Performance of Malaria Rapid Diagnostic Tests as Part of Routine Malaria Case Management in Kenya

Alexandre Macedo de Oliveira Malaria Branch, Division of Parasitic Diseases, National Center for Vector-Borne, Zoonotic, and Enteric Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Workforce and Career Development, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Nairobi, Kenya

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Jacek Skarbinski Malaria Branch, Division of Parasitic Diseases, National Center for Vector-Borne, Zoonotic, and Enteric Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Workforce and Career Development, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Nairobi, Kenya

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Peter O. Ouma Malaria Branch, Division of Parasitic Diseases, National Center for Vector-Borne, Zoonotic, and Enteric Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Workforce and Career Development, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Nairobi, Kenya

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Simon Kariuki Malaria Branch, Division of Parasitic Diseases, National Center for Vector-Borne, Zoonotic, and Enteric Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Workforce and Career Development, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Nairobi, Kenya

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John W. Barnwell Malaria Branch, Division of Parasitic Diseases, National Center for Vector-Borne, Zoonotic, and Enteric Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Workforce and Career Development, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Nairobi, Kenya

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Kephas Otieno Malaria Branch, Division of Parasitic Diseases, National Center for Vector-Borne, Zoonotic, and Enteric Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Workforce and Career Development, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Nairobi, Kenya

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Phillip Onyona Malaria Branch, Division of Parasitic Diseases, National Center for Vector-Borne, Zoonotic, and Enteric Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Workforce and Career Development, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Nairobi, Kenya

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Louise M. Causer Malaria Branch, Division of Parasitic Diseases, National Center for Vector-Borne, Zoonotic, and Enteric Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Workforce and Career Development, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Nairobi, Kenya

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Kayla F. Laserson Malaria Branch, Division of Parasitic Diseases, National Center for Vector-Borne, Zoonotic, and Enteric Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Workforce and Career Development, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Nairobi, Kenya

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Willis S. Akhwale Malaria Branch, Division of Parasitic Diseases, National Center for Vector-Borne, Zoonotic, and Enteric Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Workforce and Career Development, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Nairobi, Kenya

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Laurence Slutsker Malaria Branch, Division of Parasitic Diseases, National Center for Vector-Borne, Zoonotic, and Enteric Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Workforce and Career Development, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Nairobi, Kenya

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Mary Hamel Malaria Branch, Division of Parasitic Diseases, National Center for Vector-Borne, Zoonotic, and Enteric Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Workforce and Career Development, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Nairobi, Kenya

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Data on malaria rapid diagnostic test (RDT) performance under routine program conditions are limited. We assessed the attributes of RDTs performed by study and health facility (HF) staffs as part of routine malaria case management of patients ≥ 5 years of age in Kenya. Expert microscopy was used as our gold standard. A total of 1,827 patients were enrolled; 191 (11.6%) were parasitemic by expert microscopy. Sensitivity and specificity of RDTs performed by study staff were 86.6% (95% confidence interval [CI]: 79.8–93.5%) and 95.4% (95% CI: 93.9–96.9%), respectively. Among tests performed by HF staff, RDTs were 91.7% (95% CI: 80.8–100.0%) sensitive and 96.7% (95% CI: 92.8–100.0%) specific, whereas microscopy was 52.5% (95% CI: 33.2–71.9%) sensitive and 77.0% (95% CI: 67.9–86.2%) specific. Our findings suggest that RDTs perform better than microscopy under routine conditions. Further efforts are needed to maintain this high RDT performance over time.

Author Notes

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