TUBERCULOSIS: Rapid Tuberculosis Diagnostic Methods Inaccurate Alone

April 04, 2011.

Rapid microbial and immunological diagnostic methods are not accurate enough to diagnose or exclude pulmonary tuberculosis, according to a study published online March 21 in the Journal of Internal Medicine.

MONDAY, April 4 (HealthDay News) -- Rapid microbial and immunological diagnostic methods are not accurate enough to diagnose or exclude pulmonary tuberculosis, according to a study published online March 21 in the Journal of Internal Medicine.
Claudia Jafari, M.D., from the Research Center Borstel in Germany, and colleagues evaluated different methods used for an initial treatment decision in 135 individuals with suspected pulmonary tuberculosis. A specific algorithm including initial smear microscopy and M. tuberculosis-specific nucleic acid amplification from sputum, was used to enroll individuals with suspected tuberculosis. Tuberculin skin testing, bronchoscopy with transbronchial biopsies, and interferon-γ release assays (IGRAs) in peripheral blood and bronchoalveolar lavage (BAL) fluid were performed in cases of negative test results.
The researchers identified 42 cases of tuberculosis, 10 cases of non-tuberculous mycobacteria pulmonary infection/colonization, and 84 with a different diagnosis. Sputum microscopy had sensitivity of 41 percent and specificity of 99 percent. BAL nucleic acid amplification had sensitivity of 31 percent and specificity of 98 percent. M. tuberculosis-specific BAL fluid IGRAs had 92 percent sensitivity and 87 percent specificity for the tuberculosis diagnosis in patients with acid-fast bacilli smear-negative tuberculosis.
"The key finding of the study was that none of the evaluated methods alone was able to reliably diagnose or exclude tuberculosis," the authors write. "A stepwise diagnostic approach may yield the best results for a rapid preliminary diagnosis of tuberculosis, justifying treatment initiation while the results of M. tuberculosis cultures are pending."
http://www.doctorslounge.com/index.php/news/pb/19092

TUBERCULOSIS: Tanzania: half of all cases were missed, adding to a large death toll

Tristan Pollock




Credit: Wikimedia


One of the most difficult problems with tuberculosis is detecting it. In 2007, for example, half of all cases in Tanzania were missed, adding to a large death toll. The World Health Organization estimates that 1.7 million people die of tuberculosis yearly. One organization, launched in 2008, has an unusual solution: use 18-inch-long “HeroRATs” to sniff out the disease in samples provided by TB clinics. In Tanzania, HeroRATs have identified over 1,600 tuberculosis-positive samples (read: patients) where the diagnosis was initially missed by microscopy tests at local laboratories. This represents a 30 percent increase in the detection rate. The rats are remarkably accurate.
The HeroRATs idea was devised by Bart Weetjens, a Buddhist monk and the founder ofAPOPO, an organization that researches, develops and deploys rat-detection technology for humanitarian purposes. The other half of APOPO’s work is mentioned in its name, a Dutch acronym meaning Anti-Personnel Land Mines Detection Product Development. Similar to tuberculosis detection, where rats identify positive patients by sniffing sputum samples, rats trained to detect land mines are trained with TNT-tainted soil beginning at four weeks old. When a rat chooses correctly it is rewarded with food. As training progresses, rats learn to detect trace amounts of TNT in real, but deactivated, landmines buried at the HeroRAT landmine training field in Tanzania. Before receiving HeroRAT status and working in real minefields, each rat must ace a rigorous series of accredited APOPO tests and certifications by the National Institute of Demining in the respective country that the HeroRAT will be working.
Since beginning mine-removal operations in 2006, HeroRAT teams — humans and rats side-by-side — have returned over 2.1 million square meters of land to the Mozambique population, removing over 1,100 mines. The International Campaign to Ban Landmines reports that over 73,576 casualties worldwide from 1999 to 2009 were land-mine related, and in 2007 there were 5,426 recorded casualties, with nearly a fifth of them in 24 African countries.
The need for a worldwide low-cost highly effective solution to both land mines and tuberculosis detection is apparent and Weetjens hopes to fill that void, “APOPO is now standardizing our HeroRATs technology to enable large scale deployment and significantly increase the impact of of our humanitarian action. This will include expanding our operations to new countries as well as researching new scent-detection applications for our HeroRATs.”
http://news.yourolivebranch.org/2011/03/18/hero-rats-sniff-out-tuberculosis-and-land-mines-in-africa/

