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Performance of Local Light Microscopy and the ParaScreen Pan/Pf Rapid Diagnostic Test to Detect Malaria in Health Centers in Northwest Ethiopia  [PDF]
Tekola Endeshaw, Patricia M. Graves, Berhan Ayele, Aryc W. Mosher, Teshome Gebre, Firew Ayalew, Asrat Genet, Alemayehu Mesfin, Estifanos Biru Shargie, Zerihun Tadesse, Tesfaye Teferi, Berhanu Melak, Frank O. Richards, Paul M. Emerson
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0033014
Abstract: Background Diagnostic tests are recommended for suspected malaria cases before treatment, but comparative performance of microscopy and rapid diagnostic tests (RDTs) at rural health centers has rarely been studied compared to independent expert microscopy. Methods Participants (N = 1997) with presumptive malaria were recruited from ten health centers with a range of transmission intensities in Amhara Regional State, Northwest Ethiopia during October to December 2007. Microscopy and ParaScreen Pan/Pf? RDT were done immediately by health center technicians. Blood slides were re-examined later at a central laboratory by independent expert microscopists. Results Of 1,997 febrile patients, 475 (23.8%) were positive by expert microscopists, with 57.7% P.falciparum, 24.6% P.vivax and 17.7% mixed infections. Sensitivity of health center microscopists for any malaria species was >90% in five health centers (four of which had the highest prevalence), >70% in nine centers and 44% in one site with lowest prevalence. Specificity for health center microscopy was very good (>95%) in all centers. For ParaScreen RDT, sensitivity was ≥90% in three centers, ≥70% in six and <60% in four centers. Specificity was ≥90% in all centers except one where it was 85%. Conclusions Health center microscopists performed well in nine of the ten health centers; while for ParaScreen RDT they performed well in only six centers. Overall the accuracy of local microscopy exceeded that of RDT for all outcomes. This study supports the introduction of RDTs only if accompanied by appropriate training, frequent supervision and quality control at all levels. Deficiencies in RDT use at some health centers must be rectified before universal replacement of good routine microscopy with RDTs. Maintenance and strengthening of good quality microscopy remains a priority at health center level.
Laboratory diagnosis of malaria in children under five years in a rural community: microscopy versus malaria PF test
CP Enwuru, SI Umeh, UM Abasi, RC Egbuobi
African Journal of Clinical and Experimental Microbiology , 2011,
Abstract: The morbidity and mortality associated with malaria in children below 5 years is really worrisome especially in the rural communities with little or no laboratory diagnostic facilities. This study was carried out to compare microscopy with Malaria Pf test for the diagnosis of malaria in a rural community in Ideato North Local Government Area of Imo State. Two hundred and fifty blood smears of children below 5 years were stained with Giemsa and examined microscopically for malaria parasites. Also the Malaria Pf rapid diagnostic test was used to test the same blood samples for malaria antigens. Thirty two per cent of the blood samples were positive for malaria parasite. Compared with microscopy, the sensitivity of the Malaria Pf test was 90.0%, the specificity was 98.2%. The positive predictive value was 96.0% and negative predictive value was 95.4%. The Malaria Pf test is reliable in the parasite based diagnosis of malaria in children under 5 years. We recommend the application of this test for parasitological confirmation of malaria in all places where it is not possible to provide facilities for good quality microscopy especially in the rural communities. KEY WORDS: MALARIA, DIAGNOSIS, CHILDREN, MICROSCOPY, MALARIA PF
Self-treatment of malaria in rural communities, Butajira, southern Ethiopia  [cached]
Deressa Wakgari,Ali A.,Enqusellassie F.
Bulletin of the World Health Organization , 2003,
Abstract: OBJECTIVES: To quantify the use of self-treatment and to determine the actions taken to manage malaria illness. METHODS: A cross-sectional study was undertaken in six peasant associations in Butajira district, southern Ethiopia, between January and September 1999. Simple random sampling was used to select a sample of 630 households with malaria cases within the last six months. FINDINGS: Overall, 616 (>97%) of the study households acted to manage malaria, including the use of antimalarial drugs at home (112, 17.8%), visiting health services after taking medication at home (294, 46.7%), and taking malaria patients to health care facilities without home treatment (210, 33.3%). Although 406 (64.5%) of the households initiated treatment at home, the use of modern drugs was higher (579, 92%) than that of traditional medicine (51, 8%). Modern drugs used included chloroquine (457, 73.5%) and sulfadoxine-pyrimethamine (377, 60.6%). Malaria control programmes were the main sources of antimalarials. In most cases of malaria, treatment was started (322, 52.3%) or health services visited (175, 34.7%) within two days of the onset of symptoms. Cases of malaria in the lowland areas started treatment and visited health services longer after the onset of malaria than those in the midland areas (adjusted odds ratio, 0.44; 95% confidence interval (CI), 0.30-0.64; and adjusted odds ratio, 0.37; 95% CI, 0.25-0.56, respectively). Similarly, those further than one hour's walk from the nearest health care facility initiated treatment later than those with less than one hour's walk (adjusted odds ratio, 0.62; 95% CI 0.43-0.87). This might be because of inaccessibility to antimalarial drugs and distant health care facilities in the lowland areas; however, statistically insignificant associations were found for sex, age, and religion. CONCLUSION: Self-treatment at home is the major action taken to manage malaria. Efforts should be made to improve the availability of effective antimalarials to communities in rural areas with malaria, particularly through the use of community health workers, mother coordinators, drug sellers, and shop owners.
