title: Plasmodium falciparum parasite infection prevalence from a household survey in Zambia using microscopy and a rapid diagnostic test: implications for monitoring and evaluation.
abstract: This paper presents estimates of P. falciparum infection prevalence in children under 5 years old in the context of a population-based household survey in Luangwa District (Lusaka Province), Zambia, an area where greater than 75% of households possess at least one insecticide-treated mosquito net (ITN). The sensitivity and specificity of an HRP-2 rapid diagnostic test (RDT) (ICT Malaria Pf((R))) compared to microscopy, as well as factors associated with discordant diagnostic results are also presented. P. falciparum infection prevalence was estimated at 7.0% (95% CI 4.9-9.0%) using microscopy. Using microscopy as the gold standard, the sensitivity of the HRP-2 RDT was 100% and specificity was 91.5%; positive predictive value was estimated to be 46.7% (95% CI 36.3-57.4%). RDT discordance, or HRP-2 false positivity, was highest among older children, those in the northern part of Luangwa District, and those with a reported history of antimalarial treatment. These data suggest microscopy should remain the gold standard for estimating malaria parasite point prevalence from household surveys for monitoring and evaluation purposes.
authors.affiliation: Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, United States of America. jkeating@tulane.edu
authors.forename: Joseph
authors.initials: J
authors.lastname: Keating
authors.forename: John M
authors.initials: JM
authors.lastname: Miller
authors.forename: Adam
authors.initials: A
authors.lastname: Bennett
authors.forename: Hawela B
authors.initials: HB
authors.lastname: Moonga
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Eisele
mesh_terms: D000818:Animals; D002675:Child, Preschool; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008853:Microscopy / Q000379:methods*; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D015995:Prevalence; D012680:Sensitivity and Specificity; D015024:Zambia / Q000453:epidemiology