Research Article Comparison of Partec Rapid Malaria Test with Conventional Light Microscopy for Diagnosis of Malaria in Northwest Ethiopia Meseret Birhanie Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia Correspondence should be addressed to Meseret Birhanie; [email protected] Received 30 September 2015; Revised 10 December 2015; Accepted 17 December 2015 Academic Editor: D. S. Lindsay Copyright © 2016 Meseret Birhanie. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Laboratory diagnosis of malaria is the key for effective disease management. Diagnosis of malaria infection requires rapid, sensitive, and specific test methods with an affordable cost. is study was aimed to assess the diagnostic performance of Partec rapid malaria test with reference to light microscopy for the diagnosis of malaria in Northwest Ethiopia. Methods. A total of 180 febrile patients were tested for malaria using Giemsa stain microscopy and Partec rapid malaria test from June to July 2013 at Gendewuha health centers, Metema district. Data were analyzed using SPSS version 20 statistical soſtware. Odds ratio with 95% CI was calculated. Result. e sensitivity and specificity of Partec rapid malaria test were 93.8% (95% CI = 87.1%–100%) and 87.9% (95% CI = 79.7%–96.1%), respectively, while the positive predictive value and negative predictive value were 6.4% (95% CI = 77.2%–95.5%) and 94.6% (95% CI = 88.7%–100%), respectively. ere was also an excellent agreement between two tests with Kappa value of 0.811 (95% CI = 0.625–0.996). Conclusion. Partec rapid malaria test showed good sensitivity and specificity with an excellent agreement to the reference light microscopy. erefore PT can be considered as alternative diagnostic tools in malaria endemic areas. 1. Background Malaria is the most common fatal disease in the world. According to 2013 WHO malaria report, an estimated 3.4 billion people were at risk of malaria globally and populations living in sub-Saharan Africa have the highest risk of acquiring malaria. Approximately 80% of cases and 90% of deaths are estimated to occur in the African region [1]. In Ethiopia approximately 52 million people (68%) live in malaria risk areas. Plasmodium falciparum and P. vivax are the dominant species of malaria in Ethiopia, with 60% and 40% relative frequencies, respectively. P. falciparum is the most dominant species in endemic areas and causes severe and complicated disease and death [2]. In Ethiopia half a million microscopically confirmed cases of malaria are reported to the Federal Ministry of Health (FMOH) in each year from basic health services. However, the actual number of malaria cases in the country is estimated to be more than 5 million each year [2]. So, choosing an accurate, rapid, and cost-effective diagnostic test is mainstay of efficient clinical and epidemiological management of malaria [3, 4]. Clinical diagnosis is the most widely used diagnostic method in rural areas and where laboratory facility does not exist. It is inexpensive to perform and requires no special equipment or supplies [2]. However, according to WHO 2011 guidelines clinical diagnosis of malaria based on signs and symptoms alone is not recommended since it has low specificity and increases the chances of the patient being misdiagnosed and leads to misuse of drugs [5, 6]. A laboratory diagnosis of malaria is one possibility in the management of a patient presenting with fever. To improve the quality care of the patients, many diagnostic procedures have been developed which aim to have accurate diagnosis, to reduce the time of preparation and training needed [3, 4]. Even though Giemsa stain microscopy remains a gold standard method for malaria diagnosis in many developing countries [4, 7, 8], but it is not 100% sensitive and specific [9]. Hindawi Publishing Corporation Journal of Parasitology Research Volume 2016, Article ID 3479457, 5 pages http://dx.doi.org/10.1155/2016/3479457
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Research ArticleComparison of Partec Rapid Malaria Test withConventional Light Microscopy for Diagnosis ofMalaria in Northwest Ethiopia
Meseret Birhanie
Department of Medical Parasitology School of Biomedical and Laboratory Sciences College of Medicine and Health SciencesUniversity of Gondar PO Box 196 Gondar Ethiopia
Correspondence should be addressed to Meseret Birhanie mesibir21gmailcom
Received 30 September 2015 Revised 10 December 2015 Accepted 17 December 2015
Academic Editor D S Lindsay
Copyright copy 2016 Meseret Birhanie This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited
Background Laboratory diagnosis of malaria is the key for effective disease management Diagnosis of malaria infection requiresrapid sensitive and specific test methods with an affordable cost This study was aimed to assess the diagnostic performance ofPartec rapid malaria test with reference to light microscopy for the diagnosis of malaria in Northwest EthiopiaMethods A total of180 febrile patients were tested for malaria using Giemsa stain microscopy and Partec rapid malaria test from June to July 2013 atGendewuha health centers Metema district Data were analyzed using SPSS version 20 statistical software Odds ratio with 95 CIwas calculated ResultThe sensitivity and specificity of Partec rapidmalaria test were 938 (95CI = 871ndash100) and 879 (95CI= 797ndash961) respectively while the positive predictive value and negative predictive valuewere 64 (95CI= 772ndash955)and 946 (95 CI = 887ndash100) respectivelyThere was also an excellent agreement between two tests with Kappa value of 0811(95 CI = 0625ndash0996) Conclusion Partec rapid malaria test showed good sensitivity and specificity with an excellent agreementto the reference light microscopy Therefore PT can be considered as alternative diagnostic tools in malaria endemic areas
1 Background
Malaria is the most common fatal disease in the worldAccording to 2013 WHO malaria report an estimated 34billion people were at risk ofmalaria globally and populationsliving in sub-SaharanAfrica have the highest risk of acquiringmalaria Approximately 80 of cases and 90 of deaths areestimated to occur in the African region [1] In Ethiopiaapproximately 52 million people (68) live in malaria riskareas Plasmodium falciparum and P vivax are the dominantspecies of malaria in Ethiopia with 60 and 40 relativefrequencies respectively P falciparum is the most dominantspecies in endemic areas and causes severe and complicateddisease and death [2]
In Ethiopia half a million microscopically confirmedcases of malaria are reported to the Federal Ministry ofHealth (FMOH) in each year from basic health servicesHowever the actual number of malaria cases in the countryis estimated to be more than 5 million each year [2] So
choosing an accurate rapid and cost-effective diagnostictest is mainstay of efficient clinical and epidemiologicalmanagement of malaria [3 4]
Clinical diagnosis is the most widely used diagnosticmethod in rural areas and where laboratory facility does notexist It is inexpensive to perform and requires no specialequipment or supplies [2] However according to WHO2011 guidelines clinical diagnosis of malaria based on signsand symptoms alone is not recommended since it has lowspecificity and increases the chances of the patient beingmisdiagnosed and leads to misuse of drugs [5 6]
A laboratory diagnosis of malaria is one possibility in themanagement of a patient presenting with fever To improvethe quality care of the patients many diagnostic procedureshave been developed which aim to have accurate diagnosisto reduce the time of preparation and training needed [34] Even though Giemsa stain microscopy remains a goldstandard method for malaria diagnosis in many developingcountries [4 7 8] but it is not 100 sensitive and specific [9]
Hindawi Publishing CorporationJournal of Parasitology ResearchVolume 2016 Article ID 3479457 5 pageshttpdxdoiorg10115520163479457
2 Journal of Parasitology Research