TUBERCULOSIS: Giant Rats Detect Tuberculosis

Nathan Seppa, Science News : December 23, 2010

Animals can be trained to sniff out TB in sputum samples, adding to accuracy of microscope test

Low-income countries struggling to keep tuberculosis under control might get a boost from an unlikely source—giant African rats.
The big rodents spotted hundreds of TB-positive sputum samples that a standard microscope test missed on first pass, researchers report in the December American Journal of Tropical Medicine and Hygiene.
The TB bacterium currently infects one in three people worldwide, the World Health Organization estimates, with the highest rates in Africa.
Giant African rats, also called Gambian pouched rats (Cricetomys gambianus), are native to much of Africa and have been used before to sniff out land mines. Training captive-bred rats to detect TB takes about five or six months, says study coauthor Alan Poling, a psychologist and animal-learning expert at Western Michigan University in Kalamazoo. Attempts to train captured giant rats didn’t work because the animals proved unmanageable, he says. “In the wild, they’re really nasty.”
The rats are exposed to sputum samples through holes in the floor of a cage, and if they correctly pause for five seconds to smell a TB sample, they are rewarded with a mouthful of banana. Lingering over non-TB samples gets no reward. Eventually, the rats can check a string of holes moving “about as fast as they can walk,” Poling says.
In the largest analysis to date, Poling and a research team in Tanzania collected sputum samples from more than 10,000 people and tested them using a standard microscopic analysis for TB. The researchers found that about 1,400 people had the disease. The TB samples had been rendered noninfectious using heat and pressure, a safety measure designed to prevent transmission of live TB from dropped or spilled samples, Poling says.
When the rats sniffed the same sputum samples, the animals correctly identified more than 90 percent of those found as positive in the lab. But the rats also tagged more than 1,400 additional people as positive. When reanalyzed more closely under the microscope, those samples turned out to include 620 people who indeed had TB. Thus, while the standard test found that 13.3 percent of people were TB-positive, the rats bumped that figure up to more than 19 percent.
It may seem that the rats turned in a lot of false positives, sensing samples as TB-positive that a second microscope test couldn’t confirm. But many might not be false, Poling says. “We’re thinking that in at least some of these people, there are bacteria present that our people [using microscopes] didn’t see. There might be low concentrations.”
The gold standard for TB testing is to culture the bacteria in the sputum, but that can take weeks. “There’s a need to deploy a new generation of technologies to get new diagnostics out there against TB,” says Peter Hotez, a physician and microbiologist at George Washington University in Washington, D.C. “[Using rats] is definitely a low-tech approach,” he says.
But he says the rats’ accuracy rate would need to improve for this to become a standard screening strategy. A new lab test that uses a polymerase chain reaction is 98 percent accurate in detecting TB, researchers reported in the Sept. 9 New England Journal of Medicine. That technique, which copies key bacterial DNA, appears to be the TB test of the future, Hotez says. It is being tested in the field and may become commercially available soon.
Poling and his group are using the DNA test to verify results from the standard microscopy and the rat tests. But the DNA test currently costs about $20 per sample, he says, which is far too high for developing countries. It’s unclear how much the rats would cost per sample, he says, since the method has not been scaled up commercially. But once the rats are trained, they can whip through a dozen samples in less than a minute and be used again and again.
http://www.usnews.com/science/articles/2010/12/23/giant-rats-detect-tuberculosis.html

MALARIA: Malaria Treatment Guidelines - are health workers aware?

