Abstract：
BACKGROUND: Malaria has been identified as a significant public health burden, exhibiting a high risk of death and morbidity. In sub-Saharan Africa, most young children attending primary healthcare facilities are commonly diagnosed with malaria. Thus, introduction of malaria rapid diagnostic test (mRDT) kits and effective antimalarials has substantially improved the management of malaria cases. However, healthcare worker confidence and adherence to procedures dependent on malaria test results remain variable in high-burden settings due to lacking alternative point-of-care tests to diagnose other causes of fever. In this study, we compared the results of malaria screenings using mRDT and microscopy in febrile children presenting at a primary health facility.
METHODS: This study was conducted at a primary health center in Owo, Ondo State, Nigeria. Children with fever were assessed for malaria by health staff and, where indicated, screened using Plasmodium falciparum histidine-rich protein-2 mRDT kits. Blood samples were collected on slides for microscopy and in hematocrit tubes for hematocrit determination simultaneously, whereas the mRDT test was done by routine health staff. Children found positive for malaria via mRDT were diagnosed as uncomplicated malaria cases and treated as outpatients using artemether-lumefantrine. Blood slides were read independently by two trained microscopists blinded to the mRDT results. The parasite densities were defined as average counts by both microscopists. We then assessed the sensitivity, specificity, and predictive value of mRDT for the diagnosis of malaria.
RESULTS: We compared the test results of 250 febrile children who are under 15 years old. The test positivity rates were 93.6% (234/250) and 97.2% (243/250) using microscopy and rapid RDTs, respectively. The sensitivity and specificity of mRDT compared to microscopy were 100.0% and 43.8%, respectively, with a positive predictive value of 96.3% (95% CI 93.1-98.3). The hematocrit value was <30% in 64% of the children.
CONCLUSIONS: As per our findings, mRDTs have correctly detected infections in febrile children. Healthcare workers and caregivers should be encouraged to act in accordance with the test results by means of regular feedback on the quality of mRDTs in use in malaria case management.
METHODS: This study was conducted at a primary health center in Owo, Ondo State, Nigeria. Children with fever were assessed for malaria by health staff and, where indicated, screened using Plasmodium falciparum histidine-rich protein-2 mRDT kits. Blood samples were collected on slides for microscopy and in hematocrit tubes for hematocrit determination simultaneously, whereas the mRDT test was done by routine health staff. Children found positive for malaria via mRDT were diagnosed as uncomplicated malaria cases and treated as outpatients using artemether-lumefantrine. Blood slides were read independently by two trained microscopists blinded to the mRDT results. The parasite densities were defined as average counts by both microscopists. We then assessed the sensitivity, specificity, and predictive value of mRDT for the diagnosis of malaria.
RESULTS: We compared the test results of 250 febrile children who are under 15 years old. The test positivity rates were 93.6% (234/250) and 97.2% (243/250) using microscopy and rapid RDTs, respectively. The sensitivity and specificity of mRDT compared to microscopy were 100.0% and 43.8%, respectively, with a positive predictive value of 96.3% (95% CI 93.1-98.3). The hematocrit value was <30% in 64% of the children.
CONCLUSIONS: As per our findings, mRDTs have correctly detected infections in febrile children. Healthcare workers and caregivers should be encouraged to act in accordance with the test results by means of regular feedback on the quality of mRDTs in use in malaria case management.
摘要：
背景：疟疾已被确定为重大的公共卫生负担，表现出很高的死亡和发病风险。在撒哈拉以南非洲，大多数在初级医疗机构就诊的幼儿通常被诊断为疟疾。因此，疟疾快速诊断测试（mRDT）试剂盒和有效的抗疟药物的引入大大改善了疟疾病例的管理。然而,在高负担环境中,医护人员对依赖于疟疾检测结果的程序的信心和依从性仍然存在差异,因为缺乏诊断其他发热原因的替代即时检测.在这项研究中,我们比较了在初级医疗机构就诊的发热儿童中使用mRDT和显微镜进行疟疾筛查的结果.
方法：这项研究是在Owo的初级保健中心进行的，OndoState,尼日利亚。医护人员对发烧儿童进行了疟疾评估，在指示的地方，使用恶性疟原虫富含组氨酸的蛋白2mRDT试剂盒进行筛选。将血液样本收集在载玻片上进行显微镜检查，并同时收集在血细胞比容管中进行血细胞比容测定。而mRDT测试是由常规卫生人员完成的。通过mRDT发现疟疾阳性的儿童被诊断为无并发症的疟疾病例，并使用蒿甲醚-lumefantrine作为门诊患者进行治疗。由两名对mRDT结果不知情的受过训练的显微镜员独立地读取血片。寄生虫密度被定义为平均计数由两个显微镜。然后我们评估了敏感度，特异性，mRDT对疟疾诊断的预测价值。
结果：我们比较了250名15岁以下发热儿童的测试结果。使用显微镜和快速RDT的测试阳性率分别为93.6％（234/250）和97.2％（243/250），分别。mRDT相对于显微镜的敏感性和特异性分别为100.0%和43.8%,分别,阳性预测值为96.3%（95%CI93.1-98.3）。64%的儿童血细胞比容值<30%。
结论：根据我们的发现，mRDT已正确检测到发热儿童的感染。应鼓励医疗保健工作者和护理人员根据测试结果采取行动，定期反馈疟疾病例管理中使用的mRDT的质量。
方法：这项研究是在Owo的初级保健中心进行的，OndoState,尼日利亚。医护人员对发烧儿童进行了疟疾评估，在指示的地方，使用恶性疟原虫富含组氨酸的蛋白2mRDT试剂盒进行筛选。将血液样本收集在载玻片上进行显微镜检查，并同时收集在血细胞比容管中进行血细胞比容测定。而mRDT测试是由常规卫生人员完成的。通过mRDT发现疟疾阳性的儿童被诊断为无并发症的疟疾病例，并使用蒿甲醚-lumefantrine作为门诊患者进行治疗。由两名对mRDT结果不知情的受过训练的显微镜员独立地读取血片。寄生虫密度被定义为平均计数由两个显微镜。然后我们评估了敏感度，特异性，mRDT对疟疾诊断的预测价值。
结果：我们比较了250名15岁以下发热儿童的测试结果。使用显微镜和快速RDT的测试阳性率分别为93.6％（234/250）和97.2％（243/250），分别。mRDT相对于显微镜的敏感性和特异性分别为100.0%和43.8%,分别,阳性预测值为96.3%（95%CI93.1-98.3）。64%的儿童血细胞比容值<30%。
结论：根据我们的发现，mRDT已正确检测到发热儿童的感染。应鼓励医疗保健工作者和护理人员根据测试结果采取行动，定期反馈疟疾病例管理中使用的mRDT的质量。
