title: Accuracy of Mobile Phone and Handheld Light Microscopy for the Diagnosis of Schistosomiasis and Intestinal Protozoa Infections in Côte d'Ivoire.
abstract: Handheld light microscopy using compact optics and mobile phones may improve the quality of health care in resource-constrained settings by enabling access to prompt and accurate diagnosis.
  
  
  
  Laboratory technicians were trained to operate two handheld diagnostic devices (Newton Nm1 microscope and a clip-on version of the mobile phone-based CellScope). The accuracy of these devices was compared to conventional light microscopy for the diagnosis of Schistosoma haematobium, S. mansoni, and intestinal protozoa infection in a community-based survey in rural Côte d'Ivoire. One slide of 10 ml filtered urine and a single Kato-Katz thick smear from 226 individuals were subjected to the Newton Nm1 microscope and CellScope for detection of Schistosoma eggs and compared to conventional microscopy. Additionally, 121 sodium acetate-acetic acid-formalin (SAF)-fixed stool samples were examined by the Newton Nm1 microscope and compared to conventional microscopy for the diagnosis of intestinal protozoa.
  
  
  
  The prevalence of S. haematobium, S. mansoni, Giardia intestinalis, and Entamoeba histolytica/E. dispar, as determined by conventional microscopy, was 39.8%, 5.3%, 20.7%, and 4.9%, respectively. The Newton Nm1 microscope had diagnostic sensitivities for S. mansoni and S. haematobium infection of 91.7% (95% confidence interval (CI) 59.8-99.6%) and 81.1% (95% CI 71.2-88.3%), respectively, and specificities of 99.5% (95% CI 97.0-100%) and 97.1% (95% CI 92.2-99.1%), respectively. The CellScope demonstrated sensitivities for S. mansoni and S. haematobium of 50.0% (95% CI 25.4-74.6%) and 35.6% (95% CI 25.9-46.4%), respectively, and specificities of 99.5% (95% CI 97.0-100%) and 100% (95% CI 86.7-100%), respectively. For G. intestinalis and E. histolytica/E. dispar, the Newton Nm1 microscope had sensitivity of 84.0% (95% CI 63.1-94.7%) and 83.3% (95% CI 36.5-99.1%), respectively, and 100% specificity.
  
  
  
  Handheld diagnostic devices can be employed in community-based surveys in resource-constrained settings after minimal training of laboratory technicians to diagnose intestinal parasites.
authors.affiliation: Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.|Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.|Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Jean T
authors.initials: JT
authors.lastname: Coulibaly
authors.affiliation: Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.|Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.
authors.forename: Mamadou
authors.initials: M
authors.lastname: Ouattara
authors.affiliation: Department of Bioengineering, University of California-Berkeley, Berkeley, California, United States of America.
authors.forename: Michael V
authors.initials: MV
authors.lastname: D'Ambrosio
authors.affiliation: Department of Bioengineering, University of California-Berkeley, Berkeley, California, United States of America.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Fletcher
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Keiser
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Jürg
authors.initials: J
authors.lastname: Utzinger
authors.affiliation: Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.|Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.
authors.forename: Eliézer K
authors.initials: EK
authors.lastname: N'Goran
authors.affiliation: Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, United States of America.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Andrews
authors.affiliation: Divisions of Internal Medicine and Infectious Diseases, Toronto General Hospital, Toronto, Canada.|Department of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Isaac I
authors.initials: II
authors.lastname: Bogoch
mesh_terms: D000818:Animals; D040421:Cell Phone; D007560:Cote d'Ivoire / Q000453:epidemiology; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000175:diagnosis* / Q000469:parasitology; D008853:Microscopy / Q000295:instrumentation* / Q000379:methods*; D011528:Protozoan Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000469:parasitology; D012548:Schistosoma haematobium / Q000302:isolation & purification; D012550:Schistosoma mansoni / Q000302:isolation & purification; D012552:Schistosomiasis / Q000175:diagnosis* / Q000453:epidemiology / Q000469:parasitology; D012680:Sensitivity and Specificity; D012987:Soil / Q000469:parasitology
chemical_list: D012987:Soil