Field evaluation of a PfHRP-2/pLDH rapid diagnostic test and light microscopy for diagnosis and screening of falciparum malaria during the peak seasonal transmission in an endemic area in Yemen

Background: Malaria is a public health threat in Yemen, with 149,451 cases being reported in 2013. Of these, Plasmodium falciparum represents 99 %. Prompt diagnosis by light microscopy (LM) and rapid diagnostic tests (RTDs) is a key element in the national strategy of malaria control. The heterogeneous epidemiology of malaria in the country necessitates the field evaluation of the current diagnostic strategies, especially RDTs. Thus, the present study aimed to evaluate LM and an RDT, combining both P. falciparum histidine-rich protein-2 (PfHRP-2) and Plasmodium lactate dehydrogenase (pLDH), for falciparum malaria diagnosis and survey in a malaria-endemic area during the transmission season against nested polymerase chain reaction (PCR) as the reference method. Methods: A household-based, cross-sectional malaria survey was conducted in Mawza District, a malaria-endemic area in Taiz governorate. A total of 488 participants were screened using LM and PfHRP-2/pLDH RDT. Positive samples (160) and randomly selected negative samples (52) by both RDT and LM were further analysed using 18S rRNA-based nested PCR. Results: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the RDT were 96.0 % (95 % confidence interval (CI): 90.9-98.3), 56.0 % (95 % CI: 44.7-66.8), 76.3 % (95 % CI: 69.0-82.3), and 90.4 % (95 % CI: 78.8-96.8), respectively. On the other hand, LM showed sensitivity of 37.6 % (95 % CI: 29.6-46.3), specificity of 97.6 % (95 % CI: 91.7-99.7), PPV of 95.9 % (95 % CI: 86.3-98.9), and NPV of 51.3 % (95 % CI: 43.2-59.2). The sensitivity of LM dropped to 8.5 % for detecting asymptomatic malaria. Malaria prevalence was 32.8 % (32.1 and 37.5 % for ≥10 and <10 years, respectively) with the RDT compared with 10.7 % (10.8 and 9.4 % for age groups of ≥10 and