Evaluation of light microscopy and rapid diagnostic test for the detection of malaria under operational field conditions: a household survey in Ethiopia
Tekola Endeshaw, Teshome Gebre, Jeremiah Ngondi, Patricia M Graves, Estifanos B Shargie, Yeshewamebrat Ejigsemahu, Berhan Ayele, Gedeon Yohannes, Tesfaye Teferi, Ayenew Messele, Mulat Zerihun, Asrat Genet, Aryc W Mosher, Paul M Emerson, Frank O Richards
Malaria Journal , 2008, DOI: 10.1186/1475-2875-7-118
Abstract: This study aimed to estimate the prevalence of malaria parasites in randomly selected malarious areas of Amhara, Oromia, and Southern Nations, Nationalities and Peoples' (SNNP) regions of Ethiopia, using microscopy and RDT, and to investigate the agreement between microscopy and RDT under field conditions.A population-based survey was conducted in 224 randomly selected clusters of 25 households each in Amhara, Oromia and SNNP regions, between December 2006 and February 2007. Fingerpick blood samples from all persons living in even-numbered households were tested using two methods: light microscopy of Giemsa-stained blood slides; and RDT (ParaScreen device for Pan/Pf).A total of 13,960 people were eligible for malaria parasite testing of whom 11,504 (82%) were included in the analysis. Overall slide positivity rate was 4.1% (95% confidence interval [CI] 3.4–5.0%) while ParaScreen RDT was positive in 3.3% (95% CI 2.6–4.1%) of those tested. Considering microscopy as the gold standard, ParaScreen RDT exhibited high specificity (98.5%; 95% CI 98.3–98.7) and moderate sensitivity (47.5%; 95% CI 42.8–52.2) with a positive predictive value of 56.8% (95% CI 51.7–61.9) and negative predictive value of 97.6% (95% CI 97.6–98.1%) under field conditions.Blood slide microscopy remains the preferred option for population-based prevalence surveys of malaria parasitaemia. The level of agreement between microscopy and RDT warrants further investigation in different transmission settings and in the clinical situation.Malaria is one of the leading public health problems in Ethiopia. About 75% of the total area of the country is malarious, with more than two thirds of the total population estimated to be at risk of infection [1,2]. Malaria transmission in Ethiopia is seasonal, depending mostly on altitude and rainfall. The two main seasons for transmission of malaria in Ethiopia are September to November, sometimes extended to December after heavy summer rains, and March to May, after the
Comparison of CareStart HRP2/pLDH COMBO rapid malaria test with light microscopy in north-west Ethiopia  [cached]
Moges Beyene,Amare Bemnet,Belyhun Yeshambel,Tekeste Zinaye
Malaria Journal , 2012, DOI: 10.1186/1475-2875-11-234
Abstract: Background In Ethiopia, light microscopy is the gold standard for malaria diagnosis although it is not available in most peripheral health facilities. It is time consuming, requires trained personnel and needs careful preparation and application of reagents to ensure quality results. This study was aimed at testing the diagnostic performance of CareStart malaria rapid diagnostic test (RDT) with reference to light microscopy for the diagnosis of falciparum and vivax malaria in Ethiopia. Methods Blood samples were collected from 254 patients suspected to have malaria at Kola Diba Health Center in the late malaria transmission peak season from November 2011 to December 2011. The samples were examined immediately by light microscopy and the RDT (CareStart Malaria HRP2/pLDH COMBO Test kit). Statistical analysis was performed using SPSS version 16 and the JavaStat two-way contingency table analysis. Results The overall sensitivity and specificity of CareStartTM RDT was found to be 95% (90–97.9%, 95% CI) and 94.2% (90.9–96%, 95% CI), respectively. The sensitivity of the CareStartTM RDT for Plasmodium falciparum or mixed infection was calculated to be 92.9% (82.5–98%, 95%CI) while a sensitivity of 90.9% (74.1–98.4%, 95%CI) was found for non-falciparum species. The specificity for P. falciparum or mixed infections was found to be 95.4% (92.5–96.8%, 95%CI) while it was 97.3% (94.8–98.4%, 95%CI) for non-falciparum species. There was an excellent agreement between the two tests with a kappa value of 0.918. Conclusion The CareStartTM RDT test showed good sensitivity and specificity with an excellent agreement to the reference light microscopy. The RDT could therefore be used in place of light microscopy, which in poor set-ups cannot be used routinely.