The Partec rapid malaria test (PT) is newly inno-vative fluorescence microscopy method for the detectionof Plasmodium species DNA in human blood It usesreadily prepared and ready-to-use slides labeled with anunspecific DNA-binding fluorescent dye (41015840-6-diamidino-2-phenylindole (DAPI) emission 365 nm) that detects plas-modial DNA It is ultra compact and robust microscopedesign and has connector for optionally available CCDcamera upgrade for visualization of the slides on any PCWindows with USB connection [10 11] The sensitivity andspecificity of the test were not assessed in Ethiopia Thusthis study was conducted to evaluate the performance ofCyScope florescence microscopy (Partec rapid malaria test)in reference to light microscopy in Northwest Ethiopia
2 Methods
21 Study Area and Period A study was conducted atGendewuha health center found in Metema district NorthGondar Zone Amhara Regional State from June to July2013 The district is found at the Ethio-Sudan border Itis far 925 km from Addis Ababa (capital city of Ethiopia)and found at 180 km west of Gondar town The meanannual temperature ranges from 22∘C to 28∘C and the dailytemperature reaches as high as 43∘C during the months ofMarch to May Mean annual rainfall ranges from 850mmto 1100mm and has unimodal pattern The altitudes rangefrom 550 to 1068 meters above sea level [12] The district ismalarious and endemic for all Plasmodium species But theprevalence of P falciparum is very high The health centeris serving around 18000 people in Gendewuha town andsurrounding areas
22 Study Subject One hundred and eighty malaria sus-pected patients attending at Gendewuha health center duringthe study period were included and screened for malariainfection using light microscopy and Partec rapid malariatest Patients who had received antimalarial drugs during thepast twoweeks children under 1 year and critically ill patientswho were unable to respond to the interview were excludedfrom the study
23 Specimen Collection and Processing Sociodemographicand clinical data of the study participantswere collected usingstructured questionnaire Three milliliters of venous bloodwas collected with EDTA tubes by laboratory techniciansfrom each study subject for smear preparation of lightmicroscopy and PT
24 Light Microscopy After collecting blood samples thickand thin blood smears were prepared and stained with 10Giemsa working solution for 10 minutes Blood films wereobserved under 100x objectives for the detection of malariaparasites and the result was reported as positive if asexualmalaria parasites were seen or negative if malaria parasiteswere not seen after observing 100 fields of the thick smear Allblood films were reexamined by an experiencedmicroscopistat University of Gondar Hospital laboratory who was blindedto initial light microscopy result
Malaria parasitesWBCs
Figure 1 Partec CyScope fluorescence microscope and malariaparasites (adapted from [11])
25 Partec Rapid Malaria Test Partec rapid malaria testwas carried out according to the manufacturerrsquos instructionsBriefly on the collected EDTA blood 10 120583L blood was placedon the dye labeled area of a slide and cover slipped incubatedat room temperature for a minute and observed with 40xobjective under LED UV light (365 nm) The presence ofbright shiny intracellular tiny dots against a dark backgroundobserved under the UV light indicated the presence ofmalaria parasites in the erythrocytes as shown in Figure 1
26 Statistical Analysis The data was entered into SPSSversion 20 software for analysis Odds ratio sensitivityspecificity positive predictive value negative predictive valueand Kappa value were calculated at 95 CI
27 Ethical Approval Ethical clearance was obtained fromUniversity of Gondar School of Biomedical and LaboratorySciences Ethical Committee and permission was obtainedfromGendewuha health office and Gendewuha health centerauthorities to conduct the study After informing about theobjective of the study written consent was taken from allstudy participants or parentsguardians Participants whowere positive to malaria parasite were given the appropriatetreatment at the health centre
3 Result
A total of 180 malaria suspected patients were diagnosed formalaria About 99 (55) of the study participants were malesand 81 (45) were females The mean age of the participantswas 19 plusmn 1249 years and majority of the participants 60(333) were within the age range of 20ndash29 years and428 of the participants were illiterate The rural residencehas statistically significant association with malaria infection(AOR = 0437 CI = 0028ndash0835) (Table 1)
31 Light Microscopy The overall prevalence of malariausing light microscopy was 81 (45) From this Plasmodiumfalciparum accounts for 76 (938) P vivax were 4 (49)and mixed infection (P falciparum and P vivax) was 1(13) There were 2 discordant results between the first
Journal of Parasitology Research 3
Table 1 Sociodemographic characteristics of patients and malaria positivity by light microscopy Gendewuha health center NorthwestEthiopia from June to July 2013
CharacteristicsLight microscopy
Tested patients119873 ()
Positive119873() Negative119873 () COR 95 CI AOR 95 CI
GenderMale 99 (550) 53 (535) 46 (465) 0459 0250ndash0839Female 81 (450) 28 (346) 53 (654) 1
Age in years1ndash9 51 (283) 15 (294) 36 (706) 1029 0234ndash452110ndash19 44 (244) 17 (386) 27 (614) 0681 0155ndash299720ndash29 60 (333) 42 (700) 18 (300) 0199 0046ndash0853 0179 0040ndash079230ndash39 15 (83) 5 (333) 10 (667) 0857 0152ndash4819ge40 10 (56) 3 (300) 7 (700) 1
ResidenceRural 86 (478) 49 (570) 37 (430) 0390 0213ndash0713 0437 00228ndash0835Urban 94 (522) 32 (340) 62 (660) 1
Educational backgroundIlliterate 76 (422) 39 (513) 37 (487) 0632 0100ndash400Read and write 39 (217) 17 (436) 22 (564) 0863 0129ndash5756Primary school 51 (283) 21 (412) 30 (588) 1033 0158ndash6741Secondary 9 (50) 3 (333) 6 (667) 1333 0139ndash12818Collegeuniversity 5 (28) 2 (400) 3 (600) 1
OccupationFarmer 39 (217) 18 (462) 21 (538) 0648 0184ndash228Merchant 34 (189) 10 (294) 24 (706) 133 0357ndash498Civil servant 7 (39) 2 (286) 5 (714) 1389 0194ndash996Daily laborers 47 (261) 31 (660) 16 (340) 0287 0082ndash099Housewife 30 (167) 12 (400) 18 (600) 0833 0224ndash310Private 9 (50) 4 (444) 5 (556) 0694 0126ndash383Student 14 (78) 5 (357) 9 (643) 1119873 = number COR = crude odds ratio AOR = adjusted odds ratio CI = confidence interval
(study site) reader and the final reading by experiencedmicroscopist thus the final report was based on the finalreading Turnaround time of Giemsa stain microscopy wasmore than an hour
32 Partec Rapid Malaria Test The parasite positivity ofmalaria by using Partec rapid malaria test was 88 (489)Seventy-six slides were positive with Partec rapidmalaria testand the gold standardGiemsa stainmicroscopy Twelve slideswere positive with Partec rapidmalaria test and negative withlight microscopy while 5 slides were negative with Partecrapid malaria test and positive with light microscopy and 87slides were negative for both (Table 2)
33 Sensitivity and Specificity Using light microscopy asstandard test for diagnosing malaria the sensitivity andspecificity of Partec rapid malaria test were 938 (95 CI =871ndash100) and 879 (95 CI = 797ndash961) respectively Therewas also an excellent agreement between light microscopy
Table 2 Results of light microscopy and Partec rapid malaria test
Light microscopyPositive Negative Total
Partec rapidmalaria test
Positive 76 12 88Negative 5 87 92Total 81 99 180
and Partec rapid malaria test with Kappa value of 0811 (95CI = 0625ndash0996) (Table 3)
In addition operational characteristics were observedCompared to lightmicroscopy PT ismore sensitive less laborintensive and faster to use and has a less turnaround timethan the LM (an average of 5 minutes) PT also requires verylittle training and there is no need of reagent preparationFurthermore the CyScope florescence microscope is batteryoperated the battery can be kept on for 6 hours after fullcharge making it best for field work It is easier to use and
4 Journal of Parasitology Research
Table 3 Performance of Partec rapid malaria test using light microscopy as a standard
Test Sensitivity(95 CI)
Specificity(95 CI)
PPV(95 CI)
NPV(95 CI)
Kappa value(95 CI)
Partec rapidmalaria test
938(871ndash100)
879(797ndash961)
864(772ndash955)
946(887ndash100)
811(625ndash996)
to adjust and can be switched from UV light to bright fieldHowever the PT is not suitable for species identification andparasitic load determination and blood films cannot be storedfor a long period of time
4 Discussion
