title: Malaria in children of Tshimbulu (Western Kasai, Democratic Republic of the Congo): epidemiological data and accuracy of diagnostic assays applied in a limited resource setting.
abstract: BACKGROUND
  The literature data on malaria in Western Kasai, DRC, are limited and inadequate. A recent molecular survey there has detected Plasmodium ovale and Plasmodium malariae as mixed infections with Plasmodium falciparum. In Tshimbulu, Western Kasai, during a humanitarian initiative designed to provide children with free preventive screening and to reduce the local high malaria death rate, accurate species identification was performed, in order to collect unambiguous epidemiological data and to evaluate the reliability of locally applied diagnostics.
  
  
  METHODS
  Finger pricks provided fresh blood for microscopic analysis (MA), for rapid diagnostic test (RDT) and for molecular diagnostics (MD). MA and RDT were first performed by the local team and then a re-interpretation of the results (on the same slides and on RDT's taken pictures) was conducted in Italy, where MD were performed.
  
  
  RESULTS
  The analysis was conducted on 306 children; RDT found 80.9 % as P. falciparum-positive (37.4 % as two-band positive, P. falciparum single infection). MA identified a further four children as positive to P. falciparum and six co-infections with P. ovale. The second RDT evaluation confirmed a similar infection rate (78.2 %) but interpreted as two-band positive a significantly higher share of tests (56.8 %). MA confirmed 80.0 % of the children as malaria positive and, in addition to P. falciparum, identified P. malariae (13.8 %), P. vivax (3.4 %) and P. ovale (2.4 %), and detected Babesia microti in 19 smears. MD confirmed all of the species found (Babesia microti included), classified as mono-infection with P. falciparum a rate of spots comparable to MA revision, and identified all P. ovale as Plasmodium ovale wallikeri. The RDT used locally proved 93.1 % sensitive and 92.1 % specific for P. falciparum.
  
  
  CONCLUSIONS
  The malaria prevalence among the children and the presence of four Plasmodium species, highlighted in this study, identified a sanitary issue which proved to be more alarming than expected, as it was worsened by the unpredictable presence of P. vivax and Babesia microti (never before reported in DRC). Each diagnostic tool showed its point of weakness. Therefore, the most correct approach is by the combined use of different, locally available, diagnostic tools.
authors: Dip. Sanità Pubblica e Malattie infettive, Università "Sapienza", P.le Aldo Moro 5, 00185, Rome, Italy. simona.gabrielli@uniroma1.it.
authors: Simona
authors: S
authors: Gabrielli
authors: MobileDiagnosis Onlus, via Sciuti 180, 90144, Palermo, Italy. liviabellina@gmail.com.
authors: Livia
authors: L
authors: Bellina
authors: Dip. Sanità Pubblica e Malattie infettive, Università "Sapienza", P.le Aldo Moro 5, 00185, Rome, Italy. giovanni-milardi@hotmail.it.
authors: Giovanni Luigi
authors: GL
authors: Milardi
authors: St François Hospital, Tshimbulu, BP 185, Kananga, Western Kasai, Democratic Republic of Congo. bonifacekabasele2013@gmail.com.
authors: Boniface Kabasele
authors: BK
authors: Katende
authors: Dip. Sanità Pubblica e Malattie infettive, Università "Sapienza", P.le Aldo Moro 5, 00185, Rome, Italy. vale.totino@hotmail.it.
authors: Valentina
authors: V
authors: Totino
authors: St François Hospital, Tshimbulu, BP 185, Kananga, Western Kasai, Democratic Republic of Congo. valerio_fullin@yahoo.it.
authors: Valerio
authors: V
authors: Fullin
authors: Dip. Sanità Pubblica e Malattie infettive, Università "Sapienza", P.le Aldo Moro 5, 00185, Rome, Italy. gabriella.cancrini@uniroma1.it.
authors: Gabriella
authors: G
authors: Cancrini
mesh_terms: D002675:Child, Preschool; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D010963:Plasmodium falciparum / Q000502:physiology; D041122:Plasmodium ovale / Q000502:physiology; D010966:Plasmodium vivax / Q000502:physiology