Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Malaria Journal
Published in: Malaria Journal 1/2010

Open Access 01-12-2010 | Research

Use of HRP-2-based rapid diagnostic test for Plasmodium falciparum malaria: assessing accuracy and cost-effectiveness in the villages of Dielmo and Ndiop, Senegal

Authors: Alioune Badara Ly, Adama Tall, Robert Perry, Laurence Baril, Abdoulaye Badiane, Joseph Faye, Christophe Rogier, Aissatou Touré, Cheikh Sokhna, Jean-François Trape, Rémy Michel

Published in: Malaria Journal | Issue 1/2010

Login to get access

Abstract

Background

In 2006, the Senegalese National Malaria Control Programme (NMCP) has recommended artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated malaria and, in 2007, mandated testing for all suspected cases of malaria with a Plasmodium falciparum HRP-2-based rapid diagnostic test for malaria (RDT(Paracheck®). Given the higher cost of ACT compared to earlier anti-malarials, the objectives of the present study were i) to study the accuracy of Paracheck® compared to the thick blood smear (TBS) in two areas with different levels of malaria endemicity and ii) analyse the cost-effectiveness of the strategy of the parasitological confirmation of clinically suspected malaria cases management recommended by the NMCP.

Methods

A cross-sectional study was undertaken in the villages of Dielmo and Ndiop (Senegal) nested in a cohort study of about 800 inhabitants. For all the individuals consulting between October 2008 and January 2009 with a clinical diagnosis of malaria, a questionnaire was filled and finger-prick blood samples were taken both for microscopic examination and RDT. The estimated costs and cost-effectiveness analysis were made considering five scenarios, the recommendations of the NMCP being the reference scenario. In addition, a sensitivity analysis was performed assuming that all the RDT-positive patients and 50% of RDT-negative patients were treated with ACT.

Results

A total of 189 consultations for clinically suspected malaria occurred during the study period. The sensitivity, specificity, positive and negative predictive values were respectively 100%, 98.3%, 80.0% and 100%. The estimated cost of the reference scenario was close to 700€ per 1000 episodes of illness, approximately twice as expensive as most of the other scenarios. Nevertheless, it appeared to us cost-effective while ensuring the diagnosis and the treatment of 100% of malaria attacks and an adequate management of 98.4% of episodes of illness. The present study also demonstrated that full compliance of health care providers with RDT results was required in order to avoid severe incremental costs.