The current study revealed a high sensitivity and specificity ofPartec rapid malaria test The high sensitivity and specificityare in agreement with the reports in Sudan [13] Howeverthe sensitivity and specificity are lower than the reports inZimbabwe [14] Ghana [11 15] Sudan [16] and Uganda [17]These differences might be due to observer variation or hostfactors Partec rapid malaria test had high PPV and NPVThus a high NPV indicates that a person does not have thedisease with high certainty meaning that PT is reliable testmethod in diagnosing of malaria parasites
Partec rapid malaria test had detected 12 cases whichwere negative by light microscopy Unlike Giemsa stain lightmicroscopy PT has sensitive fluorescent dye 46-diamidino-2-phenylindole (DAPI) which can be detected in such lowlevel of parasites In addition the presence of artifacts suchas nonspecific aggregated DAPI immature erythrocytes orbacterial cellsmight have beenmisinterpreted as PlasmodiumDNA [15] On the other hand PT produced 5 false negativeresults which were positive by light microscopy This mightbe due to the fact that unlysed red blood cells may lie on eachother or overlap with each other thereby preventing parasitesin red blood cells that may be lying beneath other cells Theperformance characteristics of the tests were very similar asindicated in their sensitivities specificities PPV and NPVwith very good agreements to the light microscopy
Determination of parasitemia with Partec rapid malariatest is difficult because the red blood cell may overlap eachother and make the parasites invisible under the UV lightThis finding is in line with the finding of the study conductedin Ghana [15] Though PT is useful as light microscopy thickfilm for screening purpose in malaria endemic areas
The overall prevalence of malaria in the study area wasvery high as detected by both the LM (45) and the PT(489) This result is higher than the report from otherregions in Ethiopia [18 19] The high prevalence could bepartly explained by the fact that the study was conducted inmalaria transmission season of the country
5 Conclusion
Partec rapid malaria test showed good sensitivity and speci-ficity with an excellent agreement to the reference lightmicroscopy PT has very short turnaround times requires
little training and is applicable under field conditionsThere-fore PT can be considered as alternative diagnostic toolsin malaria endemic areas Further studies are needed todetermine the cost-effectiveness and long term performanceof the Partec rapid malaria test in diagnosing malaria
Abbreviations
PT Partec rapid malaria testLM Light microscopyPPV Positive predictive valueNPV Negative predictive valueUV Ultraviolet
Conflict of Interests
The author declares that there is no conflict of interests
Authorsrsquo Contribution
Meseret Birhanie supervised the data collection performedlaboratory tests and analyzed and wrote the paper
Acknowledgments
The author would like to extend their appreciation to Gen-dewuha health center laboratory professionals for their helpin the collection of data and processing and analyzing oflaboratory tests Also the author wants to express theirgreat thanks to the study participants for their patience andcooperation Finally the author would like to acknowledgethe USAID ENHAT-CS program for the financial support ofthis research and Partec GmbH Germany for providing thePartec CyScope microscope and the Partec rapid malaria testkits
References
[1] WHOWorld Malaria Report 2013 World Health OrganizationGeneva Switzerland 2013
[2] Federal Republic of Ethiopia Ministry of Health NationalMalaria Guide Lines FMOH Addis Ababa Ethiopia 3rdedition 2012
[3] N Tangpukdee C Duangdee P Wilairatana and S KrudsoodldquoMalaria diagnosis a brief reviewrdquo Korean Journal of Parasitol-ogy vol 47 no 2 pp 93ndash102 2009
[4] WHO Universal Access to Malaria Diagnostic Testing AnOperational Manual WHO Geneva Switzerland 2011 httpwwwwhointmalariaen
[5] WHOWorldMalaria Report 2011 httpwwwwhointmalariaworld malaria report 2011WMR2011 factsheetpdf
Journal of Parasitology Research 5
[6] T Leslie A Mikhail I Mayan et al ldquoOver diagnosis andmistreatment of malaria among febrile patients at primaryhealth care level in Afghanistanrdquo British Medical Journal vol345 Article ID e4389 2012
[7] AMoody ldquoRapid diagnostic tests formalaria parasitesrdquoClinicalMicrobiology Reviews vol 15 no 1 pp 66ndash78 2002
[8] P Lee and M N Shaio ldquoA review and comparison of malariadiagnostic testsrdquo Kuang Tien Medical Journal vol 2 no 4 pp57ndash64 2007
[9] B S C Uzochukwu L O Chiegboka C Enwereuzo et alldquoExamining appropriate diagnosis and treatment of malariaavailability and use of rapid diagnostic tests and artemisinin-based combination therapy in public and private health facilitiesin south east Nigeriardquo BMC Public Health vol 10 pp 486ndash4952010
[10] Partec Essential Healthcare httpnsc-ksacomcatalogueNSC20CATALOGUESFlow20cytometersEssential-Health-carepdf
[11] B Nkrumah A Agyekum S E K Acquah et al ldquoComparisonof the novel partec rapidmalaria test to the conventional giemsastain and the gold standard real-time PCRrdquo Journal of ClinicalMicrobiology vol 48 no 8 pp 2925ndash2928 2010
[12] T Desalew A Tegegne L Nigatu and W Teka Range-land Condition and Feedresources in Metema District NorthGondar Zone Amhara Region Ethiopia International LivestockResearch Institute Nairobi Kenya 2010
[13] S E-DHHassan A E DHaggaz E BMohammed-ElhassanE MMalik and I Adam ldquoFluorescencemicroscope (Cyscope)for malaria diagnosis in pregnant women in Medani HospitalSudanrdquo Diagnostic Pathology vol 6 no 1 article 88 2011
[14] L Gwanzura J Mayini K Mabhanga et al ldquoEvaluation oflsquoCyscopersquo a novel fluorescence-based microscopy technique forthe detection of malariardquo Journal of Infections in DevelopingCountries vol 6 no 2 pp 212ndash215 2011
[15] N Nkrumah S E K Acquah L Ibrahim et al ldquoComparativeevaluation of two rapid field tests for malaria diagnosis PartecRapid Malaria Test and Binax Now malaria rapid diagnostictestrdquo BMC Infectious Diseases vol 11 article 143 2011
[16] S El-Din Hassan S I Okoued M A Mudathir and E MMalik ldquoTesting the sensitivity and specificity of the fluorescencemicroscope (Cyscope) for malaria diagnosisrdquo Malaria Journalvol 9 article 88 2010
[17] J C Sousa-Figueiredo D Oguttu M Adriko et al ldquoInvestigat-ing portable fluorescentmicroscopy (CyScope) as an alternativerapid diagnostic test for malaria in children and women ofchild-bearing agerdquo Malaria Journal vol 9 no 1 article 2452010
[18] T Endeshaw T Gebre J Ngondi et al ldquoEvaluation of lightmicroscopy and rapid diagnostic test for the detection ofmalaria under operational field conditions a household surveyin EthiopiardquoMalaria Journal vol 7 article 118 2008
[19] BMoges B Amare Y Belyhun et al ldquoComparison of CareStartHRP2pLDHCOMBO rapidmalaria test with light microscopyin north-west Ethiopiardquo Malaria Journal vol 11 article 2342012
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2 Journal of Parasitology Research
The Partec rapid malaria test (PT) is newly inno-vative fluorescence microscopy method for the detectionof Plasmodium species DNA in human blood It usesreadily prepared and ready-to-use slides labeled with anunspecific DNA-binding fluorescent dye (41015840-6-diamidino-2-phenylindole (DAPI) emission 365 nm) that detects plas-modial DNA It is ultra compact and robust microscopedesign and has connector for optionally available CCDcamera upgrade for visualization of the slides on any PCWindows with USB connection [10 11] The sensitivity andspecificity of the test were not assessed in Ethiopia Thusthis study was conducted to evaluate the performance ofCyScope florescence microscopy (Partec rapid malaria test)in reference to light microscopy in Northwest Ethiopia
2 Methods
21 Study Area and Period A study was conducted atGendewuha health center found in Metema district NorthGondar Zone Amhara Regional State from June to July2013 The district is found at the Ethio-Sudan border Itis far 925 km from Addis Ababa (capital city of Ethiopia)and found at 180 km west of Gondar town The meanannual temperature ranges from 22∘C to 28∘C and the dailytemperature reaches as high as 43∘C during the months ofMarch to May Mean annual rainfall ranges from 850mmto 1100mm and has unimodal pattern The altitudes rangefrom 550 to 1068 meters above sea level [12] The district ismalarious and endemic for all Plasmodium species But theprevalence of P falciparum is very high The health centeris serving around 18000 people in Gendewuha town andsurrounding areas
