Diagnostic performance of rapid diagnostic test, light microscopy and polymerase chain reaction during mass survey conducted in low and high malaria-endemic areas from two North-Eastern states of India (original) (raw)
Abstract
An early and accurate diagnosis followed by prompt treatment is pre-requisite for the management of any disease. Malaria diagnosis is routinely performed by microscopy and rapid diagnostic tests (RDTs) in the field settings; however, their performance may vary across regions, age and asymptomatic status. Owing to this, we assessed the diagnostic performance of conventional and advanced molecular tools for malaria detection in low and high malaria-endemic settings. We performed mass blood surveys in low and high endemic regions of two North-Eastern districts from the states of Assam and Meghalaya. A total of 3322 individuals were screened for malaria using RDT, microscopy and PCR and measures of diagnostic accuracy were estimated. Out of 3322 individuals, 649 (19.5%) were detected with malaria parasite. Asymptomatic were 86.4% (2872/3322), of which 19.4% (557/2872) had Plasmodium infection. The sensitivity and specificity of microscopy were 42.7% and 99.3%, and RDT showed 49.9% and 90.4%, respectively, considering PCR as standard. RDT (AUC: 0.65 vs 0.74; p = 0.001) and microscopy (AUC: 0.64 vs 0.76; p < 0.0001) performances were significantly lower in low compared to high endemic areas. True positive rate was lower in asymptomatics but true negative rate was found similar to symptomatic individuals. The conventional diagnostic tools (RDT and microscopy) had detected malaria in children with nearly twofold greater sensitivity than in the adults (p < 0.05). To conclude, asymptomatics, adults and low malaria-endemic regions require major attention due to mediocre performance of conventional diagnostic tools in malaria detection.
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Acknowledgements
The guidance and support provided by Dr. William Layam, Sr. Regional Director Meghalaya, Dr. Parthajyoti Gogoi, Sr. Regional Director Assam, Dr. H. P. Gupta and Dr. Vas Dev, Ex-Officer-in-Charge, NIMR field unit, Guwahati is highly acknowledged. We thank State Health Programme and Dr. Neena Valecha, Director, NIMR for being a coordinator of the study. The authors also wish to extend their thanks to the experienced technicians of our institute for performing rigorous quality check of microscopy results.
Funding
This study was funded by the Indian Council of Medical Research, New Delhi, India vide grant no. NER/55/2015-ECD-I.
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Authors and Affiliations
- Parasite-Host Biology Group, ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi, 110077, India
Hari Shankar, Mrigendra Pal Singh & Neelima Mishra - ICMR-National Institute of Malaria Research Field Unit, Guwahati, Assam, 781022, India
Sobhan Phookan & Kuldeep Singh
Authors
- Hari Shankar
- Mrigendra Pal Singh
- Sobhan Phookan
- Kuldeep Singh
- Neelima Mishra
Contributions
SP was the principal investigator of the study. SP and NM conceived and designed the study. HS and MPS contributed substantially in data collection, data analysis and interpretation of the results. HS, SP and MPS executed the field and laboratory work. KS and NM coordinated the field operations and logistic arrangements. HS drafted the first version of the manuscript. MPS and NM critically reviewed the manuscript and all authors provided intellectual inputs, reviewed and approved this manuscript.
Corresponding author
Correspondence toNeelima Mishra.
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Ethical approval
The procedures performed in this study were in accordance with the ethical standards of the Institutional Ethics Committee of National Institute of Malaria Research (Ref. No. ECR/ NIMR/ EC/ 2015/ 490). Informed consent was obtained from all individual participants included in the study.
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The authors declare/s no competing interests.
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Section Editor: Nawal Hijjawi
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Shankar, H., Singh, M.P., Phookan, S. et al. Diagnostic performance of rapid diagnostic test, light microscopy and polymerase chain reaction during mass survey conducted in low and high malaria-endemic areas from two North-Eastern states of India.Parasitol Res 120, 2251–2261 (2021). https://doi.org/10.1007/s00436-021-07125-8
- Received: 17 December 2020
- Accepted: 15 March 2021
- Published: 27 March 2021
- Version of record: 27 March 2021
- Issue date: June 2021
- DOI: https://doi.org/10.1007/s00436-021-07125-8