Factoring Quality Laboratory Diagnosis into the Malaria Control Agenda for Sub-Saharan Africa

Michael Aidoo Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia

Search for other papers by Michael Aidoo in
Current site
Google Scholar
PubMed
Close
Restricted access

Recent progress in malaria control in sub-Saharan Africa has been achieved primarily through provision of insecticide-treated nets, indoor residual spraying, and antimalarial drugs. Although these interventions are important, proper case identification and accurate measurement of their impact depend on quality diagnostic testing. Current availability of diagnostic testing for malaria in sub-Saharan Africa is inadequate to support disease management, prevention programs, and surveillance needs. Challenges faced include a dearth of skilled workforce, inadequate health systems infrastructure, and lack of political will. A coordinated approach to providing pre-service clinical and laboratory training together with systems that support a scale-up of laboratory services could provide means not only for effective malaria case management but also, management of non-malaria febrile illnesses, disease surveillance, and accurate control program evaluation. A synthesis of the challenges faced in ensuring quality malaria testing and how to include this information in the malaria control and elimination agenda are presented.

Author Notes

* Address correspondence to Michael Aidoo, Centers for Disease Control and Prevention, 1600 Clifton Road, Mail Stop-A06, Atlanta, GA 30333. E-mail: maidoo@cdc.gov

Author's address: Michael Aidoo, Malaria Branch, Division of Parasitic Diseases and Malaria Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: maidoo@cdc.gov.

  • 1.

    World Health Organization, 2012. World Malaria Report, 2012. Geneva, Switzerland: World Health Organization.

  • 2.

    Bouyou-Akotet MK, Mawili-Mboumba DP, Kendjo E, Mabika-Mamfoumbi M, Ngoungou EB, Dzeing-Ella A, Pemba-Mihindou M, Ibinga E, Efame-Eya E, Planche T, Kremsner PG, Kombila M, 2009. Evidence of decline of malaria in the general hospital of Libreville, Gabon from 2000 to 2008. Malar J 8: 300.

    • Search Google Scholar
    • Export Citation
  • 3.

    Zhou G, Githeko AK, Minakawa N, Yan G, 2010. Community-wide benefits of targeted indoor residual spray for malaria control in the Western Kenya Highland. Malar J 9: 67.

    • Search Google Scholar
    • Export Citation
  • 4.

    Barnes KI, Chanda P, Ab BG, 2009. Impact of the large-scale deployment of artemether/lumefantrine on the malaria disease burden in Africa: case studies of South Africa, Zambia and Ethiopia. Malar J 8 (Suppl 1): S8.

    • Search Google Scholar
    • Export Citation
  • 5.

    Ishengoma DR, Rwegoshora RT, Mdira KY, Kamugisha ML, Anga EO, Bygbjerg IC, Ronn AM, Magesa SM, 2009. Health laboratories in the Tanga region of Tanzania: the quality of diagnostic services for malaria and other communicable diseases. Ann Trop Med Parasitol 103: 441–453.

    • Search Google Scholar
    • Export Citation
  • 6.

    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.

    • Search Google Scholar
    • Export Citation
  • 7.

    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.

    • Search Google Scholar
    • Export Citation
  • 8.

    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.

    • Search Google Scholar
    • Export Citation
  • 9.

    Nankabirwa J, Zurovac D, Njogu JN, Rwakimari JB, Counihan H, Snow RW, Tibenderana JK, 2009. Malaria misdiagnosis in Uganda—implications for policy change. Malar J 8: 66.

    • Search Google Scholar
    • Export Citation
  • 10.

    Rowe AK, de Leon GF, Mihigo J, Santelli AC, Miller NP, Van-Dunem P, 2009. Quality of malaria case management at outpatient health facilities in Angola. Malar J 8: 275.

    • Search Google Scholar
    • Export Citation
  • 11.

    Nomhwange TI, Whitty CJ, 2009. Diagnosis of malaria in children's outpatient departments in Abuja, Nigeria. Trop Doct 39: 90–92.

  • 12.

    Ansah EK, Narh-Bana S, Epokor M, Akanpigbiam S, Quartey AA, Gyapong J, Whitty CJ, 2010. 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 340: c930.

    • Search Google Scholar
    • Export Citation
  • 13.

