Performance of local light microscopy and the ParaScreen Pan/Pf rapid diagnostic test to detect malaria in health centres in Northwest Ethiopia

Endeshaw, Tekola, Graves, Patricia M., Ayele, Berhan, Mosher, Aryc W., Gebre, Teshome, Ayalew, Firew, Genet, Asrat, Mesfin, Alemayehu, Shargie, Estifanos Biru, Tadesse, Zerihun, Teferi, Tesfaye, Melak, Berhanu, Richards, Frank O., and Emerson, Paul M. (2012) Performance of local light microscopy and the ParaScreen Pan/Pf rapid diagnostic test to detect malaria in health centres in Northwest Ethiopia. PLoS ONE, 7 (4). e33014. pp. 1-12.

PDF (Published Version) - Published Version
Download (1MB)
View at Publisher Website:


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.

Item ID: 28626
Item Type: Article (Research - C1)
ISSN: 1932-6203
Keywords: microscopy, parascreen, diagnostic test, detect malaria, health centres
Additional Information:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funders: Carter Centar Malaria Control Program
Date Deposited: 21 Aug 2013 06:53
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111799 Public Health and Health Services not elsewhere classified @ 100%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920499 Public Health (excl. Specific Population Health) not elsewhere classified @ 100%
Downloads: Total: 1023
Last 12 Months: 5
More Statistics

Actions (Repository Staff Only)

Item Control Page Item Control Page