Assessment of Accuracy and Effectiveness of Rapid Diagnostic Test for Malaria Diagnosis at Primary Health Centres in Abeokuta Nigeria

Abstract

Malaria is a deadly disease that needs proper and prompt diagnosis in order to treat its symptoms as early as possible. Rapid diagnosis test is a pre-requisite for the effective treatment of malaria in other to reduce the mortality and morbidity of the disease especially at the Primary Health Centre (PHC) facilities. This study compares RDTs test results from PHCs with malaria Quantitative Buffy Coat (QBC) and microscopy test results. A total of 113 subjects with clinical signs of malaria were enrolled after obtaining consent of patients at the Primary Health Centres and questionnaires administered to assess awareness and use of RDTs kit. Storage and compliance to standards of usage of the Kits were observed. The results were analyzed using SPSS version 16.0. There was a significant difference (p<0.05) in sensitivity to malaria parasite between the three diagnostic methods as QBC was more sensitive compared with other diagnostic methods, while Microscopy was more sensitive compared with RDT kits. A total number of 86(76.1%), 28(24.8%) and 39(34.5%) malaria positive cases were detected by QBC, RDT and Microscopy respectively. Out of the 86(76.1%) blood samples confirmed positive by QBC, 27(31.4%) and 38(44.2%) positive cases were detectable by RDT and Microscopy respectively. Furthermore, Microcopy detected 15(53.6%) of the total positive cases detected by RDT, while RDT was able to detect 15(34.5%) of the total positive cases detected by microscopy. When compared with QBC, RDT shown a sensitivity and specificity of 32.56% (95% Cl= 22.84 – 43.52%) and 31.76% (95% Cl= 22.09% - 42.76%) respectively. On the other hand, 71.8% (95% Cl=55.12% - 84.98%) sensitivity and 87.1% (95% Cl= 78.02 – 93.35%) specificity was shown by RDT when microscopy was used as gold standard. Compliance to manufacturer’s instruction on RDT usage was poor as some of the health workers collected the blood sample directly from the pricked finger into the sample well rather than the designated capillary pipette method, while others did not comply with time before reading the results of the kits. The result from this study showed that the sensitivity and accuracy of RDTs kit is low and there is need for proper training of the health workers to avoid misuse of the kit.