22 Study Subject One hundred and eighty malaria sus-pected patients attending at Gendewuha health center duringthe study period were included and screened for malariainfection using light microscopy and Partec rapid malariatest Patients who had received antimalarial drugs during thepast twoweeks children under 1 year and critically ill patientswho were unable to respond to the interview were excludedfrom the study
23 Specimen Collection and Processing Sociodemographicand clinical data of the study participantswere collected usingstructured questionnaire Three milliliters of venous bloodwas collected with EDTA tubes by laboratory techniciansfrom each study subject for smear preparation of lightmicroscopy and PT
24 Light Microscopy After collecting blood samples thickand thin blood smears were prepared and stained with 10Giemsa working solution for 10 minutes Blood films wereobserved under 100x objectives for the detection of malariaparasites and the result was reported as positive if asexualmalaria parasites were seen or negative if malaria parasiteswere not seen after observing 100 fields of the thick smear Allblood films were reexamined by an experiencedmicroscopistat University of Gondar Hospital laboratory who was blindedto initial light microscopy result
Malaria parasitesWBCs
Figure 1 Partec CyScope fluorescence microscope and malariaparasites (adapted from [11])
25 Partec Rapid Malaria Test Partec rapid malaria testwas carried out according to the manufacturerrsquos instructionsBriefly on the collected EDTA blood 10 120583L blood was placedon the dye labeled area of a slide and cover slipped incubatedat room temperature for a minute and observed with 40xobjective under LED UV light (365 nm) The presence ofbright shiny intracellular tiny dots against a dark backgroundobserved under the UV light indicated the presence ofmalaria parasites in the erythrocytes as shown in Figure 1
26 Statistical Analysis The data was entered into SPSSversion 20 software for analysis Odds ratio sensitivityspecificity positive predictive value negative predictive valueand Kappa value were calculated at 95 CI
27 Ethical Approval Ethical clearance was obtained fromUniversity of Gondar School of Biomedical and LaboratorySciences Ethical Committee and permission was obtainedfromGendewuha health office and Gendewuha health centerauthorities to conduct the study After informing about theobjective of the study written consent was taken from allstudy participants or parentsguardians Participants whowere positive to malaria parasite were given the appropriatetreatment at the health centre
3 Result
A total of 180 malaria suspected patients were diagnosed formalaria About 99 (55) of the study participants were malesand 81 (45) were females The mean age of the participantswas 19 plusmn 1249 years and majority of the participants 60(333) were within the age range of 20ndash29 years and428 of the participants were illiterate The rural residencehas statistically significant association with malaria infection(AOR = 0437 CI = 0028ndash0835) (Table 1)
31 Light Microscopy The overall prevalence of malariausing light microscopy was 81 (45) From this Plasmodiumfalciparum accounts for 76 (938) P vivax were 4 (49)and mixed infection (P falciparum and P vivax) was 1(13) There were 2 discordant results between the first
Journal of Parasitology Research 3
Table 1 Sociodemographic characteristics of patients and malaria positivity by light microscopy Gendewuha health center NorthwestEthiopia from June to July 2013
CharacteristicsLight microscopy
Tested patients119873 ()
Positive119873() Negative119873 () COR 95 CI AOR 95 CI
GenderMale 99 (550) 53 (535) 46 (465) 0459 0250ndash0839Female 81 (450) 28 (346) 53 (654) 1
Age in years1ndash9 51 (283) 15 (294) 36 (706) 1029 0234ndash452110ndash19 44 (244) 17 (386) 27 (614) 0681 0155ndash299720ndash29 60 (333) 42 (700) 18 (300) 0199 0046ndash0853 0179 0040ndash079230ndash39 15 (83) 5 (333) 10 (667) 0857 0152ndash4819ge40 10 (56) 3 (300) 7 (700) 1
ResidenceRural 86 (478) 49 (570) 37 (430) 0390 0213ndash0713 0437 00228ndash0835Urban 94 (522) 32 (340) 62 (660) 1
Educational backgroundIlliterate 76 (422) 39 (513) 37 (487) 0632 0100ndash400Read and write 39 (217) 17 (436) 22 (564) 0863 0129ndash5756Primary school 51 (283) 21 (412) 30 (588) 1033 0158ndash6741Secondary 9 (50) 3 (333) 6 (667) 1333 0139ndash12818Collegeuniversity 5 (28) 2 (400) 3 (600) 1
OccupationFarmer 39 (217) 18 (462) 21 (538) 0648 0184ndash228Merchant 34 (189) 10 (294) 24 (706) 133 0357ndash498Civil servant 7 (39) 2 (286) 5 (714) 1389 0194ndash996Daily laborers 47 (261) 31 (660) 16 (340) 0287 0082ndash099Housewife 30 (167) 12 (400) 18 (600) 0833 0224ndash310Private 9 (50) 4 (444) 5 (556) 0694 0126ndash383Student 14 (78) 5 (357) 9 (643) 1119873 = number COR = crude odds ratio AOR = adjusted odds ratio CI = confidence interval
(study site) reader and the final reading by experiencedmicroscopist thus the final report was based on the finalreading Turnaround time of Giemsa stain microscopy wasmore than an hour
32 Partec Rapid Malaria Test The parasite positivity ofmalaria by using Partec rapid malaria test was 88 (489)Seventy-six slides were positive with Partec rapidmalaria testand the gold standardGiemsa stainmicroscopy Twelve slideswere positive with Partec rapidmalaria test and negative withlight microscopy while 5 slides were negative with Partecrapid malaria test and positive with light microscopy and 87slides were negative for both (Table 2)
33 Sensitivity and Specificity Using light microscopy asstandard test for diagnosing malaria the sensitivity andspecificity of Partec rapid malaria test were 938 (95 CI =871ndash100) and 879 (95 CI = 797ndash961) respectively Therewas also an excellent agreement between light microscopy
Table 2 Results of light microscopy and Partec rapid malaria test
Light microscopyPositive Negative Total
Partec rapidmalaria test
Positive 76 12 88Negative 5 87 92Total 81 99 180
and Partec rapid malaria test with Kappa value of 0811 (95CI = 0625ndash0996) (Table 3)
In addition operational characteristics were observedCompared to lightmicroscopy PT ismore sensitive less laborintensive and faster to use and has a less turnaround timethan the LM (an average of 5 minutes) PT also requires verylittle training and there is no need of reagent preparationFurthermore the CyScope florescence microscope is batteryoperated the battery can be kept on for 6 hours after fullcharge making it best for field work It is easier to use and
4 Journal of Parasitology Research
Table 3 Performance of Partec rapid malaria test using light microscopy as a standard
Test Sensitivity(95 CI)
Specificity(95 CI)
PPV(95 CI)
NPV(95 CI)
Kappa value(95 CI)
Partec rapidmalaria test
938(871ndash100)
879(797ndash961)
864(772ndash955)
946(887ndash100)
811(625ndash996)
to adjust and can be switched from UV light to bright fieldHowever the PT is not suitable for species identification andparasitic load determination and blood films cannot be storedfor a long period of time
4 Discussion
The current study revealed a high sensitivity and specificity ofPartec rapid malaria test The high sensitivity and specificityare in agreement with the reports in Sudan [13] Howeverthe sensitivity and specificity are lower than the reports inZimbabwe [14] Ghana [11 15] Sudan [16] and Uganda [17]These differences might be due to observer variation or hostfactors Partec rapid malaria test had high PPV and NPVThus a high NPV indicates that a person does not have thedisease with high certainty meaning that PT is reliable testmethod in diagnosing of malaria parasites
Partec rapid malaria test had detected 12 cases whichwere negative by light microscopy Unlike Giemsa stain lightmicroscopy PT has sensitive fluorescent dye 46-diamidino-2-phenylindole (DAPI) which can be detected in such lowlevel of parasites In addition the presence of artifacts suchas nonspecific aggregated DAPI immature erythrocytes orbacterial cellsmight have beenmisinterpreted as PlasmodiumDNA [15] On the other hand PT produced 5 false negativeresults which were positive by light microscopy This mightbe due to the fact that unlysed red blood cells may lie on eachother or overlap with each other thereby preventing parasitesin red blood cells that may be lying beneath other cells Theperformance characteristics of the tests were very similar asindicated in their sensitivities specificities PPV and NPVwith very good agreements to the light microscopy
