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Comparative Study
. 2019 Apr 11;18(1):130.
doi: 10.1186/s12936-019-2766-2.

Distribution of Plasmodium species and assessment of performance of diagnostic tools used during a malaria survey in Southern and Western Provinces of Zambia

Lungowe Sitali  1   2   3 , John M Miller  4 , Mulenga C Mwenda  4 , Daniel J Bridges  4 , Moonga B Hawela  5 , Busiku Hamainza  5 , Elizabeth Chizema-Kawesha  5 , Thomas P Eisele  6   7 , James Chipeta  8   9 , Bernt Lindtjørn  10
Affiliations
Comparative Study

Distribution of Plasmodium species and assessment of performance of diagnostic tools used during a malaria survey in Southern and Western Provinces of Zambia

Lungowe Sitali et al. Malar J. .

Abstract

Background: Zambia continues to make strides in reducing malaria burden through the use of proven malaria interventions and has recently pledged to eliminate malaria by 2021. Case management services have been scaled up at community level with rapid diagnostic tests (RDTs) providing antigen-based detection of falciparum malaria only. Key to national malaria elimination goals is the ability to identify, treat and eliminate all Plasmodium species. This study sought to determine the distribution of non-falciparum malaria and assess the performance of diagnostic tests for Plasmodium falciparum in Western and Southern Provinces of Zambia, two provinces planned for early malaria elimination.

Methods: A sub-set of individuals' data and samples from a cross-sectional household survey, conducted during peak malaria transmission season in April and May 2017, was used. The survey collected socio-demographic information on household members and coverage of malaria interventions. Malaria testing was done on respondents of all ages using blood smears and RDTs while dried blood spots were collected on filter papers for analysis using photo-induced electron transfer polymerase chain reaction (PET-PCR). Slides were stained using Giemsa stain and examined by microscopy for malaria parasites.

Results: From the 1567 individuals included, the overall prevalence of malaria was 19.4% (CI 17.5-21.4) by PCR, 19.3% (CI 17.4-21.4) by RDT and 12.9% (CI 11.3-14.7) by microscopy. Using PET-PCR as the gold standard, RDTs showed a sensitivity of 75.7% (CI 70.4-80.4) and specificity of 94.2% (CI 92.8-95.4). The positive predictive value (PPV) was 75.9% (CI 70.7-80.6) and negative predictive value (NPV) was 94.1% (CI 92.1-95.4). In contrast, microscopy for sensitivity, specificity, PPV, and NPV values were 56.9% (CI 51.1-62.5), 97.7% (CI 96.7-98.5), 85.6% (CI 80.0-90.2), 90.4% (CI 88.7-91.9), respectively. Non-falciparum infections were found only in Western Province, where 11.6% of P. falciparum infections were co-infections with Plasmodium ovale or Plasmodium malariae.

Conclusion: From the sub-set of survey data analysed, non-falciparum species are present and occurred as mixed infections. As expected, PET-PCR was slightly more sensitive than both malaria RDTs and microscopy to detecting malaria infections.

Keywords: Malaria; Mixed infections; Non-falciparum infection; Rapid diagnostic tests; Zambia.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Map of Zambia showing location of Southern and Western Provinces. The study area is highlighted showing the red circles indicate the exact locations where samples were collected in the two provinces
Fig. 2
Fig. 2
Prevalence of malaria among the participants by province
Fig. 3
Fig. 3
Prevalence of Plasmodium falciparum, mixed infection and mono non-falciparum infection by PET-PCR
See this image and copyright information in PMC

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References

    1. Gething PW, Elyazar IR, Moyes CL, Smith DL, Battle KE, Guerra CA, et al. A long neglected world malaria map: Plasmodium vivax endemicity in 2010. PLoS Negl Trop Dis. 2012;6:e1814. doi: 10.1371/journal.pntd.0001814. - DOI - PMC - PubMed
    1. Geleta G, Ketema T. Severe malaria associated with Plasmodium falciparum and P. vivax among children in Pawe Hospital, Northwest Ethiopia. Malar Res Treat. 2016;2016:1240962. - PMC - PubMed
    1. Asua V, Tukwasibwe S, Conrad M, Walakira A, Nankabirwa JI, Mugenyi L, et al. Plasmodium species infecting children presenting with malaria in Uganda. Am J Trop Med Hyg. 2017;97:753–757. doi: 10.4269/ajtmh.17-0345. - DOI - PMC - PubMed
    1. Collins WE, Jeffery GM. Plasmodium ovale: parasite and disease. Clin Microbiol Rev. 2005;18:570–581. doi: 10.1128/CMR.18.3.570-581.2005. - DOI - PMC - PubMed
    1. Autino B, Noris A, Russo R, Castelli F. Epidemiology of malaria in endemic areas. Mediterr J Hematol Infect Dis. 2012;4:e2012060. doi: 10.4084/mjhid.2012.060. - DOI - PMC - PubMed

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