title: Performance of malaria rapid diagnostic tests as part of routine malaria case management in Kenya.
abstract: Data on malaria rapid diagnostic test (RDT) performance under routine program conditions are limited. We assessed the attributes of RDTs performed by study and health facility (HF) staffs as part of routine malaria case management of patients > or = 5 years of age in Kenya. Expert microscopy was used as our gold standard. A total of 1,827 patients were enrolled; 191 (11.6%) were parasitemic by expert microscopy. Sensitivity and specificity of RDTs performed by study staff were 86.6% (95% confidence interval [CI]: 79.8-93.5%) and 95.4% (95% CI: 93.9-96.9%), respectively. Among tests performed by HF staff, RDTs were 91.7% (95% CI: 80.8-100.0%) sensitive and 96.7% (95% CI: 92.8-100.0%) specific, whereas microscopy was 52.5% (95% CI: 33.2-71.9%) sensitive and 77.0% (95% CI: 67.9-86.2%) specific. Our findings suggest that RDTs perform better than microscopy under routine conditions. Further efforts are needed to maintain this high RDT performance over time.
authors.affiliation: Malaria Branch, Division of Parasitic Diseases, National Center for Vector-Borne, Zoonotic, and Enteric Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. acq7@cdc.gov
authors.forename: Alexandre Macedo
authors.initials: AM
authors.lastname: de Oliveira
authors.forename: Jacek
authors.initials: J
authors.lastname: Skarbinski
authors.forename: Peter O
authors.initials: PO
authors.lastname: Ouma
authors.forename: Simon
authors.initials: S
authors.lastname: Kariuki
authors.forename: John W
authors.initials: JW
authors.lastname: Barnwell
authors.forename: Kephas
authors.initials: K
authors.lastname: Otieno
authors.forename: Phillip
authors.initials: P
authors.lastname: Onyona
authors.forename: Louise M
authors.initials: LM
authors.lastname: Causer
authors.forename: Kayla F
authors.initials: KF
authors.lastname: Laserson
authors.forename: Willis S
authors.initials: WS
authors.lastname: Akhwale
authors.forename: Laurence
authors.initials: L
authors.lastname: Slutsker
authors.forename: Mary
authors.initials: M
authors.lastname: Hamel
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use; D019090:Case Management; D004338:Drug Combinations; D004983:Ethanolamines / Q000627:therapeutic use; D005449:Fluorenes / Q000627:therapeutic use; D006268:Health Facilities; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D018512:Parasitemia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes