Author's details
Reviewer's details
Malaria Rapid Diagnostic Test (mRDT): An Alternative and Effective Diagnostic Tool for Malaria case Management in Low Resource Clinical settings
Malaria is one of the leading public health problems that causes significant morbidity and mortality, especially in Sub-Saharan Africa. It is caused by Plasmodium species which is transmitted through the bite of an infected female Anopheles mosquito. To date, six different plasmodium species are known to cause illness in human, namely: Plasmodium falciparum, P. vivax, P. ovale and P. malaria; then the simian malaria species – P. knowlesi and P. simium. P. falciparum is the dominant specie responsible for more than 95% of cases of clinical malaria in Nigeria. According to the World Health Organization (WHO), an estimated 263 million cases of malaria were reported in the year 2023, resulting in about 600,000 deaths. Additionally, approximately 95% of all malaria cases and death occurs in Sub-Saharan Africa.
In the 2010 malaria guideline, the WHO recommended that parasitological confirmation of malaria infection should be done prior to treatment with Artemisinin based Combination Therapy (ACT). The forms of parasitological diagnosis of malaria infection are: blood smear microscopy, Polymerase Chain Reaction (PCR) and malaria Rapid Diagnostic Test (mRDT). Blood smear microscopy which is the gold standard, requires experienced laboratory technicians with training and technical expertise, high quality equipment & reagents and electrivity. These may not be readily available in many low resource clinical settings, as studies have shown that many health facilities in malaria endemic region lack the capacity to perform clinical microscopy; thus making accurate diagnosis unfeasible.6-8 PCR on the hand is an expensive and more complex method which is used mostly in research laboratories. Therefore, the WHO recommends RDTs as a good alternative method for malaria diagnosis in the absence of well-trained technician, equipment and electricity in many areas of Sub-Saharan Africa.
Most widely used RDTs for malaria are based on the detection of parasite histidine-rich protein II (HRP2) in addition to Plasmodium LDH by the parasite during the erythrocyte cycle. Although mRDTs have a high sensitivity of approximately 100 parasites/ʯl of blood and a high specificity of 90% when compared to microscopy; its major constraints are false positives (because HRP2 persists in the blood for several days after infection clearance) and false negatives (at lower parasite density of <100 parasites/ʯl of blood).
This case shows the efficacy of mRDT in malaria diagnosis. It has proven to be an effective alternative to malaria microscopy9, especially in low-resource clinical settings as obtained in Sub-Saharan Africa; Nigeria inclusive. It detects P. falciparum infection which is the cause of more than 95% of cases of malaria infection in Nigeria. Additionally, findings have shown that mRDT correctly detected malaria infection in febrile children in Nigeria, with a Positive Predictive Value (PPV) of 96.3%.9 This reduces misdiagnosis, which leads to effective treatment and improved patient outcomes.
Malaria RDT provides rapid and accurate result which leads to prompt and effective management of malaria; thereby reducing morbidity and mortality particularly in low-resource clinical setting.
I.K, a four-year-old boy was brought to the clinic by his mother on account of symptoms of fever of three-days duration. There was associated chills and reduced appetite. A mRDT was performed and the result was positive. Other ancillary investigations were normal. Based on the test result, I.K was treated as a case of uncomplicated malaria with Artemisinin-based Combination Therapy (ACT) according to national guideline. I.K had significant improvement in his health when seen at follow-up clinic within 24hours after commencement of therapy; and was discharged from the clinic after three days.
Malaria Rapid Diagnostic Test.
- Boyce MR, O’Meara WP. Use of Malaria RDTs in various health contexts across Sub-Saharan Africa: a systematic review. BMC Public Health. 2017; 17(470): 1-15 DOI 10.1186/s12889-017-4398-1
- Mukkala A.N, Kwan J, Lau R, Harris D, Kain D, Boggild A.K. An update on Malaria Rapid Diagnostic Tests. Current Infectious Disease Reports. 2018;20(49): 48-55
- Oriero E.C, Olukosi A.Y, Oduwole O.A, Djimbe A, D’Alessandro U, Meremikwu M.M, Amanibua-Ngwa A. Sero-prevalence and parasite rates of Plasmodium malaria in High Malaria Transmission setting of Southern Nigeria. Am J Trop Med Hyg. 2020;103(6): 2208-16.
- World Health Organization. World Malaria Report 2024. Available from https: //www.who.int/team/global. [Accessed March 2025]
- World Health Organization (WHO). Guidelines for the treatment of malaria. 2nd ed. Geneva. WHO 2010.
