Is molecular biology the best alternative for diagnosis of malaria to microscopy? A comparison between microscopy, antigen detection and molecular tests in rural Kenya and urban Tanzania
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Summary: Objective To assess the agreement of different diagnostic methods for the diagnosis and confirmation of the clinical suspicion of Plasmodium infection in children in Tanzania and Kenya. Method Blood samples were collected by the finger prick method from 338 children. Blood samples were collected from 338 children with the clinical suspicion of uncomplicated malaria in health clinics in Tanzania and Kenya. The presence of Plasmodium parasites was assessed with microscopy, rapid diagnostic tests (RDTs) and the molecular assays, quantitative nucleic acid sequence based amplification (QT‐NASBA) and polymerase chain reaction (PCR). The results were compared and analysed for agreement. Results There was a high degree of agreement (88.6–100%) between RDTs or molecular tests and microscopy. In rural Kenya, with a high incidence of malaria cases, the correlation coefficient ranged from 0.94 for RDTs to 0.76 for PCR. In urban Tanzania, where there was a low incidence of cases, R for RDTs was 1.0 but only 0.25 for PCR and 0.33 for NASBA. Conclusion Malaria is overestimated if the diagnosis is based solely on clinical signs. Therefore, laboratory confirmation is essential. Microscopy is a reliable method in rural areas where malaria is prevalent, but RDTs offer a good alternative with the advantage that it is an easy and rapid method. Molecular tests are more sensitive but difficult to implement in rural areas. In areas with lower incidence, molecular tests detect a significantly higher number of Plasmodium infections than RDTs or microscopy. Although implementation of molecular tools can be difficult, the prospect of an easy and cheap detection system makes them promising tools for the near future.
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Low-density parasitemias serve as a reservoir for continued transmission of malaria and may contribute to negative health.
“These low-density parasitemias serve as a reservoir for continued transmission of the disease and may contribute to negative health. 9-11”
From What is the burden of submicroscopic malaria in pregnancy in central India? (2015) · cites this paper as [11]
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- Authors
- Mens, P., Spieker, N., Omar, S., Heijnen, M., Schallig, H., & Kager, P. A.
- Affiliations
- Royal Tropical Institute (NL)
- Aga Khan Hospital Dar es Salaam (TZ)
- Kenya Medical Research Institute (KE)
- Amsterdam UMC Location University of Amsterdam (NL)
- Corresponding author
- Mens, P.
- ORCID
- Venue
- Tropical Medicine & International Health
- Publisher
- Wiley
- Published
- 2006-11-27
- Volume
- 12
- Issue
- 2
- Pages
- 238-244
- ISSN
- 1360-2276 (ISSN-L)
- 1365-3156
- OpenAlex
- W2075339636
- Cited by
- 116
- References
- 23
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 2 · 2023: 7 · 2022: 4 · 2021: 6 · 2020: 7 · 2019: 5 · 2018: 5 · 2017: 2 · 2016: 6 · 2015: 7 · 2014: 7 · 2013: 4 · 2012: 12
- FWCI
- 6.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Tropical Medicine & International Health (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Physical Sciences › Engineering › Biomedical Engineering › Biosensors and Analytical Detection
- Life Sciences › Immunology and Microbiology › Parasitology › Bird parasitology and diseases
- Keywords
- malaria diagnosis, malaria, microscopy, rapid diagnostic tests, molecular diagnosis, NASBA, PCR, antigen detection, diagnostic agreement, children, rural Kenya, urban Tanzania, malaria incidence, overdiagnosis
- MeSH terms
- Antigens, Protozoan, Child, Child, Preschool, Diagnostic Tests, Routine, Female, Humans, Infant, Kenya, Malaria, Male, Microscopy, Parasite Egg Count, Prospective Studies, Rural Health, Tanzania, Urban Health, Incidence, Polymerase Chain Reaction, Malaria, Falciparum, Nucleic Acid Amplification Techniques
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