Accuracy of Malaria Diagnosis by Microscopy, Rapid Diagnostic Test, and PCR Methods and Evidence of Antimalarial Overprescription in Non-Severe Febrile Patients in Two Tanzanian Hospitals
Abstract
The study was aimed to evaluate the malaria over/underdiagnosis and over/underprescription of antimalarial drugs. Between February and March 2007 blood samples were collected from 336 non-severe febrile outpatients attended in two peripheral Tanzanian hospitals. Microscopy and a rapid diagnostic test (RDT) were done locally and the accuracy evaluated by qualitative polymerase chain reaction (PCR) for Plasmodium spp. The testing was performed at National Institute for Infectious Diseases Lazzaro Spallanzani (INMI), Rome, Italy. As a result of PCR, we identified 26 malaria cases out of 336 (7.7%) patients. Microscopy and RDT accuracies were 93.5% and 97.6%, respectively. Overprescription and underdiagnosis rates were 29.3% and 30.8%, respectively. On-field training, clinical management of febrile illness, and malaria microscopy in remote settings should be considered.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
RDTs demonstrated variable sensitivities compared with PCR for the diagnosis of malaria in nonpregnant symptomatic populations.
“RDTs also demonstrated variable sensitivities compared with PCR for the diagnosis of malaria in nonpregnant symptomatic populations [19–22].”
From Diagnosing malaria in pregnancy: An update (2012) · cites this paper as [19]
Cites
Saiki, R. K., Scharf, S., Faloona, F., Mullis, K. B., Horn, G. T., Erlich, H. A., & Arnheim, N. (1985) · Science · doi:10.1126/science.2999980 · Cited by 8,956 · see citing works
Snounou, G., Viriyakosol, S., Zhu, X. P., Jarra, W., Pinheiro, L., do Rosario, V. E., Thaithong, S., & Brown, K. N. (1993) · Molecular and Biochemical Parasitology · doi:10.1016/0166-6851(93)90077-b · Cited by 1,591 · see citing works
Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study
Reyburn, H., Mbatia, R., DRAKELEY, C. J., Carneiro, I. A., Mwakasungula, E., Mwerinde, O., Saganda, K., Shao, J. F., Kitua, A. Y., Olomi, R. M., et al. (2004) · BMJ · doi:10.1136/bmj.38251.658229.55 · Cited by 675 · see citing works
Self-citationMalaria misdiagnosis: effects on the poor and vulnerable.
Amexo, M., Tolhurst, R., Barnish, G., & Bates, I. (2004) · The Lancet · doi:10.1016/s0140-6736(04)17446-1 · Cited by 519 · see citing works
Reyburn, H., Mbakilwa, H., Mwangi, R., Mwerinde, O., Olomi, R. M., DRAKELEY, C. J., & Whitty, C. W. M. (2007) · BMJ · doi:10.1136/bmj.39073.496829.ae · Cited by 435 · see citing works
Insecticide-treated bednets and curtains for preventing malaria
Lengeler, C. (1998) · doi:10.1002/14651858.cd000363 · Cited by 281 · see citing works
Symptom overlap for malaria and pneumonia—policy implications for home management strategies
Källander, K., Nsungwa‐Sabiiti, J., & Peterson, S. (2004) · Acta Tropica · doi:10.1016/j.actatropica.2003.11.013 · Cited by 236 · see citing works
Use of clinical algorithms for diagnosing malaria1
Chandramohan, D., Jaffar, S. S., & Greenwood, B. M. (2002) · Tropical Medicine & International Health · doi:10.1046/j.1365-3156.2002.00827.x · Cited by 216 · see citing works
Microscopy and outpatient malaria case management among older children and adults in Kenya
Zurovac, D., Midia, B., Ochola, S. A., et al. (2006) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2006.01587.x · Cited by 175 · see citing works
Coleman, R. E., Sattabongkot, J., Promstaporm, S., Maneechai, N., Tippayachai, B., Kengluecha, A., Rachapaew, N., Zollner, G. E., Miller, R. S., Vaughan, J. A., et al. (2006) · Malaria Journal · doi:10.1186/1475-2875-5-121 · Cited by 174 · see citing works