- Wafula R, Sang E, Cheruiyot O, Aboto A, Menya D, Prudhomme O’Meara W. High Sensitivity and Specificity of Clinical microscopy in rural health facilities in Western Kenya under an external quality assurance program. Am J Trop Med Hyg. 2014; 91: 481-5
- Makanjuola R.O, Taylor-Robinson W. Improving Accuracy of Malaria Diagnosis in Underserved Rural and Remote Endemic Areas of Sub-Saharan Africa: A call to Develop MultiplexingRapid Diagnostic Tests. Scientifica. 2020. Available from: htpps://onlinelibrarywiley.com/doi/10.1155/2020/3901409. [Accessed March 2025]
- Berzosa P, Lucio A.D, Barja M.R, Herrador Z, Gonzalez V, Garcia L, et al. Comparison of three diagnostic methods (microscopy, RDT & PCR) for the detection of malaria parasites in representative samples from Equitorial Guinea. Malar J. 2018. 17:333. Available from: https://doi.org/10.1186/s12936-018-2481-4. [Accessed March 2025]
- Odeniyi O.M, Agomo C.O, Okangba C.C, Olaniyan K.O, Oyibo W.A. Comparison of Performance characteristics of two Malaria Rapid Diagnostic tests in detecting malaria infection among febrile patients in urban area of Lagos, Nigeria. Ife J Sci. 2020; 22(2):191-9.
Author's details
Reviewer's details
Malaria Rapid Diagnostic Test (mRDT): An Alternative and Effective Diagnostic Tool for Malaria case Management in Low Resource Clinical settings
Malaria is one of the leading public health problems that causes significant morbidity and mortality, especially in Sub-Saharan Africa. It is caused by Plasmodium species which is transmitted through the bite of an infected female Anopheles mosquito. To date, six different plasmodium species are known to cause illness in human, namely: Plasmodium falciparum, P. vivax, P. ovale and P. malaria; then the simian malaria species – P. knowlesi and P. simium. P. falciparum is the dominant specie responsible for more than 95% of cases of clinical malaria in Nigeria. According to the World Health Organization (WHO), an estimated 263 million cases of malaria were reported in the year 2023, resulting in about 600,000 deaths. Additionally, approximately 95% of all malaria cases and death occurs in Sub-Saharan Africa.
In the 2010 malaria guideline, the WHO recommended that parasitological confirmation of malaria infection should be done prior to treatment with Artemisinin based Combination Therapy (ACT). The forms of parasitological diagnosis of malaria infection are: blood smear microscopy, Polymerase Chain Reaction (PCR) and malaria Rapid Diagnostic Test (mRDT). Blood smear microscopy which is the gold standard, requires experienced laboratory technicians with training and technical expertise, high quality equipment & reagents and electrivity. These may not be readily available in many low resource clinical settings, as studies have shown that many health facilities in malaria endemic region lack the capacity to perform clinical microscopy; thus making accurate diagnosis unfeasible.6-8 PCR on the hand is an expensive and more complex method which is used mostly in research laboratories. Therefore, the WHO recommends RDTs as a good alternative method for malaria diagnosis in the absence of well-trained technician, equipment and electricity in many areas of Sub-Saharan Africa.
Most widely used RDTs for malaria are based on the detection of parasite histidine-rich protein II (HRP2) in addition to Plasmodium LDH by the parasite during the erythrocyte cycle. Although mRDTs have a high sensitivity of approximately 100 parasites/ʯl of blood and a high specificity of 90% when compared to microscopy; its major constraints are false positives (because HRP2 persists in the blood for several days after infection clearance) and false negatives (at lower parasite density of <100 parasites/ʯl of blood).
- Boyce MR, O’Meara WP. Use of Malaria RDTs in various health contexts across Sub-Saharan Africa: a systematic review. BMC Public Health. 2017; 17(470): 1-15 DOI 10.1186/s12889-017-4398-1
- Mukkala A.N, Kwan J, Lau R, Harris D, Kain D, Boggild A.K. An update on Malaria Rapid Diagnostic Tests. Current Infectious Disease Reports. 2018;20(49): 48-55
- Oriero E.C, Olukosi A.Y, Oduwole O.A, Djimbe A, D’Alessandro U, Meremikwu M.M, Amanibua-Ngwa A. Sero-prevalence and parasite rates of Plasmodium malaria in High Malaria Transmission setting of Southern Nigeria. Am J Trop Med Hyg. 2020;103(6): 2208-16.
- World Health Organization. World Malaria Report 2024. Available from https: //www.who.int/team/global. [Accessed March 2025]
- World Health Organization (WHO). Guidelines for the treatment of malaria. 2nd ed. Geneva. WHO 2010.
- Wafula R, Sang E, Cheruiyot O, Aboto A, Menya D, Prudhomme O’Meara W. High Sensitivity and Specificity of Clinical microscopy in rural health facilities in Western Kenya under an external quality assurance program. Am J Trop Med Hyg. 2014; 91: 481-5
- Makanjuola R.O, Taylor-Robinson W. Improving Accuracy of Malaria Diagnosis in Underserved Rural and Remote Endemic Areas of Sub-Saharan Africa: A call to Develop MultiplexingRapid Diagnostic Tests. Scientifica. 2020. Available from: htpps://onlinelibrarywiley.com/doi/10.1155/2020/3901409. [Accessed March 2025]
- Berzosa P, Lucio A.D, Barja M.R, Herrador Z, Gonzalez V, Garcia L, et al. Comparison of three diagnostic methods (microscopy, RDT & PCR) for the detection of malaria parasites in representative samples from Equitorial Guinea. Malar J. 2018. 17:333. Available from: https://doi.org/10.1186/s12936-018-2481-4. [Accessed March 2025]
- Odeniyi O.M, Agomo C.O, Okangba C.C, Olaniyan K.O, Oyibo W.A. Comparison of Performance characteristics of two Malaria Rapid Diagnostic tests in detecting malaria infection among febrile patients in urban area of Lagos, Nigeria. Ife J Sci. 2020; 22(2):191-9.