Conclusions

A rational use of ACT requires laboratory testing of all patients presenting with presumed malaria. Use of RDTs inevitably has incremental costs, but the strategy associating RDT use for all clinically suspected malaria and prescribing ACT only to patients tested positive is cost-effective in areas where microscopy is unavailable.
Appendix
Available only for authorised users
Literature
1.
2.
Snow RW, Guerra CA, Noor AM, Myint HY, Hay SI: The global distribution of clinical episodes of Plasmodium falciparum malaria. Nature. 2005, 434: 214-217. 10.1038/nature03342.PubMedCentralCrossRefPubMed
3.
Trape JF, Pison G, Spiegel A, Enel C, Rogier C: Combating malaria in Africa. Trends Parasitol. 2002, 18: 224-230. 10.1016/S1471-4922(02)02249-3.CrossRefPubMed
4.
5.
Ogbonna A, Uneke CJ: Artemisinin-based combination therapy for uncomplicated malaria in sub-Saharan Africa: the efficacy, safety, resistance and policy implementation since Abuja 2000. Trans R Soc Trop Med Hyg. 2008, 102: 621-627. 10.1016/j.trstmh.2008.03.024.CrossRefPubMed
6.
World Health Organization: New perspectives in malaria diagnosis. WHO/MAL/2000.1091. Book New perspectives in malaria diagnosis. WHO/MAL/2000.1091.
7.
Gatti S, Gramegna M, Bisoffi Z, Raglio A, Gulletta M, Klersy C, Bruno A, Maserati R, Madama S, Scaglia M: A comparison of three diagnostic techniques for malaria: a rapid diagnostic test (NOW Malaria), PCR and microscopy. Ann Trop Med Parasitol. 2007, 101: 195-204. 10.1179/136485907X156997.CrossRefPubMed
8.
Abeku TA, Kristan M, Jones C, Beard J, Mueller DH, Okia M, Rapuoda B, Greenwood B, Cox J: Determinants of the accuracy of rapid diagnostic tests in malaria case management: evidence from low and moderate transmission settings in the East African highlands. Malar J. 2008, 7: 202-10.1186/1475-2875-7-202.PubMedCentralCrossRefPubMed
9.
Hopkins H, Kambale W, Kamya MR, Staedke SG, Dorsey G, Rosenthal PJ: Comparison of HRP2- and pLDH-based rapid diagnostic tests for malaria with longitudinal follow-up in Kampala, Uganda. Am J Trop Med Hyg. 2007, 76: 1092-1097.PubMed
10.
McCutchan TF, Piper RC, Makler MT: Use of malaria rapid diagnostic test to identify Plasmodium knowlesi infection. Emerg Infect Dis. 2008, 14: 1750-1752.PubMedCentralCrossRefPubMed
11.
Piper R, Lebras J, Wentworth L, Hunt-Cooke A, Houze S, Chiodini P, Makler M: Immunocapture diagnostic assays for malaria using Plasmodium lactate dehydrogenase (pLDH). Am J Trop Med Hyg. 1999, 60: 109-118.PubMed
12.
13.
Gaye O, Diouf M, Dansokho EF, McLaughlin G, Diallo S: Diagnosis of Plasmodium falciparum malaria using ParaSight F, ICT malaria PF and malaria IgG CELISA assays. Parasite. 1998, 5: 189-192.CrossRefPubMed
14.
Kiszewski A, Johns B, Schapira A, Delacollette C, Crowell V, Tan-Torres T, Ameneshewa B, Teklehaimanot A, Nafo-Traore F: Estimated global resources needed to attain international malaria control goals. Bull World Health Organ. 2007, 85: 623-630. 10.2471/BLT.06.039529.PubMedCentralCrossRefPubMed
15.
Dondorp AM, Nosten F, Yi P, Das D, Phyo AP, Tarning J, Lwin KM, Ariey F, Hanpithakpong W, Lee SJ, Ringwald P, Silamut K, Imwong M, Chotivanich K, Lim P, Herdman T, An SS, Yeung S, Singhasivanon P, Day NP, Lindegardh N, Socheat D, White NJ: Artemisinin resistance in Plasmodium falciparum malaria. N Engl J Med. 2009, 361: 455-467. 10.1056/NEJMoa0808859.PubMedCentralCrossRefPubMed
16.
Carrara VI, Zwang J, Ashley EA, Price RN, Stepniewska K, Barends M, Brockman A, Anderson T, McGready R, Phaiphun L, Proux S, van Vugt M, Hutagalung R, Lwin KM, Phyo AP, Preechapornkul P, Imwong M, Pukrittayakamee S, Singhasivanon P, White NJ, Nosten F: Changes in the treatment responses to artesunate-mefloquine on the northwestern border of Thailand during 13 years of continuous deployment. PLoS One. 2009, 4: e4551-10.1371/journal.pone.0004551.PubMedCentralCrossRefPubMed
17.
Noedl H, Socheat D, Satimai W: Artemisinin-resistant malaria in Asia. N Engl J Med. 2009, 361: 540-541. 10.1056/NEJMc0900231.CrossRefPubMed
18.
