title: Comparison of clinical, microscopic and rapid diagnostic test methods in the diagnosis of Plasmodium falciparum malaria in Enugu, Nigeria.
abstract: OBJECTIVE
  To compare the use of clinical, microscopic and immunochromato-graphic methods in the diagnosis of Plasmodium falciparum malaria.
  
  
  METHODS
  Children with history of fever were consecutively recruited. Information on personal characteristics, and clinical features were obtained with the parental consent before enrolment. Malaria parasite density was done with quantitative microscopy, as well as specie identification in both local and reference laboratories. Rapid diagnostic test (RDT) kits were also used for parasite detection.
  
  
  RESULTS
  Eighty three children had clinical diagnosis of malaria, while the remaining 6 had other diagnoses. On microscopy 89 and 26 patients had parasitaemia by the local and reference laboratories respectively. With the RDT, 15 patients had parasitaemia with corresponding minimum densities of 1200 and 716 parasites per ul from the local and reference laboratories. The sensitivity and specificity of the RDT to the reference laboratory were 42.31% and 93.65% respectively, while concordance was 57.69% for RDT, 30.49% for clinical diagnosis (all symptoms), 43.75% for clinical diagnosis (fever alone), and 29.21% for local laboratory.
  
  
  CONCLUSIONS
  There was a significant deficiency in malaria diagnosis using any of the methods alone. For reliable diagnosis of malaria a combination of the methods of diagnosis is recommended. Degradation of the RDTs might have contributed to its low sensitivity. Training and better quality assurance should be established for the medical and laboratory workers in order to improve malaria diagnosis.
authors.affiliation: Department of Paediatrics, College of Medicine,University of Nigeria Enugu Campus. ogwualu@gmail.com
authors.forename: Oguonu
authors.initials: O
authors.lastname: Tagbo
authors.forename: U Okafor
authors.initials: UO
authors.lastname: Henrietta
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000175:diagnosis*; D008297:Male; D008828:Microbiological Techniques; D008853:Microscopy; D009549:Nigeria; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results