All negative RDT must be followed by microscopy to confirm the result.In addition, all positive RDT’s should also followed by microscopy. Accuracy of results . The sensitivity and specificity of all RDTs is such that they can replace or extend the access of diagnostic services for uncomplicated P. falciparum malaria. Malaria rapid diagnostic tests (RDTs) may improve fever management in areas without microscopy. The selection of the best-in-class RDTs was based on the results of the WHO–FIND product testing programme (Rounds 1–6), which has evaluated the performance of 171 unique RDT products on malaria samples at standardized parasitaemia (200 and 2000 parasites/µL) [].The reactivity of each RDT against P. falciparum or P. vivax isolates is reported …

RDTs should be sensitive enough to reliably detect malaria parasites at densities associated with disease. Swift diagnosis of Plasmodium falciparum malaria in areas where the disease is not endemic is frequently complicated by the lack of experience on the side of involved laboratory personal. 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 … Rapid diagnostic tests selection.

Sensitivity is determined by the quality of manufacture, species, number, viability and strain of parasites present, condition of the RDT (including storage conditions), technique and care used in performing the test as well as reader’s interpretation. For the diagnosis of P. malariae and P. ovale infections, the sensitivity is lower than that of P. falciparum malaria at all levels of parasitemia on both the PfHRP2/PMA and the pLDH tests. The specificity of RDTs in rural areas was lower than in urban areas, this may also be due to the fact that some patients maintain a high level of antibodies against malaria for more days or did not received adequate treatments [ 22 ]. The sensitivity of an RDT for detecting malaria parasitaemia (or recent parasitaemia) depends on the concentration of circulating antigens in the patient’s blood, and the ability of the labelled antibody on the RDT to bind the antigen and accumulate to form a visible line. The specificity appears to be better with the pLDH test than the PfHRP2/PMA test for … The HRP-2 antigen persists even after effective treatment and so is not useful for detecting treatment failures. The RDT may not be able to detect some infections with lower number of malaria parasites circulating in the patient’s bloodstream. HRP-2 antibody types may be more sensitive but are less specific than pLDH antibody-based tests, but the differences are small. The use of the RDT does not eliminate the need for malaria microscopy. RDTs permit a reliable detection of malaria infections particularly in remote areas with limited access to good quality microscopy services.

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