Trape JF, Rogier C, Konate L, Diagne N, Bouganali H, Canque B, Legros F, Badji A, Ndiaye G, Ndiaye P, Brahimi K, Faye O, druihle P, da Silva LP: The Dielmo project: a longitudinal study of natural malaria infection and the mechanisms of protective immunity in a community living in a holoendemic area of Senegal. Am J Trop Med Hyg. 1994, 51: 123-137.PubMed
19.
Fontenille D, Lochouarn L, Diagne N, Sokhna C, Lemasson JJ, Diatta M, Konate L, Faye F, Rogier C, Trape JF: High annual and seasonal variations in malaria transmission by anophelines and vector species composition in Dielmo, a holoendemic area in Senegal. Am J Trop Med Hyg. 1997, 56: 247-253.PubMed
20.
Fontenille D, Lochouarn L, Diatta M, Sokhna C, Dia I, Diagne N, Lemasson JJ, Ba K, Tall A, Rogier C, Trape JF: Four years' entomological study of the transmission of seasonal malaria in Senegal and the bionomics of Anopheles gambiae and A. arabiensis. Trans R Soc Trop Med Hyg. 1997, 91: 647-652. 10.1016/S0035-9203(97)90506-X.CrossRefPubMed
21.
Trape JF: Rapid evaluation of malaria parasite density and standardization of thick smear examination for epidemiological investigations. Trans R Soc Trop Med Hyg. 1985, 79: 181-184. 10.1016/0035-9203(85)90329-3.CrossRefPubMed
22.
World Health Organization: Assessment and monitoring of antimalarial drug efficacy for the treatment of uncomplicated falciparum malaria. Geneva, WHO/HTM/RBM/2003.50
23.
Willcox ML, Sanogo F, Graz B, Forster M, Dakouo F, Sidibe O, Falquet J, Giani S, Diakite C, Diallo D: Rapid diagnostic tests for the home-based management of malaria, in a high-transmission area. Ann Trop Med Parasitol. 2009, 103: 3-16. 10.1179/136485909X384983.CrossRefPubMed
24.
Lubell Y, Reyburn H, Mbakilwa H, Mwangi R, Chonya K, Whitty CJ, Mills A: The cost-effectiveness of parasitologic diagnosis for malaria-suspected patients in an era of combination therapy. Am J Trop Med Hyg. 2007, 77: 128-132.PubMed
25.
Shillcutt S, Morel C, Goodman C, Coleman P, Bell D, Whitty CJ, Mills A: Cost-effectiveness of malaria diagnostic methods in sub-Saharan Africa in an era of combination therapy. Bull World Health Organ. 2008, 86: 101-110. 10.2471/BLT.07.042259.PubMedCentralCrossRefPubMed
26.
Uzochukwu BS, Obikeze EN, Onwujekwe OE, Onoka CA, Griffiths UK: Cost-effectiveness analysis of rapid diagnostic test, microscopy and syndromic approach in the diagnosis of malaria in Nigeria: implications for scaling-up deployment of ACT. Malar J. 2009, 8: 265-10.1186/1475-2875-8-265.PubMedCentralCrossRefPubMed
27.
Rolland E, Checchi F, Pinoges L, Balkan S, Guthmann JP, Guerin PJ: Operational response to malaria epidemics: are rapid diagnostic tests cost-effective?. Trop Med Int Health. 2006, 11: 398-408. 10.1111/j.1365-3156.2006.01580.x.CrossRefPubMed
28.
Zikusooka CM, McIntyre D, Barnes KI: Should countries implementing an artemisinin-based combination malaria treatment policy also introduce rapid diagnostic tests?. Malar J. 2008, 7: 176-190. 10.1186/1475-2875-7-176.PubMedCentralCrossRefPubMed
29.
Nicastri E, Bevilacqua N, Sane Schepisi M, Paglia MG, Meschi S, Ame SM, Mohamed JA, Mangi S, Fumakule R, Di Caro A, Capobianchi MR, Kitua A, Molteni F, Racalbuto V, Ippolito G: Accuracy of malaria diagnosis by microscopy, rapid diagnostic test, and PCR methods and evidence of antimalarial overprescription in non-severe febrile patients in two Tanzanian hospitals. Am J Trop Med Hyg. 2009, 80: 712-717.PubMed
30.
Hamer DH, Ndhlovu M, Zurovac D, Fox M, Yeboah-Antwi K, Chanda P, Sipilinyambe N, Simon JL, Snow RW: Improved diagnostic testing and malaria treatment practices in Zambia. JAMA. 2007, 297: 2227-2231. 10.1001/jama.297.20.2227.PubMedCentralCrossRefPubMed
31.
Reyburn H, Mbakilwa H, Mwangi R, Mwerinde O, Olomi R, Drakeley C, Whitty CJ: Rapid diagnostic tests compared with malaria microscopy for guiding outpatient treatment of febrile illness in Tanzania: randomised trial. BMJ. 2007, 334: 403-10.1136/bmj.39073.496829.AE.PubMedCentralCrossRefPubMed
32.
Drummond MF, O'Brien BJ, Stoddard GL, Torrence GW: Methods for the economic evaluation of health care programmes. 1997, New York: Oxford University Press, 2