Meta-Analysis: Accuracy of Rapid Tests for Malaria in Travelers Returning from Endemic Areas
Marx, A., Pewsner, D., Egger, M., Nüesch, R., Bucher, H. C., Genton, B., Hatz, C., & Jüni, P. (2005) · Annals of Internal Medicine · doi:10.7326/0003-4819-142-10-200505170-00009 · Cited by 164 · see citing works
Barat, L. M., Chipipa, J., KOLCZAK, M. S., et al. (1999) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.1999.60.1024 · Cited by 133 · see citing works
Makani, J. (2003) · QJM · doi:10.1093/qjmed/hcg059 · Cited by 113 · see citing works
Magesa, S., Lengeler, C., deSavigny, D., Miller, J. E., Njau, R. J., Kramer, K., Kitua, A. Y., & Mwita, A. (2005) · Malaria Journal · doi:10.1186/1475-2875-4-34 · Cited by 111 · see citing works
Self-citationClinical algorithms for malaria diagnosis lack utility among people of different age groups
Mwangi, T., Mohammed, M., Dayo, H., et al. (2005) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2005.01439.x · Cited by 108 · see citing works
Barker, R. H., Banchongaksorn, T., Courval, J. M., et al. (1994) · Experimental Parasitology · doi:10.1006/expr.1994.1057 · Cited by 49 · see citing works
Mboera, L., Kamugisha, M., Rumisha, S., et al. (2006) · Tanzania journal of health research/Tanzania Journal of Health Research · doi:10.4314/thrb.v8i1.14266 · Cited by 19 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Mubi, M., Janson, A., Warsame, M., Mårtensson, A., Källander, K., Petzold, M. G., Ngasala, B., Maganga, G., Gustafsson, L. L., Massele, A., et al. (2011) · PLoS ONE · doi:10.1371/journal.pone.0019753 · Cited by 155 · see citing works
Diagnosing malaria in pregnancy: An update
Fried, M., Muehlenbachs, A., & Duffy, P. E. (2012) · Expert Review of Anti-infective Therapy · doi:10.1586/eri.12.98 · Cited by 80 · see citing works
- Authors
- Nicastri, E., Bevilacqua, N., Schepisi, M. S., Paglia, M. G., Meschi, S., Ame, S. M., Mohamed, J. A., Mangi, S., Fumakule, R., Di Caro, A., Capobianchi, M. R., Kitua, A., Molteni, F., Racalbuto, V., & Ippolito, G.
- Affiliations
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (IT)
- Virology and Microbiology Laboratories, Epidemiology and Clinical Departments, National Institute for Infectious Diseases Lazzaro Spallanzani (INMI), Via Portuense 292, 00149 Rome, Italy; Public Health Laboratory–Ivo De Carneri Pemba, Chake Chake Hospital, Pemba, Zanzibar; Tosamaganga Hospital, United Republic of Tanzania; National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania; Italian Cooperation, Italian Ministry of Foreign Affairs, Rome Italy
- Corresponding author
- Bevilacqua, Nazario
- ORCID
- Venue
- The American Journal of Tropical Medicine and Hygiene
- Published
- 2009-05
- Volume
- 80
- Issue
- 5
- Pages
- 712-717
- ISSN
- 0002-9637 (ISSN-L)
- OpenAlex
- W2169630017
- Cited by
- 80
- References
- 18
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 5 · 2022: 2 · 2021: 4 · 2020: 2 · 2019: 2 · 2018: 3 · 2017: 5 · 2016: 4 · 2015: 8 · 2014: 8 · 2013: 7 · 2012: 5
- FWCI
- 8.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Tropical Medicine and Hygiene (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Health Sciences › Medicine › Genetics › Hemoglobinopathies and Related Disorders
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Keywords
- malaria diagnosis, diagnostic accuracy, rapid diagnostic tests, microscopy, PCR, underdiagnosis, Plasmodium, outpatients, Tanzania, remote settings
- MeSH terms
- Adolescent, Adult, Aged, Antimalarials, Child, Child, Preschool, Cross-Sectional Studies, Drug Utilization, Female, Fever, Humans, Infant, Malaria, Male, Middle Aged, Tanzania, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
