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With no prejudice towards the reported utility of malaria rapid diagnostic test (RDT) towards a substantial reduction of over-prescription of antimalarials1, we feel it would be essential to realize that all malaria RDT formats involve immunological tests. They comprise antigen-antibody reaction at optimal conditions, while microscopy involves staining and visual examination of slides. At ambient temperatures, around 10oC at 3,000 m above sea-level, lower temperatures would not alter the efficacy of any microscopic evaluation.
Nevertheless, the performance of immunochromatographic RDT test could be far from optimal. At extremes of temperatures, sick patients would be provided protective clothing: laboratory premises would be operating at ambient temperatures. On the contrary, high ambient temperatures might selectively impair the quality of performance of malaria RDT. That could be possible in malaria-endemic deserts, including the Khation Region, a valley-desert landscape in south of Tadjikistan.2
Introduction of external quality assessments for malaria RDT and microscopy at the national or regional would be essential to monitor the quality of the results generated at individual health care centres and to reduce over- or under-prescription of antimalarial formations. An improvement was evident during the second external quality assessment of Giemsa-stained blood film microscopy in the Democratic Republic of the Congo. While the quality of blood film microscopy continued to be poor in 277 laboratories, there was an overall improvement in the quality of results generated by laboratories that had participated in the external quality assessments.3 Recently, a large scale SMS based external quality assessment (EQA) on correct reading and interpretation of photographs of three-band malaria RDT among laboratory health workers was organized in 9 of the 11 provinces in the Democratic Republic of the Congo. The errors in reading and interpretation of malaria RDTs were widespread and stock outs of RDTs were also frequent.4
In conclusion, an extended program for external quality assessment of malaria microscopy of RDT would be useful in all settings to ensure judicious prescriptions of antimalarial or antibiotic formulations.
1. Odaga J, Sinclair D, Lokong JA, Donegan S, Hopkins H, Garner P. Rapid diagnostic tests versus clinical diagnosis for managing people with fever in malaria endemic settings. Cochrane Database Syst Rev. 2014 Apr 17;4:CD008998. doi: 10.1002/14651858.CD008998.pub2
2. Karimov SS, Kadamov DS, Murodova NKh. Karimov SS, Kadamov DS, Murodova NKh. [The current malaria situation in Tadjikistan] Med Parazitol (Mosk). 2008 Jan-Mar;(1):33-6.
3. Mukadi P, Gillet P, Lukuka A, Atua B, Sheshe N, Kanza A, Mayunda JB, Mongita B, Senga R, Ngoyi J, Muyembe JJ, Jacobs J, Lejon V. External quality assessment of Giemsa-stained blood film microscopy for the diagnosis of malaria and sleeping sickness in the Democratic Republic of the Congo. Bull World Health Organ. 2013 Jun 1;91(6):441-8. doi: 10.2471/BLT.12.112706
4. Mukadi P, Gillet P, Lukuka A, Mbatshi J, Otshudiema J, Muyembe JJ, Buyze J, Jacobs J, Lejon V. External quality assessment of reading and interpretation of malaria rapid diagnostic tests among 1849 end-users in the Democratic Republic of the Congo through Short Message Service (SMS). PLoS One. 2013 Aug 13;8(8):e71442. doi: 10.1371/journal.pone.0071442. eCollection 2013.
Re: Rapid diagnostic tests for malaria
With no prejudice towards the reported utility of malaria rapid diagnostic test (RDT) towards a substantial reduction of over-prescription of antimalarials1, we feel it would be essential to realize that all malaria RDT formats involve immunological tests. They comprise antigen-antibody reaction at optimal conditions, while microscopy involves staining and visual examination of slides. At ambient temperatures, around 10oC at 3,000 m above sea-level, lower temperatures would not alter the efficacy of any microscopic evaluation.
Nevertheless, the performance of immunochromatographic RDT test could be far from optimal. At extremes of temperatures, sick patients would be provided protective clothing: laboratory premises would be operating at ambient temperatures. On the contrary, high ambient temperatures might selectively impair the quality of performance of malaria RDT. That could be possible in malaria-endemic deserts, including the Khation Region, a valley-desert landscape in south of Tadjikistan.2
Introduction of external quality assessments for malaria RDT and microscopy at the national or regional would be essential to monitor the quality of the results generated at individual health care centres and to reduce over- or under-prescription of antimalarial formations. An improvement was evident during the second external quality assessment of Giemsa-stained blood film microscopy in the Democratic Republic of the Congo. While the quality of blood film microscopy continued to be poor in 277 laboratories, there was an overall improvement in the quality of results generated by laboratories that had participated in the external quality assessments.3 Recently, a large scale SMS based external quality assessment (EQA) on correct reading and interpretation of photographs of three-band malaria RDT among laboratory health workers was organized in 9 of the 11 provinces in the Democratic Republic of the Congo. The errors in reading and interpretation of malaria RDTs were widespread and stock outs of RDTs were also frequent.4
In conclusion, an extended program for external quality assessment of malaria microscopy of RDT would be useful in all settings to ensure judicious prescriptions of antimalarial or antibiotic formulations.
1. Odaga J, Sinclair D, Lokong JA, Donegan S, Hopkins H, Garner P. Rapid diagnostic tests versus clinical diagnosis for managing people with fever in malaria endemic settings. Cochrane Database Syst Rev. 2014 Apr 17;4:CD008998. doi: 10.1002/14651858.CD008998.pub2
2. Karimov SS, Kadamov DS, Murodova NKh. Karimov SS, Kadamov DS, Murodova NKh. [The current malaria situation in Tadjikistan] Med Parazitol (Mosk). 2008 Jan-Mar;(1):33-6.
3. Mukadi P, Gillet P, Lukuka A, Atua B, Sheshe N, Kanza A, Mayunda JB, Mongita B, Senga R, Ngoyi J, Muyembe JJ, Jacobs J, Lejon V. External quality assessment of Giemsa-stained blood film microscopy for the diagnosis of malaria and sleeping sickness in the Democratic Republic of the Congo. Bull World Health Organ. 2013 Jun 1;91(6):441-8. doi: 10.2471/BLT.12.112706
4. Mukadi P, Gillet P, Lukuka A, Mbatshi J, Otshudiema J, Muyembe JJ, Buyze J, Jacobs J, Lejon V. External quality assessment of reading and interpretation of malaria rapid diagnostic tests among 1849 end-users in the Democratic Republic of the Congo through Short Message Service (SMS). PLoS One. 2013 Aug 13;8(8):e71442. doi: 10.1371/journal.pone.0071442. eCollection 2013.
Competing interests: No competing interests