Abstract
BACKGROUND: One of the main challenge for controlling the morbidity and mortality related to malaria is the absence of reliable treatment and precise diagnostic tools in malaria-prone regions. Despite the number of diagnostic techniques used, and inconsistent results were found from previous studies. The aim of this study is to assess the effectiveness of 18S nested PCR(Polymerase Chain Reaction),microscopy, and CarestartTMpf/pan RDT(Rapid Diagnostic Tests) as malaria diagnostic methods using Microscopy and 18S nested PCR as reference techniques. METHODS: A facilities and community based cross-sectional study was conducted in the villages of Batodegama kebele and Adama malaria control center from December 2016 to February 2017. A fingerprick blood sample was collected from each participant for the CarestartTM pf/pan RDT test, microscopy, and dry blood spot (DBS) analysis and 18S nested PCR assay. Data were analyzed using STATA11 to calculate the sensitivity, specificity, predictive values, and accuracy. RESULTS: Among the 128 asymptomatic patients, 26 (20.3%) were positive for malaria nested 18S PCR, 5 (3.9%) through RDT, and 8 (6.3%) through microscopy. From 202 symptomatic Patients, 55 (27.23%), 26 (12.87%), and 28 (13.86%) individuals were positive for 18S nested PCR, RDT, and microscopy, respectively. Comparative analysis of 18S nested PCR, microscopy, and CarestartTMpf/pan RDT have similar sensitivities of 50% and specificities of 100%.for diagnosing symptomatic malaria infections. Furthermore, species level analysis showed that 18S nested PCR has a higher detection rate of 26 (20.31%) than microscopy 8 (6.25%) and CareStartTM pf/pan RDT 5 (4.1%). The CarestartTMpf/pan RDT had a sensitivity of 15.4% and specificity of 98% in detecting asymptomatic malaria infections. However, the two methods have comparable sensitivities. CONCLUSIONS: The 18S nested PCR assay showed superior performance in all circumstances. On the other hand, the overall performance of CareStart TM pf/pan RDTs was found to be comparable to that of microscopy. This finding highlights the value of parallel application of CareStart TM pf/pan RDTs and microscopy in a resource-limited setup.