33.
Ochola LB, Vounatsou P, Smith T, Mabaso ML, Newton CR: The reliability of diagnostic techniques in the diagnosis and management of malaria in the absence of a gold standard. Lancet Infect Dis. 2006, 6: 582-588. 10.1016/S1473-3099(06)70579-5.CrossRefPubMed
34.
Wongsrichanalai C, Barcus MJ, Muth S, Sutamihardja A, Wernsdorfer WH: A review of malaria diagnostic tools: microscopy and rapid diagnostic test (RDT). Am J Trop Med Hyg. 2007, 77: 119-127.PubMed
35.
Mboera LE, Fanello CI, Malima RC, Talbert A, Fogliati P, Bobbio F, Molteni F: Comparison of the Paracheck-Pf test with microscopy, for the confirmation of Plasmodium falciparum malaria in Tanzania. Ann Trop Med Parasitol. 2006, 100: 115-122. 10.1179/136485906X78571.CrossRefPubMed
36.
Bharti PK, Silawat N, Singh PP, Singh MP, Shukla M, Chand G, Dash AP, Singh N: The usefulness of a new rapid diagnostic test, the First Response Malaria Combo (pLDH/HRP2) card test, for malaria diagnosis in the forested belt of central India. Malar J. 2008, 7: 126-10.1186/1475-2875-7-126.PubMedCentralCrossRefPubMed
37.
Hopkins H, Bebell L, Kambale W, Dokomajilar C, Rosenthal PJ, Dorsey G: Rapid diagnostic tests for malaria at sites of varying transmission intensity in Uganda. J Infect Dis. 2008, 197: 510-518. 10.1086/526502.CrossRefPubMed
38.
Swarthout TD, Counihan H, Senga RK, Van den Broek I: Paracheck-Pf® accuracy and recently treated Plasmodium falciparum infections: is there a risk of over-diagnosis?. Malar J. 2007, 6: 58-10.1186/1475-2875-6-58.PubMedCentralCrossRefPubMed
39.
Kyabayinze DJ, Tibenderana JK, Odong oW, Rwakimari JB, Counihan H: Operational accuracy and comparative persistent antigenicity of HRP2 rapid diagnostic tests for Plasmodium falciparum malaria in a hyperendemic region of Uganda. Malar J. 2008, 7: 221-10.1186/1475-2875-7-221.PubMedCentralCrossRefPubMed
40.
Kamugisha ML, Msangeni H, Beale E, Malecela EK, Akida J, Ishengoma DR, Lemnge MM: Paracheck Pf compared with microscopy for diagnosis of Plasmodium falciparum malaria among children in Tanga City, north-eastern Tanzania. Tanzan J Health Res. 2008, 10: 14-19.CrossRefPubMed
41.
Forney JR, Magill AJ, Wongsrichanalai C, Sirichaisinthop J, Bautista CT, Heppner DG, Miller RS, Ockenhouse CF, Gubanov A, Shafer R, DeWitt CC, Quino-Ascurra HA, Kester KE, Kain KC, Walsh DS, Ballou WR, Gasser RA: Malaria rapid diagnostic devices: performance characteristics of the ParaSight F device determined in a multisite field study. J Clin Microbiol. 2001, 39: 2884-2890. 10.1128/JCM.39.8.2884-2890.2001.PubMedCentralCrossRefPubMed
42.
Sayang C, Soula G, Tahar R, Basco LK, Gazin P, Moyou-Somo R, Delmont J: Use of a histidine-rich protein 2-based rapid diagnostic test for malaria by health personnel during routine consultation of febrile outpatients in a peripheral health facility in Yaounde, Cameroon. Am J Trop Med Hyg. 2009, 81: 343-347.PubMed
43.
Coleman RE, Maneechai N, Rachapaew N, Kumpitak C, Soyseng V, Miller RS, Thimasarn K, Sattabongkot J: Field evaluation of the ICT Malaria Pf/Pv immunochromatographic test for the detection of asymptomatic malaria in a Plasmodium falciparum/vivax endemic area in Thailand. Am J Trop Med Hyg. 2002, 66: 379-383.PubMed
44.
Bell DR, Wilson DW, Martin LB: False-positive results of a Plasmodium falciparum histidine-rich protein 2-detecting malaria rapid diagnostic test due to high sensitivity in a community with fluctuating low parasite density. Am J Trop Med Hyg. 2005, 73: 199-203.PubMed
45.
Iqbal J, Siddique A, Jameel M, R Hira P: Persistent histidine-rich protein 2, parasite lactate dehydrogenase and panmalarial antigen reactivity after clearance of Plasmodium falciparum monoinfection. J Clin Microbiol. 2004, 42: 4237-4241. 10.1128/JCM.42.9.4237-4241.2004.PubMedCentralCrossRefPubMed
46.
Mayxay M, Pukrittayakamee S, Chotivanich K, Looareesuwan S, White NJ: Persistence of Plasmodium falciparum HRP-2 in successfully treated acute falciparum malaria. Trans R Soc Trop Med Hyg. 2001, 95: 179-182. 10.1016/S0035-9203(01)90156-7.CrossRefPubMed
47.