Bill Brieger : 26 Dec 2010
Malaria Journal published a few days ago an article comparing the costs of treating children and adults for malaria at a Nigerian hospital based on clinical diagnosis versus treating only when microscopy was positive for parasites. Normally we would pass abstracts from such articles on to members of our listserve (see link at right), but comments from a colleague in Nigeria gave pause.
He rightly pointed out that normally any research that helps us consider the factors involved in proper malaria diagnosis and treatment is welcome as we move toward universal coverage and elimination. His concern was that the researchers, who conducted their study in 2009, had not followed national malaria treatment policy and guidelines, which had been promulgated in 2005 based on the alarming growth of resistance of malaria parasites to the common, though cheap, antimalarials such as chloroquine and sulphadoxine-pyrimethamine (SP).
First the cost findings from the team at Bowen University Teaching Hospital (aka Baptist Medical Center, Ogbomosho) -
For children, testing all but treating only Giemsa positives was $6.04/child
Empiric treatment of all children clinically diagnosed was $4.49/child
For adults, treating only Giemsa positives was $4.84/adult for treatment option one and $4.97/adult for option two
Empiric treatment for adults was $4.14/adult for option one and $4.63/adult for option 2
In spite of the cost findings, the researchers did point out the drawbacks of empirical or clinical diagnosis in terms of accuracy and potentials for promoting drug resistance and called for scale up of rapid diagnostic tests (RDTs) to address these concerns.
The treatment regimens in this study included …
Pediatric patients: artesunate (6-9 tablets of 3 mg/kg on day one and 1.5 mg/kg for the next four days) plus amodiaquine (10 mg/kg on days one to two and 5 mg/kg on day three in suspension)
Adult option one: four and one-half 50 mg artesunate tablets on day one and nine additional artesunate tablets over the next four days, plus three 500 mg sulphadoxine/25 mg pyrimethamine tablets
Adult option two: four and one-half 50 mg artesunate tablets on day one and nine additional artesunate tablets for the next four days plus nine 200 mg tablets of amodiaquine at a dose of 10 mg/kg on day one to two and 5 mg/kg on day three
National treatment guidelines specifically stress use of artemisinin-based combination therapy (ACT) for basic, uncomplicated malaria treatment.These guidelines are undergoing further revision with a stronger emphasis on ACT use based on RDTs and microscopy where available and recognition of the dangers of monotherapy drugs like chloroquine, SP and even artesunate itself.
The researchers from Ogbomosho are rightly concerned about cost issues, and being a private/NGO university and hospital, they do witness the direct effects of medication costs on patients that health staff in the public sector may not see.
This is still no excuse for not following national treatment guidelines when these drugs were available for their procurement in 2009. Now with the advent of the Affordable Medicine Facility malaria (AMFm) in Nigeria all health facilities, especially NGO hospitals like Ogbomosho, have no reason not to buy and dispense the correct medicines.
To re-emphasize this point, a press release from November 2010 clearly states -
“The Federal Government has directed all medical doctors and other health officials in the country to henceforth start using Artemisinin-based Combined Therapy (ACT) for the treatment of malaria disease in the country. Minister of Health, Prof. Onyebuchi Chukwu, gave the directive yesterday in Abuja during the ministerial press briefing on Affordable Medicines Facility (AMF) for malaria programme. According to the minister, the spread of malaria had become so critical that everyone in the country was now involved.”
We hope health workers in all sectors get the word! Hopefully national authorities will step up their efforts to disseminate guidelines to all front line health workers whether in public, private or NGO sectors.

One Response to “Malaria Treatment Guidelines - are health workers aware?”
on 26 Dec 2010 at 11:07 am 1.Bill Brieger said …
Bright Chukwudi Orji commented on FaceBook …
The Challenge is still the availability of the AMfm drugs. We hope that government will make do their promises and make the drugs available. Out in the field, my primary concern is to put these drugs on the hands of those at risk, but when …the drugs are not available, what happens? However, this is no excuse for the Ogbomoso University not to follow the national anti-malarial drug policy. This brings to mind the question on national ethical review board. I learnt it has been constituted but not sure if functioning and how to reach the board?
http://www.malariafreefuture.org/blog/?p=1134

