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Meta-Analysis
. 2020 Jun;10(1):010411.
doi: 10.7189/jogh.10.010411.

High value of rapid diagnostic tests to diagnose malaria within children: A systematic review and meta-analysis

Wenjun Zhu  1 , XiaoXiao Ling  2 , Wenru Shang  1 , Yanqiu Du  1 , Jinyu Liu  1 , Yuanyuan Cao  3 , Mengmeng Yang  3 , Guoding Zhu  3   4   5 , Jun Cao  3   4   5 , Jiayan Huang  1
Affiliations
Meta-Analysis

High value of rapid diagnostic tests to diagnose malaria within children: A systematic review and meta-analysis

Wenjun Zhu et al. J Glob Health. 2020 Jun.

Abstract

Background: Children aged under five years accounted for 61% of all malaria deaths worldwide in 2017, and quicker differential diagnosis of malaria fever is vital for them. Rapid diagnostic tests (RDTs) are strips to detect.

Plasmodium: specific antigens promptly and are helpful in resource-limited areas. Thus, our aim is to assess the diagnostic accuracy of RDTs for malaria in children against the gold standard.

Methods: MEDLINE, Web of Science, EMBASE, Cochrane Library, the China National Knowledge Infrastructure, Wanfang, and Sinomed databases were systematically searched on August 23, 2019. Studies that compared RDTs with microscopy or polymerase chain reaction in malaria diagnoses for children were eligible. Relevant data were extracted. The quality of studies was evaluated using the revised Quality Assessment of Diagnostic Accuracy Studies instrument. Meta-analyses were carried out to calculate the pooled estimates and 95% confidence intervals of sensitivity and specificity.

Results: 51 articles were included. For diagnostic accuracy, the pooled estimates of the sensitivity and specificity of RDTs were 0.93 (95% confidence interval (CI) = 0.90, 0.95) and 0.93 (95% CI = 0.90, 0.96) respectively. Studies were highly heterogeneous, and subgroup analyses showed that the application of RDTs in high malaria transmission areas had higher sensitivity but lower specificity than those in low-to-moderate areas.

Conclusions: RDTs have high accuracy for malaria diagnosis in children, and this characteristic is more prominent in high transmission areas. As they also have the advantages of rapid-detection, are easy-to-use, and can be cost-effective, it is recommended that the wider usage of RDTs should be promoted, especially in resource-limited areas. Further research is required to assess their performance in WHO South-East Asia and Americas Region.

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Conflict of interest statement

Competing interests: The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author), and declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of the selection procedure. PCR – polymerase chain reaction.
Figure 2
Figure 2
Methodological quality assessment of studies included in the review. Panel A. Overall quality of studies included in the review. Panel B. Detailed quality of studies included in the review.
Figure 3
Figure 3
Forest plots of sensitivity and specificity of RDTs.
Figure 4
Figure 4
HSROC curve of sensitivity vs specificity of RDTs. HSROC – hierarchical summary receiver operating characteristic curve.
Figure 5
Figure 5
The effect of each categorical variables on the accuracy of RDTs. Panel A. The effect of each categorical variables on the sensitivity of RDTs. Type II, type unclear, and single-blind groups did not have enough test evaluations to perform meta-analysis. HRP2 – histidine-rich protein-2. LDH = lactate dehydrogenase. Pan = all Plasmodium species. PCR – polymerase chain reaction. Panel B. The effect of each categorical variables on the specificity of RDTs. Type II, type unclear, and single-blind groups did not have enough test evaluations to perform meta-analysis. HRP2 – histidine-rich protein-2. LDH – lactate dehydrogenase. Pan – all Plasmodium species. PCR – polymerase chain reaction.
Figure 6
Figure 6
The effect of sample size on the accuracy of RDTs. Panel A. The effect of sample size on the sensitivity of RDTs. Panel B. The effect of sample size on the specificity of RDTs.
Figure 7
Figure 7
Publication bias of studies included in the review.
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