The replacement of conventional antimalarial drugs with high-cost, artemisinin-based alternatives has created a gap in the successful management of malaria. This gap reflects an increased need for accurate disease diagnosis that cannot be met by traditional microscopy techniques. The recent introduction of rapid diagnostic tests (RDTs) has the potential to meet this need, but successful RDT implementation has been curtailed by poor product performance, inadequate methods to determine the quality of products and a lack of emphasis and capacity to deal with these issues. Economics and a desire for improved case management will result in the rapid growth of RDT use in the coming years. However, for their potential to be realized, it is crucial that high-quality RDT products that perform reliably and accurately under field conditions are made available. In achieving this goal, the shift from symptom-based diagnosis to parasite-based management of malaria can bring significant improvements to tropical fever management, rather than represent a further burden on poor, malaria-endemic populations and their overstretched health services.
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The authors wish to thank L. Dini and R. Peeling for advice and for reviewing the manuscript.
The authors declare no competing financial interests.
Entrez Genome Project
- Lateral flow immunochromatographic assay
A device that produces a visible mark to signal the presence or absence of a protein antigen, based on the accumulation of dye-labelled antibodies to form a visible line after binding directly, or through a common antigen, to a fixed line of unlabelled antibody.
- Artemisinin-based combination therapies (ACT)
Drug therapy for malaria consisting of a combination of an artemisinin derivative (derived from the plant Artemisia, also known by the Chinese name Qing Hao), and another drug with anti-plasmodial activity. ACT is rapidly replacing cheaper conventional medicines, to which parasite resistance is now widespread.
- Positive predictive value (PPV)
The probability that a positive result accurately indicates the presence of infection.
- Negative predictive value (NPV)
The probability that a negative result accurately indicates the absence of infection.
- Arrhenius equation
The Arrhenius equation describes the relationship between temperature and the rate at which a reaction proceeds.
- Heterophile antibodies
IgM antibodies that can reach high levels in serum after febrile illnesses (for example, infectious mononucleosis), and can bind nonspecifically to other proteins. They can cause false-positive reactions in immunochromatographic assays.
- Giemsa-stained light microscopy
Detection of malaria parasites in blood by drying a thin blood film on a glass slide, fixing with methanol and staining with a mixture of aninline dyes, designed to highlight Plasmodium parasites when examined under a high-powered light microscope. Sometimes other aniline dye-based stains are used (for example, JSB or Field's stain).
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Bell, D., Wongsrichanalai, C. & Barnwell, J. Ensuring quality and access for malaria diagnosis: how can it be achieved?. Nat Rev Microbiol 4, S7–S20 (2006). https://doi.org/10.1038/nrmicro1525
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