title: The accuracy of the first response histidine-rich protein2 rapid diagnostic test compared with malaria microscopy for guiding field treatment in an outbreak of falciparum malaria.
abstract: BACKGROUND
  Recent WHO guidelines recommended a universal "test and treat" strategy for malaria mainly by use of the rapid diagnostic test (RDT) in all areas. There are concerns about RDT that use the antigen histidine-rich protein2 (HRP2) to detect Plasmodium falciparum, because infection can persist after effective treatment.
  
  
  OBJECTIVE
  The aim of this paper is to describe the accuracy of the first response (HRP2)-RDT compared with malaria microscopy used for guiding the field treatment of patients in an outbreak situation in the Al-Rahabah area in Al-Rydah district in Hadramout/Yemen.
  
  
  METHODS
  An ad hoc cross sectional survey of all febrile patients in the affected area was conducted in May 2011. The field team was developed including the case management group and the entomology group. The group of case management prepared their plan based on "test and treat" strategy by using First Response Malaria Antigen HRP2 rapid diagnostic test for falciparum malaria, artemsinin-based combination therapy (ACT) according to the national policy of anti-malaria drugs in Yemen were supplied to treat those who were found to be RDT positive in the field; also blood smear films were taken from every patient with fever in order to validate the use of the RDT in the field. Blood film slides prepared and read by skilled lab technicians, the fourth reading was done by one lab expert in the malaria referral lab.
  
  
  RESULTS
  The accuracy parameters of HRP2 compared with microscopy are: Sensitivity (74%), specificity (94%). The positive predictive value is 68% and the negative predictive value is 96%. Total agreement is 148/162 (93%) and the overall prevalence is 14%. All the positive malaria cases were of P. falciparum either coming from RDT or microscopy.
  
  
  CONCLUSIONS
  HRP2-rapid test is an acceptable test as a guide for field treatment in an outbreak situation where prompt response is indicated. Good prepared blood film slides should be used as it is feasible to evaluate the accuracy of RDTs as a quality control tool.
authors.affiliation: Department of Family Medicine, Hadramout University, Malaria Control Program (Hadramout region/Yemen), Yemen.
authors.forename: Abdulla Salim Bin
authors.initials: AS
authors.lastname: Ghouth
authors.forename: Faraj Mubarak
authors.initials: FM
authors.lastname: Nasseb
authors.forename: Khaled Hussin
authors.initials: KH
authors.lastname: Al-Kaldy
keywords: Malaria; Yemen; rapid diagnostic test