Comparative Evaluation Of Three Histidine-Rich Protein-2 Based Rapid Diagnostic Tests, Microscopy And Pcr For Guiding Malaria Treatment In Ibadan, Southwest Nigeria

Background: Malaria rapid diagnostic tests (mRDTs) are the preferred option for programmatic deployment. Aims: There are numerous mRDTs on the Nigerian market and there is a need to guide practitioners on the relative performance of the commonly used brands of mRDT in Nigeria. Subjects and Methods: The performance of three commonly used Histidine-Rich-Protein-2-based mRDTs (SD-Bioline (TM), Carestart (TM) and Paracheck-Pf (TM)) against microscopy of Giemsa stained blood and polymerase chain reaction (PCR) was evaluated among 190 febrile under-5 children in Ibadan, Nigeria. We calculated the sensitivity, specificity, predictive values, accuracy, and agreements. Results: There were 53.2% males. The prevalence of malaria parasite by microscopy was 46.8% and 57.9% by PCR. Malaria parasite detection by SD-Bioline (TM) was 60.5%, Carestart (TM): 60.0% and Paracheck-Pf (TM) 60.0%. Using microscopy as the gold standard, the sensitivities of SD-Bioline (TM), Carestart (TM) and Paracheck-Pf (TM) mRDT were 97.8%, 96.7% and 97.8% respectively while the specificities were 73.0%, 72.0% and 74.0% respectively. Using PCR as the gold standard, the sensitivity for both SD-Bioline (TM) and Paracheck-Pf (TM) was 85.5% and for CareStart was 84.6% while the specificity of SD-Bioline (TM), Carestart (TM), and Paracheck-Pf (TM) was 73.8%, 72.4%, and 75.0% respectively. The test accuracy was 81.0% for both SD-Bioline (TM) and Paracheck-Pf (TM) and 80.0% for Caresatrt (TM). The kappa coefficient of agreement between PCR and each of SD-Bioline (TM), Carestart, ParaCheck (TM) and microscopy was 0.597, 0.578, 0.609 and 0.739 respectively. Conclusion: The performance of the three mRDTs is a proof that any of the three is suitable for use in the diagnosis of malaria in the southwest of Nigeria.