Background Over recent years, there has been an increase in the use of a histidine-rich protein 2(HRP-2)-based rapid diagnostic test (RDT) in the diagnosis of malaria. Accurate and prompt diagnosis of malaria will help reduce parasite reservoir and reduce malaria transmission. However, the underdiagnosis of malaria due to low parasite density hinders malaria eradication. The study aimed at establishing the baseline information on the accuracy of the HRP2-based RDT used in Ghana in three communities (Agona [rural], Kuntanase [peri-urban] and Kumasi [urban]) while determining the haematological difference among malaria patients.
Methods Cross-sectional study was conducted from January to April 2018. A total of 304 participants were recruited in the study. Microscopy and RDT were used in the detection of malaria parasitaemia in all the samples.
Results The overall sensitivity, specificity, negative predictive value and positive predictive value was 75.9%, 95.6%, 64.7% and 97.4% respectively. The HRP-2 based RDT was highly sensitive (100%) for parasite density ≥250 parasite µl and relatively low for parasite density ≤100 parasite/µl (50%- Kumasi, 67%- Agona and 75%- Kuntanase). On the other hand, Agona (rural) recorded the highest prevalence (15.8%) followed by Kumasi (urban) (9%) and Kuntanase (peri-urban) being the lowest (6.8%). The difference in prevalence was however not statistically significant across the three communities. The rural area also accounted for highest parasite density (mean 99.53) and lowest in urban (60.29) with a statistical difference (p<0.001). The difference in white blood cell levels was significant (<0.0001) across Agona, Kuntanase and Kumasi. RBC and Hb levels were however not significant.
Conclusion The high specificity observed indicates that the majority of the patients without malaria were correctly diagnosed. Notwithstanding, the sensitivity was relatively low and below the WHO standard of ≥95% hence a significant number of malaria-positive cases were misdiagnosed. It is therefore important that the accuracy of RDT should be frequently assessed to improve its quality.
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