Malaria-related perceptions and practices of women with children under the age of five years in rural Ethiopia
Wakgari Deressa, Ahmed Ali
BMC Public Health , 2009, DOI: 10.1186/1471-2458-9-259
Abstract: This community-based study was conducted in 2003 in an area of seasonal malaria transmission in Adami Tulu District, south-central Ethiopia. Total samples of 2087 rural women with children less than five years of age from 18 rural kebeles (the smallest administrative units) were interviewed about their perceptions and practices regarding malaria. In addition, focus group discussions and in-depth interviews were conducted on similar issues to complement the quantitative data.Malaria, locally known as busaa, is perceived as the main health problem in the study area. Mosquitoes are perceived to be the main cause of the disease, and other misperceptions were also widespread. The use of prevention measures was very low. Most mothers were familiar with the main signs and symptoms of mild malaria, and some of them indicated high grade fever, convulsions and mental confusion as a manifestation of severe malaria. Very few households (5.6%) possessed one or two nets. More than 60% of the mothers with recent episodes of malaria received initial treatment from non-public health facilities such as community health workers (CHWs) (40%) and private care providers (21%). Less than 40% of the reported malaria cases among women were treated by public health facilities.Malaria was perceived as the main health problem among women and children. The use of malaria preventive measures was low. A significant proportion of the respondents received initial malaria treatments from CHWs, private care providers and public health facilities. Concerted effort is needed to scale-up the distribution of insecticide-treated nets and improve the knowledge of the community about the link between malaria and mosquitoes. Effective antimalarial drugs should also be available at the grassroots level where the problem of malaria is rampant.Despite the considerable increase in funds over the recent years to control malaria in Ethiopia, the disease has been the most frequently reported cause of morbidity and
Community awareness about malaria, its treatment and mosquito vector in rural highlands of central Ethiopia
M Legesse, W Deressa
Ethiopian Journal of Health Development , 2009,
Abstract: Background: Despite the rapid expansion of malaria into highland areas of Ethiopia and the movement of malaria inexperienced people to endemic areas, there is no enough information about how highland communities perceive malaria. Objective: To assess communities’ awareness of malaria and its mosquito vector in highland rural communities of central Ethiopia. Methods: A community-based cross–sectional survey involved 770 heads of household was conducted during September 2005 to February 2006 in nine peasant associations of five purposely selected districts in highland areas where malaria has been recently introduced, or currently free from the disease. Results: The majority of the study participants knew that malaria is a serious disease that can attack all age groups of a population (81.0%). A considerable number of individuals, 357 (47.5%) responded that they visited malarious area and about 50% of these individuals reported that they or their families had got the disease. A large proportion of participants (81.6%) mentioned that mosquito transmits malaria through biting (91.6%), while 176 (42.6%) individuals are aware that mosquitoes bite during night. Participants from Sheno, Muka Turi and Sululita areas were found to better in associating the cause of malaria with mosquito bites than those participants from Ginchi and Holeta areas (p < 0.05). In contrast, participants from Ginchi area were found to better in identifying the common signs/symptoms of malaria and recommending modern antimalarial drug for treatment than participants from other localities (p< 0.05). Some of the respondents believed that mosquito bites or landing can be prevented using various methods like mosquito net, eating or keeping garlic in pocket, while more than half (67.1%) of the participants had no information about preventive methods of mosquito bites. Conclusion: Communities residing in the highland of the present study areas were aware that malaria is a serious disease. However, they had no clear information about its cause, mode of transmission and preventive methods. Hence, emphasis should be given to increase community awareness through implementation of appropriate health education program for prevention and control of the disease from expanding into highland areas of Ethiopia.