Determination of parasitemia with Partec rapid malariatest is difficult because the red blood cell may overlap eachother and make the parasites invisible under the UV lightThis finding is in line with the finding of the study conductedin Ghana [15] Though PT is useful as light microscopy thickfilm for screening purpose in malaria endemic areas
The overall prevalence of malaria in the study area wasvery high as detected by both the LM (45) and the PT(489) This result is higher than the report from otherregions in Ethiopia [18 19] The high prevalence could bepartly explained by the fact that the study was conducted inmalaria transmission season of the country
5 Conclusion
Partec rapid malaria test showed good sensitivity and speci-ficity with an excellent agreement to the reference lightmicroscopy PT has very short turnaround times requires
little training and is applicable under field conditionsThere-fore PT can be considered as alternative diagnostic toolsin malaria endemic areas Further studies are needed todetermine the cost-effectiveness and long term performanceof the Partec rapid malaria test in diagnosing malaria
Abbreviations
PT Partec rapid malaria testLM Light microscopyPPV Positive predictive valueNPV Negative predictive valueUV Ultraviolet
Conflict of Interests
The author declares that there is no conflict of interests
Authorsrsquo Contribution
Meseret Birhanie supervised the data collection performedlaboratory tests and analyzed and wrote the paper
Acknowledgments
The author would like to extend their appreciation to Gen-dewuha health center laboratory professionals for their helpin the collection of data and processing and analyzing oflaboratory tests Also the author wants to express theirgreat thanks to the study participants for their patience andcooperation Finally the author would like to acknowledgethe USAID ENHAT-CS program for the financial support ofthis research and Partec GmbH Germany for providing thePartec CyScope microscope and the Partec rapid malaria testkits
References
[1] WHOWorld Malaria Report 2013 World Health OrganizationGeneva Switzerland 2013
[2] Federal Republic of Ethiopia Ministry of Health NationalMalaria Guide Lines FMOH Addis Ababa Ethiopia 3rdedition 2012
[3] N Tangpukdee C Duangdee P Wilairatana and S KrudsoodldquoMalaria diagnosis a brief reviewrdquo Korean Journal of Parasitol-ogy vol 47 no 2 pp 93ndash102 2009
[4] WHO Universal Access to Malaria Diagnostic Testing AnOperational Manual WHO Geneva Switzerland 2011 httpwwwwhointmalariaen
[5] WHOWorldMalaria Report 2011 httpwwwwhointmalariaworld malaria report 2011WMR2011 factsheetpdf
Journal of Parasitology Research 5
[6] T Leslie A Mikhail I Mayan et al ldquoOver diagnosis andmistreatment of malaria among febrile patients at primaryhealth care level in Afghanistanrdquo British Medical Journal vol345 Article ID e4389 2012
[7] AMoody ldquoRapid diagnostic tests formalaria parasitesrdquoClinicalMicrobiology Reviews vol 15 no 1 pp 66ndash78 2002
[8] P Lee and M N Shaio ldquoA review and comparison of malariadiagnostic testsrdquo Kuang Tien Medical Journal vol 2 no 4 pp57ndash64 2007
[9] B S C Uzochukwu L O Chiegboka C Enwereuzo et alldquoExamining appropriate diagnosis and treatment of malariaavailability and use of rapid diagnostic tests and artemisinin-based combination therapy in public and private health facilitiesin south east Nigeriardquo BMC Public Health vol 10 pp 486ndash4952010
[10] Partec Essential Healthcare httpnsc-ksacomcatalogueNSC20CATALOGUESFlow20cytometersEssential-Health-carepdf
[11] B Nkrumah A Agyekum S E K Acquah et al ldquoComparisonof the novel partec rapidmalaria test to the conventional giemsastain and the gold standard real-time PCRrdquo Journal of ClinicalMicrobiology vol 48 no 8 pp 2925ndash2928 2010
[12] T Desalew A Tegegne L Nigatu and W Teka Range-land Condition and Feedresources in Metema District NorthGondar Zone Amhara Region Ethiopia International LivestockResearch Institute Nairobi Kenya 2010
[13] S E-DHHassan A E DHaggaz E BMohammed-ElhassanE MMalik and I Adam ldquoFluorescencemicroscope (Cyscope)for malaria diagnosis in pregnant women in Medani HospitalSudanrdquo Diagnostic Pathology vol 6 no 1 article 88 2011
[14] L Gwanzura J Mayini K Mabhanga et al ldquoEvaluation oflsquoCyscopersquo a novel fluorescence-based microscopy technique forthe detection of malariardquo Journal of Infections in DevelopingCountries vol 6 no 2 pp 212ndash215 2011
[15] N Nkrumah S E K Acquah L Ibrahim et al ldquoComparativeevaluation of two rapid field tests for malaria diagnosis PartecRapid Malaria Test and Binax Now malaria rapid diagnostictestrdquo BMC Infectious Diseases vol 11 article 143 2011
[16] S El-Din Hassan S I Okoued M A Mudathir and E MMalik ldquoTesting the sensitivity and specificity of the fluorescencemicroscope (Cyscope) for malaria diagnosisrdquo Malaria Journalvol 9 article 88 2010
[17] J C Sousa-Figueiredo D Oguttu M Adriko et al ldquoInvestigat-ing portable fluorescentmicroscopy (CyScope) as an alternativerapid diagnostic test for malaria in children and women ofchild-bearing agerdquo Malaria Journal vol 9 no 1 article 2452010
[18] T Endeshaw T Gebre J Ngondi et al ldquoEvaluation of lightmicroscopy and rapid diagnostic test for the detection ofmalaria under operational field conditions a household surveyin EthiopiardquoMalaria Journal vol 7 article 118 2008
[19] BMoges B Amare Y Belyhun et al ldquoComparison of CareStartHRP2pLDHCOMBO rapidmalaria test with light microscopyin north-west Ethiopiardquo Malaria Journal vol 11 article 2342012
Submit your manuscripts athttpwwwhindawicom
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Anatomy Research International
PeptidesInternational Journal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporation httpwwwhindawicom
International Journal of
Volume 2014
Zoology
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Molecular Biology International
GenomicsInternational Journal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
BioinformaticsAdvances in
Marine BiologyJournal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Signal TransductionJournal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
BioMed Research International
Evolutionary BiologyInternational Journal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Biochemistry Research International
ArchaeaHindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Genetics Research International
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Advances in
Virolog y
Hindawi Publishing Corporationhttpwwwhindawicom
Nucleic AcidsJournal of
Volume 2014
Stem CellsInternational
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Enzyme Research
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
International Journal of
Microbiology
Journal of Parasitology Research 3
Table 1 Sociodemographic characteristics of patients and malaria positivity by light microscopy Gendewuha health center NorthwestEthiopia from June to July 2013
CharacteristicsLight microscopy
Tested patients119873 ()
Positive119873() Negative119873 () COR 95 CI AOR 95 CI
GenderMale 99 (550) 53 (535) 46 (465) 0459 0250ndash0839Female 81 (450) 28 (346) 53 (654) 1
Age in years1ndash9 51 (283) 15 (294) 36 (706) 1029 0234ndash452110ndash19 44 (244) 17 (386) 27 (614) 0681 0155ndash299720ndash29 60 (333) 42 (700) 18 (300) 0199 0046ndash0853 0179 0040ndash079230ndash39 15 (83) 5 (333) 10 (667) 0857 0152ndash4819ge40 10 (56) 3 (300) 7 (700) 1
ResidenceRural 86 (478) 49 (570) 37 (430) 0390 0213ndash0713 0437 00228ndash0835Urban 94 (522) 32 (340) 62 (660) 1
Educational backgroundIlliterate 76 (422) 39 (513) 37 (487) 0632 0100ndash400Read and write 39 (217) 17 (436) 22 (564) 0863 0129ndash5756Primary school 51 (283) 21 (412) 30 (588) 1033 0158ndash6741Secondary 9 (50) 3 (333) 6 (667) 1333 0139ndash12818Collegeuniversity 5 (28) 2 (400) 3 (600) 1
OccupationFarmer 39 (217) 18 (462) 21 (538) 0648 0184ndash228Merchant 34 (189) 10 (294) 24 (706) 133 0357ndash498Civil servant 7 (39) 2 (286) 5 (714) 1389 0194ndash996Daily laborers 47 (261) 31 (660) 16 (340) 0287 0082ndash099Housewife 30 (167) 12 (400) 18 (600) 0833 0224ndash310Private 9 (50) 4 (444) 5 (556) 0694 0126ndash383Student 14 (78) 5 (357) 9 (643) 1119873 = number COR = crude odds ratio AOR = adjusted odds ratio CI = confidence interval
(study site) reader and the final reading by experiencedmicroscopist thus the final report was based on the finalreading Turnaround time of Giemsa stain microscopy wasmore than an hour
32 Partec Rapid Malaria Test The parasite positivity ofmalaria by using Partec rapid malaria test was 88 (489)Seventy-six slides were positive with Partec rapidmalaria testand the gold standardGiemsa stainmicroscopy Twelve slideswere positive with Partec rapidmalaria test and negative withlight microscopy while 5 slides were negative with Partecrapid malaria test and positive with light microscopy and 87slides were negative for both (Table 2)
33 Sensitivity and Specificity Using light microscopy asstandard test for diagnosing malaria the sensitivity andspecificity of Partec rapid malaria test were 938 (95 CI =871ndash100) and 879 (95 CI = 797ndash961) respectively Therewas also an excellent agreement between light microscopy
Table 2 Results of light microscopy and Partec rapid malaria test
Light microscopyPositive Negative Total
Partec rapidmalaria test
Positive 76 12 88Negative 5 87 92Total 81 99 180
and Partec rapid malaria test with Kappa value of 0811 (95CI = 0625ndash0996) (Table 3)
In addition operational characteristics were observedCompared to lightmicroscopy PT ismore sensitive less laborintensive and faster to use and has a less turnaround timethan the LM (an average of 5 minutes) PT also requires verylittle training and there is no need of reagent preparationFurthermore the CyScope florescence microscope is batteryoperated the battery can be kept on for 6 hours after fullcharge making it best for field work It is easier to use and
4 Journal of Parasitology Research
Table 3 Performance of Partec rapid malaria test using light microscopy as a standard
Test Sensitivity(95 CI)
Specificity(95 CI)
PPV(95 CI)
NPV(95 CI)
Kappa value(95 CI)
Partec rapidmalaria test
938(871ndash100)
879(797ndash961)
864(772ndash955)
946(887ndash100)
811(625ndash996)
to adjust and can be switched from UV light to bright fieldHowever the PT is not suitable for species identification andparasitic load determination and blood films cannot be storedfor a long period of time
4 Discussion
The current study revealed a high sensitivity and specificity ofPartec rapid malaria test The high sensitivity and specificityare in agreement with the reports in Sudan [13] Howeverthe sensitivity and specificity are lower than the reports inZimbabwe [14] Ghana [11 15] Sudan [16] and Uganda [17]These differences might be due to observer variation or hostfactors Partec rapid malaria test had high PPV and NPVThus a high NPV indicates that a person does not have thedisease with high certainty meaning that PT is reliable testmethod in diagnosing of malaria parasites
Partec rapid malaria test had detected 12 cases whichwere negative by light microscopy Unlike Giemsa stain lightmicroscopy PT has sensitive fluorescent dye 46-diamidino-2-phenylindole (DAPI) which can be detected in such lowlevel of parasites In addition the presence of artifacts suchas nonspecific aggregated DAPI immature erythrocytes orbacterial cellsmight have beenmisinterpreted as PlasmodiumDNA [15] On the other hand PT produced 5 false negativeresults which were positive by light microscopy This mightbe due to the fact that unlysed red blood cells may lie on eachother or overlap with each other thereby preventing parasitesin red blood cells that may be lying beneath other cells Theperformance characteristics of the tests were very similar asindicated in their sensitivities specificities PPV and NPVwith very good agreements to the light microscopy
Determination of parasitemia with Partec rapid malariatest is difficult because the red blood cell may overlap eachother and make the parasites invisible under the UV lightThis finding is in line with the finding of the study conductedin Ghana [15] Though PT is useful as light microscopy thickfilm for screening purpose in malaria endemic areas
The overall prevalence of malaria in the study area wasvery high as detected by both the LM (45) and the PT(489) This result is higher than the report from otherregions in Ethiopia [18 19] The high prevalence could bepartly explained by the fact that the study was conducted inmalaria transmission season of the country
5 Conclusion
Partec rapid malaria test showed good sensitivity and speci-ficity with an excellent agreement to the reference lightmicroscopy PT has very short turnaround times requires
little training and is applicable under field conditionsThere-fore PT can be considered as alternative diagnostic toolsin malaria endemic areas Further studies are needed todetermine the cost-effectiveness and long term performanceof the Partec rapid malaria test in diagnosing malaria
Abbreviations
PT Partec rapid malaria testLM Light microscopyPPV Positive predictive valueNPV Negative predictive valueUV Ultraviolet
Conflict of Interests
The author declares that there is no conflict of interests
Authorsrsquo Contribution
Meseret Birhanie supervised the data collection performedlaboratory tests and analyzed and wrote the paper
Acknowledgments
The author would like to extend their appreciation to Gen-dewuha health center laboratory professionals for their helpin the collection of data and processing and analyzing oflaboratory tests Also the author wants to express theirgreat thanks to the study participants for their patience andcooperation Finally the author would like to acknowledgethe USAID ENHAT-CS program for the financial support ofthis research and Partec GmbH Germany for providing thePartec CyScope microscope and the Partec rapid malaria testkits
References
[1] WHOWorld Malaria Report 2013 World Health OrganizationGeneva Switzerland 2013
[2] Federal Republic of Ethiopia Ministry of Health NationalMalaria Guide Lines FMOH Addis Ababa Ethiopia 3rdedition 2012
[3] N Tangpukdee C Duangdee P Wilairatana and S KrudsoodldquoMalaria diagnosis a brief reviewrdquo Korean Journal of Parasitol-ogy vol 47 no 2 pp 93ndash102 2009
[4] WHO Universal Access to Malaria Diagnostic Testing AnOperational Manual WHO Geneva Switzerland 2011 httpwwwwhointmalariaen
[5] WHOWorldMalaria Report 2011 httpwwwwhointmalariaworld malaria report 2011WMR2011 factsheetpdf
Journal of Parasitology Research 5
[6] T Leslie A Mikhail I Mayan et al ldquoOver diagnosis andmistreatment of malaria among febrile patients at primaryhealth care level in Afghanistanrdquo British Medical Journal vol345 Article ID e4389 2012
[7] AMoody ldquoRapid diagnostic tests formalaria parasitesrdquoClinicalMicrobiology Reviews vol 15 no 1 pp 66ndash78 2002
[8] P Lee and M N Shaio ldquoA review and comparison of malariadiagnostic testsrdquo Kuang Tien Medical Journal vol 2 no 4 pp57ndash64 2007
[9] B S C Uzochukwu L O Chiegboka C Enwereuzo et alldquoExamining appropriate diagnosis and treatment of malariaavailability and use of rapid diagnostic tests and artemisinin-based combination therapy in public and private health facilitiesin south east Nigeriardquo BMC Public Health vol 10 pp 486ndash4952010
[10] Partec Essential Healthcare httpnsc-ksacomcatalogueNSC20CATALOGUESFlow20cytometersEssential-Health-carepdf
[11] B Nkrumah A Agyekum S E K Acquah et al ldquoComparisonof the novel partec rapidmalaria test to the conventional giemsastain and the gold standard real-time PCRrdquo Journal of ClinicalMicrobiology vol 48 no 8 pp 2925ndash2928 2010
[12] T Desalew A Tegegne L Nigatu and W Teka Range-land Condition and Feedresources in Metema District NorthGondar Zone Amhara Region Ethiopia International LivestockResearch Institute Nairobi Kenya 2010
[13] S E-DHHassan A E DHaggaz E BMohammed-ElhassanE MMalik and I Adam ldquoFluorescencemicroscope (Cyscope)for malaria diagnosis in pregnant women in Medani HospitalSudanrdquo Diagnostic Pathology vol 6 no 1 article 88 2011
[14] L Gwanzura J Mayini K Mabhanga et al ldquoEvaluation oflsquoCyscopersquo a novel fluorescence-based microscopy technique forthe detection of malariardquo Journal of Infections in DevelopingCountries vol 6 no 2 pp 212ndash215 2011
