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  • Review Article
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Tropical infectious diseases

Diagnostics for the developing world

Key Points

  • Better and more widely available diagnostic tests would facilitate the control of many important infectious diseases in developing countries. The roles of current diagnostic tests for the control of selected major infectious diseases in developing countries are reviewed.

  • The authors discuss how case-finding, case-management and disease surveillance could be improved.

  • For most infectious diseases, laboratory-based tests with reasonable sensitivities and specificities exist, but are not available in the peripheral health centres that serve most of the population. The authors review the characteristics of tests that are available at present, including point-of-care tests.

  • What are the priorities for investment in diagnostics? The authors discuss disease burden; the likely impact of a new test on disease burden; the availability, expense and toxicity of treatment; the feasibility of global or local disease elimination; and the feasibility of developing an appropriate test.

  • The ideal diagnostic test is discussed, including ASSURED test characterisitics, and the barriers that exist to the development of new tests.

  • New and ongoing initiatives for diagnostic-test development are reviewed, including the UNICEF/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (TDR), the Foundation for Innovative New Diagnostics (FIND) and the Sexually Transmitted Diseases Diagnostics Initiative (SDI).

  • Finally, the authors discuss the opportunities for innovation in diagnostics, including improved understanding of pathogens and host responses to infection, new technologies and long-term innovations.


Although 'diseases of affluence', such as diabetes and cardiovascular disease, are increasing in developing countries, infectious diseases still impose the greatest health burden. Annually, just under 1 million people die from malaria, 4.3 million from acute respiratory infections, 2.9 million from enteric infections and 5 million from AIDS and tuberculosis. Other sexually transmitted infections and tropical parasitic infections are responsible for hundreds of thousands of deaths and an enormous burden of morbidity. More than 95% of these deaths occur in developing countries. Simple, accurate and stable diagnostic tests are essential to combat these diseases, but are usually unavailable or inaccessible to those who need them.

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Figure 1: The burden of disease worldwide.
Figure 2: Scheme to assess priorities for diagnostics development for selected diseases in the developing world.
Figure 3: Diagnostics development: steps, barriers and solutions.

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The authors would like to thank R. Mondesire for critical reading of the manuscript and helpful discussions.

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Correspondence to David Mabey.

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Related links

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Infectious Disease Information




Chlamydia trachomatis



guinea worm












Trypanosoma brucei gambiense



Entrez Genome

Foundation for Innovative New Diagnostics (FIND)

Medicines for Malaria Venture (MMV)

Netherlands Royal Tropical Institute (KIT) microarrays web page

Program for Appropriate Technology in Health

Small Business Innovation Research (SBIR) programme

Special Programme for Research and Training in Tropical Diseases (TDR)

The Global Alliance for Vaccines and Immunisation (GAVI)

The Global Drug Facility for TB

The Global Fund to Fight AIDS, Tuberculosis and Malaria

The World Health Organization (WHO)

Wellcome Trust Sanger Institute

WHO HIV Diagnostics

WHO Malaria Rapid Diagnostics Tests

WHO Sexually Transmitted Diseases Diagnostics Initiative



The identification of asymptomatic or poorly symptomatic cases of a disease or infection.


The control of insect vectors of infectious diseases, usually using insecticides or traps.


(POC tests). Diagnostic tests performed in the clinic, with results available within a short time so that patients can be treated without a return visit.


Test based on a strip of paper coated with an immobilized antibody specific for an antigen that is characteristic of a disease. Samples conjugated to a second antibody (which allows chromogenic detection) can be applied to the paper strip and results visualized in less than 10 minutes. By using multiple antigens at different positions on the strip, multiple diseases can be screened for in one sample.


The first point of contact between sick people and the health service, such as a health centre or dispensary.


Treatment of a patients with a syndrome (a characteristic combination of symptoms and signs) for all the common infectious causes of that syndrome.

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Mabey, D., Peeling, R., Ustianowski, A. et al. Diagnostics for the developing world. Nat Rev Microbiol 2, 231–240 (2004).

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