TUBERCULOSIS: Immediate treatment for drug resistant tuberculosis possible with “while you wait” test

Geoff Watts An instrument developed in the US after the country’s anthrax contaminated letters scare of 2001 has now been endorsed by the World Health Organization as a more effective means of testing for tuberculosis.
Manufactured by the Californian company Cepheid, the Xpert MTB/RIF uses a disposable cartridge containing all the reagents required to perform the test. Results are available in about 90 minutes.
Sputum smear microscopy, the method commonly used for detecting tuberculosis, was developed 125 years ago. It misses many cases, especially in children and people who are HIV positive. The diagnosis of drug resistant tuberculosis relies on bacterial culture and drug susceptibility testing. These findings are not available for weeks or even months during which time a drug resistant strain can continue to spread.
The new test is fully automated, poses few biosafety hazards, can be operated in a non-specialist laboratory, and detects the presence of rifampicin drug resistance, an indicator of multiple drug resistance. Patients can be offered the appropriate treatment immediately.
Demonstrated this week at press conferences held in London and Geneva, journalists were able to see for themselves how straightforward the instrument is to use.
The operator first scans the bar code on a small lidded cartridge, a few centimetres square. The addition to the sputum sample of a prepared solution renders it non-infectious within 15 minutes. Using a pipette, 2 mL of this mixture are put into the cartridge which, after closing its lid, is slipped into the instrument. The results are displayed on a laptop computer.
Giorgio Roscigno, chief executive of the Foundation for Innovative New Diagnostics (FIND), the not-for-profit organisation that helped to develop its application to tuberculosis, said, “By changing the cartridges you could also use this instrument for other diseases.”
Explaining WHO’s decision to endorse the instrument Karin Weyer, of its Stop TB department, pointed to the accumulated data. “An expert group reviewed the evidence from around 12 000 patients evaluated in a variety of settings,” she said. “We are now recommending that we move as quickly as possible to provide policy guidance and a road map to countries to get this test working in the field.”
Multiple drug resistance poses a severe challenge to national tuberculosis programmes according to a recent editorial in the New England Journal of Medicine (2010;363:1070-1). “Globally,” say the authors, “fewer than two per cent of the estimated cases of multi-drug resistant disease are reported to the WHO and managed according to international guidelines.”
The new instrument costs $17 000 (£10 800; €12 900) and can perform 16-20 tests in eight hours. Each test costs $16.86, but will drop to $10.72 by 2014 if uptake proceeds as intended. South Africa and India are among countries that have plans to use the system, and many non-governmental bodies active in fighting tuberculosis have also expressed interest or said they will promote it.
http://www.bmj.com/content/341/bmj.c7132.full

MALARIA: Are rapid diagnostic tests more accurate in diagnosis of Plasmodium falciparum malaria compared to microscopy at rural health centres?

Malaria Journal 2010, 9:349doi:10.1186/1475-2875-9-349
Published: 2 December 2010

Vincent Batwala , Pascal Magnussen and Fred Nuwaha

Background
Prompt, accurate diagnosis and treatment with artemisinin combination therapy remains vital to current malaria control. Blood film microscopy the current standard test for diagnosis of malaria has several limitations that necessitate field evaluation of alternative diagnostic methods especially in low income countries of sub-Saharan Africa where malaria is endemic.

Methods
The accuracy of axillary temperature, health centre (HC) microscopy, expert microscopy and a HRP2-based rapid diagnostic test (Paracheck) was compared in predicting malaria infection using polymerase chain reaction (PCR) as the gold standard. Three hundred patients with a clinical suspicion of malaria based on fever and or history of fever from a low and high transmission setting in Uganda were consecutively enrolled and provided blood samples for all tests. Accuracy of each test was calculated overall with 95% confidence interval and then adjusted for age-groups and level of transmission intensity using a stratified analysis. The endpoints were: sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). This study is registered with Clinicaltrials.gov, NCT00565071.