[15] N Nkrumah S E K Acquah L Ibrahim et al ldquoComparativeevaluation of two rapid field tests for malaria diagnosis PartecRapid Malaria Test and Binax Now malaria rapid diagnostictestrdquo BMC Infectious Diseases vol 11 article 143 2011
[16] S El-Din Hassan S I Okoued M A Mudathir and E MMalik ldquoTesting the sensitivity and specificity of the fluorescencemicroscope (Cyscope) for malaria diagnosisrdquo Malaria Journalvol 9 article 88 2010
[17] J C Sousa-Figueiredo D Oguttu M Adriko et al ldquoInvestigat-ing portable fluorescentmicroscopy (CyScope) as an alternativerapid diagnostic test for malaria in children and women ofchild-bearing agerdquo Malaria Journal vol 9 no 1 article 2452010
[18] T Endeshaw T Gebre J Ngondi et al ldquoEvaluation of lightmicroscopy and rapid diagnostic test for the detection ofmalaria under operational field conditions a household surveyin EthiopiardquoMalaria Journal vol 7 article 118 2008
[19] BMoges B Amare Y Belyhun et al ldquoComparison of CareStartHRP2pLDHCOMBO rapidmalaria test with light microscopyin north-west Ethiopiardquo Malaria Journal vol 11 article 2342012
Submit your manuscripts athttpwwwhindawicom
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Anatomy Research International
PeptidesInternational Journal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporation httpwwwhindawicom
International Journal of
Volume 2014
Zoology
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Molecular Biology International
GenomicsInternational Journal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
BioinformaticsAdvances in
Marine BiologyJournal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Signal TransductionJournal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
BioMed Research International
Evolutionary BiologyInternational Journal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Biochemistry Research International
ArchaeaHindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Genetics Research International
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Advances in
Virolog y
Hindawi Publishing Corporationhttpwwwhindawicom
Nucleic AcidsJournal of
Volume 2014
Stem CellsInternational
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Enzyme Research
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
International Journal of
Microbiology
4 Journal of Parasitology Research
Table 3 Performance of Partec rapid malaria test using light microscopy as a standard
Test Sensitivity(95 CI)
Specificity(95 CI)
PPV(95 CI)
NPV(95 CI)
Kappa value(95 CI)
Partec rapidmalaria test
938(871ndash100)
879(797ndash961)
864(772ndash955)
946(887ndash100)
811(625ndash996)
to adjust and can be switched from UV light to bright fieldHowever the PT is not suitable for species identification andparasitic load determination and blood films cannot be storedfor a long period of time
4 Discussion
The current study revealed a high sensitivity and specificity ofPartec rapid malaria test The high sensitivity and specificityare in agreement with the reports in Sudan [13] Howeverthe sensitivity and specificity are lower than the reports inZimbabwe [14] Ghana [11 15] Sudan [16] and Uganda [17]These differences might be due to observer variation or hostfactors Partec rapid malaria test had high PPV and NPVThus a high NPV indicates that a person does not have thedisease with high certainty meaning that PT is reliable testmethod in diagnosing of malaria parasites
Partec rapid malaria test had detected 12 cases whichwere negative by light microscopy Unlike Giemsa stain lightmicroscopy PT has sensitive fluorescent dye 46-diamidino-2-phenylindole (DAPI) which can be detected in such lowlevel of parasites In addition the presence of artifacts suchas nonspecific aggregated DAPI immature erythrocytes orbacterial cellsmight have beenmisinterpreted as PlasmodiumDNA [15] On the other hand PT produced 5 false negativeresults which were positive by light microscopy This mightbe due to the fact that unlysed red blood cells may lie on eachother or overlap with each other thereby preventing parasitesin red blood cells that may be lying beneath other cells Theperformance characteristics of the tests were very similar asindicated in their sensitivities specificities PPV and NPVwith very good agreements to the light microscopy
Determination of parasitemia with Partec rapid malariatest is difficult because the red blood cell may overlap eachother and make the parasites invisible under the UV lightThis finding is in line with the finding of the study conductedin Ghana [15] Though PT is useful as light microscopy thickfilm for screening purpose in malaria endemic areas
The overall prevalence of malaria in the study area wasvery high as detected by both the LM (45) and the PT(489) This result is higher than the report from otherregions in Ethiopia [18 19] The high prevalence could bepartly explained by the fact that the study was conducted inmalaria transmission season of the country
5 Conclusion
Partec rapid malaria test showed good sensitivity and speci-ficity with an excellent agreement to the reference lightmicroscopy PT has very short turnaround times requires
little training and is applicable under field conditionsThere-fore PT can be considered as alternative diagnostic toolsin malaria endemic areas Further studies are needed todetermine the cost-effectiveness and long term performanceof the Partec rapid malaria test in diagnosing malaria
Abbreviations
PT Partec rapid malaria testLM Light microscopyPPV Positive predictive valueNPV Negative predictive valueUV Ultraviolet
Conflict of Interests
The author declares that there is no conflict of interests
Authorsrsquo Contribution
Meseret Birhanie supervised the data collection performedlaboratory tests and analyzed and wrote the paper
Acknowledgments
The author would like to extend their appreciation to Gen-dewuha health center laboratory professionals for their helpin the collection of data and processing and analyzing oflaboratory tests Also the author wants to express theirgreat thanks to the study participants for their patience andcooperation Finally the author would like to acknowledgethe USAID ENHAT-CS program for the financial support ofthis research and Partec GmbH Germany for providing thePartec CyScope microscope and the Partec rapid malaria testkits
References
[1] WHOWorld Malaria Report 2013 World Health OrganizationGeneva Switzerland 2013
[2] Federal Republic of Ethiopia Ministry of Health NationalMalaria Guide Lines FMOH Addis Ababa Ethiopia 3rdedition 2012
[3] N Tangpukdee C Duangdee P Wilairatana and S KrudsoodldquoMalaria diagnosis a brief reviewrdquo Korean Journal of Parasitol-ogy vol 47 no 2 pp 93ndash102 2009
[4] WHO Universal Access to Malaria Diagnostic Testing AnOperational Manual WHO Geneva Switzerland 2011 httpwwwwhointmalariaen
[5] WHOWorldMalaria Report 2011 httpwwwwhointmalariaworld malaria report 2011WMR2011 factsheetpdf
Journal of Parasitology Research 5
[6] T Leslie A Mikhail I Mayan et al ldquoOver diagnosis andmistreatment of malaria among febrile patients at primaryhealth care level in Afghanistanrdquo British Medical Journal vol345 Article ID e4389 2012
[7] AMoody ldquoRapid diagnostic tests formalaria parasitesrdquoClinicalMicrobiology Reviews vol 15 no 1 pp 66ndash78 2002
[8] P Lee and M N Shaio ldquoA review and comparison of malariadiagnostic testsrdquo Kuang Tien Medical Journal vol 2 no 4 pp57ndash64 2007
[9] B S C Uzochukwu L O Chiegboka C Enwereuzo et alldquoExamining appropriate diagnosis and treatment of malariaavailability and use of rapid diagnostic tests and artemisinin-based combination therapy in public and private health facilitiesin south east Nigeriardquo BMC Public Health vol 10 pp 486ndash4952010
[10] Partec Essential Healthcare httpnsc-ksacomcatalogueNSC20CATALOGUESFlow20cytometersEssential-Health-carepdf
[11] B Nkrumah A Agyekum S E K Acquah et al ldquoComparisonof the novel partec rapidmalaria test to the conventional giemsastain and the gold standard real-time PCRrdquo Journal of ClinicalMicrobiology vol 48 no 8 pp 2925ndash2928 2010
[12] T Desalew A Tegegne L Nigatu and W Teka Range-land Condition and Feedresources in Metema District NorthGondar Zone Amhara Region Ethiopia International LivestockResearch Institute Nairobi Kenya 2010