Harani MS, Beg MA, Khaleeq L, Adil SN, Kakepoto GN, Khurshid M: Role of ICT malaria immunochromatographic test for rapid diagnosis of malaria. J Pak Med Assoc. 2006, 56: 167-171.PubMed
48.
Tjitra E, Suprianto S, McBroom J, Currie BJ, Anstey NM: Persistent ICT malaria P.f/P.v panmalarial and HRP2 antigen reactivity after treatment of Plasmodium falciparum malaria is associated with gametocytemia and results in false-positive diagnoses of Plasmodium vivax in convalescence. J Clin Microbiol. 2001, 39: 1025-1031. 10.1128/JCM.39.3.1025-1031.2001.PubMedCentralCrossRefPubMed
49.
Lubell Y, Reyburn H, Mbakilwa H, Mwangi R, Chonya S, Whitty CJ, Mills A: The impact of response to the results of diagnostic tests for malaria: cost-benefit analysis. BMJ. 2008, 336: 202-205. 10.1136/bmj.39395.696065.47.PubMedCentralCrossRefPubMed
50.
Luxemburger C, Nosten F, Kyle DE, Kiricharoen L, Chongsuphajaisiddhi T, White NJ: Clinical features cannot predict a diagnosis of malaria or differentiate the infecting species in children living in an area of low transmission. Trans R Soc Trop Med Hyg. 1998, 92: 45-49. 10.1016/S0035-9203(98)90950-6.CrossRefPubMed
51.
Msellem MI, Martensson A, Rotllant G, Bhattarai A, Stromberg J, Kahigwa E, Garcia M, Petzold M, Olumese P, Ali A, Bjorkman A: Influence of rapid malaria diagnostic tests on treatment and health outcome in fever patients, Zanzibar: a crossover validation study. PLoS Med. 2009, 6: e1000070-10.1371/journal.pmed.1000070.PubMedCentralCrossRefPubMed
52.
Bhattarai A, Ali AS, Kachur SP, Martensson A, Abbas AK, Khatib R, Al-Mafazy AW, Ramsan M, Rotllant G, Gerstenmaier JF, Molteni F, Abdulla S, Montgomery SM, Kaneko A, Bjorkman A: Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar. PLoS Med. 2007, 4: e309-10.1371/journal.pmed.0040309.PubMedCentralCrossRefPubMed
53.
Ansah EK, Narh-Bana S, Epokor M, Akanpigbiam S, Quartey AA, Gyapong J, Whitty CJ: Rapid testing for malaria in settings where microscopy is available and peripheral clinics where only presumptive treatment is available: a randomised controlled trial in Ghana. BMJ. 2010, 340: c930-10.1136/bmj.c930.PubMedCentralCrossRefPubMed
54.
Mosha JF, Conteh L, Tediosi F, Gesase S, Bruce J, Chandramohan D, Gosling R: Cost implications of improving malaria diagnosis: findings from north-eastern Tanzania. PLoS One. 5: e8707-10.1371/journal.pone.0008707.
Metadata
Title
Use of HRP-2-based rapid diagnostic test for Plasmodium falciparum malaria: assessing accuracy and cost-effectiveness in the villages of Dielmo and Ndiop, Senegal
Authors
Alioune Badara Ly
Adama Tall
Robert Perry
Laurence Baril
Abdoulaye Badiane
Joseph Faye
Christophe Rogier
Aissatou Touré
Cheikh Sokhna
Jean-François Trape
Rémy Michel
Publication date
01-12-2010
Publisher
BioMed Central
Published in
Malaria Journal / Issue 1/2010
Electronic ISSN: 1475-2875
DOI
https://doi.org/10.1186/1475-2875-9-153

Other articles of this Issue 1/2010

Malaria Journal 1/2010 Go to the issue

Research

Malaria resurgence risk in southern Europe: climate assessment in an historically endemic area of rice fields at the Mediterranean shore of Spain

Research

Perspectives of people in Mali toward genetically-modified mosquitoes for malaria control

Research

The kinetics of antibody binding to Plasmodium falciparum VAR2CSA PfEMP1 antigen and modelling of PfEMP1 antigen packing on the membrane knobs

Research

An open randomized clinical trial in comparing two artesunate-based combination treatments on Plasmodium falciparum malaria in Nigerian children: artesunate/sulphamethoxypyrazine/pyrimethamine (fixed dose over 24 hours) versus artesunate/amodiaquine (fixed dose over 48 hours)

Research

Field experiments of Anopheles gambiae attraction to local fruits/seedpods and flowering plants in Mali to optimize strategies for malaria vector control in Africa using attractive toxic sugar bait methods

Research

Pyrethroid resistance in Anopheles gambiae leads to increased susceptibility to the entomopathogenic fungi Metarhizium anisopliae and Beauveria bassiana
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits