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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 Yaoundé, Cameroon

The role of a rapid diagnostic test (RDT) in the case management of Plasmodium falciparum malaria infections has not been determined in Africa. Our study was conducted during November 2007–January 2008 to assess test accuracy of an RDT in the management of febrile outpatients in a peripheral urban health facility in Cameroon. We found the overall sensitivity to be 71.4% and a specificity of 82.2%; the positive predictive value and negative predictive value were 73.8% and 80.4%, respectively. False-negative and false-positive cases represented 11.8% and 10.5% of all febrile patients. Malaria alone (31.3%) was the first cause of fever; 33.5% of fever cases were of unknown origin. Acute respiratory infections were common among children 0–2 years of age (25.5%) and decreased with age. The risk of having a clinical failure with the presumptive treatment of febrile children was seven times greater than that of the RDT-oriented management (relative risk = 6.8, 95% confidence interval = 0.88–53.4, P = 0.03) because of the delay of appropriate treatment of non-malarial febrile illness. Our results suggest that the RDT may be of limited utility for children greater than five years of age and adults and that diagnosis based on microscopic examination of blood smears should be recommended for these patient populations, as well as in areas of low transmission.

Received July 25, 2008. Accepted for publication April 12, 2009.

Acknowledgments: We thank the personnel of the dispensary for their assistance during this project. We are also grateful to all patients for their participation.

Financial support: This study was supported by the Service de Coopération et d’Action Culturelle of the French Embassy in Yaoundé, European Union (READ-UP project, STREP, contract no. 018602) and the Centre de Formation et Recherche en Médecine et Santé Tropicale, Marseille, France.

Disclaimer: The views expressed in this paper are solely those of the authors.

Disclosure: The authors have no conflicts of interest in regards to this work.

^* Address correspondence to Collins Sayang, Centre de Formation et Recherche en Médecine et Santé Tropicale, Faculté de Médecine Nord, Université de la Méditerranée (Aix-Marseille II), Marseille, France. E-mail: sayangcollins{at}gmail.com

Authors’ addresses: Collins Sayang, Georges Soula, Pierre Gazin, and Jean Delmont, Centre de Formation et Recherche en Médecine et Santé Tropicale, Faculté de Médecine Nord, Université de la Méditerranée (Aix-Marseille II), Marseille, France, E-mail: sayangcollins{at}gmail.com. Rachida Tahar and Leonardo K. Basco, Unité Mixte de Recherche 198, Institut de Recherche pour le Développement and Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la Lutte Contre les Endémies en Afrique Centrale, BP 288, Yaoundé, Cameroon. Roger Moyou-Somo, Department of Infectious Diseases, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.