Results
Of the 300 patients, 88(29.3%) had fever, 56(18.7%) were positive by HC microscopy, 47(15.7%) by expert microscopy, 110(36.7%) by Paracheck and 89(29.7%) by PCR. The overall sensitivity >90% was only shown by Paracheck 91.0% [95%CI: 83.1-96.0]. The sensitivity of expert microscopy was 46%, similar to HC microscopy. The superior sensitivity of Paracheck compared to microscopy was maintained when data was stratified for transmission intensity and age. The overall specificity rates were: Paracheck 86.3% [95%CI: 80.9-90.6], HC microscopy 93.4% [95%CI: 89.1-96.3] and expert microscopy 97.2% [95%CI: 93.9-98.9]. The NPV >90% was shown by Paracheck 95.8% [95%CI: 91.9-98.2]. The overall PPV was <88% for all methods.

Conclusion
The HRP2-based RDT has shown superior sensitivity compared to microscopy in diagnosis of malaria and may be more suitable for screening of malaria infection.
http://www.malariajournal.com/content/9/1/349

MALARIA: Diagnosis in pregnancy

Background
New diagnostic tools for malaria are required owing to the changing epidemiology of malaria, particularly among pregnant women in sub-Saharan Africa. Real-time PCR assays targeting Plasmodium falciparum lactate dehydrogenase (pfldh) gene may facilitate the identification of a high proportion of pregnant women with a P. falciparum parasitaemia below the threshold of microscopy. These molecular methods will enable further studies on the effects of these submicroscopic infections on maternal health and birth outcomes.
Methods
The pfldh real-time PCR assay and conventional microscopy were compared for the detection of P. falciparum from dried blood spots and blood smears collected from the peripheral blood of 475 Malawian women at delivery. A cycle threshold (Ct) of the real-time PCR was determined optimizing the sensitivity and specificity of the pfldh PCR assay compared to microscopy. A real-time PCR species-specific assay was applied to identify the contribution to malaria infections of three Plasmodium species (P. falciparum Plasmodium ovale and Plasmodium malariae) in 44 discordant smear and pfldh PCR assay results.
Results
Of the 475 women, P. falciparum was detected in 11 (2.3%) by microscopy and in 51 (10.7%) by real-time PCR; compared to microscopy, the sensitivity of real-time PCR was 90.9% and the specificity 91.2%. If a Ct value of 38 was used as a cut-off, specificity improved to 94.6% with no change in sensitivity. The real-time PCR species-specific assay detected P. falciparum alone in all but four samples: two samples were mixed infections with P. falciparum and P. malariae, one was a pure P. malariae infection and one was a pfldh PCR assay-positive/species-specific assay-negative sample. Of three P. malariae infections detected by microscopy, only one was confirmed by the species-specific assay.
Conclusions
Although microscopy remains the most appropriate method for clinical malaria diagnosis in field settings, molecular diagnostics such as real-time PCR offer a more reliable means to detect malaria parasites, particularly at low levels. Determination of the possible contribution of these submicroscopic infections to poor birth outcomes and maternal health is critical. For future studies to investigate these effects, this pfldh real-time PCR assay offers a reliable detection method.
http://www.malariajournal.com/content/9/1/269

