Page 107 - Invited Paper Session (IPS) - Volume 2

IPS186 Fagbamigbe, A. F.
Keywords
Rapid Diagnostic Tests; Microscopy; diagnostic accuracy; sensitivity;
specificity

1. Introduction
Malaria remains a major public health challenge in sub-Sahara Africa,
especially Nigeria [1–3]. Despite myriad efforts devoted to curbing the
menace of malaria in Nigeria, its prevalence has remained high [4] with nearly
half of Nigeria 20 million under-five children infected by malaria parasite on
daily basis. Some of the malaria eradication initiatives taken by Nigeria
government and other stakeholders include mass long-lasting insecticidal net
(LLIN) campaigns and distribution, replacement campaigns, intermittent
preventive treatment (IPT), and a massive scale-up in malaria case
management including use of RDTs.
Malaria diagnosis is a key pillar in the eradication of malaria in Africa. WHO
recommends that malaria case management is based on parasite diagnosis in
all cases [7,13] and that treatment should only commence after diagnosis [14].
The use of antigen detecting Rapid Diagnostic Tests (RDTs) is a vital part of
this strategy. Malaria RDT is the “immunochromatographic lateral flow device
for the detection of malaria parasite antigens [7,15,16]. The strategic purpose
for the introduction of RDT is to extend access to malaria diagnosis by
providing a parasite-based diagnosis in areas where “good-quality”
microscopy cannot be maintained [7], unavailable or less convenient; hence
case management is improved [11]. To enhance effective diagnosis of all
malaria cases, the diagnostic method used must be accurate and available at
the point of care.
Literature has documented the specificities, sensitivities, numbers of false
positives and false negatives and variabilities in temperature tolerances of
these tests as some of the difficulties and challenges facing current RDTs [16].
Conclusive evidence is still lacking on the accuracy and safety of a testbased
strategy for children [14]. It is, therefore, imperative to evaluate the
performances of RDTs in terms of diagnostic accuracy as this measure
provides information on the diagnostic test’s ability “discriminate between
and/or predict disease and health” [18].
The consequences of erroneous and wrong diagnosis are enormous. These
errors could be either false negative or false positive errors. The false negative
errors occur when the disease is missed when indeed, it is present. They often
result in people foregoing needed treatment and could lead to the chronic
stage of disease or even death. The false positive errors are due to wrongful
confirmation that a disease is present. It leads to a wrong focus on disease-
free subjects which may result in unnecessary treatment and sometimes
overtreatment. It could lead to a negative impact, personal inconvenience,

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