Self-use of rapid tests for malaria diagnosis by tourists

doi:10.1016/S0140-6736(99)01969-8

The Lancet

Volume 354, Issue 9190, 6 November 1999, Page 1609

https://doi.org/10.1016/S0140-6736(99)01969-8 Get rights and content

Summary

In a survey among febrile European tourists in Kenya, only 68% were able to carry out immunochromatographic dipstick tests for detection of Plasmodium falciparum antigen correctly, and ten of 11 with malaria failed to diagnose themselves correctly. Rapid tests for self-diagnosis by tourists cannot be recommended without appropriate training before departure.

References (5)

M Garcia et al.
Immunochromatographic test for malaria diagnosis
Lancet
(1996)
J Van den Ende et al.
Evaluation of two tests based on the detection of histidine rich protein 2 for the diagnosis of imported Plasmodium falciparum malaria
Trans R Soc Trop Med Hyg
(1998)

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Cited by (65)

Self-diagnosis and self-treatment of Plasmodium spp. infection by travellers (1989–2019): A systematic review and meta-analysis
2020, Travel Medicine and Infectious Disease
Citation Excerpt :
These included problems pricking finger (n = 50), positioning of the blood drop (n = 24), result interpretation (n = 15), line identification (n = 13), technical problems with the malaria kit (n = 12), understanding instructions (n = 10), adherence to waiting time for line development (n = 2) and too ill to perform the test (n = 1). Three RDT studies [17,19,20] recorded specific errors which led to invalid tests such as result interpretation (n = 32), pricking finger (n = 26), line identification (n = 18), adherence to waiting time (n = 12), positioning of the blood drop (n = 9), insufficient blood (n = 3), forgetting to add reagent (n = 1) and miscellaneous reasons (n = 4). Some participants failed on more than one point.
Standby emergency self-treatment (SBET) is often recommended as an anti-malaria strategy for travellers to low-risk endemic areas. This self-treatment enables competent malaria therapy, if medical assistance is unavailable. The World Health Organization (WHO) recommends performing reliable diagnostic tests before starting antimalarial treatment. For the self-diagnosis of malaria in travellers, rapid diagnostic tests (RDT) can be used to confirm the infection before SBET is used. The aim of this research is to assess the use of RDT and/or SBET in travellers.
We searched the databases (PubMed, Scopus, Embase, CINAHL) using terms and synonyms for ‘self-diagnosis’ and ‘self-treatment’ combined with ‘malaria’ and ‘travel’. Articles in English, French and German were included. Potential articles were screened and extracted by two authors (KU and PS). Only original articles and case reports documenting the self-use of RDT and/or SBET in travellers were included. Data were extracted using a standardised approach. We defined ‘correct use’ of RDT and SBET. Data on number and performance of RDT and SBET use, as well as malaria verification were collected in an Excel table. Five meta-analyses were performed using a random effects model and calculating pooled proportions. This systematic review was conducted according to the PRISMA guidelines and registered in PROSPERO (CRD42018108874).
The research resulted in 867 articles of possible relevance on RDT and 955 articles on SBET. After screening, a total of 4 articles on RDT use and 17 articles for SBET use in travellers were included in the systematic review. Most of the RDT were performed and interpreted properly by the travellers (pooled proportion 88%, 95% confidence interval (CI) from 64% to 97%), whereby the proportion of correct performance was increased after a pre-travel test run (97%). Major problems in the implementation such as pricking finger, placing blood drop, identifying lines and interpreting results could be discovered. We found data on 1025 SBET uses in studies of travellers to high-risk African countries. In these studies, the pooled proportion of SBET uses was 6% (95% CI from 2% to 13%). We found 545 SBET uses in studies of travellers to countries of mixed malaria risk. In these studies, the pooled proportion of SBET uses was 2% (95% CI from 1% to 7%). Furthermore, the evaluation showed a high proportion of correct SBET use (pooled proportion 69%, 95% CI from 35% to 90%). As a cause for incorrect use, errors in dosage (under- or overdose), disregard of minimal incubation period (< 7 days since first possible malaria exposure) and absence of fever were identified. Four cases of post-SBET severe adverse events were documented. In a third of travellers who used SBET, a Plasmodium spp. infection could be detected (pooled proportion 31%, 95% CI from 16% to 51%).