Self-treatment of malaria in rural communities, Butajira, southern Ethiopia
Deressa,Wakgari; Ali,A.; Enqusellassie,F.;
Bulletin of the World Health Organization , 2003, DOI: 10.1590/S0042-96862003000400007
Abstract: objectives: to quantify the use of self-treatment and to determine the actions taken to manage malaria illness. methods: a cross-sectional study was undertaken in six peasant associations in butajira district, southern ethiopia, between january and september 1999. simple random sampling was used to select a sample of 630 households with malaria cases within the last six months. findings: overall, 616 (>97%) of the study households acted to manage malaria, including the use of antimalarial drugs at home (112, 17.8%), visiting health services after taking medication at home (294, 46.7%), and taking malaria patients to health care facilities without home treatment (210, 33.3%). although 406 (64.5%) of the households initiated treatment at home, the use of modern drugs was higher (579, 92%) than that of traditional medicine (51, 8%). modern drugs used included chloroquine (457, 73.5%) and sulfadoxine-pyrimethamine (377, 60.6%). malaria control programmes were the main sources of antimalarials. in most cases of malaria, treatment was started (322, 52.3%) or health services visited (175, 34.7%) within two days of the onset of symptoms. cases of malaria in the lowland areas started treatment and visited health services longer after the onset of malaria than those in the midland areas (adjusted odds ratio, 0.44; 95% confidence interval (ci), 0.30-0.64; and adjusted odds ratio, 0.37; 95% ci, 0.25-0.56, respectively). similarly, those further than one hour's walk from the nearest health care facility initiated treatment later than those with less than one hour's walk (adjusted odds ratio, 0.62; 95% ci 0.43-0.87). this might be because of inaccessibility to antimalarial drugs and distant health care facilities in the lowland areas; however, statistically insignificant associations were found for sex, age, and religion. conclusion: self-treatment at home is the major action taken to manage malaria. efforts should be made to improve the availability of effective antimalarials to
Treatment-seeking behaviour for febrile illness in an area of seasonal malaria transmission in rural Ethiopia
Wakgari Deressa
Malaria Journal , 2007, DOI: 10.1186/1475-2875-6-49
Abstract: The aim of this study was to assess treatment-seeking behaviour for reported malaria among all age groups in an area of seasonal transmission.A community-based cross-sectional study was carried out among 2,253 households in 12 randomly selected rural kebeles in Adami Tulu district in south-central Ethiopia, during October-November 2003, using a pre-tested interviewer-administered structured questionnaire.Reported malaria was 14% among 12,225 people assessed during the last 14 days. Family/self-diagnosis was most common and the main first responses included visiting village-based community health workers (CHWs) (33%), public health facility (23%) and private clinic (17%). Home treatment was the least reported first response (3%). Only 13% had sought treatment within the first 24 hours of symptom onset. Early treatment-seeking pattern was reported among those who visited CHWs and practiced home treatment, with more delays among public facility users. Treatment-seeking behaviour was similar in all age groups.A considerable proportion of visits were made to CHWs and private providers, necessitating the importance of strengthening both community-based interventions and peripheral public and private facilities. Finally, the community should be informed and educated about the importance of early diagnosis and prompt treatment with effective antimalarials.Malaria remains the major cause of morbidity and mortality particularly in sub-Saharan Africa [1,2]. In areas with low endemicity, malaria is characterized by frequent and often large-scale epidemics associated with high case fatality rates [3,4]. Although children are at the greatest risk in these areas, all age groups of the population are at risk of severe malaria and death due to lack of protective immunity. Early diagnosis and prompt treatment has been a cornerstone of malaria control [5,6]. However, effective case management partly depends on early recognition of the disease and the subsequent treatment-seeking behav
Cost-effectiveness of three malaria treatment strategies in rural Tigray, Ethiopia where both Plasmodium falciparum and Plasmodium vivax co-dominate
Hailemariam Lemma, Miguel San Sebastian, Curt L?fgren, GebreAb Barnabas
Cost Effectiveness and Resource Allocation , 2011, DOI: 10.1186/1478-7547-9-2
Abstract: The study was conducted under a routine health service delivery following the national malaria diagnosis and treatment guideline. Every suspected malaria case, who presented to a health extension worker either at a village or health post, was included. Costing, from the provider's perspective, only included diagnosis and antimalarial drugs. Effectiveness was measured by the number of correctly treated cases (CTC) and average and incremental cost-effectiveness calculated. One-way and two-way sensitivity analyses were conducted for selected parameters.In total 2,422 subjects and 35 health posts were enrolled in the study. The average cost-effectiveness ratio showed that the parascreen pan/pf based strategy was more cost-effective (US$1.69/CTC) than both the paracheck pf (US$4.66/CTC) and the presumptive (US$11.08/CTC) based strategies. The incremental cost for the parascreen pan/pf based strategy was US$0.59/CTC to manage 65% more cases. The sensitivity analysis also confirmed parascreen pan/pf based strategy as the most cost-effective.This study showed that the parascreen pan/pf based strategy should be the preferred option to be used at health post level in rural Tigray. This finding is relevant nationwide as the entire country's malaria epidemiology is similar to the study area.Malaria continues to be a global challenge with half of the world's population at risk of the disease. In 2006 about 250 million episodes of malaria occurred globally with nearly a million deaths, mostly of children under 5 years of age. More than 85% of this disease burden was concentrated in countries in Sub-Saharan Africa (SSA). Ethiopia was one of the five main contributors to the overall African malaria burden [1,2].In Ethiopia, despite the long history of malaria control since the 1950s, the disease is still a major public health problem[3]. Though some improvements, both in mortality and morbidity, have been recently achieved, malaria has been consistently reported as one of the three
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