Content
Author's details
Reviewer's details
Malaria Rapid Diagnostic Test (mRDT): An Alternative and Effective Diagnostic Tool for Malaria case Management in Low Resource Clinical settings
Background
Malaria is one of the leading public health problems that causes significant morbidity and mortality, especially in Sub-Saharan Africa. It is caused by Plasmodium species which is transmitted through the bite of an infected female Anopheles mosquito. To date, six different plasmodium species are known to cause illness in human, namely: Plasmodium falciparum, P. vivax, P. ovale and P. malaria; then the simian malaria species – P. knowlesi and P. simium. P. falciparum is the dominant specie responsible for more than 95% of cases of clinical malaria in Nigeria. According to the World Health Organization (WHO), an estimated 263 million cases of malaria were reported in the year 2023, resulting in about 600,000 deaths. Additionally, approximately 95% of all malaria cases and death occurs in Sub-Saharan Africa.
In the 2010 malaria guideline, the WHO recommended that parasitological confirmation of malaria infection should be done prior to treatment with Artemisinin based Combination Therapy (ACT). The forms of parasitological diagnosis of malaria infection are: blood smear microscopy, Polymerase Chain Reaction (PCR) and malaria Rapid Diagnostic Test (mRDT). Blood smear microscopy which is the gold standard, requires experienced laboratory technicians with training and technical expertise, high quality equipment & reagents and electrivity. These may not be readily available in many low resource clinical settings, as studies have shown that many health facilities in malaria endemic region lack the capacity to perform clinical microscopy; thus making accurate diagnosis unfeasible.6-8 PCR on the hand is an expensive and more complex method which is used mostly in research laboratories. Therefore, the WHO recommends RDTs as a good alternative method for malaria diagnosis in the absence of well-trained technician, equipment and electricity in many areas of Sub-Saharan Africa.
Most widely used RDTs for malaria are based on the detection of parasite histidine-rich protein II (HRP2) in addition to Plasmodium LDH by the parasite during the erythrocyte cycle. Although mRDTs have a high sensitivity of approximately 100 parasites/ʯl of blood and a high specificity of 90% when compared to microscopy; its major constraints are false positives (because HRP2 persists in the blood for several days after infection clearance) and false negatives (at lower parasite density of <100 parasites/ʯl of blood).
Further readings
- Boyce MR, O’Meara WP. Use of Malaria RDTs in various health contexts across Sub-Saharan Africa: a systematic review. BMC Public Health. 2017; 17(470): 1-15 DOI 10.1186/s12889-017-4398-1
- Mukkala A.N, Kwan J, Lau R, Harris D, Kain D, Boggild A.K. An update on Malaria Rapid Diagnostic Tests. Current Infectious Disease Reports. 2018;20(49): 48-55
- Oriero E.C, Olukosi A.Y, Oduwole O.A, Djimbe A, D’Alessandro U, Meremikwu M.M, Amanibua-Ngwa A. Sero-prevalence and parasite rates of Plasmodium malaria in High Malaria Transmission setting of Southern Nigeria. Am J Trop Med Hyg. 2020;103(6): 2208-16.
- World Health Organization. World Malaria Report 2024. Available from https: //www.who.int/team/global. [Accessed March 2025]
- World Health Organization (WHO). Guidelines for the treatment of malaria. 2nd ed. Geneva. WHO 2010.
- Wafula R, Sang E, Cheruiyot O, Aboto A, Menya D, Prudhomme O’Meara W. High Sensitivity and Specificity of Clinical microscopy in rural health facilities in Western Kenya under an external quality assurance program. Am J Trop Med Hyg. 2014; 91: 481-5
- Makanjuola R.O, Taylor-Robinson W. Improving Accuracy of Malaria Diagnosis in Underserved Rural and Remote Endemic Areas of Sub-Saharan Africa: A call to Develop MultiplexingRapid Diagnostic Tests. Scientifica. 2020. Available from: htpps://onlinelibrarywiley.com/doi/10.1155/2020/3901409. [Accessed March 2025]
- Berzosa P, Lucio A.D, Barja M.R, Herrador Z, Gonzalez V, Garcia L, et al. Comparison of three diagnostic methods (microscopy, RDT & PCR) for the detection of malaria parasites in representative samples from Equitorial Guinea. Malar J. 2018. 17:333. Available from: https://doi.org/10.1186/s12936-018-2481-4. [Accessed March 2025]
- Odeniyi O.M, Agomo C.O, Okangba C.C, Olaniyan K.O, Oyibo W.A. Comparison of Performance characteristics of two Malaria Rapid Diagnostic tests in detecting malaria infection among febrile patients in urban area of Lagos, Nigeria. Ife J Sci. 2020; 22(2):191-9.
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