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Paper Title: Diagnostic Efficiency of Rapid Diagnosis Test kits in Malaria diagnosis - The Nigerian story

Authors: Kennedy T. W, Otokunefor K.

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 Malaria constitutes a significant global public health problem. WHO guidelines recommend actual prompt parasitological confirmation
before therapy. Microscopy remains the gold standard for parasitological diagnosis but requires trained personnel and elaborate equipment,
contributing to cases of presumptive diagnosis. The development of new malarial rapid test kits has contributed to solving this problem of
presumptive diagnosis. These RDTs have gained increasing widespread application in Nigeria. WHO recommended RDT standards
include a sensitivity of 95% for the detection of 100/l of P. falciparum and 95% specificity. Diagnostic accuracy of these tests however
varies based on geographical region. No current review of the literature has however been carried out to assess the diagnostic accuracy of
RDTs in the Nigerian setting. A survey of the literature on RDT use in Nigeria identified twenty-six different comparative studies
following a PubMed and Google search. These studies reported a range of sensitivity and specificity values, with mean values of 76.7% and
91.2% respectively. The sensitivity values in this study were similar to previous reports but specificity values were on average higher than
sensitivity values. This finding differed from the generally accepted dogma of lower specificity of HRP2-based RDTs due to the ability of
HRP2 to persist in the bloodstream even after clearance of the parasite. This study provides a summary of the current research on the use
of RDT in malaria diagnosis in Nigeria. It highlights the increase in use of RDTs and points at a need for more standardized multisite
studies to provide a better understanding of the effects of variables on diagnostic accuracy of these tests and better inform on policies.

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