TUBERCULOSIS: new $240 microscope

A new $240 microscope that runs on AA batteries is as effective for diagnosing tuberculosis as $40,000 professional laboratory models.
The microscope, described online in the journal PLoS ONE, weighs just two and a half pounds and could be used in developing countries that lack expensive lab equipment and reliable electricity.
"The World Health Organization estimates that 1.3 million people died from tuberculosis in 2008," study researcher Rebecca Richards-Kortum, a professor of bioengineering at Rice University, said in a statement. The microscope, "which is portable, durable and inexpensive, could be used to diagnose tuberculosis in community or rural health centers with limited infrastructure in the developing world, promoting early detection and successful treatment of the disease."
The microscope was developed by Andrew Miller, then a Rice undergraduate and now a designer for San Francisco-based medical device firm Thoratec.
To test the microscope's reliability, Miller and his colleagues used 64 slides of saliva samples, some of which were contaminated with tuberculosis. Each sample was stained and examined under Miller's portable Global Focus microscope and under a standard laboratory microscope worth thousands of dollars. The person examining the slides did not know which were contaminated. In 98.4 percent of cases, the examiner's conclusions using both microscopes were identical.
The researchers have filed a patent on the microscope and have contracted with the medical device company 3rd Stone Design to produce 20 models that will be field tested next month, according to Rice University.
"This is hugely significant as a point-of-care tool clinicians can use for tuberculosis patients, whether they're in Asia or Africa or even in West Texas," study co-author Edward Graviss of the Methodist Hospital Research Institute in Houston said in the statement.
"The first identification of TB is usually made with a smear, and it will be good to know that in the field instead of having to wait three or four days to get the smear to a lab."
http://www.msnbc.msn.com/id/38645474/ns/technology_and_science-innovation/

MALARIA: U.S Army Medical Research Unit: Improving Malaria Diagnosis in Africa, One Lab at a Time

Rick Scavetta US Army Africa
June 21, 2010
Inside Rachuonyo district hospital, Simba Mobagi peers through his laboratory's only microscope at a sick woman's blood sample. The 33-year-old laboratory technologist's goal - rapidly identifying malaria parasites. Dozens more samples await his eyes. Each represents a patient suffering outside on wooden benches. Mogabi takes little time to ponder his workload. He quickly finds malaria parasites, marks his findings on a pink patient record and moves to the next slide. Much to his surprise, a U.S. Army officer arrives, removes his black beret and sets down a large box. Inside Maj. Eric Wagar's box is a new microscope - a small gesture within U.S. Army Medical Research Unit-Kenya's larger efforts to improve malaria diagnostics in Africa. For more than 40 years, USAMRU-K - known locally as the Walter Reed Project - has studied diseases in East Africa through a partnership with the Kenya Medical Research Institute. Wagar heads USAMRU-K's Malaria Diagnostics and Control Center of Excellence in Kisumu, a unique establishment begun in 2004 that's since trained more than 650 laboratory specialist to better their malaria microscopy skills. "Working with the Walter Reed Project is so good for the community, as it benefits the patient," Mobagi said, who is looking forward to attending the center's malaria diagnostics course. "Plus, having a new microscope improves our work environment. Work will be easier and we will have better outcomes." Back in Kisumu, wall maps mark the center's success, with hundreds of trained lab technicians from more than a dozen countries across the African continent. International students have come from Ireland, the U.S. and Thailand.
Many students are sponsored through U.S. government aid programs aimed at reducing disease in Africa or by nongovernmental organizations. Most of the center's $450,000 annual budget comes from the U.S. President's Malaria Initiative. Other funding is from the U.S. Defense Department, NGOs and pharmaceutical companies. For students to practice malaria identification, five Kenyan lab technicians work tirelessly to create a variety of blood specimens. Slides may show one or more of malaria's several species - others are free of parasites. The majority of malaria cases are the falciparum species, but many people are co-infected with other species and it's important for students to recognize that, Wagar said. "At our course, lab students learn skills and habits that increase their ability to accurately detect malaria on blood slides. Yet, when they return to their local laboratories, they face the challenge of changing habits and procedures," Wagar said. "Changing behavior is hard to do." In late-April, Wagar accompanied Jew Ochola, 28, the center's daily operations manager to Oyugis, the district center of Rachuonyo that lies roughly 30 miles south of Kisumu in Kenya's Nyanza province. "First I do an assessment of the hospital's lab, what procedures they have, the number of people on staff and the equipment they use," Ochola said. "By partnering with laboratory managers, we hope to increase standards and improve efficient and effective diagnosis. The goal is to lessen the burden of malaria on the local people." To mark progress, lab staffs must collect 20 slides each month that show properly handled blood samples. Monthly visits will mark performance improvement. Through quality malaria diagnosis, USAMRU-K is part of a larger public health effort to reduce malaria's impacts on Kenyan's lives. Illness means paying for treatment and less wages earned, creating an impact on the economy. "By mitigating a public health burden, people should have more time to grow food and have money for things other than medical care," Wagar said. "We can't expect to see change right away, but hopefully things will be a little bit better every month." Working with the Djibouti-based Combined Joint Task Force - Horn of Africa and other DoD agencies, the center recently offered microscopy courses through U.S. military partnership events in Ghana, Nigeria and Tanzania. The effort supports U.S. Army Africa's strategic engagement goal of increasing capabilities and strengthening capacity with the militaries of African nations, Wagar said. "To date, that includes eight Kenyan military lab techs, 17 from the Tanzania People's Defense Force and 30 Nigerians," Wagar said. Accurate diagnosis is also a key factor for military readiness, Wagar said. For example, a Kenyan soldier stationed in Nairobi - where malaria is less prevalent - is susceptible to the disease if posted elsewhere in the country. "Improving malaria diagnosis within African military laboratories sets conditions for healthier troops," Wagar said. "When forces are healthy, they are more capable to support their government and regional security."
http://www.health.mil/News_And_Multimedia/News/detail/10-06-21/U_S_Army_Medical_Research_Unit_Improving_Malaria_Diagnosis_in_Africa_One_Lab_at_a_Time.aspx