[13] S E-DHHassan A E DHaggaz E BMohammed-ElhassanE MMalik and I Adam ldquoFluorescencemicroscope (Cyscope)for malaria diagnosis in pregnant women in Medani HospitalSudanrdquo Diagnostic Pathology vol 6 no 1 article 88 2011
[14] L Gwanzura J Mayini K Mabhanga et al ldquoEvaluation oflsquoCyscopersquo a novel fluorescence-based microscopy technique forthe detection of malariardquo Journal of Infections in DevelopingCountries vol 6 no 2 pp 212ndash215 2011
[15] N Nkrumah S E K Acquah L Ibrahim et al ldquoComparativeevaluation of two rapid field tests for malaria diagnosis PartecRapid Malaria Test and Binax Now malaria rapid diagnostictestrdquo BMC Infectious Diseases vol 11 article 143 2011
[16] S El-Din Hassan S I Okoued M A Mudathir and E MMalik ldquoTesting the sensitivity and specificity of the fluorescencemicroscope (Cyscope) for malaria diagnosisrdquo Malaria Journalvol 9 article 88 2010
[17] J C Sousa-Figueiredo D Oguttu M Adriko et al ldquoInvestigat-ing portable fluorescentmicroscopy (CyScope) as an alternativerapid diagnostic test for malaria in children and women ofchild-bearing agerdquo Malaria Journal vol 9 no 1 article 2452010
[18] T Endeshaw T Gebre J Ngondi et al ldquoEvaluation of lightmicroscopy and rapid diagnostic test for the detection ofmalaria under operational field conditions a household surveyin EthiopiardquoMalaria Journal vol 7 article 118 2008
[19] BMoges B Amare Y Belyhun et al ldquoComparison of CareStartHRP2pLDHCOMBO rapidmalaria test with light microscopyin north-west Ethiopiardquo Malaria Journal vol 11 article 2342012
Submit your manuscripts athttpwwwhindawicom
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Anatomy Research International
PeptidesInternational Journal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporation httpwwwhindawicom
International Journal of
Volume 2014
Zoology
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Molecular Biology International
GenomicsInternational Journal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
BioinformaticsAdvances in
Marine BiologyJournal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Signal TransductionJournal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
BioMed Research International
Evolutionary BiologyInternational Journal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Biochemistry Research International
ArchaeaHindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Genetics Research International
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Advances in
Virolog y
Hindawi Publishing Corporationhttpwwwhindawicom
Nucleic AcidsJournal of
Volume 2014
Stem CellsInternational
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Enzyme Research
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
International Journal of
Microbiology
Journal of Parasitology Research 5
[6] T Leslie A Mikhail I Mayan et al ldquoOver diagnosis andmistreatment of malaria among febrile patients at primaryhealth care level in Afghanistanrdquo British Medical Journal vol345 Article ID e4389 2012
[7] AMoody ldquoRapid diagnostic tests formalaria parasitesrdquoClinicalMicrobiology Reviews vol 15 no 1 pp 66ndash78 2002
[8] P Lee and M N Shaio ldquoA review and comparison of malariadiagnostic testsrdquo Kuang Tien Medical Journal vol 2 no 4 pp57ndash64 2007
[9] B S C Uzochukwu L O Chiegboka C Enwereuzo et alldquoExamining appropriate diagnosis and treatment of malariaavailability and use of rapid diagnostic tests and artemisinin-based combination therapy in public and private health facilitiesin south east Nigeriardquo BMC Public Health vol 10 pp 486ndash4952010
[10] Partec Essential Healthcare httpnsc-ksacomcatalogueNSC20CATALOGUESFlow20cytometersEssential-Health-carepdf
[11] B Nkrumah A Agyekum S E K Acquah et al ldquoComparisonof the novel partec rapidmalaria test to the conventional giemsastain and the gold standard real-time PCRrdquo Journal of ClinicalMicrobiology vol 48 no 8 pp 2925ndash2928 2010
[12] T Desalew A Tegegne L Nigatu and W Teka Range-land Condition and Feedresources in Metema District NorthGondar Zone Amhara Region Ethiopia International LivestockResearch Institute Nairobi Kenya 2010
[13] S E-DHHassan A E DHaggaz E BMohammed-ElhassanE MMalik and I Adam ldquoFluorescencemicroscope (Cyscope)for malaria diagnosis in pregnant women in Medani HospitalSudanrdquo Diagnostic Pathology vol 6 no 1 article 88 2011
[14] L Gwanzura J Mayini K Mabhanga et al ldquoEvaluation oflsquoCyscopersquo a novel fluorescence-based microscopy technique forthe detection of malariardquo Journal of Infections in DevelopingCountries vol 6 no 2 pp 212ndash215 2011
[15] N Nkrumah S E K Acquah L Ibrahim et al ldquoComparativeevaluation of two rapid field tests for malaria diagnosis PartecRapid Malaria Test and Binax Now malaria rapid diagnostictestrdquo BMC Infectious Diseases vol 11 article 143 2011
[16] S El-Din Hassan S I Okoued M A Mudathir and E MMalik ldquoTesting the sensitivity and specificity of the fluorescencemicroscope (Cyscope) for malaria diagnosisrdquo Malaria Journalvol 9 article 88 2010
[17] J C Sousa-Figueiredo D Oguttu M Adriko et al ldquoInvestigat-ing portable fluorescentmicroscopy (CyScope) as an alternativerapid diagnostic test for malaria in children and women ofchild-bearing agerdquo Malaria Journal vol 9 no 1 article 2452010
[18] T Endeshaw T Gebre J Ngondi et al ldquoEvaluation of lightmicroscopy and rapid diagnostic test for the detection ofmalaria under operational field conditions a household surveyin EthiopiardquoMalaria Journal vol 7 article 118 2008
[19] BMoges B Amare Y Belyhun et al ldquoComparison of CareStartHRP2pLDHCOMBO rapidmalaria test with light microscopyin north-west Ethiopiardquo Malaria Journal vol 11 article 2342012
Submit your manuscripts athttpwwwhindawicom
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Anatomy Research International
PeptidesInternational Journal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporation httpwwwhindawicom
International Journal of
Volume 2014
Zoology
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Molecular Biology International
GenomicsInternational Journal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
BioinformaticsAdvances in
Marine BiologyJournal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Signal TransductionJournal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
BioMed Research International
Evolutionary BiologyInternational Journal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Biochemistry Research International
ArchaeaHindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Genetics Research International
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Advances in
Virolog y
Hindawi Publishing Corporationhttpwwwhindawicom
Nucleic AcidsJournal of
Volume 2014
Stem CellsInternational
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Enzyme Research
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
International Journal of
Microbiology
Submit your manuscripts athttpwwwhindawicom
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Anatomy Research International
PeptidesInternational Journal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporation httpwwwhindawicom
International Journal of
Volume 2014
Zoology
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Molecular Biology International
GenomicsInternational Journal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
BioinformaticsAdvances in
Marine BiologyJournal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Signal TransductionJournal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
BioMed Research International
Evolutionary BiologyInternational Journal of
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Biochemistry Research International
ArchaeaHindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Genetics Research International
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Advances in
Virolog y
Hindawi Publishing Corporationhttpwwwhindawicom
Nucleic AcidsJournal of
Volume 2014
Stem CellsInternational
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
Enzyme Research
Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014
International Journal of
Microbiology
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