diagnostic performance of malaria rapid diagnostic test (mRDT) and microscopy. Diagnostic performance of histidine-rich protein II (HRP-II)/pan-lactate dehydrogenase (pLDH)-based mRDT and microscopy was evaluated against polymerase chain reaction (PCR) for the diagnosis of Plasmodium falciparum infection among 316 primary schoolchildren in Kibiti district, in 2016. Polymerase chain reaction detected more cases of P. falciparum infection than mRDT or microscopy. Using PCR as reference, the sensitivity and specificity of mRDT were 75.9% (95% CI = 62.8-86.1) and 96.9% (95% CI = 94.0-98.7), respectively, whereas that of microscopy were 63.8% (95% CI = 50.1-76.0) and 95.7% (95% CI = 92.5-97.9), respectively. Polymerase chain reaction and other molecular methods should be considered for use in schools and other epidemiological surveys as supplement to mRDT or microscopy.