    Chanda P, Hamainza B, Mulenga S, Chalwe V, Msiska C, Chizema-Kawesha E, 2009. Early results of integrated malaria control and implications for the management of fever in under-five children at a peripheral health facility: a case study of Chongwe rural health centre in Zambia. Malar J 8: 49.

    • Search Google Scholar
    • Export Citation
  • 14.

    Otten M, Aregawi M, Were W, Karema C, Medin A, Bekele W, Jima D, Gausi K, Komatsu R, Korenromp E, Low-Beer D, Grabowsky M, 2009. Initial evidence of reduction of malaria cases and deaths in Rwanda and Ethiopia due to rapid scale-up of malaria prevention and treatment. Malar J 8: 14.

    • Search Google Scholar
    • Export Citation
  • 15.

    Jensen TP, Bukirwa H, Njama-Meya D, Francis D, Kamya MR, Rosenthal PJ, Dorsey G, 2009. Use of the slide positivity rate to estimate changes in malaria incidence in a cohort of Ugandan children. Malar J 8: 213.

    • Search Google Scholar
    • Export Citation
  • 16.

    Okech BA, Mwobobia IK, Kamau A, Muiruri S, Mutiso N, Nyambura J, Mwatele C, Amano T, Mwandawiro CS, 2008. Use of integrated malaria management reduces malaria in Kenya. PLoS One 3: e4050.

    • Search Google Scholar
    • Export Citation
  • 17.

    Eastman RT, Fidock DA, 2009. Artemisinin-based combination therapies: a vital tool in efforts to eliminate malaria. Nat Rev Microbiol 7: 864–874.

    • Search Google Scholar
    • Export Citation
  • 18.

    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, 2009. Artemisinin resistance in Plasmodium falciparum malaria. N Engl J Med 361: 455–467.

    • Search Google Scholar
    • Export Citation
  • 19.

    Lim P, Wongsrichanalai C, Chim P, Khim N, Kim S, Chy S, Sem R, Nhem S, Yi P, Duong S, Bouth DM, Genton B, Beck HP, Gobert JG, Rogers WO, Coppee JY, Fandeur T, Mercereau-Puijalon O, Ringwald P, Le Bras J, Ariey F, 2010. Decreased in vitro susceptibility of Plasmodium falciparum isolates to artesunate, mefloquine, chloroquine, and quinine in Cambodia from 2001 to 2007. Antimicrob Agents Chemother 54: 2135–2142.

    • Search Google Scholar
    • Export Citation
  • 20.

    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.

    • Search Google Scholar
    • Export Citation
  • 21.

    McMorrow ML, Masanja MI, Abdulla SM, Kahigwa E, Kachur SP, 2008. Challenges in routine implementation and quality control of rapid diagnostic tests for malaria—Rufiji District, Tanzania. Am J Trop Med Hyg 79: 385–390.

    • Search Google Scholar
    • Export Citation
  • 22.

    Harvey SA, Jennings L, Chinyama M, Masaninga F, Mulholland K, Bell DR, 2008. Improving community health worker use of malaria rapid diagnostic tests in Zambia: package instructions, job aid and job aid-plus-training. Malar J 7: 160.

    • Search Google Scholar
    • Export Citation
  • 23.

    McMorrow ML, Masanja MI, Kahigwa E, Abdulla SM, Kachur SP, 2010. Quality assurance of rapid diagnostic tests for malaria in routine patient care in rural Tanzania. Am J Trop Med Hyg 82: 151–155.

    • Search Google Scholar
    • Export Citation
  • 24.

    World Health Organization, 2012. Malaria Rapid Diagnostic Test Performance: Results of WHO Product Testing of Malaria RDTs: Round 4. Geneva: World Health Organization.

    • Search Google Scholar
    • Export Citation
  • 25.

    Thiam S, Thior M, Faye B, Ndiop M, Diouf ML, Diouf MB, Diallo I, Fall FB, Ndiaye JL, Albertini A, Lee E, Jorgensen P, Gaye O, Bell D, 2011. Major reduction in anti-malarial drug consumption in Senegal after nation-wide introduction of malaria rapid diagnostic tests. PLoS One 6: e18419.

    • Search Google Scholar
    • Export Citation
  • 26.