This systematic review and meta-analysis showed that the majority of travellers were able to use RDT and SBET correctly. Standardised pre-travel instructions and specific training are indicated to increase the proportions of correct RDT and SBET use. With improved and user-friendly technology, RDT may become an integral part of SBET malaria recommendations for travellers. Combined use of RDT and SBET could be an appropriate strategy for selected subgroups of travellers to low-risk, remote malaria areas. Future research should focus on combined RDT and SBET strategies.
Self-diagnosis and self-treatment of malaria by the traveler
2018, Travel Medicine
At present, a comprehensive, single, safe, and highly effective method to prevent malaria in travelers to endemic areas is not available, despite considerable recent progress in the malaria vaccine field. Recommendations for the prevention of malaria in travelers are therefore based predominantly on the combination of avoiding mosquito bites (“exposure prophylaxis”) and an appropriate chemoprophylactic regimen. Even such a combination, however, does not provide 100% protection. More importantly, only a minority of travelers makes use of available protective measures. For example, in a cohort of 1659 malaria patients observed in Europe, 60.4% of the European travelers and 72.4% of those visiting friends or relatives (VFRs) had traveled without using chemoprophylaxis, and only a small number of individuals tried to adhere fully to the prevention of insect bites.
Self-Diagnosis and Self-Treatment of Malaria by the Traveler
2013, Travel Medicine: Third Edition
Malaria Prevention in Travelers
2012, Infectious Disease Clinics of North America
MALARIA
2009, Feigin and Cherry's Textbook of Pediatric Infectious Diseases, Sixth Edition
Point-of-care testing for malaria outbreak management
2008, Transactions of the Royal Society of Tropical Medicine and Hygiene
A rapid antigen assay for malaria was performed on blood samples collected during a simultaneous outbreak of falciparum malaria and vivax malaria on a remote island in the Indonesian archipelago. During the outbreak, a total of 89 patients (4.3% of the population) were diagnosed with malaria within a week. Microscopic examination revealed 78 malaria slide-positive cases, of whom 49 (62.8%) were identified as P. falciparum, 7 (9.0%) as P. vivax and 22 (28.2%) as mixed P. falciparum and P. vivax infections. The rapid malaria assay showed excellent correlation with expert-confirmed routine microscopy for P. falciparum and P. vivax monoinfections and mixed infections with a parasite density >50 parasites/μl. Several slide-negative blood samples collected from febrile patients with clinical malaria tested positive in the rapid test. The estimated sensitivity calculated for the rapid test (91.0%) was slightly higher than that of microscopy (87.6%). The result indicates that rapid antigen detection for malaria could be a useful alternative to microscopy to reduce the workload during emergency outbreak situations.

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Summary

References (5)

Immunochromatographic test for malaria diagnosis

Lancet

Evaluation of two tests based on the detection of histidine rich protein 2 for the diagnosis of imported Plasmodium falciparum malaria

Trans R Soc Trop Med Hyg

Cited by (65)

Self-diagnosis and self-treatment of Plasmodium spp. infection by travellers (1989–2019): A systematic review and meta-analysis

Self-diagnosis and self-treatment of malaria by the traveler

Self-Diagnosis and Self-Treatment of Malaria by the Traveler

Malaria Prevention in Travelers

MALARIA

Point-of-care testing for malaria outbreak management

Research LettersSelf-use of rapid tests for malaria diagnosis by tourists

Summary

Lancet

Trans R Soc Trop Med Hyg

Research Letters
Self-use of rapid tests for malaria diagnosis by tourists