Accuracy and Reliability of Malaria Diagnostic Techniques for Guiding Febrile Outpatient Treatment in Malaria-Endemic Countries

Hanitra Rakotonirina Malaria Unit Research and Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274, Antananarivo 101, Madagascar

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Céline Barnadas Malaria Unit Research and Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274, Antananarivo 101, Madagascar

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Rogelin Raherijafy Malaria Unit Research and Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274, Antananarivo 101, Madagascar

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Hery Andrianantenaina Malaria Unit Research and Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274, Antananarivo 101, Madagascar

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Arsène Ratsimbasoa Malaria Unit Research and Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274, Antananarivo 101, Madagascar

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Laurence Randrianasolo Malaria Unit Research and Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274, Antananarivo 101, Madagascar

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Martial Jahevitra Malaria Unit Research and Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274, Antananarivo 101, Madagascar

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Valérie Andriantsoanirina Malaria Unit Research and Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274, Antananarivo 101, Madagascar

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Didier Ménard Malaria Unit Research and Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274, Antananarivo 101, Madagascar

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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 Plasmodium parasites was assessed by conventional microscopy, 2 rapid diagnostic tests (one HRP2-based test, PALUTOP+4, 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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