Volume 78, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


The main purpose of this study was to assess the accuracy of various techniques available for diagnosis of malaria. Blood samples were collected from 313 patients with clinical suspicion of uncomplicated malaria in 2 primary health centers in Madagascar. The presence of parasites was assessed by conventional microscopy, 2 rapid diagnostic tests (one HRP2-based test, PALUTOP, and one pLDH-based test, OptiMAL-IT), and real-time polymerase chain reaction (PCR), which is used as the “gold standard” method. The degree of agreement observed was very high for microscopy (0.99) and the HRP2-based test (0.93) and high for the pLDH-based test (0.82). Public-health implications are also discussed in this paper.


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  1. World Health Organization, 1993. Implementation of the global malaria control strategy. Report of a WHO Study Group on the Implementation of the Global Plan of Action for Malaria Control 1993–2000. World Health Organ Tech Rep Ser 839 : 1–57.
  2. Chandramohan D, Jaffar S, Greenwood B, 2002. Use of clinical algorithms for diagnosing malaria. Trop Med Int Health 7 : 45–52.
  3. Kallander K, Nsungwa-Sabiiti J, Peterson S, 2004. Symptom overlap for malaria and pneumonia—policy implications for home management strategies. Acta Trop 90 : 211–214.
  4. Mwangi TW, Mohammed M, Dayo H, Snow RW, Marsh K, 2005. Clinical algorithms for malaria diagnosis lack utility among people of different age groups. Trop Med Int Health 10 : 530–536.
  5. Amexo M, Tolhurst R, Barnish G, Bates I, 2004. Malaria misdiagnosis: effects on the poor and vulnerable. Lancet 364 : 1896–1898.
  6. Reyburn H, Mbatia R, Drakeley C, Carneiro I, Mwakasungula E, Mwerinde O, Saganda K, Shao J, Kitua A, Olomi R, Greenwood BM, Whitty CJ, 2004. Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study. BMJ 329 : 1212.
  7. Zurovac D, Midia B, Ochola SA, English M, Snow RW, 2006. Microscopy and outpatient malaria case management among older children and adults in Kenya. Trop Med Int Health 11 : 432–440.
  8. Mutabingwa TK, Anthony D, Heller A, Hallett R, Ahmed J, Drakeley C, Greenwood BM, Whitty CJ, 2005. Amodiaquine alone, amodiaquine+sulfadoxine–pyrimethamine, amodiaquine+artesunate, and artemether–lumefantrine for outpatient treatment of malaria in Tanzanian children: a four-arm randomised effectiveness trial. Lancet 365 : 1474–1480.
  9. Bell D, Peeling RW, 2006. Evaluation of rapid diagnostic tests: malaria. Nat Rev Microbiol 4 : S34–S38.
  10. Moody A, 2002. Rapid diagnostic tests for malaria parasites. Clin Microbiol Rev 15 : 66–78.
  11. Wongsrichanalai C, 2001. Rapid diagnostic techniques for malaria control. Trends Parasitol 17 : 307–309.
  12. Beadle C, Long GW, Weiss WR, McElroy PD, Maret SM, Oloo AJ, Hoffman SL, 1994. Diagnosis of malaria by detection of Plasmodium falciparum HRP-2 antigen with a rapid dipstick antigen-capture assay. Lancet 343 : 564–568.
  13. Cruciani M, Nardi S, Malena M, Bosco O, Serpelloni G, Mengoli C, 2004. Systematic review of the accuracy of the ParaSight-F test in the diagnosis of Plasmodium falciparum malaria. Med Sci Monit 10 : MT81–MT88.
  14. Fryauff DJ, Gomez-Saladin E, Purnomo, Sumawinata I, Sutamihardja MA, Tuti S, Subianto B, Richie TL, 1997. Comparative performance of the ParaSight F test for detection of Plasmodium falciparum in malaria-immune and nonimmune populations in Irian Jaya, Indonesia. Bull World Health Organ 75 : 547–552.
  15. Hanscheid T, 1999. Diagnosis of malaria: a review of alternatives to conventional microscopy. Clin Lab Haematol 21 : 235–245.
  16. Mens P, Spieker N, Omar S, Heijnen M, Schallig H, Kager PA, 2007. Is molecular biology the best alternative for diagnosis of malaria to microscopy? A comparison between microscopy, antigen detection and molecular tests in rural Kenya and urban Tanzania. Trop Med Int Health 12 : 238–244.
  17. Murray CK, Bell D, Gasser RA, Wongsrichanalai C, 2003. Rapid diagnostic testing for malaria. Trop Med Int Health 8 : 876–883.
