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Malaria rapid diagnostic tests (RDTs) may improve fever management in areas without microscopy. We compared the accuracy of histidine-rich protein 2 (HRP2) and Plasmodium lactate dehydrogenase (pLDH)-based RDTs, using expert microscopy as a gold standard, for initial diagnosis, treatment monitoring, and diagnosis of recurrent malaria in a cohort of children followed longitudinally in a high-transmission area in Uganda. For 305 initial fever episodes, sensitivity was 98% for HRP2 and 87% for pLDH, whereas specificity was 55% and 96%, respectively. The HRP2 gave 51% false-positive results on Day 28, whereas pLDH gave no false positives after Day 7. For 59 recurrent fever episodes during follow-up, sensitivity was 100% for HRP2 and 91% for pLDH, whereas specificity was 33% and 100%, respectively. The HRP2-based RDTs are useful for initial diagnosis of malaria caused by superior sensitivity; however, as a result of superior specificity, pLDH-based RDTs are more appropriate to monitor treatment and diagnose recurrent malaria.
Financial support: This research was funded by Uganda Malaria Clinical Operational and Health Services (COHRE) training program at Makerere University, Grant D43-TW00807701A1, from the Fogarty International Centre (FIC) at the National Institute of Health (NIH).
Authors' addresses: Phoebe Mbabazi, International Hospital Kampala, Kampala, Uganda, E-mail: firstname.lastname@example.org. Heidi Hopkins, ACT Consortium, London School for Tropical Medicine and Hygiene, London, United Kingdom, E-mail: email@example.com. Emmanuel Osilo, Infectious Disease Research Collaboration, Tororo, Uganda, E-mail: firstname.lastname@example.org. Michael Kalungu, School of Statistics and Planning, Makerere University, Kampala, Uganda, E-mail: email@example.com. Pauline Byakika-Kibwika and Moses R. Kamya, Makerere University College of Health Sciences, Kampala, Uganda, E-mails: firstname.lastname@example.org and email@example.com.
Reprint requests: Phoebe Mbabazi, International Hospital Kampala, P.O. Box, 8177, Kampala, Uganda, E-mail: firstname.lastname@example.org.