    Pfeiffer K, Some F, Muller O, Sie A, Kouyate B, Haefeli WE, Zoungrana A, Gustafsson LL, Tomson G, Sauerborn R, 2008. Clinical diagnosis of malaria and the risk of chloroquine self-medication in rural health centres in Burkina Faso. Trop Med Int Health 13: 418–426.

    • Search Google Scholar
    • Export Citation
  • 27.

    Okiro EA, Hay SI, Gikandi PW, Sharif SK, Noor AM, Peshu N, Marsh K, Snow RW, 2007. The decline in paediatric malaria admissions on the coast of Kenya. Malar J 6: 151.

    • Search Google Scholar
    • Export Citation
  • 28.

    Ceesay SJ, Casals-Pascual C, Erskine J, Anya SE, Duah NO, Fulford AJ, Sesay SS, Abubakar I, Dunyo S, Sey O, Palmer A, Fofana M, Corrah T, Bojang KA, Whittle HC, Greenwood BM, Conway DJ, 2008. Changes in malaria indices between 1999 and 2007 in The Gambia: a retrospective analysis. Lancet 372: 1545–1554.

    • Search Google Scholar
    • Export Citation
  • 29.

    Ghani AC, Sutherland CJ, Riley EM, Drakeley CJ, Griffin JT, Gosling RD, Filipe JA, 2009. Loss of population levels of immunity to malaria as a result of exposure-reducing interventions: consequences for interpretation of disease trends. PLoS One 4: e4383.

    • Search Google Scholar
    • Export Citation
  • 30.

    Snow RW, Omumbo JA, Lowe B, Molyneux CS, Obiero JO, Palmer A, Weber MW, Pinder M, Nahlen B, Obonyo C, Newbold C, Gupta S, Marsh K, 1997. Relation between severe malaria morbidity in children and level of Plasmodium falciparum transmission in Africa. Lancet 349: 1650–1654.

    • Search Google Scholar
    • Export Citation
  • 31.

    Jonkman A, Chibwe RA, Khoromana CO, Liabunya UL, Chaponda ME, Kandiero GE, Molyneux ME, Taylor TE, 1995. Cost-saving through microscopy-based versus presumptive diagnosis of malaria in adult outpatients in Malawi. Bull World Health Organ 73: 223–227.

    • Search Google Scholar
    • Export Citation
  • 32.

    Ssekabira U, Bukirwa H, Hopkins H, Namagembe A, Weaver MR, Sebuyira LM, Quick L, Staedke S, Yeka A, Kiggundu M, Schneider G, McAdam K, Wabwire-Mangen F, Dorsey G, 2008. Improved malaria case management after integrated team-based training of health care workers in Uganda. Am J Trop Med Hyg 79: 826–833.

    • Search Google Scholar
    • Export Citation
  • 33.

    Msellem MI, Martensson A, Rotllant G, Bhattarai A, Stromberg J, Kahigwa E, Garcia M, Petzold M, Olumese P, Ali A, Bjorkman A, 2009. Influence of rapid malaria diagnostic tests on treatment and health outcome in fever patients, Zanzibar: a crossover validation study. PLoS Med 28.6: e1000070.

    • Search Google Scholar
    • Export Citation
  • 34.

    World Health Organization, 2010. Guidelines for the Treatment of Malaria, 2nd edition. Geneva: World Health Organization.

  • 35.

    World Health Organization, 2011. Universal Access to Malaria Diagnostic Testing: An Operational Manual. Geneva: World Health Organization.

    • Search Google Scholar
    • Export Citation
  • 36.

    Murray CJ, Rosenfeld LC, Lim SS, Andrews KG, Foreman KJ, Haring D, Fullman N, Naghavi M, Lozano R, Lopez AD, 2012. Global malaria mortality between 1980 and 2010: a systematic analysis. Lancet 379: 413–431.

    • Search Google Scholar
    • Export Citation
  • 37.

    Lynch M, Korenromp E, Eisele T, Newby H, Steketee R, Kachur SP, Nahlen B, Bhattarai A, Yoon S, MacArthur J, Newman R, Cibulskis R, 2012. New global estimates of malaria deaths. Lancet 380: 559.

    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 23 23 3
Full Text Views 275 81 0
PDF Downloads 52 17 0
 
Membership Banner
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save