MALARIA: demand for microscopes

THE lack of microscopes in government-aided health centres in Bushenyi district has hindered the fight against malaria, the district medical officer, Dr. Celestine Barigye, has said. Barigye said because of the shortage of microscopes, medical officers cannot diagnose diseases thoroughly. Barigye said when the patients go to health centres complaining of fever, the medical workers just prescribe malaria medicine even when they (patients) are not suffering from the disease. Barigye was speaking at a one-day malaria control workshop for stakeholders at Katungu Mothers’ Union Conference Centre in Bushenyi town. The workshop was organised by the West Ankole Diocese. Barigye called upon the Government to intensify the distribution of insecticide-treated mosquito nets, especially to the rural people who cannot afford them. He said to have a malaria-free country, there was need to sensitise the population about the disease. The diocese’s planning and development officer, Richard Mwesigwa, said the Church of Uganda had partnered with the district to distribute mosquito nets to vulnerable people.
http://www.newvision.co.ug/D/8/18/722638

MALARIA: RDT: Comparison of Parascreen Pan/Pf, Paracheck Pf and light microscopy for detection of malaria among febrile patients, Northwest Ethiopia.

The Carter Center, Addis Ababa, Ethiopia.
Abstract
Two malaria rapid diagnostic tests (RDT), Parascreen Pan/Pf((R)) and Paracheck Pf((R)), were tested in rural health centres in Ethiopia against independent expert microscopy (the gold standard). Participants (n =1997) presented with presumptive malaria to ten health centers in Amhara Regional State during the 2007 peak malaria season (October to December). By microscopy, 475 (23.8%) suspected malaria cases were positive, of which 57.7% were P. falciparum; 24.6% P. vivax and 17.7% mixed infections. Parascreen and Paracheck were positive for 442 (22.1%) and 277 (13.9%) febrile patients, respectively. For Parascreen, P. falciparum sensitivity was 79.6%, specificity 97.4%, positive predictive value (PPV) 86.9%, and negative predictive value (NPV) 95.6%. For Parascreen, P. vivax sensitivity was 74.4%, specificity 98.6%, PPV 76.3% and NPV 98.4%. For Paracheck, P. falciparum sensitivity was 73.7%, specificity 99.2%, PPV 95.3%, NPV 94.5%. Sensitivity was significantly higher for both tests (P<0.05)>100/mul of blood; in these cases Parascreen was 90.7% and 91.5% sensitive for P. falciparum and P. vivax, respectively, while Paracheck was 87.9% sensitive for P. falciparum. Parascreen thus performed adequately for both P. falciparum and P. vivax compared to expert microscopy and is more useful than Paracheck where microscopy is unavailable.
Trans R Soc Trop Med Hyg. 2010 Apr 6.