title: Paracheck® rapid diagnostic test for detecting malaria infection in under five children: a population-based survey in Burkina Faso.
abstract: BACKGROUND
  Over the past ten years, Rapid Diagnostic Tests (RDT) played a major role in improving the use of biological malaria diagnosis, in particular in poor-resources settings. In Burkina Faso, a recent Demography and Health Survey (DHS) gave the opportunity to assess the performance of the Paracheck® test in under five children nationwide at community level.
  
  
  METHODS
  A national representative sample of 14,947 households was selected using a stratified two-stage cluster sampling. In one out of two households, all under five children were eligible to be tested for malaria using both RDT and microscopy diagnosis. Paracheck® performance was assessed using miscroscopy as the gold standard. Sensitivity and specificity were calculated as well as the diagnosis accuracy (DA) and the Youden index.
  
  
  RESULTS
  The malaria infection prevalence was estimated at 66% (95% CI: 64.8-67.2) according to microscopy and at 76.2% (95% CI: 75.1-77.3) according to Paracheck®. The sensitivity and specificity were estimated at 89.9% (95% CI: 89.0-90.8) and 50.4% (95% CI: 48.3-52.6) respectively with a Diagnosis Accuracy of 77% and a Youden index of 40%. The positive predictive value for malaria infection was 77.9% (95% CI: 76.7-79.1) and the negative predictive value was 72.1% (95% CI: 69.7-74.3). Variations were found by age group, period of the year and urban and rural areas, as well as across the 13 regions of the country.
  
  
  CONCLUSIONS
  While the sensitivity of the Paracheck® test was high, its specificity was poor in the general under five population of Burkina Faso. These results suggest that Paracheck® is not suitable to assess malaria infection prevalence at community level in areas with high malaria transmission. In such settings, malaria prevalence in the general population could be estimated using microscopy.
authors.affiliation: Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL), Clos Chapelle-aux-champs 30, bte B1,30,13, 1200 Bruxelles, Belgium. sekou.samadoulougou@uclouvain.be.
authors.forename: Sekou
authors.initials: S
authors.lastname: Samadoulougou
authors.forename: Fati
authors.initials: F
authors.lastname: Kirakoya-Samadoulougou
authors.forename: Sophie
authors.initials: S
authors.lastname: Sarrassat
authors.forename: Halidou
authors.initials: H
authors.lastname: Tinto
authors.forename: Fidèle
authors.initials: F
authors.lastname: Bakiono
authors.forename: Issa
authors.initials: I
authors.lastname: Nebié
authors.forename: Annie
authors.initials: A
authors.lastname: Robert
mesh_terms: D002050:Burkina Faso / Q000453:epidemiology; D002675:Child, Preschool; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008288:Malaria / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods; D010274:Parasitology / Q000379:methods*; D011237:Predictive Value of Tests; D015995:Prevalence; D012680:Sensitivity and Specificity