  18. Robert V, Le Goff G, Andrianaivolambo L, Randimby FM, Domarle O, Randrianarivelojosia M, Raharimanga V, Raveloson A, Ravaonjanahary C, Ariey F, 2006. Moderate transmission but high prevalence of malaria in Madagascar. Int J Parasitol 36 : 1273–1281.
  19. World Health Organization, 2001. Monitoring Antimalarial Drug Resistance, Report of WHO Consultation, Geneva, December 3–5, 2001 (WHO/CDS/CSR/EPH/2002.7). Geneva, Switzerland: WHO, Department of Communicable Disease, Surveillance and Response. Available at: http://www.who.int/malaria/cmc_upload/0/000/015/800/200239.pdf.
  20. Golvan YJ, Ambroise-Thomas P, 1990. Les Nouvelles Techniques en Parasitologie. Paris: Flammarion Medecine Sciences, 134.
  21. World Health Organization, 1996. Management of Uncomplicated Malaria and the Use of Antimalarial Drugs for the Protection of Travellers. Report of an Informal Consultation (WHO/MAL/96). Geneva, Switzerland: World Health Organization, 98.
  22. World Health Organization, 2003. Malaria Rapid Diagnosis: Making It Work. Meeting Report [RS/2003/GE/05(PHL)], January 20–23, 2003. Manila: World Health Organization.
  23. Mangold KA, Manson RU, Koay ES, Stephens L, Regner M, Thomson RBJ, Peterson LR, Kaul KL, 2005. Real-time PCR for detection and identification of Plasmodium spp. J Clin Microbiol 43 : 2435–2440.
  24. Altman DG, 1991. Statistics in medical journals: developments in the 1980s. Stat Med 10 : 1897–1913.
  25. Ochola LB, Vounatsou P, Smith T, Mabaso ML, Newton CR, 2006. The reliability of diagnostic techniques in the diagnosis and management of malaria in the absence of a gold standard. Lancet Infect Dis 6 : 582–588.
  26. Shute GT, 1988. The microscopic diagnosis of malaria. Wernsdorfer WH, McGregor I, eds. Malaria: Principles and Practices of Malariology. Edinburgh: Churchill Livingstone.
  27. Singh N, Saxena A, Valecha N, 2000. Field evaluation of the ICT malaria P.f/P.v immunochromatographic test for diagnosis of Plasmodium falciparum and P. vivax infection in forest villages of Chhindwara, Central India. Trop Med Int Health 5 : 765–770.
  28. Quintana M, Piper R, Boling HL, Makler M, Sherman C, Gill E, Fernandez E, Martin S, 1998. Malaria diagnosis by dipstick assay in a Honduran population with coendemic Plasmodium falciparum and Plasmodium vivax. Am J Trop Med Hyg 59 : 868–871.
  29. World Health Organization, 2005. Interim Notes on Selection of Type of malaria Rapid Diagnostic Test in Relation to the Occurrence of Different Parasite Species. Guidance for National Malaria Control Programmes, August 2005. Geneva, Switzerland: WHO Roll Back Malaria Department.
  30. Chiodini PL, Bowers K, Jorgensen P, Barnwell JW, Grady KK, Luchavez J, Moody AH, Cenizal A, Bell D, 2007. The heat stability of Plasmodium lactate dehydrogenase-based and histidine-rich protein 2–based malaria rapid diagnostic tests. Trans R Soc Trop Med Hyg 101 : 331–337.
  31. Ratsimbasoa A, Randriamanantena A, Raherinjafy R, Rasoarilalao N, Menard D, 2007. Which malaria rapid test for Madagascar? Field and laboratory evaluation of three tests and expert microscopy of samples from suspected malaria patients in Madagascar. Am J Trop Med Hyg 76 : 481–485.
  32. D’Acremont V, Lengeler C, Genton B, 2007. Stop ambiguous messages on malaria diagnosis. BMJ 334 : 489.
  33. Hamer DH, Ndhlovu M, Zurovac D, Fox M, Yeboah-Antwi K, Chanda P, Sipilinyambe N, Simon JL, Snow RW, 2007. Improved diagnostic testing and malaria treatment practices in Zambia. JAMA 297 : 2227–2231.
  34. Reyburn H, Mbakilwa H, Mwangi R, Mwerinde O, Olomi R, Drakeley C, Whitty CJ, 2007. Rapid diagnostic tests compared with malaria microscopy for guiding outpatient treatment of febrile illness in Tanzania: randomised trial. BMJ 334 : 403.
  35. Talisuna AO, Meya DN, 2007. Diagnosis and treatment of malaria. BMJ 334 : 375–376.

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  • Received : 10 Jul 2007
  • Accepted : 17 Oct 2007

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